CNS

Uttar Pradesh must ban Gutkha and enforce FSSA Act

[हिंदी] Uttar Pradesh must ban Gutkha as it is categorised as a food item by Food Safety and Standards Act (FSSA), 2006, and no food item can contain tobacco or nicotine as per this law. This was the outcome of the CNS Media Dialogue organized by Asha Parivar, National Alliance of People’s Movements (NAPM), Citizen News Service (CNS), The Movement of India, Sachchi Muchchi, Indian Society Against Smoking (ISAS) and Vote For Health Campaign.

Scene1: A brick walled house in a narrow by lane of a typical urban slum of Lucknow. A small open veranda leads to two small, dingy and damp rooms, with no access to sunlight, and hardly any ventilation. One of the rooms doubles up as a kitchen, which has a chulha (mud stove) run on wood fuel. The smoke from the stove and from the bidis (cheap cigarettes) smoked by the family head lingers in the suffocating environs where Shiv Prasad, a daily wage labourer, his wife Ramdulari and his 4 children manage to eke an existence. Shiv Prasad underwent TB treatment 7 years ago (the cough has returned again) and his 6 years old son is currently on treatment for pulmonary TB.

The call to end AIDS at the recently concluded XIX International AIDS Conference (AIDS 2012) warrants us to act upon a range of AIDS related interventions. One of these is around preventing HIV transmission. "We have to address the needs, challenges and opportunities for development of multiple prevention technologies (MPTs) that would provide simultaneous protection against HIV, other sexually transmitted infections (STIs) and unintended pregnancies" said Dr Helen Rees, Executive Director, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, South Africa, who was co-chairing the "New Products, New Paradigms:Combination Products for Women" satellite session at AIDS 2012. This session was co-convened by the Population Council and Coalition Advancing Multipurpose Innovations (CAMI), along with AVAC - Global Advocacy for HIV Prevention, CONRAD, USAID, and WHO.

The Citizen News Service (CNS) had a team of writers from a range of countries in Asia and Africa (see below) to provide issue-based coverage from XIX International AIDS Conference (AIDS 2012) in July 2012. CNS generated 73 in-depth articles that were published in a range of media channels around the world apart from being disseminated through social media platforms (such as blogs, youtube, twitter, facebook, etc) and other electronic discussion forums such as the Stop-TB eForum (to join, send an email to: Stop-TB-subscribe@yahoogroups.com), SEA-AIDS, ITPC, ITPC India, IRMA listserv, IRMA blog, among others.

Quicker Response Required to Fight MDR TB

Harare, Zimbabwe – Zimbabwe, like many countries across the world, is set to benefit from ongoing research into cheaper, quicker clinical responses to MDR-TB. Each year, 440,000 MDR-TB cases emerge and 150,000 people die. To prevent these unnecessary deaths, the International Union Against Tuberculosis and Lung Disease (the Union) programme, TREAT TB Initiative, is sponsoring a multi-country clinical trial – STREAM – which will evaluate a markedly shorter and more tolerable treatment regimen for MDR-TB.

In an increasingly globalised world, the impact of trade and investment liberalisation is an important area of policy focus. With the emergence of bilateral free trade and investment agreements and clamour for more and more foreign direct investment, all in the name of economic growth, the gender impact of these policies is changing and impacting women’s roles in society. Indian women face a number of challenges everyday as workers, care givers, food providers, healthcare seekers. In a country like India, where economic, social and gender inequalities persist historically, and where trade policies are not 'gender neutral' the impact of trade policy on women must be paid serious attention to.

"It is high time that anal health and hygiene comes out of the closet" said Dr Ross Cranston from University of Pittsburgh, USA. Dr Cranston was referring to the multitude of anal health complications people practicing receptive anal sex are likely to be dealing with in their lives and very little quality care and products that exist to relieve them. The awareness level in people (women, men, transgender women) who reported to practice receptive anal sex was abysmally low. Zero per cent of such respondents had knowledge related to their anal cancer risk, and just half of them knew about Herpes Simplex Virus (HSV - the virus that causes genital herpes). Awareness certainly needs to be upped in people practicing receptive anal sex.

