CNS

Zimbabwe Battles HIV and TB Epidemics

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a hospital in Kadoma, Zimbabwe but the bacteria that causes the disease was not detected in his sputum. Determined to get to the bottom of his illness, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected. “I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza. But after two years, Raradza started coughing uncontrollably again. He went to get tested for TB again. “At the hospital, it was discovered that I had TB for the second time, so I was given 60 injections and tablets – it was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

Integrating TB/HIV Services in Zimbabwe: A Key Public Health Priority

Harare, ZIMBABWE - In Zimbabwe, there is a wide recognition of the need to integrate TB and HIV services but for people living with HIV (PLHIV), it is not evident, said Martha Tholanah, Coordinator of the International Community of Women Living with HIV (ICW) Zimbabwe Chapter. While Zimbabwe has made progress in implementing collaborative TB/HIV activities, much work still remains to be done to make them an integral part of the health service. Tholanah said that civil society in had also failed to spearhead the integration of TB and HIV in the country. “There is too much fragmentation. National AIDS Council (NAC) needs to strengthen coordination. I think we (CS) have always made much noise about demanding NAC to be accountable, but I do not think we have been accountable ourselves,” said Tholanah.

At least half a million children become ill with tuberculosis (TB) and up to 70 000 children die of it every year. The World Health Organization has estimated that around 10% of global TB caseload occurs in children (0-14 years). However, there are reports that children account for up to 40% of all cases being treated for TB. Children are also susceptible to the dual epidemic of TB-HIV. Most children will catch tuberculosis from a family member and if they are living with HIV they are even more in danger of developing more severe forms of tuberculosis with higher mortality rates. HIV-infected children are at 20 times greater risk of TB disease than HIV-negative children and at much higher risk of TB-related deaths. Paediatric TB has until recently not been a main priority of global TB control efforts for various reasons.

A declaration calling for global support to end the AIDS epidemic was announced recently (10.7.2012) by the International AIDS Society (IAS) and the University of California, San Francisco (UCSF). This Washington, D.C. Declaration, which seeks to build broad support for beginning to end the AIDS epidemic through a 9-point action plan, will be the official declaration of the XIX International AIDS Conference (AIDS 2012), which will take place in Washington, D.C. from 22 to 27 July 2012, and bring together some 25,000 delegates, including HIV professionals, activists, global and community leaders and people living with HIV. The conference is co-chaired by Elly Katabira, President of the International AIDS Society and Diane Havlir, MD, chief of the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Centre.

TB-HIV co-infection a challenge in Thailand (Thai language)

Duangkamol Donchaum - CNS writes this in-depth feature interviewing experts from the International Union Against Tuberculosis and Lung Disease (The Union) on Tuberculosis (TB) and HIV co-infection in Thailand. To read the article in Thai language, click here, and to listen to audio podcast in Thai language, click here.

Let Me Be Myself As I Walk Together With You

It has been three years since Section 377 of Indian Penal Code drafted in 1860, (which reads as 'Whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal, shall be punished') was repealed by the Delhi High Court on July2, 2009, as the Division Bench of Justice A P Shah and Justice S Muralidhar noted that the provision of Section 377 which criminalised consensual sexual acts of adults in private, violated the fundamental right of life and liberty and the right to equality as guaranteed in the Constitution.

The action of the Delhi High Court to repeal the 150 years old Indian Penal Code (IPC) Section 377 legislation was a landmark legal decision to strike down a punitive barrier and impediment to effective public health action. July 2012 marks the third anniversary of this ground-breaking judgment. Since July 2009 Delhi High Court judgment, there are fifteen Special Leave Petitions (SLPs) filed against this judgment in the Supreme Court and five SLPs filed in support of the Delhi High Court judgment. The decision from the Supreme Court is yet to come. In a very timely roundtable consultation, The Road Ahead Section 377 Judgment, organized by the United Nations Development Programme (UNDP) India, Naz Foundation International (NFI), Article 39: Centre for Legal Aid and Rights, and Project DIVA, different experts and participants raised key issues for what lies ahead of this judgment.

“We have found that the biggest problem with punitive laws is that they drive the affected populations underground” said Aradhana Johri, Additional Secretary, National AIDS Control Organization (NACO), Department of AIDS Control, Government of India. She was speaking as one of the panelists at the ‘The Road Ahead Section 377’ roundtable organized by the United Nations Development Programme (UNDP) India in association with Naz Foundation International (NFI), Article 39: Centre for Legal Aid and Rights, and Project DIVA.

As I speak to the emaciated bone forms, the golden rays of sunlight streaking across the well ventilated and very clean TB wards of the King George’s Medical University (KGMU) surprise me pleasantly and lift my sagging spirits. What I see here is very different from the generally filthy and unkempt general wards of government hospitals in India. Perhaps it is the dynamism of Professor (Dr) Surya Kant, who heads the Department of Pulmonary Medicine at King George's Medical University (KGMU), which ensures the best of care to the lowliest of the TB patients admitted in the hospital.

