Women Deliver: Harnessing technology to empower women

While maternal, reproductive and newborn health health have remained chronically neglected issues, innovative technologies have emerged during the 21st century which could dramatically improve access to and quality of care for women in the developing world.

On June 8, Women Deliver is holding a special one-day technology symposium entitled '50 years after the pill - the revolution continues'. The underlying theory is that emerging technology can be harnessed in a creative and groundbreaking way to address persistent reproductive and maternal health issues for women and girls worldwide.

Some important new technologies in women’s health include: new ways to stop bleeding after childbirth; cervical screening and prevention tools; mobile technology to improve maternal health in resource restrained countries; new contraceptive methods from gels and sprays to contraceptive methods for men; and women-initiated HIV prevention tools.

In Sub-Saharan Africa, women account for nearly two thirds of estimated HIV infections and women and girls are disproportionately vulnerable to HIV/AIDS for a multitude of reasons, both cultural and biological.

But new antiretroviral-based microbicides hold the promise of long-lasting and discreet HIV prevention for women that would not require the consent of a partner or husband. Trials of microbicides in various forms are currently underway.

A new vaginal ring formulation utilizes a popular contraceptive method to provide a gradual release of microbicides over a period of one month; on the horizon, there are plans to combine such HIV prevention technologies with contraceptive technologies, providing women in the developing world new options for prevention and agency and prevention.

Discussing new promises in women-initiated HIV prevention, Dr Zeda Rosenberg, CEO of the International Partnership for Microbicides, announced the launch of a clinical trial in Southern and Eastern Africa testing the safety and acceptability of a vaginal ring containing an antiretroviral drug. This tool could one day empower women by providing long-lasting, discreet protection from HIV during sex.

HIV/AIDS is the leading cause of death for women of reproductive age worldwide yet women in developing countries do not have the tools they need to protect themselves. The new vaginal ring study borrows from birth control to develop a novel tool for HIV prevention.

Mikkel Vestergaard Frandsen, CEO of Vestergaard Frandsen, said public-private partnerships are addressing public health challenges in Kenya where Vestergaard Frandsen, the program sponsor, has partnered with the Kenyan Ministry of Health. The integrated campaign combines voluntary HIV counselling and testing (VCT) with distribution of an evidence-based CarePack containing multiple interventions for the prevention of malaria, diarrhoea and HIV.

People attending the campaign are offered HIV counselling and testing services, health education and a free CarePack containing a PermaNet long-lasting insecticidal net, a LifeStraw family point-of-use water purifier, condoms and educational material about preventing malaria, diarrhoea and HIV. People who are diagnosed with HIV are referred for further care and given a three-month starter kit of cotrimoxazole prophylaxis, a broad spectrum antibiotic recommended by the WHO.

Nearly 50,000 people have participated in the community-based voluntary HIV testing. This campaign has had an impact on MDG Goal 6 (Combat HIV/AIDS, Malaria and Other Diseases) and MDG goal 7 (Ensure environmental sustainability – halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation).

This is a novel concept showing that by working together to deliver multiple disease prevention initiatives, time and costs can be dramatically reduced. Additionally, the unique integrated approach, targeting HIV, malaria and water-borne diseases, provides health authorities with information that can lead to more multi-disease prevention approaches.

Women Deliver is pushing donors to commit an additional US $12 billion in funding each year for maternal, reproductive and newborn health, which would include funding and access to such new technologies.

Even though these technologies are being developed, they do not often reach the women who need them most. Political will and financial commitment can change that.

Ishdeep Kohli-CNS

Women Deliver: HIV/AIDS, pregnancy and abortion

Photo by Marina(im.back)“HIV affects, or potentially affects, all the dimensions of women’s sexual and reproductive health - pregnancy, childbirth, breastfeeding, abortion, use of contraception, exposure to, diagnosis and treatment of STIs and their exposure to sexual violence. For instance, HIV infection accelerates the natural history of some reproductive illnesses and increases the severity of others”, World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

It has been noted in some countries that women living with HIV have been forced or feel pressured by healthcare workers to have abortions. Positive women may choose to have an abortion because they are misinformed about the possible impact of a pregnancy on their health and that of their child or they may be told that the risks of perinatal transmission are high.

Such misconceptions can be heightened by health workers who promote a view that women with HIV should not have children. However, positive women should never be pressured by their partners, families or health workers to have an abortion as this is a violation of their human rights.

The limited research data available suggest that women living with HIV/AIDS have an increased risk of miscarriage (also called spontaneous abortion) and stillbirths (WHO). However, many women living with HIV/AIDS lack access to safe post abortion care services.

Research shows that women living with HIV have unwanted pregnancies for many of the same reasons that HIV negative women do, including pregnancies from rape and incest and the desire not to bring a child into a situation of ongoing domestic violence. Some women have achieved their desired family size or do not feel they have the economic resources to care for another child.

A positive HIV status may also cause women to reject pregnancy for new reasons. Some women need to spend their restricted incomes on accessing medications and treatments for their own family and perhaps other family members’. Some women believe that a pregnancy could have a negative impact on their health or they fear infecting a child with HIV.

In some situations, HIV positive women have been denied safe abortion care or have been asked to agree to sterilization in order to access abortion services. This is a violation of their rights to unbiased health care.

Clinical research regarding provision of abortion care to HIV positive women is almost nonexistent. We do not yet know whether complications of unsafe abortions differ between HIV positive women who are asymptomatic, immunocompromised and not receiving antiretroviral drugs (ARVs) and women who are taking ARVs.

And we do not yet know if women living with HIV respond to surgical and medical abortion methods differently than HIV negative women.

Women living with HIV/AIDS are prone to septicaemia and may be particularly at risk of complications, so that preventing unintended pregnancies and unsafe abortion is essential for improving the health of these women. Ensuring that safe abortion is available and accessible to the full extent allowed by law to women living with HIV/AIDS who do not want to carry a pregnancy to term is essential to preserving their reproductive health.

Laws should also be enacted to ensure women’s reproductive and sexual rights, including the right of independent access to reproductive and STD health information and services and means of contraception, including safe and legal abortion and the freedom to choose among these, the right to determine number and spacing of children, the right to demand safer sex practices and the right to legal protection from sexual violence, outside and inside marriage, including legal provisions for marital rape.

To make an informed decision about whether to continue with the pregnancy or have an abortion, women living with HIV/AIDS need to know the risks of pregnancy to their own health, the risks of transmission of HIV to their infant and the effectiveness and the availability and cost of antiretroviral drugs for treating HIV infection and for preventing HIV infection among infants as well as the potential toxicity of such drugs.

They also need to know the side effects and risks of the abortion procedures available. The woman should make the final decision to terminate a pregnancy.

There is a need for improved policy formulation and service provision that include stronger linkages between HIV/AIDS and reproductive health services.

Ishdeep Kohli-CNS

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Women Deliver: Integrating sexual and reproductive health with HIV services

Photo by mileamneWomen Deliver 2010, a global conference taking place in Washington from June 7-9, is focusing on the theme of ‘Delivering Solutions for Girls and Women’.

It aims to generate political commitment and financial investment for fulfilling Millennium Development Goal 5, to reduce maternal mortality and achieve universal access to reproductive health.

Sexual and reproductive health and HIV/AIDS advocates are teaming up at the conference to find innovative ways to give women more control over their health.

Debate has raged for decades about the advantages and costs of integrating health services. And as we place greater emphasis on strengthening health systems, there is renewed pressure to integrate them.

A panel of leading international figures in health systems, sexual health and reproductive health and HIV/AIDS discussed these critical issues during the Chairman’s session 'Integration: Is it the holy grail?'

Steven Sinding, Senior Fellow at the Guttmacher Institute and on the board of trustees of the International HIV/AIDS Alliance, moderated the session.

Michel D Kazatchkine, Executive Director of the Global Fund said the Millennium Development Goals 4, 5, and 6 are indivisible.

He said HIV, TB and malaria directly cause 1.1 million deaths a year among women aged 15-59 years and 1.2 million deaths among children aged 0-14 years. HIV is a leading cause of death among women of reproductive age.

HIV and malaria are among the most common indirect causes of maternal deaths. HIV prevention and care are core elements of sexual and reproductive health, and gender inequities are a common underlying barrier to improving women’s health.

Professor Kazatchkine further emphasized that the Global Fund has been investing in the health of women and children since inception and has addressed maternal and child health by accelerating PMTCT (preventing mother-to-child transmission) scale-up; 2.5 million people received ART through Global Fund support programs of which approximately 60% are estimated to be women; cumulatively 790,000 HIV positive pregnant women have received ART to prevent mother-to-child transmission thus also averting 82,000 HIV infections in children and 104 million insecticide-treated bednets have been distributed, saving170,000 children.

By investing in women, we are investing in the health and development of families, of communities and ultimately, of entire countries.

Helene Gayle, President and CEO of CARE USA, spoke about the broader integration of health into development programmes. She said linking services such as HIV/AIDS, sexual and reproductive health, microfinance and savings would empower women and girls.

