National partnership for TB care and control shapes up in India

Photo by busymommyA national multi-stakeholder partnership for tuberculosis (TB) care and control is shaping up in India.

On 4 November 2008, representatives from a range of TB-focused organizations participated in a meeting at the LRS Institute of Tuberculosis and Respiratory Diseases in New Delhi. The meeting was facilitated by the International Union Against Tuberculosis and Lung Disease (IUATLD) India Resource Center.

India is ranked first on a WHO list of 22 high-TB burdened countries and the country is home to about one fifth of the world’s TB cases. According to WHO’s 2008 anti-TB drug resistance report, India and China are responsible for more than 50% of the world’s drug-resistant TB cases and India is home to a number of cases of multi-drug resistant TB (MDR-TB).

But India has made considerable strides towards better TB care and control, testing more than 40 million people for TB and rolling out anti-TB treatment to more than nine million people with the disease since 1997.

Every month more than 100,000 people with TB are put on Directly Observed Treatment, Short-course (DOTS) and India has reported a cure rate of 85% among people with TB. However the poor performance of DOTS programs has resulted in increases in the amount of drug-resistant cases.

According to Dr LS Chauhan, Deputy Director General for TB with the Directorate General of Health Services, “Partnerships in TB care and control are not new to India.”

“Since 1995, India has forged partnerships with different sectors to improve TB program performances,” Dr Chauhan said. “Despite the involvement of more than 2500 NGOs, private practitioners, 260 medical colleges and 110 corporate sector hospitals . . . the contribution of the TB programs is not at the desired level.”

“There is a need now for close coordination and clear communication while working together to face the challenge of including those who are currently outside the reach of the public health system.”

Recent reports have identified a number of issues impeding responses to TB in India, including limited community awareness, sub-optimal community participation, issues of TB and HIV co-infection and the emergence of drug-resistant strains of the disease.

“Eight million new TB cases are diagnosed every year and two TB deaths take place every three minutes in India,” Dr D Behera, Director of the LRS Institute of Tuberculosis and Respiratory Diseases in New Dehli, said.

“Just providing anti-TB treatment is not sufficient. Treatment is interrupted due to poverty, unemployment.”

Robin Mardeusz of the United States Agency for International Development (USAID), said partnerships provide multi-active and innovative solutions to these problems.

“At USAID, partnerships are the way to do business. Partnerships enhance efficiency and effectiveness, rational division of labour, maximize synergy,” Mardeusz said.

A civil-society TB partnership that has been operating in India since March 2007 to complement India’s Revised National TB Control Program is the NGO TB Consortium which includes eight major civil society organizations contributing to TB care and control—the Adventist Development Relief Agency, the Damien Foundation India Trust, the German Leprosy and TB Relief Association, the LEPRA Society, PATH India, Project Concern International India, TB Alert India and World Vision India.

How this partnership will complement other efforts remains to be seen and the goals of strengthening information exchange platforms, genuine dialogue and TB advocacy remain daunting challenges.

Maybe it is time to step out of our organizational entities and join hands for stronger efforts to help communities affected by TB and push India achieve the prevention, treatment and care targets it has set.

Bobby Ramakant-CNS

Ten days Fast in support of Dr Binayak Sen begins in 5 countries

Ten days Fast in support of Dr Binayak Sen begins in 5 countries

A 10-days fast (16 - 25 June 2008) demanding the release of Dr Binayak Sen began today in India, Pakistan, Thailand, US and UK. More than 100 organizations have endorsed this fast and campaign demanding justice for Dr Sen worldwide.

Twenty-two Nobel laureates from around the world had earlier appealed to the Indian government to allow Dr Binayak Sen to receive the 2008 Jonathan Mann Award for Global Health and Human Rights in person at the end of May 2008. But Indian government denied the permission and Dr Sen's wife received the coveted award on his behalf.

Dr Binayak Sen of Raipur, Chhattisgarh, India, who has helped establish a hospital serving poor mine workers in the region, founded a health and human rights organization that supports community health workers in 20 villages, and is the general secretary of the People's Union for Civil Liberties (PUCL), has been imprisoned in Raipur for more than a year now without trial as a result of allegations that he violated state antiterrorism laws. Not only Dr Sen denies committing any crime, but his lifetime contribution to strengthen democracy and fight for the most underserved communities defies such accusations.

This 10-days fast is being organized at Raipur in Chhattisgarh, where Dr Sen is imprisoned, along with in other Indian states and other countries too, to express solidarity with Dr Binayak Sen, Ajay T G (filmmaker) -- both are members of the PUCL, and many others detained under the draconian Chhattisgarh Special Public Security Act (CSPSA) 2005, and the Unlawful Activities Prevention Act (UAPA) 1967, amended in 2004.

These draconian laws sanction the violation of due process by the state, and thus contravene internationally accepted norms of jurisprudence as well as democratic governance. As Senior Advocate K G Kannabiran, National President of PUCL, India, argues in his letter to the National Human Rights Commission (NHRC), the CSPSA and UAPA operate by criminalizing the very performance of civil liberties activities, and culpability is decided upon not by direct proof, but through guilt by association.

The PUCL-Chhattisgarh Unit, with Dr. Binayak Sen's active leadership as its General Secretary, had exposed the government sponsored so-called campaign Salwa-Judum in Chhattisgarh which legitimizes extra-constitutional violence and pits adivasis against adivasis.

The Fast is to ensure that human rights of marginalized people are not trampled upon and human rights defenders continue to work fearlessly. The Fast will end on 25th June, the day Emergency Rule in India was declared in 1975, followed by a National Convention on Repressive Laws & Human Rights on 25th & 26th June 2008 at Raipur.

Published in

Central Chronicle, Madhya Pradesh/ Chhattisgarh, India

Rediff News, India/ USA

India Abroad, USA

Media for Freedom, Nepal

The Seoul Times, Seoul, South Korea

Indian Vanguard

News Blaze, USA

Assam Times, Assam, India

American Chronicle, USA

Two Circles.Net

Web India 123

Thai Indian News

Binayak Sen. Net

My News, India

New Kerala News, India

Kify News, India

Santa Barbara Chronicle, Santa Barbara, USA

World Sentinel, USA

Addressing HIV and IDU issues vital for TB programs in Nepal

Photo by MMMpicturesMore than 90% of people diagnosed with tuberculosis (TB) in Nepal successfully complete treatment, according to Dr Dirgh Singh Bam, Secretary of the Ministry of Health and former Vice-President of Nepal’s Anti-Tuberculosis Association (NATA).

But Dr Bam also says that the poor performance of Directly Observed Treatment Short-course (DOTS) programs has resulted in the development of drug-resistant forms of TB, including multi-drug-resistant strains of the disease.

About 1.8% of all new TB infections in Nepal involve multi-drug-resistant TB (MDR-TB), which is resistant to isoniazid and rifampicin. These drugs are part of ‘first-line’ TB treatments and resistance can occur when they are misused or mismanaged.

People with TB who do not complete a full course of treatment run the risk of developing MDR-TB, which also results from the prescription of the wrong medication, incorrect dosages, and the provision of low-quality treatment.

Dr Bam says that 29% of all TB cases in Nepal involve HIV co-infection, particularly among injection drug users (IDUs). “Without addressing HIV and IDU issues, it will be very difficult to effectively respond to TB,” Dr Bam says.