Despite the fact that TB is curable and HIV is treatable, an estimated 8.5 million new and relapsed TB cases were reported in 2010, and an estimated 1.4 million died, which included 350,000 people living with HIV and co-infected with TB. The two diseases are closely linked because TB is frequently the first opportunistic infection in people living with HIV (PLHIV) and is the leading cause of death among them too, with one in four AIDS-related deaths caused by TB. Yet in 2010, only 34% of TB patients (1.7 million) were screened for HIV, and only 5% of HIV patients were screened for TB worldwide.

Strengthening Maternal and Child Healthcare is crucial for HIV control

Every year, many children are newly infected with HIV, mainly through mother-to-child transmission. An overwhelming majority – more than 90 per cent – of HIV infections in infants and children are passed on by mothers during pregnancy, labour, delivery or breastfeeding. In 2010, an estimated 1.49 million (1.3–1.6 million) pregnant women in low- and middle-income countries were living with the human immunodeficiency virus (HIV). Also in 2010, globally around 390 000 children were born with HIV.

The Indian state of Uttar Pradesh (UP) has close to 20% of patients with active TB disease in India. According to the recent TB report published by the Revised National TB Control Programme (RNTCP), 277,245 patients were registered in one year (2010) for TB Treatment in UP out of 15,22,147 total new TB cases in entire country (source: RNTCP report, December 2011). According to the drug surveillance reports, UP state might have up to 17% of these TB patients as drug-resistant. With drug susceptibility testing (DST) services available in only few cities (such as Agra and Lucknow) and alarming levels of other risk factors such as high tobacco use, malnutrition, weak health systems, irrational use of drugs, and diabetes to name a few, UP might be in for a serious battle ahead with TB and drug-resistant TB.

According to the Microbicides Trials Network (MTN), HIV continues to disproportionately affect racial minorities and men who have sex with men (MSM). MTN estimates that 5 to 10 percent of the world’s population engages in anal sex and globally, MSM are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex, because the rectal lining being only one-cell thick, it allows the virus to easily reach immune cells to infect.

Despite the fact that tuberculosis (TB) is curable and human immunodeficiency virus (HIV) infection is treatable, 350,000 people co-infected with the two diseases died in 2010, according to the World Health Organization (WHO). For most healthy people, the risk of developing active TB disease is very low, but, for people living with HIV (PLHIV), the risk is 20-30 times higher because HIV weakens the immune defence system. The two diseases are closely linked because TB is frequently the first opportunistic infection in PLHIV. Globally, millions of PLHIV are also at risk of developing TB. According to the WHO, TB caused one in four HIV/AIDS-related deaths in 2010.

We have been fighting against the Koodankulam Nuclear power Project (KKNPP) since the late 1980s. This Russian project was shelved right after the Soviet Union's collapse and taken up again in 1997. The Indian government and Russians have constructed two huge reactors of 1000 MW each without any consent of or consultation with the local people. We have just obtained the outdated Environmental Impact Assessment (EIA) report after 23 years of long and hard struggle. The Indian nuclear authorities have not shared any basic information about the project with the public. They do not give complete and truthful answers for our questions on the 'daily routine emissions' from these reactors, the amount and management of nuclear waste, fresh water needs, impact of the coolant water on our sea and seafood, decommissioning costs and effects, Russian liability and so forth.

It is heartening to see one full coloured page in the local edition of a national newspaper highlighting the message of Sri Akhilesh Yadav, the Chief Minister of Uttar Pradesh on the occasion of the statewide celebration of the Van Mahotsav Saptah (Forestry Week) from 4th to 10 July, 2012. To quote our young and dynamic Chief Minister—“we all know the importance of tress and forests in our lives. Forests are not only life line for all living creatures and environment but they also play a very important role in conserving and increasing the water level of the earth. With growing urbanization of the modern civilization, the forests are diminishing day by day. In such times we must not only understand the importance of forests but should also strive to garner public participation for a massive and sustained TREE PLANTATION drive. I hereby appeal to all citizens of the state to come forward and participate in the VAN MAHOTSAV and plant as many TREES as you can, as it is your pious responsibility towards the present and future generations.”

Imagine a life confined to imprisonment for years and sometimes a life time in that predicament. A person is removed from society, cut off from family and friends and turns into a lonely soul made into a convict to repent for his actions. The very thought conjures up images of sad people living aimlessly within the four walls of the prison they are housed in. With no hope of respite from boredom, loneliness and guilt, and in absence of a support or care system, their situation is indeed worrisome.