Joy Phumaphi of Botswana, a consultant with WHO, World Bank and Gavi, stressed the provision of full and comprehensive holistic services for women and children. She said the challenge is to plan and finance development programmes and to ensure that these really happen. The inability of the global community to integrate and act together could lead to failure of the MDGs.

Nils Daulaire, Director of the Office of Global Health Affairs, Department of Health and Human Services, said that Under President Obama’s leadership, the U.S. has made improving health around the world a top priority.

The President’s historic six year, $63 billion Global Health Initiative expands and builds upon existing programs and incorporates what we’ve learned in the last decade to generate measurable, sustainable outcomes.

It embraces the global commitment to improving maternal and child health by expanding efforts to make pregnancy and childbirth safer, increasing education of family planning and reproductive health, and strengthening health systems to better respond to the needs of women and girls.

Tore Godal, Special Advisor to the Prime Minister of Norway, stressed his country's commitment to reduce the mortality rates of pregnant women and young children in poor countries.

Increasingly, advocates believe Millennium Development Goals 4 (to reduce child mortality), 5 (to improve maternal health) and 6 (to combat major disease including HIV) must be tackled together.

Unless experts in sexual and reproductive health - including maternal and child health (MCH) - and HIV join up and take an integrated approach, rather than addressing each MDG separately, progress will be further delayed.

Ishdeep Kohli-CNS

Girls, women and the Millennium Development Goals

In September 2000, world leaders came together at United Nations Headquarters in New York, committing their nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets, with a deadline of 2015. In 2001, the effort was refined to eight broad Millennium Development Goals.

The eight Millennium Development Goals (MDGs) range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015. They form a blueprint agreed to by all the world’s countries and all of the world’s leading development institutions. They have galvanized unprecedented efforts to meet the needs of the world’s poorest.

Girls and Women are key to achieving the MDGs, and not just around goal five on maternal health and goal three on gender equality. Women's empowerment is critical in order to attain all the other goals:

Goal 1: Eradicate extreme poverty and hunger: Smaller families and wider intervals between babies, owing to reproductive healthcare including contraceptive use - allows parents to invest more in each child’s nutrition and health. When a woman is too ill, anaemic or hungry to work, her household economic situation deteriorates and poverty increases. This means her children are less likely to attend school. Meanwhile, a woman with fewer children is more likely to enter the workforce.

Goal 2: Achieve universal primary education: Each year of education for girls and women improves their family's health and economic output. Families with fewer children can afford to invest more in education, making it more likely that girls will be sent to and stay in school.

Goal 3: Promote gender equality and empower women: Women who can plan the timing and number of their births will have greater opportunities for work, education and civil involvement. Violence and discrimination against girls and women in law and custom not only abuses their human rights, but also robs society of critical energy, economic production and creative talent.

Goal 4: Reduce child mortality: Care for the health of mothers is inseparable from the health of newborns. Newborns whose mothers die are far more likely to die within two years than those whose mothers survive. Young girls married off at puberty bear children at risk: babies born to girls under 15 are five times as likely to die as those born to women in their 20s.

Goal 5: Improve Maternal Health: This is often called the heart of the MDGs, because if it fails, the others will too. One target is to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. The second, added in October 2006, is to achieve universal access to reproductive health. To do these things will require investment in education, basic health care systems and emergency care facilities.

Goal 6: Combat HIV/AIDS, malaria and other diseases: Comprehensive sexual and reproductive healthcare includes preventing and treating HIV/AIDS and other sexually transmitted infections. At the same time, programs to fight HIV infection work best when they incorporate comprehensive reproductive healthcare. Antenatal and post-natal care facilities can bring mothers and their families into the health care system, encouraging diagnosis and treatment of many other illnesses for many more people.

Goal 7: Ensure environmental sustainability: Helping women avoid unintended pregnancies and to stay healthy and economically productive through pregnancy and motherhood helps stabilize rural areas, slows urban migration and crowding, and balances natural resource use with the needs of the population. As women are responsible for most household resource use, educating them leads to more efficiency and less waste and environmental degradation.

Goal 8: Develop a global partnership for development: Healthy and economically productive women can be half of every country’s engine for growth and development. Affordable prices for drugs, global economic stability and a secure supply of commodities would greatly advance reproductive health programmes, which are especially needed in developing countries.

The Millennium Development Goals will not be achieved without ensuring universal access to sexual and reproductive health services and without an effective global response to HIV/AIDS. A gender-responsive and rights-based approach is required to implement and monitor progress of the goals.

Ishdeep Kohli-CNS

Study finds orphanages are viable options for some children

DURHAM, N.C. -- A Duke University study of more than 3,000 orphaned and abandoned children in five Asian and African countries has found that children in institutional orphanages fare as well or better than those who live in the community.

The findings contrast sharply with research that associates institutions with poorer health and well-being, and the policies adopted by many international agencies/governments.

“Our research is not saying that institutions are better. What we found is that institutions may be a viable option for some kids,” said study leader Kathryn Whetten, director of the Center for Health Policy at the Duke Global Health Institute. “As the number of orphans continues to rise worldwide, it is vital not to discount orphanages before assessing whether they are harmful to the millions of children for whom they care.”

Whetten’s research team compared the physical health, cognitive functioning, emotion, behaviour and growth of orphaned or abandoned children ages 6-12, half of them living in institutions and the other half dwelling in the community. The study found that children in institutions in five countries reported significantly better health scores, lower prevalence of recent sickness and fewer emotional difficulties than community dwelling children. These findings suggest the overall health of children in orphanages is no worse than that of children in communities.

The research team has been following the 3,000 orphans involved in the study for three years, and they plan to continue tracking them into their late teens and early 20s to determine how their childhood affects their life course.

Published today in the interactive open-access journal PLoS ONE, this is one of the most comprehensive studies of orphans ever conducted. Data were collected between May 2006 and February 2008 from children and their caregivers in 83 institutional care settings and 311 community clusters. The study assessed five culturally, politically and religiously-distinct countries that face rising orphan populations. Sites included Cambodia, Ethiopia, Hyderabad and Nagaland in India, Kenya, and Tanzania.

“Very few studies cross a span of countries like ours does,” said Whetten. “The design flaw of past studies is that they compared a small number of orphanages against community houses. Those limited results can’t be generalized to other places.”

Some of the most influential studies on child institutions were conducted in eastern bloc countries. But the greatest burden of orphans and abandoned children is in sub-Saharan Africa and Southern and Southeastern Asia.

Of the estimated 143 million orphans and abandoned children worldwide, roughly half reside in South and East Asia, according to UNICEF. An estimated 12 percent of all children in Africa will be orphaned by next year as a result of malaria, tuberculosis, pregnancy complications, HIV/AIDS and natural disasters, according to the World Health Organization.

The Duke study included less formal institutions in Asia and Africa that were not studied before, and not easily recognized. Researchers spent the first six months meeting with members of each community to identify and map orphanage locations. In Moshi, Tanzania, the research team found 23 orphanages, after initially learning of just three from local government officials.

“What people don’t understand is that, in many cases, the institutions are the community’s response to caring for orphaned and abandoned children,” said Whetten. “These communities love kids and as parents die, children are left behind. So, the individuals who love children most and want to care for them build a building and that becomes an institution. These institutions do not look or feel like the images that many in this country have of eastern bloc orphanages, they are mostly places where kids are being loved and cared for and have stable environments.”

The research findings run contrary to global policies held by childrens rights organizations such as UNICEF and UNAIDS, which recommend institutions for orphaned and abandoned children only as a last resort, and urge that such children be moved as quickly as possible to a residential family setting.

“This is not the time to be creating policies that shut down good options for kids. We need to have as many options as possible,” said Whetten. “Our research just says ‘slow down and let’s look at the facts.' It’s assumed that the quality of care-giving is a function of being institutionalized, but you can change the care-giving without changing the physical building.”

Whetten said more studies are needed to understand which kinds of care promote child well-being. She believes successful approaches may transcend the structural definitions of institutions or family homes.

“Let’s get beyond labeling an institution as good or bad," she said. "What is the quality of care inside that building, and how can we help the community identify cost-feasible solutions that can be delivered in small group homes, large group homes and family homes?”

The study was supported by grants from the National Institute of Child Health and Development. Other Duke researchers involved in the study include Rachel Whetten, Jan Ostermann, Nathan Thielman, Karen O’Donnell, Brian Pence and Lynne Messer.

PLoS One: “A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6-12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations” htttp://dx.plos.org/10.1371/journal.pone.0008169

Ishdeep Kohli-CNS

Closing Session: NGO Forum Berlin

The United Nations Population Fund (UNFPA) and the German government hosted the NGO Forum 2 - 4 September, 2009, in Berlin to discuss strategies to push "sexual and reproductive health and rights" at the local, national and international level. The conference is to commemorate the fifteenth anniversary of the International Conference on Population and Development (ICPD) that was held in Cairo in 1994.)