IDUs and people with both HIV and TB are also at a risk of contracting hepatitis C (HCV) in Nepal. HCV is an infectious blood-borne viral disease, which can cause liver inflammation. Chronic HCV can lead to cirrhosis (scarring of the liver) and liver cancer.

HCV transmission rates are higher than that of HIV, and the condition is often more severe in IDUs. People who share injection equipment are vulnerable to HCV and HIV infection, says Dr Bam, and in Nepal, there is a separate health program to respond to HCV.

“Community participation is very essential for effective TB and HIV care in Nepal,” Dr Bam said. The Patients’ Charter for Tuberculosis Care, outlines the rights and responsibilities of people with TB and it empowers those with the disease and their communities.

Dr Bam said the Patients’ Charter for Tuberculosis Care could be used as a tool to empower people with TB to be aware of their rights and responsibilities, which would also improve the performance of TB-related programs.

Bobby Ramakant-CNS

Will the global recession impede TB care and control?

Photo by James CridlandGovernments all over the world are struggling to cope with the economic recession and millions more people are expected to lose their jobs.

In most countries, leaders are resorting to extreme cost-cutting measures that threaten funding for tuberculosis (TB) treatment and control measures across the globe.

While the Global Fund to fight AIDS, TB and Malaria (GFATM) continues its search for the US$ 5 billion in funding still needed for 2009-2010, Wall Street corporations have given themselves $18 billion in holiday bonuses (read more).

The money for these bonuses came from US tax payers but would tax payers rather fund holidays for bankers, or save lives in countries hit hard by the three diseases? The Merrill Lynch bonuses alone would have paid off GFATM’s funding short-fall in full (read more).

Jeffery Sachs, Director of Columbia University’s Earth Institute and a Special Adviser to the UN Secretary General, has called on the US government to take back the $18 billion and use the money to help buy antiretroviral drugs and mosquito nets.

Calling the bonuses, “unbelievably egregious” Sachs said, “Those bonuses are being paid out of our bailout funds . . . I suggest the US government reclaim that funding and put the money into the Global Fund immediately.” (read more)

According to articles published last week (read more), GFATM provides a quarter of all international funding for the response to HIV, two-thirds of all the money that goes to tackling TB and three quarters of all money spent on stopping malaria.

But GFATM has only collected $3 billion of the $8 billion needed to fund projects around the world in 2009 and 2010. Sachs says the $5 billion funding short-fall faced by GFTAM is less than half a percent of the money G8 countries have spent on bailing out failed banks in the past three months (read more).

Sachs also says that the US has failed to keep its promises to GFATM and has not handed over 0.7% to 1% of its annual gross national product as agreed. “We’re at 0.16 of 1% of our income for development assistance. It’s the lowest level of all 22 donor countries,” Sachs said.

Bobby Ramakant-CNS

Finally, anti-HIV microbicide research provides hope

Photo by bobbyramakantResearch into anti-HIV microbicides has finally produced a positive outcome—the microbicide gel PRO2000 achieved a 30% reduction in HIV transmission among women during recent clinical trials.

Women offered PRO2000 and condoms experienced 30% fewer HIV infections than women offered only condoms or condoms and a placebo gel, according to trial results presented by Protocol Chair Dr Salim S Abdool Karim, of the University of KwaZulu-Natal in Durban, South Africa.

Dr Karim presented the results at the 2009 Conference on Retroviruses and Opportunistic Infections (CROI). This multi-site clinical trial was known as HPTN 035, and was responsible for testing two candidate microbicides (PRO2000 and Buffer Gel). It was conducted by the US National Institute of Health (NIH) and was funded by the Microbicides Trial Network (MTN) in South Africa, Malawi, Zambia, Zimbabwe and the US.

The PRO2000 microbicide gel showed anti-HIV activity by reducing the HIV transmission risk among women by 30%, but the Buffer Gel was found to be ineffective.

The news of PRO2000's success is particularly encouraging to health advocates because microbicide research has faced so much disappointing news in the past decade, with different microbicide-candidate-products under research showing no positive anti-HIV effect in human trials.

According to WHO, microbicides are compounds that can be topically applied inside the vagina or rectum to protect against sexually transmitted infections (STIs) including HIV. They can be formulated as gels, creams, films, or suppositories. Microbicides may or may not have spermicidal activity (a contraceptive effect). At present, an effective microbicide is not available, and different candidate-microbicides are in various stages of research.

The Global Campaign for Microbicides (GCM), an advocacy organization that has been campaigning to expand women's HIV prevention options for over a decade, said in a press statement that adherence to the PRO2000 gel during the trials was as high as 81%. In another analysis that accounted for the time that women did not use contraceptives because they were pregnant, the study found PRO2000 to be 36% protective against HIV compared to the control arms.

"The results on PRO2000 are a ray of hope for women," observed Lori Heise, Director of the Global Campaign for Microbicides (GCM). "This is the first time that we have had human data actually showing that a vaginal gel can work to reduce infection. It's not a home run, but this "proof of concept" should invigorate the field"

Another effectiveness trial of PRO2000, conducted by the UK-funded Microbicide Development Programme (MDP), is currently in its final stages in South Africa, Tanzania, Uganda and Zambia. This trial—known as MDP 301—has enrolled over 9000 women, three times the number enrolled in HPTN 035.

“This second trial should help us refine our estimate of how effective PRO2000 actually is,” noted Dr. Samu Dube, GCM’s Africa Program Leader in the GCM press statement. “With three times the number of women, the MDP trial will yield an even more precise estimate of effectiveness. We will need such data before deciding whether it makes sense to move this product forward toward licensing and distribution.”

The development of microbicides is seen as a key to empowering women to protect themselves against HIV. Women are biologically more vulnerable to the transmission of STIs and many cultural and economic factors compound this vulnerability.

Millions of women live in societies that permit them no role in sexual decision-making, that condone male infidelity and assign the burden of shame and stigma associated with infectious diseases to women. Existing preventative strategies have largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use, none of which are easily controlled by women.

Vaginal microbicides are also likely to fail until men understand and respect the need for women to protect themselves against HIV and other STIs. Not only do women need preventative options that they can choose to use freely but the gender inequalities that make it harder for women to insist on safer sex must be addressed.

For more information about microbicide development and trials, go to:
Global Campaign for Microbicides (GCM)
International Partnership for Microbicides (IPM)

Bobby Ramakant-CNS

Evidence is key in improving health responses during financial crisis

Photo by Nick J WebbEvidence is key in improving health responses during financial crisis

The study of causes, distribution, spread and control of diseases in populations, epidemiology, is a fundamental science and an integral part of public health. Epidemiology has helped address old public health challenges and continues to be a tool to investigate new challenges by providing evidence required for sound public health action.

Efforts to strengthen epidemiology should remain a priority of Member States even when plagued by the challenge of climate change, an energy crisis or a global financial crisis.

"To address each of these challenges, what we need is the information or the evidence or data not only for developing of our strategies and policies, but also for advocacy," said Dr Samlee Plianbangchang, Regional Director of the World Health Organization (WHO) South-East Asia at the inauguration of a "Regional Meeting on Application of Epidemiological Principles for Public Health Action" in New Delhi.

The two-day meeting is aimed at formulating an agreed framework for action, both within WHO and in Member States. This would help to strengthen epidemiological capacities in the Region and to apply this know-how and skills to overcome current public health challenges such as those arising from the current financial downturn, climate change and from emergence of new pathogens.