At the recently concluded XIX International AIDS Conference (AIDS 2012), not only the decibels went up on ending AIDS but also sane voices were heard demanding a well-costed and thought-through strategy on how to end AIDS. One of the strategies that will complement a comprehensive HIV prevention, treatment, care and support plan to end AIDS is preventing HIV transmission. In this context, we need to look beyond the Phase III trials in HIV prevention research so that if the product being tested is proved to be effective, we have the means and well-thought plan to make it available for those people in need, without delay.

While interviewing a range of experts involved with research, development and advocacy of new HIV prevention tools at the recently concluded XIX International AIDS Conference (AIDS 2012), I was reminded of a transgender woman who had said to me in an interview four years back that: "There is no doubt that we need more HIV prevention options - current options don't work especially for people like us... and this is the only possible reason to motivate me to advocate for new prevention options." This community expert further added: "...'perfect' technologies that disregard social realities don't necessarily deliver results..." The need to engage affected communities as research moves ahead, and engage them with dignity as equal partners is the key to ensure that finally we develop products that are efficient and also when they become available, are actually used by populations in need.

World Breastfeeding Week, 1-7 August 2012

Mother’s milk is the ideal nutritionally perfect food for newborns and infants. It is like nectar for the infant and is aptly called the first vaccine that can be given to the child. During the initial post natal phase, breast milk is in the form of yellow viscous milk or colostrums which is packed with antibodies (immune globulins), and give the child an integral immunity against various diseases, including acute respiratory infections and diarrhoea. Breast milk is also rich in proteins, has enzymatic activity that prevents the growth of bacteria and viruses, and fulfils all the nutritional requirements of the new born for the first six months. It is safe, easy to digest, is readily available and very affordable. Thus breastfeeding is the cheapest and most effective way to ensure a child’s health and survival.

The International AIDS Conference (AIDS 2012) in Washington DC this week is the 19th in count. All International AIDS conferences are important, hectic and full of event. But, many believe that AIDS 2012 is a historic event on the path to the end of the epidemic. The fact that AIDS conference has returned to the US in itself is of paramount importance. After a long gap of 22 years and through a process of US reforming its stand on HIV (allowing people living with HIV (PLHIV) to enter the country since 2010), the conference is back to their home turf. Most would agree that without US' roles in research and funding, the battle against HIV would not go further. However, when this US leadership comes across with a stronger sense of solidarity, opened borders and a sense that HIV is everyone’s problem including US, the momentum gains another level.

[Below CNS article dated May 2012 is reproduced to mark Hiroshima Day, 6th August]

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

Women are more likely to be infected with HIV than men due to a combination of socio-cultural factors, physiology and biology. And yet women have had little control over most prevention methods. Condom use, abstinence, fidelity and male circumcision are all effective methods for HIV prevention, but they rely on a male partner's cooperation or action, which is not always possible. Unfortunately, current methods have not done enough to stem the epidemic among women. Women already make up half of the 34.2 million people worldwide living with HIV. According to UNAIDS figures, 1.3 million women and girls became HIV positive last year and 63% of those are young women between 15-24 living with the virus. In Sub-Saharan Africa, 60% of those with HIV are women and girls.

THE fight against AIDS, tuberculosis (TB) and malaria requires innovative ways to expedite interventions that centre on expanding outreach to the affected populations, especially those in remote, developing countries. At the XIX International AIDS Conference (AIDS 2012) being held in Washington DC, experts from India, African nations and United States explained how they are reaching populations through new media - social media! The expert eluded to breakthroughs taking place in India, South Africa, Zambia, United States and Guatemala where doctors are having questions answered and patients are getting better treatment through e-learning. Apart from capacity of the medical personnel, technology has also been used to diagnose patients and administer treatment.

Despite all efforts to increase access to affordable antiretroviral (ARV) pills over the past years, all people living with HIV (PLHIV) who need them most are still struggling to have them in developing countries. The access to these essential medicines is further decimated by the ever changing rules on trade globally. Brazil was a pioneering country where a compulsory licensing mechanism was opted specifically for Efavirenz and this led to the reduction in the cost of the drug and helped put many more PLHIV on treatment within same resources. According to Francisco Viegas Neves da Silva, this initiative on putting flexibility in the TRIPS is economically efficient while at the same time, improved access to drugs. This pioneering action of Brazil inspired community activism for greater access to life saving drugs.