The Global Partners in Action forum put governments and international donors on notice today that advocates for women’s health and rights will now be speaking more frankly and pressing more strongly for speedy action, investment and an end to gender-based discrimination.

Speakers at the closing session of the three-day Non-Governmental Organization Forum on Sexual and Reproductive Health and Development called upon the 400 delegates from 131 countries to mount public demonstrations to command attention, to promote open discussion of sexual behavior, and to insist upon scaling up successful programs of voluntary family planning, comprehensive sex education and maternal and newborn health care.

“Everywhere injustice is driven by silence,” summed up Gill Greer, chair of the Forum steering group and Director-General of the International Planned Parenthood Federation.

At an earlier news conference, Greer said NGOs can and should point out, for example, that unsafe abortion is a major cause of death for girls 15-19 in the developing world. Meeting the unmet need for family planning could prevent a third of all maternal deaths, she said. Issues confronting women, girls, young people and marginalized populations “cannot be addressed unless we recognize the realities,” she said.

At the final session, regional NGO representatives presented the five-point Berlin Call to Action to a group of parliamentarians present, who promised to relay it to governments around the world. “We have reignited the spirit of partnership,” said Purnima Mane, Deputy Executive Director of UNFPA, the UN Population Fund, which co-sponsored the conference with the German Ministry for Economic Cooperation and Development (BMZ).

Erich Stather, BMZ state secretary, noted that the eight Millennium Development Goals (MDGs) that dominate the world agenda incorporate key principles of the 1994 International Conference on Population and Development (ICPD) Programme of Action, but that progress lags most on MDG 5 (improve maternal health). “Let there be no forgotten MDGs,” he said.

Anand Grover of India, UN Special Rapporteur on the Right to Health, called on the delegates to use strong language about sexual behavior in calling on governments to guarantee human rights. “If you don’t talk about sex,” he said, “you can’t do anything.” Rights-based approaches to family planning and population needs “actually work,” he said. “This is a message you have to take home.

” At the news conference, Mane of UNFPA stressed the Forum’s call for renewed financial and human resource commitments to ICPD goals, noting that 75 percent of the US$11.1 billion in 2008 population-related spending went to combat HIV/AIDS. “We need to enlarge the pot and ensure that all areas of sexual and reproductive health and rights are funded,” she said.

Katie Chau of the Youth Coalition, which sponsored a day-long Youth Forum prior to the conference, told reporters the session had energized the young people present to carry ICPD principles into the next generations. “These issues are linked to environmental concerns and long-term economic sustainability,” she said. “We have made a strong commitment.”

Organizers plan to push the Berlin Call to Action at the 2009 International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action in Addis Ababa, Ethiopia, at the end of October.

Ishdeep Kohli-CNS

Is this the Independence we shed our blood for?

Is this the Independence we shed our blood for?
Dr Sandeep Pandey

The mainstream freedom movement of this country definitely had a vision for an egalitarian society. A society in which each family would be able to earn their livelihood with dignity and accord the same respect to every other member of the society that they would expect for themselves. People would be able to live in an atmosphere free from fear. There would be mutual respect for diversity of ideas. India would lead the world towards disarmament and peace and would help establish a just and humane global order.

The development policies adopted by the Nehru's government, completely ignoring the principles of Hind Swaraj put forward by Mahatma Gandhi, later further aggravated by the economic policies of liberalization, privatization and globalization have resulted in dual development stream in this country. A small minority of the society which possesses a purchasing power can afford the latest fruit of modern technological development available in the global market. The industrialists are allowed unhindered to produce material items for the consumption of this class and this class is allowed to consume things unbounded. Just like the American society nobody cares a damn about global warming or any such thing coming in their way of a global lifestyle. On the other hand for the vast majority of poor, devoid of the magical purchasing power - which doesn't accrue from one's capability alone - the country's parliament has passed a National Rural Employment Guarantee Act which bars machines from being used in work offered to them for the fear of causing a threat to the employment of the poor. In spite of Prime Minister's advice in a CII meeting, the CEOs resist the idea of placing a ceiling on their salaries whereas the poor earns a maximum wage of what is described as minimum daily wage. So, obviously there are two sets of policies one which allows unlimited growth and unbridled indulgence; and the other which tends to restrict.

This is not just limited to the field of economy. It extends to all other areas of human life. The elite of the country resist the idea of common school system ever since the Kothari Commission gave a recommendation in its favour in the mid '60s. Even the child of a government school teacher goes to a nearby private school. Same is the case with health care system, access to electricity, potable water, transportation, communication, etc. We have a system offering better services to the rich and another for the rest where people are asked to make do with subhuman conditions. A good example would be people who can pay a higher amount can travel in reserved coaches of the railways and those who cannot afford it are relegated to animal like travel in the general unreserved coaches.

As if things were not bad enough. The shining India now aspires to be a military power, in the august company of the country which is the single biggest threat to the sovereignty of various nations around the world. More people have probably died in India pre-maturely because of disease, poverty and debt-related suicides than would die because of dropping of a nuclear weapon by an enemy country. Through a stupid deal on nuclear energy, which has been rejected as an option for producing electricity by most of the developed nations, we're entering into a strategic tie-up with the US which will make it more difficult for us to resist exploitation by their MNCs of our natural resources and the market, will create more enemies for us in our neighbourhood and unnecessarily involve us in wars which the US will fight in this region and elsewhere. Already, our Prime Minister appears to be committed to fulfilling promises made to the US President at the cost of ignoring the priorities of people of this country. This is a serious departure from our policy of non-alignment and self-reliance. From being a leader pursuing the agenda of global peace until as late as 1995 in the International Court of Justice, we've now slipped down to being a military ally of the US in making.

It is not a coincidence that the terrorist incidents in this country have seen a rise since we decided unilaterally to join the US's war against terror in 2001. After the demolition of Babri Masjid, the first major terrorist incident which marked the arrival of right wing politics in India, there was a lull until the mysterious attack on our Parliament just before the passage of POTA Act. Since then there have been a series of incidents which have engulfed this country in an unknown fear. As we raise more brute power to crush the problem of terrorism, or for that matter Naxalism, the cycles of violence continue to grow. The government policy of acting with vengeance, instead of trying to solve the problems politically through dialogue, ends up in targeting innocent individuals like Syed Abdul Rehman Geelani and Binayak Sen. Our response to a Irom Sharmila who has been fasting for eight years now to demand repeal of the draconian Armed Forces Special Powers Act is to charge her with attempt to suicide and jail her in the hospital ward in Imphal. The Indian state doesn't know how to deal with its people except for a small elite segment loyal to it for its own vested interest. Farmers and labourers fighting to save their lands from corporate take over, for example in the name of SEZs, are labeled as Naxalites.

It is quite clear that majority of India doesn't know what it means to be 'independent'. It lives as a second rate citizen of this country, denied the fruits of modern development or of the basic human rights, working hard day and night to make two ends meet. The police, military, nuclear weapons, intelligence agencies, laws of the land and increasingly the development juggernaut do not instill a sense of security in her, rather they appear as ominous threat to their very existence.

Dr Sandeep Pandey

(Author has won the 2002 Ramon Magsaysay Award in the Emergent Leadership category for work towards empowering the poorest of the poor and lending the underprivileged in India a voice- from education to grassroots democracy to peace to promoting local ownership of resources)

Published in
The Times of India

Vienna 2010: CAPRISA 004 microbicide study – a turning point for HIV prevention

Findings from the CAPRISA 004 microbicide study mark a significant milestone both for the microbicide research field and HIV prevention as a whole. A breakthrough in the fight against HIV/AIDS is being announced at the VIII International AIDS Conference in Vienna. CAPRISA 004 is a vaginal gel for women that can significantly reduce the risk of infection with HIV. The gel contains the antiretroviral drug tenofovir and is the first method of HIV prevention that women at risk of the disease through sexual intercourse can control.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health said: “For years, antiretroviral medicines have been effectively used to treat HIV infection. Through the successful conduct of the CAPRISA 004 study, we now have proof that an antiretroviral drug, in this case tenofovir, can be formulated into a vaginal gel that can protect women against HIV infection.

"Given that women make up the majority of new HIV infections throughout the world this finding is an important step toward empowering an at-risk population with a safe and effective HIV prevention tool” he said.

Researchers from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) who conducted a study testing a vaginal microbicide with an antiretroviral (ARV) drug called tenofovir found its use before and after sex significantly more protective against HIV infection than a placebo gel among women at high risk of HIV.

CAPRISA 004 involved 889 women from Durban and a nearby rural community in South Africa, where women are at especially high risk of acquiring HIV through sexual intercourse. Women were randomly assigned to one of two study groups – tenofovir gel or placebo gel with no active ingredient - and instructed to use the study product in a regimen timed before and after sex.

At the end of the study, there were 39 percent fewer HIV infections among women who used tenofovir gel before and after sex than among those who used the placebo gel.