"The main idea behind this meeting is to ascertain how we can together strengthen and focus our attention on the application of epidemiological concepts and principles in national health programme development and management of health problems," said Dr Jai P. Narain, Director, Communicable Diseases, WHO SEARO.

More than 50 eminent epidemiologists are attending this two-day regional meeting.

Bobby Ramakant-CNS

Lower-cost female condom gets FDA approval

Photo by Jake RisbridgerEarlier this week, the Female Health Company (FHC) announced approval from the US Food and Drug Administration (FDA) for the company's Female Condom (FC2), a woman-initiated barrier method that helps to protect against sexually transmitted infections (STIs), HIV/AIDS, and unintended pregnancy.

FHC's lower-cost second generation female condom will now be sold at 30 per cent less than the earlier version of female condom.

FHC's first-generation Female Condom (FC1) originally received FDA approval for distribution in the United States in 1993. FC1 is also included in the World Health Organization's (WHO) essential products list for distribution by United Nations (UN) agencies. Since its approval, 165 million FC1 female condoms have been distributed in 142 countries.

With microbicides still in different stages of the research pipeline, the female condom is currently the only method available to prevent HIV infection and unintended pregnancy that is designed for women's initiation. FDA approval of the FC2 is significant since the new product will sell for about 30% less than its predecessor, the FC1. Female condoms have been relatively expensive in many parts of the world, due to a constellation of factors including manufacturing costs, bulk purchasing, and government and donor investment. Reduction in manufacturing costs, therefore, is one of many important avenues for making the new female condom more affordable and accessible to women and men in the US and internationally.

FHC has succeeded in reducing FC2's cost through the introduction of a new material and a different manufacturing process. FC1 is made from polyurethane and involves a labor-intensive manufacturing process, while FC2, which looks very similar to FC1, is made from a proprietary nitrile polymer that allows it to be manufactured using a highly automated process. Studies have shown that FC2 performs in a comparable manner to FC1.

Data on FC2 have been reviewed and approved by other regulatory agencies, including the European Union, WHO, and agencies in India and Brazil. In 2006, the World Health Organization (WHO), based on its own review of the scientific data, agreed that FC2 performs in the same manner as FC1 and cleared FC2 for purchase by UN agencies. Since then, over 23 million FC2 Female Condoms have been distributed in 77 countries. FDA approval of FC2 will allow USAID to procure the second-generation female condom at a lower unit cost for US-funded prevention programs around the world.

"We join women around the world in applauding the FDA's swift action to approve the FC2 female condom," stated Serra Sippel, executive director of the Center for Health and Gender Equity, in a press statement. "The HIV pandemic among women requires increased investment in woman-centered prevention options, and FC2 approval is an important step forward in putting the power of prevention in women's hands."

Advocates are now calling on the US government to react quickly to ensure rapid expansion of female condom distribution and programming, and have support from US law. In the reauthorization legislation for the President's Emergency Plan for AIDS Relief (PEPFAR) in 2008, Congress explicitly mentioned female and male condoms, emphasizing the importance of increasing availability and access to these commodities and ensuring consistent and correct use as essential for HIV/AIDS prevention efforts.

"We praise Congress for including specific references to female condoms, as both male and female condoms are safe and effective HIV prevention tools that are available to women and men today. We now look to the next leader of the Office of the Global AIDS Coordinator to ensure that female condoms are truly available, accessible and well-programmed for women and men worldwide," said Serra Sippel in the press statement.

The United States Agency for International Development (USAID) plans to phase out procurement of the FC1 upon FDA approval of the FC2, according to Saving Lives Now, a report by the Center for Health and Gender Equity (CHANGE). This means that potentially more female condoms can be procured, distributed and programmed overseas due to lower costs.

Despite their many benefits, female condoms account for only 0.2% of the world's total condom supply and make up only 1.6% of US international condom shipments. It is unclear how long it will take before the FC2 is distributed through US-funded HIV prevention programs overseas.

Bobby Ramakant-CNS

Father on indefinite fast

Press Release

Father on indefinite fast

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


About 40 people from the Beniganj Police Station of Hardoi District area are in the capital for 3 days now and the father Thakuri Prasad, resident of village Mamrejpur and a landless SC person, is on indefinite fast becasue his only son Rajkishore was murdered on 5th April, 2008 by Yatendra and Satyendra, both sons of Kamlesh resident of village Malhpur. Under political pressure the FIR has been registered against unknown people.

The villagers allege that the local MLA and cabinet minister in the present Mayawati Government, Ram Pal Verma and his nephew and local MP Ashok Rawat, whose name had earlier also cropped up in the infamous human trafickking scandal after the arrest of Gujarat BJP MP Babubhai Katara was caught at the Indira Gandhi International Airport trying to smuggle a woman to Canada on his wife's passport, are shielding the culprits.

The family of the murdered have no faith in the local police and would like to get a CB-CID enquiry conducted in the case. Thay have already requested the IG for this purpose but have not heard from his office.

The people at the dharna/fast site may be reached through Babu Ram Kamle/Rajesh at 9793271930 and Dinesh at 9919824064.

Sandeep Pandey

Rio 2009: The 3rd Stop TB Partners' Forum is less than a week away

Photo by bobbyramakant

News: 3rd Stop TB Partners' Forum
The Stop TB Partnership
**************************

Dear Stop-TB members,

The 3rd Stop TB Partners' Forum is less than one week away.

We wish to alert you to several helpful updates on the Forum web site:
http://www.stoptb.org/events/partners_forum/2009/

You can now view and download:
-----------

The complete Forum Programme
Online at: http://www.stoptb.org/events/partners_forum/2009/assets/documents/agenda_lr.pdf

The complete Special Events Programme
Online at: http://www.stoptb.org/events/partners_forum/2009/specevents.asp

And more information is now online at: http://www.stoptb.org/events/partners_forum/2009/

We look forward to seeing you in Rio!

On behalf of Dr Marcos Espinal, Executive Secretary, Stop TB Partnership

Sent by: Judith Mandelbaum-Schmid
Senior Communications Adviser
Stop TB Partnership Secretariat
World Health Organization
Email: schmidj@who.int
Website: www.stoptb.org

Bobby Ramakant-CNS

RIO 2009: Strengthening community impact on TB control and policy

Photo by bobbyramakantRIO 2009: Strengthening community impact on TB control and policy
Treatment Action Group (TAG)
******************************

[Mods note: Below is an invite to a skills building event for those Stop-TB members who are attending the 3rd Stop TB Partners' Forum in Brazil. For more information on the Forum, go to: http://www.stoptb.org/events/partners_forum/2009/ ]
*******************************

Skills Building: Strengthening community impact on TB control and policy

Date: Sunday, 22 March 2009

Time: 9am to 1 pm

Room: Sala 16, Conference Center

Build your capacity to advocate for more TB and TB/HIV resources and monitor the implementation of TB services at the country level.

We will also be identifying an advocacy agenda for the Partners' Forum and preparing activists to ensure that these advocacy priorities are addressed during the conference.

Sessions include:

Global Fund resource mobilization: Creating demand from the community
---------
TB receives less than 15% of Global Fund resources. We will be discussing how activists can participate in mobilizing Global Fund resources for TB at the country level

Monitoring and Evaluating TB control: Opportunities for civil society participation
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Do you feel you are part of the reporting process in your country? How can you be involved in this process? We will discuss important advocacy tools such as shadow reporting to hold leadership accountable for commitments that they have made to TB and the public health

Preparing for the Forum: Raising the voices of the community
---------
How do you have a strong voice at the Partners' Forum and ensure that community priorities are addressed? We will identify opportunities for communicating activist priorities during the meeting.