Vaginal and anal sex continue to put millions of people at risk those who are unable to use or negotiate the use of existing HIV prevention options. Microbicides although currently under research, are being seen as an important new HIV prevention tool that will expand the range of prevention options for men and women. Rectal and vaginal microbicides are antimicrobial agents formulated as gels, creams, films, or suppositories for application to the vagina or rectum for the prevention of HIV transmission, and/or other sexually transmitted infections (STIs). Microbicides have various modes of action like killing/ inactivating the pathogen by disrupting the viral envelope; strengthening the vagina's defence system and maintaining acidic pH; strengthening the rectum's defence system, creating a physical barrier between the pathogen and target; preventing infection spread to other cells by blocking viral replication within cells.

As world's largest AIDS conference (XIX International AIDS Conference) on the theme of 'turning the tide together' is about to open in US next month, CNS decided to share one of its interviews with noted expert on voluntary medical male circumcision and its role in HIV prevention. Voluntary medical male circumcision protects against HIV. "There are over 40 observational studies among heterosexual men, which show that circumcised men have about a 60% reduced risk of HIV compared to uncircumcised men. There were then three randomised controlled trials conducted in Sub Saharan Africa that showed circumcised men were at 60% less risk of HIV than uncircumcised men. All these three trials were stopped by independent Data Safety Monitoring Boards as the effect was so strong and it was thought unethical to not offer circumcision to men in the control arm" said Dr Helen Weiss, Reader in Epidemiology and International Health, The London School of Hygiene and Tropical Medicine (LSHTM). Dr Weiss works mainly on HIV and biomedical behavioural prevention strategies focussing mainly on sub-Saharan Africa and spoke to CNS at AIDS Vaccine 2011.

Members of the People's Union for Civil Liberties (PUCL), Bangalore and several other human rights organisations and individuals in the city gathered on Saturday, 16th June 2012 in front of Town Hall, Bangalore to express their outrage at the unjust sentencing of Seema Azad and her husband Vishwavijay Kamal by a sessions court in Allahabad, to life imprisonment and 10 years in jail, respectively. The ruling passed on 8th June 2012 was based on fabricated charges of 'waging war against the state', 'criminal conspiracy' and various sections of the draconian Unlawful Activities Prevention Act [UAPA].

Sounds funny, does it? But these plaintive cries (nay wails) are reverberating in every nook and corner of Lucknow these days, whose citizens are going to elect their mayor and 110 corporators on June 23, 2012. As per news paper reports, the city is divided into six zones and 110 wards. 10% (11) of these wards are reserved for scheduled castes (SC). Of this, 4 are reserved for women belonging to SC category. Similarly, out of the 22 wards of the city reserved for other backward castes (OBCs), in 8 of them only female OBC candidates can contest the local bodies' election. Another 25 wards are reserved solely for women candidates to test their political acumen. Thus, in effect, a total of 37 seats are reserved for women.

Close to the heels of making tuberculosis a notifiable disease, the Government of India has now banned the import, sale, manufacture and use of serodiagnostic/serological test kits for diagnosis of tuberculosis (also known as blood test or antibody test for TB). A notification (no.X-11014/13/2011-DFQC) dated 7.6.2012, issued by the Ministry of Health and Family Welfare, prohibits with immediate effect the manufacture for sale, distribution, import and use of these serodiagnostic test kits because ‘the government is satisfied that it is necessary and expedient to prohibit the use of these test kits for diagnosis of TB in public interest as they are giving inconsistent and imprecise results leading to wrong diagnosis and their use is likely to involve risk to human beings and whereas safer alternatives are available.’ Laudable sentiments indeed!

Indo-US Nuclear Deal was the first attempt by the Indian government to open up its nuclear establishment to the outside world. It was only after approval of International Atomic Energy Agency that India was officially allowed to do business with the Nuclear Suppliers Group countries in nuclear materials and technology. But the agreement to set up a nuclear power plant in Kudankulam with Russia predates Indo-US Nuclear Deal and hence was done outside the internationally accepted non-proliferation regime in an undemocratic manner. Essentially Russia, secretly and without any fuss, did what the US took one and a half years and much trouble to convince its Congress to do.

The National Hijra Habba (festival) held recently in Delhi brought out in the open the deep anguish and silent suffering of the transgender/hijra /kinnar population across the country. Although this issue is centuries old, yet the tolerance level of common people towards this community is very low. It is just one of the many paradoxes of our complex Indian culture that while on one hand it is considered auspicious to have the hijras bless our newborns and newlyweds for fertility, they are otherwise shunned and looked down upon by society.