Approximately half of the 33 million people in the world who are infected with HIV are women, and in Africa that number rises to 60 percent. Given that abstinence, using condoms and being faithful have not been successful in preventing HIV infection, use of a vaginal microbicide gel that women can use without a man’s knowledge is a significant and critical step forward.

Six other microbicides have been tested over the past 15 years, but none of them have proved to be protective against the virus.

The Microbicide Trials Network (MTN) is currently conducting another study called VOICE – Vaginal and Oral Interventions to Control the Epidemic – that will provide evidence about the safety and efficacy of tenofovir gel used daily, regardless of when participants have sex.

Tenofovir gel and the tablets being tested in VOICE and other per-exposure prophylaxis trials incorporate some of the same ARV medicines used successfully for treatment of HIV. The hope is that they will also be safe and effective for HIV prevention.

In most cases, women acquire HIV through sexual intercourse with an infected male partner. Women often cannot control if or when condoms are used by their male partners. Moreover, women are twice as likely as their male partners to acquire HIV during unprotected sex due to biological factors that make them more susceptible to infection.

Both the CAPRISA investigators and other researchers who were not involved with the study stress that these results do not mean that a tenofovir microbicide gel is ready for market but is a really exciting first step.

Ishdeep Kohli-CNS

Vienna 2010: Opening session on HIV and rights

Under the theme of ‘Rights here, Right Now’, 20,000 participants from more than 185 countries have assembled in Vienna for the XVIII International AIDS Conference. Julio Montaner, AIDS 2010 Chair, President of the International AIDS Society and Director of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada in his opening speech expressed, “I cannot hide my profound disappointment and deep frustration with the recently concluded G8/G20 meetings in Canada. By failing to take responsibility for the Universal Access pledge, and more importantly for failing to articulate next steps to meet not just the 6th MDG but all of them by 2015, the G8 has quite simply failed us”.

Some of these countries have used the fiscal crisis as an excuse, but over the last year the same leaders bailed out the greedy Wall Street bankers and a full 110 billion Euros appeared for the Greek economy. The hopes of millions were put on hold when the G8 abandoned any reference to the financial commitments they made in Gleneagles. The G8 cannot ignore their commitment and it must be ensured that AIDS remains at the top of their agenda.

Dr Yves Souteyrand of the World Health Organization stated that addressing human rights violations among vulnerable populations is essential for the future success of the global response. Although the HIV epidemic has stabilized with the annual numbers of deaths declining globally from 2.2 million in 2004 to 2 million in 2008, there are still 2.7 million new infections every year. New infections are particularly high in key population groups such as migrants, men who have sex with men and people who inject drugs.

Vienna was chosen as the host city for AIDS 2010 in part due to its proximity to Eastern Europe and Central Asia (EECA), a region with a growing epidemic fueled primarily by injecting drug use. Conference delegates will examine the epidemic in EECA, as well as in all other regions. Home to two-thirds of all people living with HIV and AIDS, Southern Africa remains the most heavily affected region globally.

In her presentation on the state of human rights in the epidemic, Paula Akugizibwe from AIDS and Rights Alliance of Southern Africa stated, “the greatest barriers to achieving universal access are social, economic and political challenges. In order to accelerate progress and achieve sustained success, there is an urgent need for the HIV response to be based on concrete human rights principles.”

Michel Sidibe, Executive Director of UNAIDS in his opening remarks said, “We cannot settle for a world where some people get treatment while others not. Where some enjoy access to prevention while others are criminalized for who they are and for who they love. Where some are offered hope while the hope of others is crushed.”

Sidibe discussed four pillars as a strategy to achieve the vision of zero new infections, zero discrimination and zero AIDS related deaths. He called for a prevention revolution as his first pillar – a global political and social movement rooted in human rights and gender equality. Without a vaccine or cure, the AIDS pandemic will become unmanageable unless the transmission rate is reduced.

Treatment 2.0, the next generation of treatment, is the second pillar. Treatment for prevention is a potent tool. Partnerships with pharmaceutical industries must be scaled up for greater access.

Ending discrimination is the third pillar. No one should endure discrimination; laws must work for all vulnerable people, not against them. The US government took a giant step this week with the announcement that US President's Emergency Plan for AIDS Relief (PEPFAR) will now support needle exchange and substitution therapy.

The fourth pillar is gender equality. Women must have better tools to protect themselves from HIV, like microbicides and female condoms. They must have the rights, skills and the power to negotiate their own sexuality and they must feel safe from violence.

UNAIDS, PEPFAR, the Global Fund, the Clinton and Gates foundations must all work together with heads of states, ministers of finance and health and civil society to make universal access a reality in country after country.

Ishdeep Kohli-CNS

Vienna 2010: Human rights, law and HIV

Countries without laws to protect sex workers, drug users and men who have sex with men only provide a fraction of the population with access to prevention. On the other hand, countries with legal protection and the protection of human rights for these people offer greater access to services. As a result, there are fewer infections, less demand for antiretroviral treatment and fewer deaths.

In light of this, the Global Commission on HIV and Law was officially launched on June 24, 2010 by Helen Clark, Administrator, United Nations Development Programme (UNDP) and Michel Sidibe, Executive Director, The Joint United Nations Programme on HIV/AIDS (UNAIDS).

The Commission’s goal is to develop actionable, evidence informed and human rights-based recommendations to enable effective HIV responses and realize the human rights of people living and most vulnerable to HIV.

The Commission will submit its report in December 2011. It will pick up the most challenging legal and human rights issues in the context of HIV, including criminalization of HIV transmission and behaviours and practices such as drug use, sex work and same sex relations.

In India, the 2009 Delhi High Court ruling striking down Section 377 of the Indian Penal Code, ‘to decriminalize same sex relations between consenting adults’, could be showcased at the Global Commission on HIV and Law.

“Striking down of Section 377 has been a very important step in this direction and has generated a lot of expectations and excitement among the people who are either affected by HIV or those with different sexual preferences,'' said Mr J.V.R. Prasada Rao, member secretary of the Commission. Mr. Rao, former Union Health Secretary in India, is at present Special Adviser to the Executive Director of the UNAIDS for the Asia-Pacific region.

The following issues are critical to a human rights approach to HIV/AIDS:-

The rights of women and girls, including their right to equality under the law; protection from violence; equal access to property and inheritance; and access to education, information, and a full range of HIV/AIDS and reproductive health services.

The rights of people who use drugs, including freedom from arbitrary arrest, torture, incarceration for low-level offences, and other abuses in the criminal justice system; access to harm reduction services such as needle exchange and substitution treatment; and equal access to antiretroviral treatment for HIV.

The rights of prisoners, including humane conditions of confinement; access to HIV prevention, treatment, and care services; freedom from arbitrarily prolonged incarceration; access to medical release; and equal treatment for prisoners living with HIV.

The rights of sex workers, men who have sex with men, and other marginalized groups, including freedom from arbitrary arrest and detention for violating laws against prostitution and sodomy; protection from rape and other forms of violence; and equality in access to health care, employment, and other services.

The rights of children affected by AIDS, including protection from abandonment, sexual violence, property grabbing, and other abuses; equal access to primary, secondary, and tertiary education; and access to a full range of HIV services, including complete HIV-prevention information and antiretroviral treatment for HIV.

The rights of youth, including complete and science-based HIV-prevention information; comprehensive adolescent sexual and reproductive rights services; and meaningful involvement in the formulation of HIV policies and programs.

The right to universal access to HIV prevention, treatment, and care, including lifting all barriers to access to prevention, treatment, and care programs such as censorship of HIV-prevention information, legal restrictions on harm reduction services for people who use drugs, excessive patent protection on HIV drugs, and restrictions on opioid pain medication for palliative care.

The XVIII International AIDS Conference takes place at a critical time, given the 2010 deadline for universal access set by world leaders. AIDS 2010 will coincide with a major push for expanded access to HIV prevention, treatment, care and support.

The theme for AIDS 2010 'Rights Here, Right Now' – emphasizes the central importance of protecting and promoting human rights as a prerequisite to a successful response to HIV.

This theme underscores the need for governments to recognize and address the fact that discrimination, abuses against and criminalization of key population groups – particularly people living with HIV; people who use drugs; female, male and transgender sex workers; sexual minorities, including men who have sex with men and transgender people – continue to fuel the epidemic and hinder efforts to achieve universal access.

Ishdeep Kohli-CNS

Women Deliver: taking the movement forward

With a number of high level summits due to take place in coming months, such as the G20 and G8, how can political leaders, advocates and donors deliver? Speakers at the final day of the Women Deliver Conference in Washington DC discussed key issues and next steps in taking the movement forward.

For the three days of the Women Deliver conference, which took place in Washington DC, stories about the best maternal and reproductive health practice and the advancement of women and girls were shared amongst attendees.

Too many women and girls die from preventable causes and there are tools available now to prevent this. The conference was well times with heads of state due to meet in Africa to discuss women’s health and renew the Maputo plan.