Claire Wingfield
TB/HIV Project
Treatment Action Group
New York, USA
Website: www.treatmentactiongroup.org

Bobby Ramakant-CNS

INVITE: Convention of Bangladesh-Bharat-Pak People's Forum

INVITE: Convention of Bangladesh-Bharat-Pak People's Forum
Bangladesh-Bharat-Pakistan People's Forum

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

Date: Sunday, 15 June 2008
Time: 10am to 8 pm
Venue: Yuba Kendra (Youth Centre), Moulali, Kolkata, West Bengal


"HUM HAI ISKI MALIK HINDUSTHAN HAMARA HAI
Ghadar Jaari hai”

Dear Friends & Comrades,

Bangladesh – Bharat – Pakistan People’s Forum (Bharat Chapter) in collaboration with Lok Raj Sangathan (New Delhi) invites you and your organization to participate, contribute in the convention as concluding part of yearlong program in the memory of 1st Independent struggle of 1857.

This program will be held on Sunday, 15th June 2008, from 10 A.M. to 8 P.M. at Yuba Kendra (Youth Center), Moulali Kolkata.

Programme:
----------

10 – 10.30 A.M. - Introduction of the program.

10.30 – 1.30 P.M. Audio Visual presentation on 1857 (Prepared by Lok Awaz Publishers).

10.30 – 11.15 A.M. The background 1700-1857

11.15 – 12.00 Hours - The Great Ghadar 1857

12.00 – 12.45 P.M. The Aftermath 1858-1947

12.45 – 1.30 P.M. - The legacy 1947 to the present

2.30 P.M. – 3.30P.M. Discussion: - Comments and contributions from participants

4.00 P.M. – 6.00 P.M. Bangladesh, Bharat & Pakistani team will perform Cultural Program

6.00 P.M. – 8.00 P.M. Convention, decision and election of State committee of B.B.P.P.F (Bharat)

16.06.08 – 10 A.M. Trinational conference (Representative from Bangladesh, Pakistan and from 12 States of Bharat will be present.)

17th & 18th.06.08 – Different program will be announced on 15th June.

With warm greetings

Manik Samajdar
General Secretary
Bangladesh-Bharat-Pakistan People's Forum (BBPPF) - Bharat
Phone: (+91) 09339317761

Registration Free but donation expected. Program may be alter slightly

Sent by:
Hindu Muslim Friendship Association
Email: hindumuslimfriend@yahoo.co.in

BANGLADESH – BHARAT – PAKISTAN PEOPLE’S FORUM
---------------------------------------------

INDIA:
28,GURUDWARA RAKABGANJ ROAD, NEW DELHI 110 001,
Email: bbp_peoples_forum@hotmail.com

PAKISTAN:
P-85, PEACE HOUSE, Mubarakbad Colony, Toba Tek Singh -3650. Pakistan.
Email: bbppfpak@gmail.com

BANGLADESH:
225, FAKIRAPOOL (3RD Floor), Motijheel, DHAKA 1000. Bangladesh.
Email: bbp_peoplesforum@yahoo.com
---------------------------------------

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

Rio 2009: Delhi's new initiative to improve healthcare in the community

Photo by foxypar4New Delhi's new initiative to improve healthcare in the community

Less than a week before the 3rd Stop TB Partners' Forum is about to begin in Brazil, a unique partnership is being forged in a community of India's capital to improve TB responses.

The residents of south Delhi and healthcare providers in this area are holding an ongoing dialogue to identify key challenges that people face in accessing the health services, and to come up with effective solutions that can potentially improve the quality of care for all residents.

The new Community Care Club in the Lado Sarai area of South Delhi (India), is working to improve the health of people in the diverse district by bringing together consumers and care-providers in a dynamic 'partnership in health'. Led by local former TB patients and people living with HIV, this is an initiative to empower not only themselves, but also to empower and mobilize a broad base of the community including the private and public sectors.

Residents and workers are now organizing to collectively address their problems, improve access and raise the standards of care in the neighborhood - to exercise their rights and take responsibilities for a healthier community.

The first series of public meetings of the Community Care Club will be held on the coming World Health Day (7 April 2009) in different 'high-volume' public spaces. At the same time, a team of people living with the diseases will be conducting a 'streetwise' survey to further ascertain what the community considers a priority for action. It is being organized by the Delhi Mahila Samiti - the Women's Forum of Delhi Network of People Living with HIV (DNP+), and the World Care Council.

The Revised National Tuberculosis Control Programme (RNTCP) of the Government of India, now includes the Patients' Charter for Tuberculosis Care (PCTC, The Charter). The Charter is also a part of the global Stop TB Strategy, and lays out the rights and responsibilities of people with TB, and how the Charter is a tool to effectively achieve the implementation of the International Standards of Tuberculosis Care (ISTC).

However, implementing the Charter on the frontlines of TB care, raising awareness about rights and responsibilities, and using it as an empowering tool for people with TB and their community in order to improve the quality of care services, is certainly a daunting task.

Just last year, at a South East Asia regional meeting on TB in New Delhi, the National TB Programme Manager of India (RNTCP) was questioned by the people from affected communities on why the Charter is not a part of the RNTCP - the next day the Charter went up on the website of RNTCP. A major step forward for people with TB, and their communities.

People committed to improving TB care and related services are organizing themselves to mobilize communities to genuinely partner with the healthcare providers, to implement the Charter effectively and advocate for scaling up the quality of TB and TB-HIV care. This initiative is powered by two principles of greater involvement of people living with HIV (GIPA) and the greater involvement of people with TB (GIPT).

A new day dawns for the community on World Health Day in India's Capital.

Bobby Ramakant-CNS

Is it ethical to provide TB treatment without quality counselling?

Photo by bobbyramakantIs it ethical to provide TB treatment without quality counselling?

How ethical is it to providing treatment for anti-TB drug resistance without quality counseling? The treatment literacy, infection control, toxicity and side-effects related to the treatment, adherence and a range of other issues need to be addressed in counseling sessions, believes the activist from the West Bengal Network of people living with HIV (BNP+) in India. This indeed provides a food for thought for delegates of the 3rd Stop TB Partners Forum (Brazil: 23-25 March 2009) and the high-level ministerial meeting on drug-resistant TB (Beijing, China: 1-3 April 2009).

For instance, a member of BNP+ (name withheld) was diagnosed of TB in 2004, but due to anti-TB drug-stock out for a week at the DOTS centre, he was asked to buy medicines from the pharmacy, which were beyond his economic means. Due to treatment interruptions possibly, only later he found out in a hospital where he was admitted for AIDS-related care, that he is suspected to having developed resistance to anti-TB drugs. The drug susceptibility tests later confirmed that he had multi-drug resistant TB (MDR-TB) now.

He could have, possibly, successfully completed the treatment for drug-susceptible TB through DOTS - only if quality counseling and regular supply of drugs among other issues were addressed. He didn’t intend to develop drug resistance to anti-TB drugs, then why is that the blame, often comes to people with TB, for not 'complying' to DOTS and fueling drug-resistant TB? Let us not forget that the other stakeholders in TB care including the clinicians are equal partners.