A strong criticism of the irrational expenditure of Rs 35 lakhs on the renovation of Planning Commission toilets has been a blessing in disguise and done wonders for sanitation problem in India. A whole lot of progressive announcements in the sanitation sector have been made as a saving grace for the government, which was unable to justify the unnecessary spending on beautification of Planning Commission toilets while crying hoarse of austerity measures.

A Financial Boost For The Search Of New TB Vaccines

In a new fillip to the much needed TB Vaccine research, the Bill & Melinda Gates Foundation has given a grant of 3 million dollars to TuBerculosis Vaccine Initiative (TBVI), a non-profit organisation that supports the development of new vaccines against tuberculosis. The award spread over 3 years will help TBVI to support the development of several TB vaccine candidates and contribute to the fight against this deadly disease.

Right to Reject could have affected 'unopposed' elections

There is no candidate fielded by any major political party against Dimple Yadav, Samajwadi Party's candidate for Kannauj Lok Sabha seat. Dimple Yadav is also the daughter-in-law of Samajwadi Party supremo Mulayam Singh Yadav and Kannauj is undoubtedly a party stronghold. There are only two candidates as per newspaper reports against her (independent candidate Sanju Katiyar and Dashrath Shankhwar of Sanyukt Samajwadi Dal) and if these candidates withdraw their nominations before 9th June, then Dimple Yadav will walk into Lok Sabha unopposed. Without getting into the debate of 'samajwaad' vs 'parivarwaad', is it really fair in democracy for a candidate to get elected 'unopposed' because how will common people figure out whether she is a unanimous choice of people (of Kannauj in this instance) or behind the scene efforts were made to ensure no one fights election against her? If our Indian Constitution had taken right to vote and right to reject at par, then this power would rest with the voter and election outcomes could be different.

Engage affected communities as equal partners to wipe out TB

In the last week of March, 2012, I received an email from a stranger living in Chandigarh, requesting for counseling as his 34 years old wife was suffering from TB. This is his tale of woes about the problems faced by her and the family who are living in a metro city of India.

The transgender, 'hijra' or 'kinnar' community is visible as usually its members can be spotted easily by way of their attire and mannerisms. However they are invisible in the sense that society shuns them and does not even want to acknowledge their existence. They face problems in all spheres of life. But, the impediments they face in accessing quality healthcare services at times, cause irreparable physical and mental damage to them and may even be life threatening.

In the lead up to the XIX International AIDS Conference (AIDS 2012), Citizen News Service (CNS) is facilitating an online consultation and conducting key informant interviews on HIV-related issues. This is an opportunity for all those affected by HIV to have their say in lead up to the AIDS 2012. The theme of XIX International AIDS Conference (AIDS 2012) is “TURNING THE TIDE TOGETHER”.

Raveena Bariha, the fire brand graduate tribal hijra activist from Chattisgarh (a relatively backward state of India) is lovingly called the chhota bomb and chhota rocket. At the recently concluded National Hijra Habba Consultation and Cultural Event, which was organized by Pehchān project, in association with India HIV/AIDS Alliance in Delhi, her diminutive frame dressed in a cotton salwar kurta without any jewellery stood apart from the other ornately dressed participants of her community. Raveena spoke to CNS about the hopes and aspirations, the trials and tribulations of the transgender and hijra/kinnar community.

[हिंदी] Different political parties have been forwarding their choices for the President's post. In the beginning it appeared that Mulayam Singh will support the candidature of A.P.J. Abdul Kalam. This belief was strengthened when he supported Sharad Pawar's proposal that the President should be a apolitical person. However, now Mulayam Singh has retracted from his position. On the other hand Lalu Yadav proposed Vice-President Hamid Ansari's name for the post. Lalu is so close to the Congress that it appeared that he was essentially voicing Congress's choice. The names of West Bengal 's former Governor Gopal Krishna Gandhi, A.K. Antony, Sushil Kumar Shinde, Meira Kumar and even Dr. Manmohan Singh has since done the rounds. There seems to be a consensus emerging around Pranab Mukherjee's name. For most political parties whether belonging to UPA or NDA, he is the most acceptable for President's post.

Pehchān, in association with India HIV/AIDS Alliance, recently organized a national consultation, aptly called Hijra Habba (Habba is a Kannada word meaning festival), in Delhi to draw attention to the current challenges facing the transgender (TG) and hijra communities of India and to develop an action plan to address the problems affecting them. It was indeed a festival where dressed in stunningly beautiful attires and glittering jewelry, hijra and transgender community members from across India voiced their fears, doubts and misgivings in front of senior officials from the National AIDS Control Organisation (NACO), UNDP, and DFID in an atmosphere marked with solemn gaiety. They shared their trials and tribulations and discussed ways and means to protect their very existence and dignity in society. Their brightly lit eyes, their unwavering voices, and the glow of steely determination on their faces clearly reflected their sombre resolve to put an end to the indignities they had been facing for centuries.