The Maputo Protocol guarantees comprehensive rights to women including the right to take part in the political process, to social and political equality with men, to control of their reproductive health and end to female genital mutilation. As the name suggests, it was adopted by the African Union in the form of a protocol to the African Charter on Human and People’s Rights. It is a terrific blueprint for how to meet the MDG5 in the region with the highest rate of maternal death.

Maternal health was the key focus at Women Deliver and more than 3,000 people from 146 countries - including parliamentarians from 80 countries, 50 ministers, first ladies and corporate groups - gathered together to confirm that women are central to families, communities and national economies.

Owing to women's death, the world loses $15 billion in lost productivity. Women are an economic force and can be saved owing to political, medical, social and community based solutions.

Jill Sheffield, President and Founder of Women Deliver, said: "The world must now deliver for women, this isn’t just the right thing to do, it’s the economically smart thing to do. If only we could reduce unintended pregnancies with the use of modern contraceptives, we could reduce maternal mortality by 60 percent."

Narges Nemat, Youth Advisor, Women’s Refugee Commission, Afghanistan, spoke about the need to engage young people and girls in the decision making process.

"Young people play a very important role, if they are given access to education, health facilities and a secure environment, the future will look a lot different than it is now".

Afghanistan has the second highest maternal mortality rate in the world; one woman dies every twenty-nine minutes while giving birth in Afghanistan. Giving birth at a very young age is also one of the lead causes of maternal death.

Bringing into focus the issues of rapes in areas of conflict, Leymah Gbowee, Executive Director, Women in Peace and Security Network, reflected on maternal health in Sierra Leone and Liberia.

Sierra Leone has the highest maternal death rate at 2,000 maternal deaths per 100,000 live births (Maternal Mortality Ratio is the number of maternal deaths per 100,000 live births). The MMR is used as a measure of the quality of a health care system. She pleaded to the international community to step up their efforts in this region.

MDG5 - to improve maternal health - is the crux on which all other MDGs hang, accroding to Dr. Keith Martin, Member of Parliament, Canada. He stressed the Canadian government’s commitment to focus this issue during the upcoming G8 and G20 conferences.

He said: "Treating the pregnant woman is the most powerful impact you can have on the health of a population, if you can treat the pregnant woman you have the basics of primary health care right there – trained health care workers, access to diagnostics, medicines, clean water, electricity, means to access the full array of family planning including access to safe abortion.

"Through this you can not only safe the woman’s life but you can also treat malnutrition, pneumonia, gastro-enteritis, TB, malaria and the consequences HIV/AIDS."

The treatment of a pregnant woman is the unifying point of contact and can have an impact on the health of the entire population.

Tore Godal, Special Advisor to the Prime Minister of Norway, conveyed that not much progress is made in regards to women’s health globally. She said: "We have an opportunity this year to make 2010 as transformative as 1910 turned out to be (the year for women’s suffrage when women got their right to vote). In order to have a transformative summit, we must keep the pressure on governments. Keep criticizing, keep challenging us in order for us to do more."

Ishdeep Kohli-CNS

Women Deliver: Contraception access for all women

Photo by irina slutskyThe benefits of contraceptive use include preventing unintended pregnancies and reducing the number of abortions. Contraceptive use enables couples to have the number of children they want and can care for, can reduce the transmission of HIV, helps reduce pressure on scarce natural resources and can improve educational and employment opportunities for women and their children. These improvements in turn contribute to reducing poverty and galvanizing economic growth.

Increased contraceptive use contributes towards two of the United Nations Millennium Development Goals – reducing maternal mortality and reversing the spread of HIV/AIDS – which contribute directly or indirectly to achieving all eight goals.

Two trends will likely drive up demand for contraceptives in the future. First, the number of women of reproductive age (15–49) will increase by 10% between 2007 and 2015 and by another 8% between 2015 and 2025. Second, contraceptive needs are expected to rise as increasing numbers of women want to have smaller families. As a result, increased investment in contraceptive services will become even more crucial.

Levels of unmet need for contraception vary greatly among subgroups of women both at the regional level and within countries. Women who are young, uneducated, poor or living in rural areas are generally at high risk of having an unintended pregnancy.

Historical trends show that educated, urban and financially better-off women have begun to want smaller families and therefore have needed contraceptives earlier than their less educated and poorer peers. Thus, educated, urban and better-off women may experience unmet need first, when their desire to have fewer children outpaces their access to and use of contraceptives. Eventually, the demand for contraceptives rises among women in poor and rural areas, as well, usually leading to an increase in unmet need in these groups.

Nearly everywhere, unmet need is higher among women living in rural areas than among those in urban areas. In many countries, unmet need is also higher among less educated women than more educated women, and among poor women compared with better-off women.

Of the 818 million women who want to avoid pregnancy, 43% rely on a reversible method (such as IUDs, pills, injectables, implants, condoms or vaginal methods), and 31% have had a tubal ligation or have a partner who has had a vasectomy (female sterilizations outnumber male sterilizations by 10 to one). Women who want to delay a birth may have different contraceptive needs compared with women who want to stop childbearing altogether. For example, sterilization is appropriate to the latter group but not the former.

If unmet need for modern methods were fully satisfied, an additional 53 million unintended pregnancies would be averted each year, resulting in 22 million fewer unplanned births, 25 million fewer induced abortions and seven million fewer miscarriages. The immediate health benefits of averting these unintended pregnancies would be substantial. Each year, an additional 150,000 women’s lives would be saved and 640,000 newborn deaths would be averted.

It is recommended that women are provided with the full range of contraceptive methods, along with counseling, to help them obtain a method that best suits their needs and to understand and manage any side effects. Other recommendations include:

    * Ensure that follow-up services are available so that women can switch methods as needed.
    * Make contraceptive services and supplies available and accessible to all women, giving special attention to women with the greatest unmet need, including rural women, adolescents, poor and marginalized women including HIV positive women.
    * Use outreach services to educate women about their risks and needs.
    * Provide young women and men with comprehensive and age-appropriate sex education in schools.
    * Provide public education and information to men and communities to promote more positive attitudes about contraception.
    * Improve contraceptive technologies through research and development, to help meet the need for methods that can be used in low-resource settings and that are accompanied by minimal side effects.

Efforts to meet the demand for contraceptives will have a tremendous impact on the health and well-being of women and their families, and on progress toward meeting the Millennium Development Goals.

Such progress is only possible, however, if national and international donor agencies, as well as developing and developed country governments, make the necessary investments to make modern contraceptives accessible to all women who need them.

Ishdeep Kohli-CNS

Global Commission on HIV and the Law Reviews Legal Barriers Obstructing Progress on AIDS in Asia-Pacific

Press Release - For Immediate Release

BANGKOK, 16 February, 2011—Thirty years after the first cases of HIV were diagnosed, 90 percent of countries in the Asia-Pacific region still have laws and practices that obstruct the rights of people living with HIV and those at higher risk of HIV exposure.

As part of a global drive to remove barriers to progress in the AIDS response, policymakers and community advocates will join experts from the Global Commission on HIV and the Law in Bangkok on 17 February for the first in a series of regional dialogues to be held across the world.

The Global Commission on HIV and the Law is an independent body comprising some of the world’s most respected legal, human rights and HIV leaders. At this week’s dialogue, approximately 150 participants from 22 countries will discuss and debate region-wide experiences of restrictive and enabling legal and social environments faced by key populations in the Asia-Pacific region, including people living with HIV.

According to UNDP Administrator Helen Clark, “The law and its application can have a profound impact on the lives of people, especially those who are marginalized and disempowered. The law is a powerful instrument to challenge stigma, promote public health, and protect human rights. We have much to learn from the positive and negative experiences in this region on the interactions between the law, legislative reform, law enforcement practices, and public health responses.”

Across the region, legislation and law enforcement often lag behind national HIV policies, with the result that the reach and effectiveness of HIV prevention, treatment and care programmes are undermined. For example, 19 countries still criminalize same-sex relations and 29 countries criminalize some aspect of sex work. Many countries in the region enforce compulsory detention for people who use drugs and in some cases (eleven countries in Asia) issue the death penalty for drug offences.

“In the Asia-Pacific region, and across the world, there are too many examples of countries with laws, policies and practices that punish, rather than protect, people in need of HIV services. Where the law does not advance justice, it stalls progress,” said Mr. Michel Sidibe, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), who will participate in the Commission’s dialogue in Bangkok. “Advancing human rights and gender equity would not only be a triumph for the AIDS response, but for human development as a whole.”

Responding on behalf of the Global Commission on HIV and the Law, the Hon. Michael Kirby, Commissioner and Co-Chair of the Commission’s Technical Advisory Group stated “the effectiveness of the HIV response will depend not just on the scale up of HIV prevention, treatment and care, but on whether the legal and social environment support or hinder programmes for those who are most vulnerable. This requires bold and effective legal and policy measures to reach out to vulnerable communities and individuals at risk”

The Regional Dialogue, hosted by the Global Commission on HIV and the Law, is jointly organized by UNDP and UNAIDS in partnership with the United Nations Economic and Social Commission on Asia and the Pacific (ESCAP). In mid-2010, ESCAP’s Member States passed Resolution 66/10 in which countries committed to address policy and legal barriers to effective HIV responses.