Childhood tuberculosis (TB) has been neglected for a long time and in terms of the global policy the focus has been on adult tuberculosis. To add fuel to fire, presentation of the disease is less specific in children, and while diagnosis is difficult, treatment is also very child unfriendly. A press conference organized by Citizen News Service (CNS), a partner of Stop TB Partnership, during the recently concluded XIX International AIDS Conference (AIDS 2012) held in Washington DC, focussed upon various issues besetting childhood TB which affects at least half a million children (and this could very well be an under estimate), killing up to 70,000 of them each year. Some ten million children have been orphaned due to TB and many more have had to quit school to care for relatives or provide a living for their families.

At the recently concluded XIX International AIDS Conference (AIDS 2012), the 'And Lubes' campaign that brought attention to the fact that condoms should be distributed along with lubricants (or lubes) to meet the needs of those practicing anal sex, was certainly not 'preaching to the choir.' Reality was grimmer with AIDS 2012 rightly promoting 'condomize' campaign but without lubes! The way condoms were in the spotlight when AIDS 2012 began lubes weren't. Only until mid-way into the conference when And Lubes campaign repeatedly raised the issue of non-availability of lubes on-site, we could then find more lubes being distributed along with male and female condoms. Even condoms along with lubes in the same sachet were made available!

The Unknown Seven Billionth Babies

On October 31, 2011, Danica May Camacho was welcomed as the world’s seven billionth baby with a chocolate cake in Manila, Philippines, and a gift certificate for free shoes. While Russia declared a boy named Alexander, born in Petropavlovsk- Kamchatsky city on the same day, as their seven billionth baby, in the Indian state of Uttar Pradesh the birth of Nargis at a Community Health Center (CHC) in Mal was greeted by her parents, several non governmental organizations and state officials and accorded a ‘symbolic’ status of the seven billionth baby of the world.

New Strategy to Boost Healthcare

In a state where infant mortality rate (IMR) is 52 and maternal mortality rate (MMR) is 312, it comes as no surprise to find Bihar lagging behind in development goals. With 36 of Bihar’s 38 districts being categorized backward, it is one of the high focus states under the National Rural Health Mission (NRHM). However, a determined bid is being made by the State Health Society Bihar to improve the lives of women and children by reducing IMR to less than 45 and MMR to 200 and improve the rate of institutional delivery to 70 percent. Further, it hopes to reduce Birth Rate (CBR) from 28.1 (SRS Dec 2011) to 27, Death Rate to 6.7 from 7 and increase contraceptive prevalence rate (CPR) from 29.4 (RCH 3, 2007-08) to 45 so that it can stabilize population by bringing down the total fertility rate. Bihar continues to be the third most populous state in India despite the 3.5 percent decline in the decadal growth of the population (2011 census).

It has been said and proved time and again that AIDS is not a medical problem solely and have deep social and economic links, consequences and implications. Global Village, over the years, at AIDS conferences has been the platform of communities, activists and practitioners representing diversity and solidarity. The Global Village at XIX International AIDS Conference (AIDS 2012) provided the space for participants from over 90 countries with over 120 booths and a wide range of activities and information. A clear testimony that Global Village is at the core of AIDS 2012.

As the discussions continue further at XIX International AIDS Conference (AIDS 2012), the consensus is that a lot of progress on fighting with HIV has been made. From death sentence in early 1980s, AIDS is now a chronic and manageable disease. A global 20% reduction in prevalence rates since 2000 is a significant achievement. Stories from countries like India bring hope. The Government of India presented the achievements of its National AIDS Control Programme (NACP) at AIDS 2012. India has recorded a 56% reduction in the prevalence rate in last decade. In a country that has remained impacted with poverty, other serious health problems, and funds deficit, this achievement is overwhelmingly positive. This has brought India’s HIV prevalence rate to 0.31%.