He legitimately needed information on TB treatment adherence, related side-effects, drug toxicity and other related issues. Being living with HIV, he had relatively much more AIDS-related treatment literacy and awareness about his rights and responsibilities than he had on TB-related care.

He later ended up buying drugs for MDR-TB treatment for 2 years (2005-2007), at a cost of Rs 3,600 (USD 72) per month. Along with his MDR-TB drugs, anti-retroviral treatment (ART) and other drugs for AIDS related opportunistic infections, he was taking 53 drugs daily - for 2 years. The side-effects were too strong and really hard for him to bear - and it was only due to strong determination to complete his treatment, he continued. He felt extremely irritated, reactive, had lower abdominal pain, developed ulcers in oral cavity, and then had eye-sight related problems after 12-14 months of MDR-TB treatment.

It was not the treating physician who provided him much-needed counseling but his private doctor who helped him understand the disease, the treatment and related issues. No one explained him about infection control measures.

Also the high-levels of HIV-related stigma rampant in TB related care settings, is alarming. Before he got diagnosed for TB, the moment the DOTS staff came to know about his HIV status, he got referred to another hospital. Mostly the reasons given were 'no instruments' to conduct biopsy. Only when he didn't reveal his HIV status, his biopsy could be performed and he tested positive for TB.

The real issues that are threatening to reverse the relative gains India has made on TB control are best-known to the affected communities who had to deal with these issues on daily basis. Time is running out before TB programme managers shift gears from clinical approaches to community-centric approaches to TB care and control.

Unless the healthcare workers and people with TB/ drug-resistant TB or TB-HIV co-infection interact as equal partners of TB care and control, how else are we going to improve the responses to TB and HIV?

The AIDS and TB pandemics have alarmingly joined forces long ago, particularly in high-HIV settings. But those working to address TB and HIV, are yet to work much more closely together on the frontlines than they are doing presently.

The initial steps have been taken in Delhi for example, where healthcare workers and community representatives are coming together to forge a Community Care Club, so as to strengthen healthcare in general, particularly for people with TB in the region. This initiative is being led by the members of Delhi Mahila Samiti (DMS), a women's forum of Delhi Network of people living with HIV (DNP+) and World Care Council (WCC).

The people from affected communities have a critical role to play as equal partners. The need to raise awareness about the rights and responsibilities of people with TB (or drug resistant TB) or TB-HIV co-infection, and opportunities for them to contribute in strengthening TB and AIDS-related care services is compelling. The members of the affected communities need to be respected with dignity as equal partners in TB care and control. Quality counseling is certainly just one of the many areas where they can potentially play a vital role with dignity.

The Patients' Charter for Tuberculosis Care (PCTC, The Charter) has been identified in the global Stop TB Strategy as a tool to achieve the International Standards for Tuberculosis Care (ISTC). Many country programmes also recognize the Charter, including the revised national TB control programme (RNTCP) of India, which enlists the Charter as part of the national TB control strategy.

However, clearly lot more needs to be done to achieve the goal of people with TB, particularly those who are at a higher risk of contracting active TB or drug-resistant TB, like people living with HIV, to embrace the Charter and advocate for raising standards of TB care in their communities.

Bobby Ramakant-CNS

ITC undermines pro-people policies: UP Govt suspends license

ITC undermines pro-people policies: UP Govt suspends license

This posting is based on The Times of India news published on 8 June 2008, to read the news, click here

Tobacco corporations across the world have not only been aggressively protecting and promoting their business markets, particularly in the developing countries, but also trying their best to either abort or weaken the public policies that begin to take shape in countries around the world.

The ITC's license to purchase 500,000 metric tonnes of wheat directly from the farmers in Uttar Pradesh (UP) state was suspended till 30 June 2008 by UP state government.

Despite of a UP government's cabinet order not to purchase wheat till 30 June 2008 during the 'Rabi' crop harvesting season, and another state government's order on 25 May 2008 which fixes stock limit for traders, ITC could manage to get a license issued from Agriculture department of UP government on 30 May 2008 to purchase 500,000 metric tonnes of wheat directly from the farmers. When the leading English newspaper The Times of India exposed this on 6 June 2008, the state government was left with no choice but come out clean - and suspend the license of ITC till June 30 (in accordance with earlier government orders and cabinet decision).

"Corporations are notorious to indulge in political lobbying and all measures to safeguard their markets, with blatant disregard to public interest and welfare" said Dr Sandeep Pandey, Convener of National Alliance of People's Movements (NAPM) and Ramon Magsaysay Awardee (2002).

In present times when food crisis is looming large over India, it is particularly of critical significance that governments put a check on these corporations.

Published in

Health News, India and Pakistan

American Chronicle, USA

News Blaze, USA

Media for Freedom, Nepal

Assam Times, Assam, India

PARIS 2008: Activists call for urgent responses to TB

Photo by bobbyramakantActivists have called for urgent global responses to tuberculosis (TB) in the lead up to the 39th World Conference on Lung Health in Paris.

Paula Akugizibwe of the AIDS and Rights Alliance for Southern Africa (ARASA) voiced concerns over the lack of genuine urgency in the response to the disease at a special session of the Stop TB Partnership’s drug-resistance mobilization sub-group on 14 October.

According to activists like Akugizibwe, the continuing failure of coordination and collaboration efforts between TB and HIV programs in severely affected countries is appalling.

“Such coordination needs to start at the highest level and be implemented consistently at every level, including joint planning and budgeting, the integration of services and implementation of the ‘Three I's’ to reduce TB and HIV co-infection (Isoniazid Preventive Therapy, Intensified Case Finding and Infection Control),” ARASA activists said.

“The unbearable sluggishness of health authorities in adopting a rational and cohesive approach to the management of this co-epidemic through the adoption of these critical measures is costing thousands of lives.”

TB is the leading cause of death among people living with HIV or AIDS in Africa, where TB mortality rates are four times higher than regional targets.

“While a few indicators of efforts to stop TB may be gradually improving, the languid rate at which this is happening does not correspond with what one would hope to see for a global health emergency,” the activists said.

“The spread of multi drug-resistant and extensively drug-resistant TB is a stark manifestation of continued failings in the management of TB, and adds impetus to the call for more urgency in this regard.”

The activists said that the basics of good TB management were missing from health systems across southern Africa and that a lack of training, supervision and support for health care workers resulted in the mismanagement of patients. They also said that the poor management of medical supplies often led to treatment interruptions, which encouraged drug resistance.

The severity of the crisis has been compounded by the failure of health authorities in many countries to work in with civil society to design and implement effective and sustainable responses to TB. Instead, many governments have alienated affected communities through the adoption of harsh and coercive approaches to the management of TB.

Bobby Ramakant-CNS

Mandate set for increased TB treatment, diagnostics

 Photo by psdA clear mandate for the acceleration of research and access to quality anti-tuberculosis (TB) drugs and diagnostics has been set by delegates at a pre-conference meeting of the 39th World Conference on Lung Health in Paris this month.

At a special session of the drug resistance mobilization sub-group of the multi-drug resistant TB working group led by the Stop TB Partnership and WHO, key TB control stakeholders called for more effective treatment and diagnostics as well as a restoration of dignity and human rights in affected communities.

The innovative session involved the screening of an hour-long documentary containing a number of short presentations by people with drug-resistant TB, people living with HIV, community activists and WHO experts.