“I am proud that, in our region, we have had such strong showing of collective will to handle these difficult issues,” said Noeleen Heyzer, Under-Secretary-General of the United Nations and Executive Secretary of ESCAP. “In adopting Resolution 66/10, our Member States highlighted the urgency of ensuring universal access to comprehensive prevention programmes, treatment, care and support. A major step towards achieving these goals is to foster an equitable and just legal and policy environment, with particular regard for key populations.”

Note to editors:

The Global Commission on HIV and the Law was launched in June 2010 by UNDP on behalf of the UNAIDS family to provide global leadership on HIV-related legal and human rights issues by analysing what is known about the interactions between the legal environments, human rights and HIV; fostering evidence-informed public dialogue on the need for rights-based law and policy in the context of HIV; and identifying clear and actionable recommendations with a concrete plan for follow-up. (www.hivlawcommission.com)

The members of the Commission are: former President of Brazil, Fernando Henrique Cardoso (Brazil, Commission Chair), Justice Edwin Cameron (South Africa), Ms. Ana Helena Chacon-Echeverria (Costa Rica), Mr. Charles Chauvel (New Zealand), Dr. Shereen El Feki (Egypt, Commission Vice-Chair), Ms. Bience Gawanas (Namibia), Dame Carol Kidu (Papua New Guinea), the Honourable Michael Kirby (Australia), the Honourable Barbara Lee (United States), Mr. Stephen Lewis (Canada), His Excellency Mr. Festus Mogae (Botswana), Mr. JVR Prasada Rao (India), Professor Sylvia Tamale (Uganda), Mr. Jon Ungphakorn (Thailand) and Professor Miriam Were (Kenya).

__________________________

For more information contact:

Beth Magne Watts, Communication Advisor, UNAIDS, magnewattsb@unaids.org or +66 (0) 81 835 3476 begin_of_the_skype_highlighting              +66 (0) 81 835 3476      end_of_the_skype_highlighting

Edmund Settle, HIV policy specialist, UNDP edmund.settle@undp.org or +66 (0) 818369300 begin_of_the_skype_highlighting      +66 (0) 818369300      end_of_the_skype_highlighting

Mika Mansukhani, Associate Social Affairs Officer, UNESCAP, mansukhani@un.org or +66 (0) 84 6529197 begin_of_the_skype_highlighting     +66 (0) 84 6529197      end_of_the_skype_highlighting

UNDP is the UN’s global development network, an organization advocating for change and connecting countries to knowledge, experience and resources to help people build a better life. We are on the ground in 166 countries, working with them on their own solutions to global and national development challenges. As they develop local capacity, they draw on the people of UNDP and our wide range of partners. Learn more at www.undp.org

UNAIDS, the Joint United Nations Programme on HIV/AIDS, is an innovative United Nations partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. Learn more at www.unaids.org

United Nations ESCAP, headquartered in Bangkok, is the largest of the UN’s five Regional Commissions in terms of its membership, population served and area covered. The only inter-governmental forum covering the entire Asia-Pacific region, ESCAP works to promote sustainable and inclusive economic and social progress. More information on ESCAP is available at www.unescap.org


Ishdeep Kohli-CNS

Connecting HIV to maternal and child health

The study, "Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5", published in the medical journal The Lancet projects that globally HIV has increased maternal mortality by 20 percent. In sub-Saharan Africa maternal mortality has been on the rise because of HIV, particularly in South Africa it is estimated that more than 50 percent of all maternal deaths can be attributed to HIV.

Researchers found that progress in reducing maternal mortality has been slowed by the ongoing HIV epidemic. Nearly one out of every five maternal deaths, a total of 61,400 in 2008 can be linked to HIV, and many countries with large populations affected by HIV have had the most difficulty in reducing their maternal mortality ratio. In 10 southern African countries, HIV causes up to one half of all maternal deaths, while in South Africa, from 2005-2007, the maternal mortality ratio was nearly 10 times higher in women known to be HIV positive. Michele Sidibe, the UNAIDS Executive Director noted at the Women Deliver conference in Washington DC this June, “this study serves as a powerful reminder that progress in maternal health efforts is hugely dependent on progress in the AIDS response in countries with the most severe HIV epidemics.”

The PLoS Medicine series article, "Sub-Saharan Africa's mothers, newborns and children: Where and why do they die?" on maternal and child health by Robert Black and colleagues, cites a study by Joy Lawn and colleagues in South Africa that reported approximately 300,000 mothers with HIV/AIDS give birth every year, with the toll of HIV infection contributing to 57 percent of all child deaths. According to the same article, 7.2 percent of all 6 week old infants attending their first immunization were already HIV infected, despite a national program launched in 2000 to provide single dose Nevirapine to HIV positive women in labor and to their infants postnatally. If South Africa were to scale up interventions for prevention of mother to child transmission of HIV (PMTCT) with appropriate feeding choices to cover 95 percent of mothers and newborns, more than 37,000 children could be saved each year. The authors say that HIV infected mothers' risk of dying is ten times higher than that of HIV negative mothers. About 16 million women over the age of 15 are living with HIV worldwide.

A stronger recognition of the linkages between HIV and maternal and child health is necessary to improve the health of affected populations. UNAIDS Goodwill Ambassador Annie Lennox giving the welcome address at the Women Deliver conference said, “I believe that the AIDS response is an excellent entry-point to better invest in women and girls at all levels, and to advance women's sexual and reproductive rights. We need to empower women and girls so that they can better protect themselves and take control of their own sexual and reproductive health.”

Reducing the number of children who die before the age of five is the fourth Millennium Development Goal (MDG 4), while doing the same for mothers during pregnancy or childbirth is the fifth goal (MDG 5). The lack of progress on these goals so far means that the 2015 targets for maternal and child health are unlikely to be met. These two Goals are often referred to as the health related MDGs along with the response to AIDS, malaria and other diseases (MDG6). These three MDGs are closely interlinked and recent data has shown how HIV has prevented further progress in improving maternal health and reducing child mortality.

Ahead of the G8 Summit in Huntsville, Muskoka, Canada, June 2010, UNAIDS Deputy Executive Director for Management and External Relations, Jan Beagle, delivered the keynote speech at an event for Canadian Parliamentarians. In her address, Ms Beagle stated that the Joint UN Programme on HIV/AIDS (UNAIDS) was encouraged by the sharp focus of the Canadian G8 Presidency on child and maternal health. “As HIV is the leading cause of death among women of reproductive age, the global response to AIDS can and must be leveraged more effectively to meet women health needs.”

The Muskoka initiative is in line with the UN Secretary-General’s global Joint Plan of Action focusing on the health of women and children which was launched in April 2010. Ms Beagle called for an integrated approach to all the Millennium Development Goals and highlighted that MDG 4 and 5 cannot be accomplished without a strong commitment and real action on universal access to HIV prevention, treatment, care and support.

Prevention of mother-to-child transmission (PMTCT) of HIV is an important platform for family centered care and an entry point for maternal and child health (MCH) services. The scale up of mother-to child-HIV transmission programmes will enable women to receive sexual and reproductive services at the facilities where they receive PMTCT services. We can stop mothers from dying of HIV and dramatically reduce maternal mortality.

Support for PMTCT interventions could avert more than two million child HIV infections over the next five years, leading to elimination of mother-to-child transmission of HIV. However, more funding is needed, especially to expand services aimed at prevention of HIV among women of reproductive age, prevention of unwanted pregnancies among women living with HIV, and early infant diagnosis, care and treatment — these are all the key pillars of PMTCT.

The Global Fund has demonstrated it will finance family planning interventions and reproductive health supplies as critical components of HIV, TB, Malaria and Health Systems Strengthening applications. The decision, Exploring Options for Optimizing Synergies with Maternal and Child Health, marks the first time that the Board has so strongly acknowledged the links between MDG 4 (reducing child mortality), MDG 5 (improving maternal health), and the Global Fund’s core mandate of MDG 6 (combating HIV, malaria, and TB).The time has come for integrating and scaling up delivery of HIV prevention and treatment services within the context of maternal and child health care.

Ishdeep Kohli-CNS

Hiroshima Day: Let us worship peace and shun violence

Hiroshima Day: Let us worship peace and shun violence
Shobha Shukla

Every year, peace loving people all over the world, and more so in Japan , observe 6th August as Hiroshima Day in memory of the millions killed and/ or maimed for life for generations to come.

Hiroshima day is a grim reminder of the dropping of the first atom bomb (ironically named Little Boy), 63 years ago, by the U.S. on the helpless and innocent citizens of Hiroshima . The Uranium bomb detonated at precisely 8.15 am, 2000 feet above the ground surface, turning a beautiful Monday morning into an inferno of unprecedented destruction.

As of today, the death toll ( due to immediate loss of life and the long drawn out radiation impacts) stands at 242,437. About 270,000 A-Bomb affected people ,called Hibakusha, live in Hiroshima today.

The second round of terror was unleashed 3 days later (9 August) with the exploding of a Plutonium bomb (called the Fat Man), directly above the Urakami Cathedral, annihilating the city of Nagasaki.

Even military experts felt that these bombs were not necessary to win the war, whose fate was virtually sealed against Japan . They were a brash announcement of the arrival of the new leader of the capitalist world, the US imperialism. Since then the US' ambition to be controller of the world has found reflection in their tactics in national and foreign policies. Atomic weapons have now given way to the more lethal nuclear weapons threatening lives world wide, as never before.

Today, Hiroshima stands tall as a picturesque and clean city; a city of peace that is almost crime free. It bears testimony to the indomitable spirit of the Japanese people, to their faith in life and in the goodness of humanity.

On this sombre day let us join hands with all like minded, peace loving people of this planet to shun war and violence in any form.

The possibility of a nuclear attack in the 21st century is not far fetched. Terrorist attacks by the so called 'jehadis' , the 'cocking a snook behaviour' and the brash insolence of the economically/ politically powerful, the communal violence perpetrated in the name of religion, the inhuman treatment of women in many parts of the world--- all these are acts of terror that can never be justified. What sometimes start as seemingly small acts of childhood intolerance and aggressive behaviour eventually end up in abject disregard for human life and cruel intolerance towards others.

Hiroshima Day should remind us of the importance of peaceful coexistence so that we never start a war. Militarism is wrong and there is no glory in war. Taking a human life is the most inhuman act and does not justify any end.

It would be pertinent here to quote from the memoirs of Dr. Richard Feynman, an eminent physicist, who was closely associated with the famous Manhattan Project ( for the making of the atom bomb) headed by Dr.Bob Wilson. Feynman recalls: "After the thing went off, there was tremendous excitement at Los Alamos . Everybody had parties, we all ran around. But one man, I remember, Bob Wilson, was just sitting there moping. He said, It's a terrible thing that we made."

It is high time we brought the terror of annihilation to an end so that our children grow up in a world free of nuclear weapons and communal prejudices.

Let us vow to celebrate life and not glorify death. Let us live and let others live. Let us as citizens, reject the Indo US Nuclear Deal.

Shobha Shukla

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

Published in
Bihar Times, Patna, Bihar
Assam Times, Guwahati, Assam
The Seoul Times, Seoul, South Korea
News Track India, Delhi
Daijiworld, Goa
Khabar Express, Bikaner, Rajasthan
Thai Indian News, Bangkok, Thailand
Scoop Independent News, New Zealand
Kashmir Times, Jammu & Kashmir (J&K)
MyNews, Delhi
Media for Freedom, Kathmandu, Nepal
Bihar and Jharkhand News Service
Manipur Comments, Imphal, Manipur
News Blaze, USA
Howrah News Service, West Bengal
The Bangladesh Today, Dhaka, Bangladesh
Pakistan Post, Karachi, Pakistan
Chiang Mai Mail, Chiang Mai, Thailand

Email address of Dr Sandeep Pandey hacked on 4th August 2014

Email address of Dr Sandeep Pandey, Magsaysay Awardee and noted social-political activist (ashaashram@yahoo.com) was hacked on 4th August 2014. We are attaching a screen-shot of the suspected login on 4th August 2014 alongside (source: Yahoo! login activity data). We are doing our best to get his email address restored and secure - till further notice, please correspond with him on: arundhatidhuru@gmail.com or call on: +91-(0)-522-2347365. Thanks

Dying of a curable disease: hepatitis C

In accordance with the 63rd World Health Assembly Resolution on viral hepatitis, earmarking July 28 as World Hepatitis Day, regional organizations working on HIV and AIDS issues across Asia have expressed serious concerns about HCV related deaths among people living with HIV and people who use drugs.

Approximately 200 Million (about 3%) of the World’s population are infected with hepatitis C (HCV) and each year another three to four million people are newly infected. The World Health Organization reports that People Who Inject Drugs (PWID) are most at risk of HCV infection with the prevalence of HCV in this group being 92% in India, upto 98% in Indonesia, 90% in Thailand and 89% in Pakistan. A large proportion are also co-infected with HIV.

Awareness about HCV including prevention, diagnosis and treatment is alarmingly low among PLHIV and PUD as well as health professionals treating HIV. Few governments adequately recognize or address hepatitis C in their HIV or public health programs contributing to these low levels of HCV education and awareness.

Although hepatitis C is a curable disease, the medications are prohibitively expensive and out of the reach of the majority of those infected resulting in poorer quality of life and in many cases, death from complications of liver disease, particularly during HIV treatment – all avoidable through HCV treatment and appropriate management of HCV HIV co infection. The patents being held by two pharmaceutical companies severely limit access to treatment for those who most need it.

Rico Gustav, APN+ Treatment Officer and Regional Coordinator of ITPC Southeast Asia, said: “Many of us are living with HIV and HCV co-infection. The ARV we take for HIV will not make sense and be of benefit if our HCV is left untreated. So investment to increase people on ARV for HIV will not have the desired results if HCV is left unaddressed”.

“Though there has been recent positive developments with the WHA resolution on viral hepatitis, the WHO,UNODC and UNAIDS Technical Guide for Universal Access, people who use drugs who are most affected by HCV still need to put pressure and demand for access to diagnostics and treatment. This is compounded by the criminalization policies of governments in Asia, which inhibits and denies access to essential Harm Reduction services” said Dean Lewis, Regional Coordinator, Asian Network of People who Use Drugs, (ANPUD).

The Regional Organizations call on policy makers, governments and the donor community to recognize the urgency of the issue. It is however clear that if HCV is left unattended and issues around prevention, testing, affordability and accessibility of treatment are not addressed, the global investment on HIV programs will not have the desired results and outcomes for those living with HIV and HCV co-infection. In fact, not addressing HCV will result in poorer health for people living with HCV and a greater burden to health systems.

Above all, what is the point of the investment when people continue to live with HIV, so far an incurable disease, but ultimately die of a curable disease: hepatitis C?

For more information, contact- Giten Khwairakpam, Regional Program Coordinator, Coalition of Asia Pacific Regional Networks on HIV/AIDS (7 Sisters), Bangkok at +66-811633923 begin_of_the_skype_highlighting              +66-811633923      end_of_the_skype_highlighting or giten@7sisters.org.

Issued by: Asia Pacific Network of People Living with HIV (APN+), Coalition of Asia Pacific Regional Networks on HIV/AIDS (7 Sisters), Asia Pacific Network of Sex Workers (APNSW), Asian Network of People who Use Drugs (ANPUD), World AIDS Campaign (WAC) and International Treatment Preparedness Coalition (ITPC).

Ishdeep Kohli-CNS

Vienna 2010: Rights-centred responses to HIV

When social worker Meena Seshu first entered a brothel in rural India, she was expecting a melodramatic scene in which poor helpless women were being victimized by brutal, aggressive men. It did not take long for her to find out that the reality was rather different. These women were, for the most part, in control of their lives but through a combination of prejudice and fear were being mistreated by every section of society.

Seshu runs Sampada Grameen Mahila Sanstha (SANGRAM), an Indian non-governmental organization that works with sex workers to stop the spread of HIV/AIDS. SANGRAM, based in rural Maharashtra, seeks to empower the women to form collectives and fight for their human rights.

Delivering the Jonathan Mann Memorial Lecture at the plenary session on Thursday 22nd July at the XVIII International AIDS Conference in Vienna, Seshu argued: “Too often, programmes that claim to be committed to rights-centred responses do not reflect that commitment”.

She presented examples of rights-centred responses to the HIV epidemic using real-life stories of programmes in western India shaped by the participation of sex workers, men who have sex with men (MSM), rural women living in poverty and young people.

Seshu said: “Sex workers’ involvement in shaping HIV education and health services helped them go from social pariahs to leaders in the HIV response while gaining community respect”.

Through this evolution, the community found the strength to challenge generations of entrenched discrimination and abuse against MSM, overturn social norms that impeded young people’s access to comprehensive sexuality education, and bring to the centre of its collective consciousness the hidden problem of violence against women. She noted that while the stories she presented arose from the Indian perspective, the challenges to be overcome and rights-centred language, tools and strategies are similar to those in many parts of the world.

Through SANGRAM she has worked for the empowerment of people in sex work, including mobilization for HIV related peer education, since1991. In 1996 this work broadened into the organization of a collective of women in prostitution called VAMP (Veshya Anyay Mukti Parishad). Seshu has worked with marginalized populations, particularly rural women, adolescents, people in sex work and MSM, on HIV and AIDS, sexual and reproductive health, violence against women, and gender and sexual minority rights through grassroots, rights-based organizations in the Indian states of Karnataka and Maharashtra.

One of the SANGRAM's most successful projects is building the capacity of sex workers to organize in collectives, negotiate condom use with their clients, and assert and defend their rights.