A person is considered to have drug-resistant TB when first-line medicines have little effect. Second-line drugs are then the only option available but they are much more expensive than first-line drugs as the market is less developed. Second-line drugs are often impossible to find in the areas where they are most needed.

Dr Paul Nunn, Director of the Stop TB Drug Resistance Unit, gave delegates at the session a global overview of the challenge posed by drug-resistant TB while Paula Akugizibwe from the AIDS and Rights Alliance for Southern Africa shared frontline stories from people most-affected by the disease.

The lack of quality diagnostics and laboratory capacity in many countries hit hard by TB and HIV has made treating drug-resistant strains of the disease a matter of guesswork, according to Alberto Colorado who led the special session in Paris.

The little data available on drug-resistant TB shows that about 500,000 new cases of multi-drug resistant TB (MDR-TB) are recorded each year. Less than 3% of these people have access to quality care and many are from the most marginalized sections of lower socio-economic communities.

As a result, drug-resistant TB is spreading fast, fuelled by the HIV pandemic and the slow pace of actions against the disease.

Celina Menezes, one of the Presidents of the World Care Council and Advocacy Officer for the Indian Network of people living with HIV told delegates that advocacy and global mobilization efforts clearly needed to be increased.

Bobby Ramakant-CNS

Tobacco smoke-free environment is a right

Tobacco smoke-free environment is a right

World Environment Day, June 5

Second-hand tobacco smoke is dangerous to health. It causes cancer, heart disease and many other serious diseases in adults. Almost half of the world's children breathe air polluted by tobacco smoke, which worsens their asthma conditions and causes dangerous diseases. At least 2 lakhs workers die every year due to exposure to second-hand smoke at work.

Tobacco is the leading preventable cause of death in the world. It causes 1 in 10 deaths among adults worldwide.

Ensuring a tobacco smoke-free environment is the only way to protect ourselves from the lethal ill effects of tobacco smoke.

According to WHO, there are some 4000 known chemicals in tobacco smoke; more than 50 of them are known to cause cancer in humans. Tobacco smoke in enclosed spaces is breathed in by everyone, exposing smokers and non-smokers alike to its harmful effects.

According to the International Labour Organization (ILO), 2 lakh workers die every year due to exposure to second-hand tobacco smoke at work.

There is no safe level of exposure to second-hand tobacco smoke. Neither ventilation nor filtration, even in combination, can reduce tobacco smoke exposure indoors to levels that are considered acceptable. Only 100% smoke-free environments provide effective protection.

Article 8 of the WHO Framework Convention on Tobacco Control, recognizes that exposure to tobacco smoke causes death, disease and disability, and asks countries to adopt and implement legislation that provides protection from second-hand smoke.

Many countries around the world have already introduced laws to protect people from exposure to tobacco smoke in public places. India is one of them.

"An Act on no-smoking in public places has been brought out by the Centre two-and-a-half years ago, but it remained only on paper. Now, we have made a modification in the already enforced rule and from 2 October 2008, the modified rule will be enforced strongly across the country," said Dr Anbumani Ramadoss, Union Health and Family Welfare Minister.

The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act-2003, of the Government of India has notified revised Rules on the Prohibition of Smoking in Public Places on 30 May 2008.

"As per the revised Rules, smoking is banned in shopping malls, cinema halls, public/private work place, hotels, banquet halls, discotheques, canteen, coffee house, pubs, bars, airport lounge, railway stations", said Dr Ramadoss.

Contrary to common belief, smoke-free environments are widely supported by both smokers and non-smokers.

Having a smoke-free environment often saves money for bars and restaurant owners, reducing their risks of fire and consequently their insurance costs. It often results in lower renovation, cleaning and maintenance costs too.

WHO spotlights the health cost of climate change

Photo by WorldIslandInfo.comWHO spotlights the health cost of climate change

“Climate change will affect all countries of our Region. We are aware that the impacts on human health will be very significant”.

- Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region

New Delhi, April 7, 2008 - On the occasion of World Health Day 2008, Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region, highlighted six health outcomes that will be directly impacted by climate change in South-East Asia. WHO is moving health to the centre of the climate change dialogue and has made the protection of health from the effects of climate change the theme of this year’s World Health Day.

Dr Plianbangchang emphasized the “serious and damaging effects” of climate change on human health. “Air quality will suffer greatly and respiratory illnesses will be exacerbated. Heat waves will be more intense and of longer duration, mainly affecting the most vulnerable populations in children and elderly through heat strokes and cardiovascular complications” he stated.

The six health outcomes which are likely to be affected by climate change in the Region are: respiratory diseases, vector-borne diseases (malaria and dengue), water-borne diseases (diarrohea and cholera), malnutrition, injuries and psychosocial stress. Urgent action is needed to strengthen the existing health systems to deal with the potential increase in health risks due to climate change.

According to the UN Inter governmental panel on climate change (IPCC), the Himalayas will experience a rapid glacier melt with a rate of recession greater than anywhere else in the world. Melting glaciers and disturbed rainfall patterns will increase floods, landslides, debris flows and droughts. This will increase the health risks in Bhutan, India and Nepal among other countries.

In Bangladesh, production of rice and wheat might drop by 8% and 32%, respectively, by the year 2050. For India, recent studies predict a 2-5% decrease in yield potential of wheat and maize for a temperature rise of 0.5 to 1.5C. The net cereal production in South-East Asian countries is projected to decline by at least 4 to 10% by the end of this century under the most conservative climate change scenario.

The most vulnerable people in the Region will be the poor, because they have fewer resources to adapt to the rapid changes of the natural environment on which their livelihoods depend.

For more information please contact:

Ms Vismita Gupta-Smith, Public Information and Advocacy Officer, WHO South-East Asia Regional Office (SEARO), New Delhi, Tel: 91-11-23309401 begin_of_the_skype_highlighting              91-11-23309401      end_of_the_skype_highlighting, e-mail: guptasmithv@searo.who.int ;

For more information please visit our website: www.searo.who.int.

Bobby Ramakant-CNS

Global climate change has implications on TB responses

Photo by woodleywonderworksThe World Health Day this year (7 April 2008) focuses on the need to protect health from the adverse effects of climate change. The theme “protecting health from climate change” puts health at the centre of the global dialogue about climate change. The World Health Organization (WHO) selected this theme for the World Health Day in recognition that climate change is posing ever growing threats to global public health security.

Discussions on Stop-TB eForum in past months have sordidly brought out the appalling conditions of health responses during civil unrest, violence and natural calamities like floods. People with active TB, had a hard time adhering to the treatments during such conditions. Moreover such conditions escalate the risk of TB transmission and exacerbate the vulnerabilities of people to infectious diseases. With health systems disrupted and healthcare providers often at risk, it is a serious concern how can we effectively improve TB and HIV responses during civil unrest, violence and natural calamities.

According to the WHO, “through increased collaboration, the global community will be better prepared to cope with climate-related health challenges worldwide.” Examples of such collaborative actions are: strengthening surveillance and control of infectious diseases like tuberculosis (TB), ensuring safer use of diminishing water supplies, and coordinating health action in emergencies.

Overwhelming evidence shows that human activities are affecting the global climate, with serious implications for public health. Catastrophic weather events, variable climates that affect food and water supplies, new patterns of infectious disease outbreaks, and emerging diseases linked to ecosystem changes, are all associated with global warming and pose health risks.

Climate and weather already exert strong influences on health: through deaths in heat waves, and in natural disasters such as floods, as well as influencing patterns of life-threatening vector-borne diseases such as malaria.