The Jonathan Mann Memorial Lecture was inaugurated at the XIII International AIDS Conference in Durban, South Africa. The lecture is sponsored and supported by the Global Health Council and honours the memory and legacy of one of the key figures of the 20th century in the fight against global poverty and illness.

Mann (1947 - 1998) is best remembered for his extraordinary contributions as the visionary physician and public health official who clearly articulated the connection between poverty and ill-health. A crusader against AIDS and a champion for human rights, Mann played a major role in focusing public attention on the fact that prejudice and discrimination were helping to drive and spread the epidemic.

Founder and the first head of the World Health Organization's Global Programme on AIDS, and the first director of Harvard's Francois-Xavier Bagnoud Center for Health and Human Rights, Mann believed that improved health couldn't be achieved without basic human rights.

Jonathan Mann and his wife Mary Lou Clements-Mann, herself a world-renowned immunologist, were killed in the fatal crash of Swissair Flight 111 in September 1998.

Ishdeep Kohli-CNS

Vienna 2010: Drug prices and new approaches to HIV treatment

Over the last decade, the scale-up of antiretroviral treatment (ART) to millions of people living with HIV/AIDS in developing countries has been possible thanks to a massive mobilization of resources and political will. The simplification of ART and the competition among drug manufacturers pushed prices for AIDS medicines down. More than four million people are alive today who would not be without treatment, and epidemiological trends show crucial progress in the battle against the epidemic.

The World Health Organization (WHO) has recently made important changes to treatment guidelines, and now recommends that people be provide treatment earlier, before the disease is allowed to progress. This would bring clinical practices in developing countries closer to standards adhered to in the developed world.

In new data from its treatment projects in Lesotho and Mozambique, Medecins Sans Frontieres (MSF) provides evidence that implementing early treatment initiation and improved first line regimen dramatically reduces mortality rates and makes treatment adherence easier for patients. But hope of these innovations reaching patients is in jeopardy due to high drug prices and a backtracking on treatment funding commitments from international donors.

At the XVIII International AIDS Conference in Vienna, MSF presented field research from its projects in Lesotho and Mozambique. In a two year study of 1,128 patients from rural Lesotho, where the government has adopted the new WHO guidelines, patients starting treatment earlier (at CD4 counts of less than 350) were 70 percent less likely to die, 40 percent less likely to remain in care, and more than 60 percent less likely to be hospitalized compared with those started when their viral load was already advanced (CD4 count less than 200).

“Treating people before they get very sick is better for the individual, better for the community and actually lessens the burden on the health system,” said Dr Helen Bygrave, HIV physician for MSF in Lesotho.

MSF also presented findings from its project in Mozambique where antiretroviral therapy was distributed through community groups. This simplified approach shows that patients in remote and poor areas can remain healthy and adhere to their treatment with limited reliance on health structures, showing similar outcomes as in clinic-based programmes.

In another study from Lesotho, MSF showed that the new WHO recommended first line combination with tenofovir leads to better health outcomes. A thirty percent price reduction for the recommended first line drug tenofovir would make the drug as cost-efficient as the older more toxic treatment with Stavudine. This is done by accounting for for the cost of treating side-effects, hospitalization and other expenses incurred through the continued use of the less effective treatments.

However, treatment scale is threatened by insufficient financial resources, increasing drug costs and patent protection, which is limiting generic competition for newer drugs. Drug companies have not been challenged at all on prices at this conference. Drugs costs need to be reduced more aggressively, making treatment easier for patients and ensuring more resources to increase access to treatment as early as possible.

AIDS 2010 brings us to critical crossroads that will determine the size and pace of the AIDS response for the coming years. We have to see how donors make political choices to fulfill their commitment to universal access to ART.

Ishdeep Kohli-CNS

India is, no longer the Guru, only a military state

India is, no longer the Guru, only a military state
Dr Sandeep Pandey

A lot of people didn't understand the hurry that Manmohan Singh was in in taking the safeguards agreement to International Atomic Energy Agency and requesting the United States President to pursue the matter with Nuclear Suppliers' Group. Even those who support the Indo-US nuclear deal are perplexed by the urgency demonstrated by the government. Manmohan Singh was willing to put at stake his prime ministership, his government and the party as well as the country for the sake of the deal. He annoyed his left supporters and forced a motion of confidence which he won not in a very dignified manner.

The Indian government has got the approval of International Atomic Energy Agency (IAEA) on the safeguards agreement expectedly quite smoothly. If Manmohan Singh is able to drive this deal through Nuclear Suppliers' Group (NSG) and the US Congress the second time, it'll be a virtual coup for him. He would have achieved what no other country on earth has been able to do so far.

He would have obtained the rights for India to engage in nuclear commerce with the 45 member NSG countries without signing on the nuclear Non Proliferation Treaty (NPT). It doesn't matter that the US and the rest of the world doesn't recognize India formally as a Nuclear Weapons State under the NPT. He would walk away without having committed India to nuclear disarmament.

It is to be noted that the big five, the permanent members of the United Nations Security Council, officially described as Nuclear Weapon States (NWS) under NPT are committed to nuclear disarmament, at least formally. The remaining countries which are signatories of NPT are anyway prohibited from making nuclear weapons. Pakistan and Israel , the only other non-signatories besides India , are also not officially committed to nuclear disarmament but then they are denied the benefit of nuclear commerce. Hence India will enjoy the unique status of a respectable member of the group of countries engaged in nuclear commerce with each other but without committing itself to nuclear disarmament. This is the diplomatic success of Manmohan Singh and a lot of countries are amazed that he has had his way violating the non-proliferation regime in place. He would like to consider this as his achievement and wants the due credit for it. This is why he wants to seal the deal during his present tenure.

It may be a personal achievement for Manmohan Singh. But what does it mean for the people and the country? Having obtained the status, even if informally, of a nuclear weapons state, India will seek to further stockpile. The nuclear power plants outside the IAEA safeguards will be used to add to India 's nuclear arsenal. This will fuel another round of arms race with Pakistan and possibly with China as well. Precious resources of the country will be dedicated to arms build up.

India has traditionally been seen as a harbinger of peace. As recently as in 1995, India's representative at the International Court of Justice described nuclear deterrence as 'abhorrent to human sentiment since it implies that a state if required to defend its own existence will act with pitiless disregard for the consequences to its own and adversary's people.'

Jawahar Lal Nehru had spurned an American offer to conduct nuclear test on India soil with American devices to preempt the Chinese nuclear test. Even though Indira Gandhi conducted the nuclear tests in 1974, Rajiv Gandhi was still seriously pursuing the cause of nuclear disarmament in the United Nations in 1988. India had taken a principled position against the discriminatory Non Proliferation Treaty and was hoping that the big five - the US , UK , Russia , France and China - would give a time bound commitment towards global nuclear disarmament.

However, the US , has now stopped surreptitiously talking about disarmament. The new phraseology is 'non-proliferation.' It is a euphemism for the continuing hegemony of the US called the 'new global order.' And slowly the world leaders have started trumpeting the idea of non-proliferation, abandoning the ideal of nuclear disarmament. The countries have either voluntarily or under coercion joined the non-proliferation order. India had resisted this design valiantly as the leader of the Non-Aligned Movement not until long back. However, with the Indo-US nuclear deal, the US thinks that India had been brought into the non-proliferation regime through the back door.

Even our political parties, like the Congress, the Communists and the Socialists, who have been traditional supporters of the idea of global nuclear disarmament have been forced by the US and its right wing allies in India, the Hindutva forces, in this debate, to take right wing position of maintaining the option to carry out nuclear tests in future and thereby increase India's nuclear and other arsenals in the name of national security. They are either now paying only lip service to the ideal of nuclear disarmament or have subscribed to the new paradigm of non-proliferation.

So, India , from a position of the leader of the Non-Aligned Movement (NAM) , advocating nuclear disarmament and global peace, fighting the US dominance, has now climbed down to be merely an ally of the only remaining super power. She was earlier a spiritual guru to the world and champion of peace. Now she is just a military power, that too a very mediocre one. She has an ambition to be in the league of security council members, but her vast majority of poor population, living on the verge of starvation and possible suicide deaths pull her down to be face to face with the reality.

While the Indian Parliament builds a nuclear bunker for itself, majority of the villagers live without electricity. From a strong believer in the concept of self-reliance we now seek dependence on others which is described as ending India 's technological isolation. Subjugation to the world power is being portrayed as India achieving its long overdue place in the comity of nations. India 's leaders think that they will be able to retain country's sovereignty and not let it degenerate into a banana republic. In reality, our position will be nothing more than a second rate UK or Israel .

Dr Sandeep Pandey

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

Published in
Bihar Times, Patna, Bihar
The Kashmir Times, Jammu, Jammu & Kashmir (J&K)
Central Chronicle, Madhya Pradesh/ Chhattisgarh
Manipur Comments, Imphal, Manipur
News Track India, Delhi
Bihar and Jharkhand News Service
Assam Times, Guwahati, Assam