Continuing climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air and water, according to WHO Director-General Dr Margaret Chan. Malnutrition, lack of access to basic sanitation including access to safe drinking water, and pollution are known factors to aggravate the risk to respiratory diseases including TB.

Areas with weak health infrastructure - mostly in developing countries - will be the least able to cope without assistance to prepare and respond. These impacts will be disproportionately greater in vulnerable populations, which include the very young, elderly, medically infirm, poor and isolated populations. With weaker health infrastructure, it will become all the more difficult for people with active TB and/or HIV and those requiring care for chronic conditions to get the required medical attention. The efforts to control drug-resistant TB will be thwarted considerably.

Increasing global temperatures affect levels and seasonal patterns of both man-made and natural air-borne particles, such as plant pollen, which can trigger asthma. About 300 million people suffer from asthma, and 255 000 people died of the disease in 2005. Asthma deaths are expected to increase by almost 20% in the next 10 years if urgent actions to curb climate change and prepare for its consequences are not taken.

The health impacts of climate change will be difficult to reverse in a few years or decades. Yet, many of these possible impacts can be avoided or controlled. There are established steps in health and related sectors to reduce the exposure to and the effect of changing climate. For example, controlling disease vectors, reducing pollution from transport, and efficient land use and water management are well-known and tested measures that can help.

Members are welcome to comment on how can we improve TB responses during natural calamities.

Bobby Ramakant-CNS

World Earth Day (22 April): Increasing community ownership of natural resources will help in disease control

Photo by sergis blogOn World Earth day (22 April 2008), I must share an anecdote of my recent visit to Mehndiganj, Varanasi (India) where when I went to the hand-pump for water, there was not a drop of it despite of my efforts to furiously piston the pump.

Frustrated I looked around to see an acquaintance who told me 'there is no water in hand-pumps'. The reason was obvious, which I have been reading and writing about: the water bottling plants which have siphoned out most of the underground water depriving local communities from having access to water resources!

I was lucky: to have an acquaintance who could show me another water source at a considerable distance on GT road (major highway in India on which this village of Mehndiganj was located) where I can have some water and also use a make-shift cubicle of a toilet-cum-bath.

Recent postings on HealthDev.net, have shown that Asian Human Rights Commission had to sound an alert for sleeping Indian authorities to respond to rising number of deaths in this village (Mehdiganj, Varanasi) due to multi-drug resistant tuberculosis (TB).

This is a village of saree-weavers, and with fading interests in hand-woven saree, the demand for work is sulking. With this, the living conditions of most of the villagers have been difficult, with barely enough income to sustain them.

In 2000, the Coca-Cola bottling plant began siphoning about 2.5 million litres of groundwater everyday. The International convention, Indian court rulings and social justice norms say that ground water is for the local communities who live on that land, to use the water for meeting their personal and domestic needs. Water is not to be 'owned' or possessed, rather to be used for personal and domestic hygiene only.

However the rapid privatisation of water has given a thrust to bottled water companies. As a result of which, the water table sank and went down so much that the local communities weren't able to pull out any water from the tube-wells, hand-pumps or other water reservoirs they had in their communities.

The living conditions of the local villagers worsened with reduced access to safe water for their daily personal and domestic use. Those who were dependent on agriculture were worst-hit by this looming water crisis.

To top it all, the Coca Cola company released the waste from the company as 'fertilizers-for-free' in the fields. Later when BBC got the waste tested in the Greenpeace laboratories in the UK, it was found that Coca-Cola was right: the waste had potassium, a fertilizer element, but didn't tell the farmers about the other toxic and deadly content of the factory waste which had detrimental effect on the arable land.

With decimated options for livelihood, water scarcity, impending food crisis, malnutrition and lack of basic hygiene has further escalated the risk of people manifold to infectious diseases like tuberculosis. Especially multi-drug resistant tuberculosis was on the rise in this village to an extent that Asian Human Rights Commission had to sound the alarm bell!

According to the WHO, “through increased collaboration, the global community will be better prepared to cope with climate-related health challenges worldwide.” Examples of such collaborative actions are: strengthening surveillance and control of infectious diseases like tuberculosis (TB), ensuring safer use of diminishing water supplies, and coordinating health action in emergencies. And to add to the list should be stopping privatisation of natural resources and creating an enabling environment where communities can have continued ownership on and skills to responsibly manage their natural resources.

Bobby Ramakant-CNS

Activists to fast demanding release of Binayak Sen

Activists to fast demanding release of Binayak Sen

To sign the appeal, click here

Hundreds of human rights activists will begin a ten-day fast from June 16 demanding the immediate release of public health expert and activist Dr. Binayak Sen, a critic of the Chhattisgarh government's Salwa Judum policy who has been in jail for more than an year under the Chhattisgarh Special Public Security Act 2005.

The fast, to be organized in Chhattisgarh's capital Raipur, will end on June 25 - the day emergency rule was imposed in the country on 1975, the activists declared on their website announcing the "Solidarity fast in support of Binayak Sen".

A recipient of the Jonathan Mann Award for Global Health and Human Rights (2008), Sen was arrested May 14, 2007, for allegedly passing letters from a Naxalite leader - who he had been treating - to another inside the Raipur jail.

Sen, a member of the People's Union for Civil Liberties (PUCL), has been a vocal critic of the Chhattisgarh government's sponsoring the Salwa-Judum campaign which allegedly thrives on extra-constitutional violence and pits tribals against tribals.

In April this year, the Supreme Court expressed its disapproval of the constitution of the 'Salwa Judum' (self-defence groups) by the Chhattisgarh government and giving them arms to tackle the naxal menace. "These draconian laws sanction the violation of due process by the state, and thus contravene internationally accepted norms of jurisprudence as well as democratic governance," said Dr. Sandeep Pandey, Ramon Magsaysay Awardee (2002). He is also a noted social activist heading the National Alliance of People's Movements (NAPM).

"The fast is to ensure that human rights of marginalized people are not trampled upon and human rights defenders continue to work fearlessly," Pandey said.

President of the People's Union for Civil Liberties (PUCL) K.G. Kannabiran has written to the National Human Rights Commission (NHRC) which, following the Supreme Court's order, is examining the allegations of excesses in the Chhatisgarh government's Salwa Judum programme.

"The Chhattisgarh Special Public Security Act and Unlawful Activities Prevention Act, both operate by criminalizing the very performance of civil liberties activities, and culpability is decided upon not by direct proof, but through guilt by association" said Kannabiran in the letter. An NHRC team visited Chhattisgarh's Bastar region in May to probe into alleged human rights violations by the Salwa Judum.

The probe team's Chhattisgarh visit follows a Supreme Court order April 15 asking an NHRC committee to look into alleged human rights violations by Salwa Judum cadres and submit a report within eight weeks.

Published in

Central Chronicle, Madhya Pradesh, India

Indo Asian News Service (IANS)

Freedom for Media, Nepal

The Seoul Times, Seoul, South Korea

Solidarity fast in support of Dr Binayak Sen

Solidarity fast in support of Dr Binayak Sen

[To read this posting in Hindi language, click here]
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Note: If you can fast for 1-10 days (up to you) from wherever-you-are in solidarity with Jonathan Mann Awardee (2008) Dr Sen, please sign-up here


TEN-DAY FAST IN PROTEST AGAINST THE BLACK LAWS & FOR RELEASE OF Dr BINAYAK SEN, AJAY TG and others

16 - 25 June 2008

A 10-day Fast beginning 16th June, 2008, is being organized at Raipur in Chhattisgarh to express solidarity with Dr. Binayak Sen (Medical Doctor), Ajay T G (Film Maker) -- both are members of the PUCL, and many others detained under the draconian Chhattisgarh Special Public Security Act 2005, and the Unlawful Activities Prevention Act (1967) amended in 2004.

These draconian laws sanction the violation of due process by the state, and thus contravene internationally accepted norms of jurisprudence as well as democratic governance. As Senior Advocate K G Kannabiran, National President of PUCL, India, argues in his letter to the National Human Rights Commission (NHRC), the CSPSA and UAPA operate by criminalizing the very performance of civil liberties activities, and culpability is decided upon not by direct proof, but through guilt by association.

The PUCL-Chhattisgarh Unit, with Dr. Binayak Sen's active leadership as its General Secretary, had exposed the government sponsored so-called campaign Salwa-Judum in Chhattisgarh which legitimizes extra-constitutional violence and pits adivasis against adivasis.

The Fast is to ensure that human rights of marginalized people are not trampled upon and human rights defenders continue to work fearlessly. The Fast will end on 25th June, the day Emergency Rule in India was declared in 1975, followed by a National Convention on Repressive Laws & Human Rights on 25th & 26th June 2008 at Raipur.

We invite you to join the campaign to end arbitrary abuse of state power and protect democratic rights of ordinary citizens by joining in the fast for any number of days either in Raipur or at your own place.

Rajendra Sail (9826804519), Gautam Bandopadhyay (9826171304), Ilina Sen (9425206875), Kavita Srivastava (9351562965), Faisal Khan (9313106745),
Sandeep Pandey (ashaashram@yahoo.com)
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Note: If you can fast for 1-10 days (up to you) from wherever-you-are in solidarity with Jonathan Mann Awardee (2008) Dr Sen, please sign-up here

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To read about the Jonathan Mann award, click here

UNAIDS PCB meeting set to start in Chiang Mai

Photo by bobbyramakantThe 22nd meeting of the Programme Coordinating Board of UNAIDS is set to be held from April 23 to 25 in Chiang Mai, Thailand.

The first time I heard about the UNAIDS Programme Coordinating Board (PCB) was when a colleague and friend attended one of the board’s meetings in Geneva last year.

Since then, I have been hearing more about the board and have had the opportunity to discover exactly what the PCB’s work means to me.

The joint UNAIDS programme is not a UN body as its name suggests. It is actually a HIV programme jointly managed by 10 UN co-sponsor organizations:

- United Nations Children’s Fund (UNICEF)

- World Health Organization (WHO)

- World Bank (WB)

- United Nations Development Programme (UNDP)

- United Nations Economic and Social Council (UNESCO)

- United Nations Population Fund (UNFPA)

- United Nations High Commissioner for Refugees (UNHCR)

- United Nations World Food Programme (WFP)

- United Nations Office on Drugs and Crime (UNODC)

- International Labour Organization (ILO)

UNAIDS is guided by the PCB, which comprises representatives from:

- 22 governments from across the world

- the UNAIDS Co-sponsors

- five NGO representatives, including associations of people living with HIV.

The PCB is responsible for the following functions:

- to establish broad policies and priorities for the UNAIDS programme;

- to review and decide upon the planning and execution of the UNAIDS programme. For this purpose it is kept informed of all aspects of the development of the Joint Programme and considers reports and recommendations submitted to it by the Executive Director of UNAIDS, and the Committee of Co-sponsoring Organizations (CCO):

- to review and approve the plan of action and budget for each financial period, prepared by the Executive Director and reviewed by the CCO;

- to review proposals of the Executive Director and approve arrangements for the financing of the UNAIDS programme;

- to review longer term plans of action and their financial implications;

- to review audited financial statements submitted by the UNAIDS programme;

- to make recommendations to the co-sponsoring organizations regarding their activities in support of the UNAIDS programme, including those of mainstreaming;

- to review periodic reports that evaluate the progress of the Joint Programme towards the achievement of its goals.

The over-arching aims of the thematic session of PCB’s April meeting are to:

- showcase the benefits of a joint HIV/TB (tuberculosis) approach to scaling up towards universal access;

- highlight the need to address TB within the comprehensive response to HIV;

- build commitment to integrated delivery of quality HIV and TB prevention, treatment, care and support services.

Let’s hope that the PCB and UNAIDS will help improve responses to HIV and TB.

Bobby Ramakant-CNS

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.

Conclusion

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

Enforce existing tobacco control legislations in India

Enforce existing tobacco control legislations in India

Despite of five years having passed by since the globally acclaimed national tobacco control parliamentary Act (The Cigarette and other tobacco products Act 2003) was formed, and more than four years since India had ratified the FCTC (Framework Convention on Tobacco Control) - which happens to be the world's first global public health and corporate accountability treaty -- the urgent need to contain tobacco-related diseases, morbidity and mortality, remains as compelling.

Tobacco companies have been aggressively promoting their brands and protecting markets, employing lifestyle and glamour imagery and surrogate advertising unabashedly.

Tobacco brand placement in films have been under scanner and India's Union Health Minister Dr Ambumani Ramadoss had reaffirmed recently in an interview that "One of the easiest ways to significantly bring down number of children and youth who get initiated to tobacco use in India, without any budgetary allocation for this public health exercise, is to remove depiction of tobacco use in films and TV".

The impact of these public welfare policy measures is yet to be seen on curtailing tobacco consumption or tobacco related health hazards. Balance sheets of tobacco companies on the other hand have shown remarkable increase in their markets. The Indian Tobacco Company (ITC)'s 2008 quarter report showed an increase of 12% profit margin.

Like other public interest measures, Governments alone cannot bring in the difference unless people are active stakeholders in implementation. The information about tobacco hazards and existing tobacco control policies still remains confined to tobacco control professionals and there is a pressing need to transmit this information about public health policies our governments have agreed to adapt at International forums far and wide.

Tobacco kills almost five million people each year. If current trends continue, it is projected to kill 10 million people a year by 2030, with 70% of those deaths occurring in developing countries. Tobacco also takes an enormous toll in health care costs, lost productivity, and of course the intangible costs of the pain and suffering inflicted upon smokers, passive smokers and their families.

The tobacco epidemic is an international problem. Developing countries are set to bear the brunt of the problem in the future. At present there are about 5.4 million deaths a year worldwide due to tobacco-related disease, with the balance split approximately between developed and developing countries.

The tobacco industry is a global industry. Faced with increased regulation and greater awareness of the health risks of smoking in Europe and North America, the tobacco multinationals are stepping up their activities in developing countries like India in search of new markets.

A number of aspects of the tobacco problem are particularly trans-boundary in nature and can only be dealt with effectively by international action, including:

- Tobacco industry marketing campaigns executed across a number of different countries simultaneously, including through satellite television;

- Smuggling of cigarettes, often coordinated by the tobacco industry on an international level, involving operations in numerous countries.

How effective these tobacco control policies will be in reversing the tobacco epidemic, shall be determined by how committed not only the governments are but also how meaningfully are people engaged, in implementing the obligations contained in the FCTC or national legislations.

Published in

Asian Tribune, Thailand/ Sri Lanka

Freedom for Media, Nepal

The Seoul Times, Seoul, South Korea