Flash back to 1981, the first case of AIDS was declared by the Center of Disease Control (CDC) in the United States. AIDS then spread, taking the form of pandemic, leaving lives shattered and people living with HIV (PLHIV) were left waiting for death with an incurable disease. years later in 1990s, the world got saw a ray of hope in form of highly active antri retroviral therapy (HAART). Since then the science has taken a giant leap ahead. Did you know that in the US in 2006, the life expectancy at 20 with HIV through ARV support stood at another 52 years? This is from 27 years in 1996. Living in seventies is almost as good as normal life expectancy. The goal of Anti Retro Viral Therapy (ART) is to control the viremia load in the infected individual to reduce morbidity and raise life expectancy.

Need to Take Advantage of Technology for Family Planning

First, it was the school health cards. This was followed by the initiative to introduce a chapter on kala azar in text books in government-run schools across the state, to create awareness about this potentially fatal parasitic disease spread by a tiny sand fly that affects hundreds every year and can be fatal. However, even while protecting its children, the Bihar health department is actively engaged in stabilizing the population in the state. With the birth rate higher and death rate lower than the national average, Bihar is the third most populous state in India. According to Mr. Sanjay Kumar, Executive Director, State Health Society, Bihar, the fertility rate is worrying as it is the highest in India. “We need to take advantage of technology to address the high unmet need for family planning. A greater focus on increasing the participation of men is also needed,” he said in an interview.

Now A for Anemia, H for Health in Bihar Schools

Ten year old Roopa is one of the brightest girls at the local government school in Cinawa, a backward village in Nalanda district. Last year, a fire accident left her face badly scarred. With her vision also affected, her dreams of studying further went up in smoke. Although her poor parents made efforts to get her treated, they were unable to afford reconstructive surgery.

Some of the loudest and most passionate demonstrations at the XIX International AIDS Conference (AIDS 2012) condemned the United States and European Union trade agreement negotiations which aim to protect the profits of pharmaceutical companies and let people in low and middle income countries die for their sake. During her address to the conference, Hillary Clinton, US Secretary of State, with an air of optimism, joined the call for an "AIDS free generation", highlighting the fact that the tools for its achievement exist. At the same time, her government, through negotiations for the Trans Pacific Partnership Agreement (TPPA), is pushing to radically expand pharmaceutical company monopolies and therefore maintain high prices on and limited access to life-saving medicines for HIV and associated co-morbidities. "Today US trade policy is threatening to undermine US AIDS policy," said Peter Maybarduk of Public Citizen, a prominent US consumer rights group.

Despite alarming HIV rates amongst the men who have sex with men (MSM) and transgender people, many countries, community leaders, media and society at large continue to hold discriminating stereotypes against them. "Punitive laws will drive MSM and transgender populations underground" rightly said Aradhana Johri of Department of AIDS Control, Government of India. In US alone, according to the Centers for Disease Control and Prevention (CDC) report, although Black American MSM people represent only 13 percent of the US population but they account for about 44 percent of the new HIV infections particularly among those aged 13 -19.

The XIX International AIDS Conference (AIDS 2012) reminds us how punitive laws and criminalizing policies keep most affected communities disengaged. Due to the policy block in US, sex workers and injecting drug users (IDUs) weren't able to participate in AIDS 2012 from around the world. In their own countries, IDUs are struggling as well with policies that criminalize drug use and drive populations underground. There are an estimated 16 million Injecting Drug Users (IDUs) in 151 countries, and they are very often unable to access HIV and TB related services due to punitive policies and discriminatory attitudes. Many of them are infected with the Hepatitis C Virus (HCV) as well.

Michel Kazatchkine, appointed as the UN Secretary-General's new Special Envoy for HIV/AIDS in Eastern Europe and Central Asia (EECA) before the XIX International AIDS Conference (AIDS 2012) opened in Washington DC, responded to a suggestion during a meeting with EECA conference participants to emphasize access to HCV care, noting that the region’s epidemic is not only a dual epidemic of HIV and drug use but rather a quadruple epidemic of HIV, drug use, TB and HCV. Similar dynamics are seen many countries Eastern Europe and Asia where sharing unsterile injecting equipment is driving HIV epidemics.

Nineteen years after female condoms were approved by the US FDA in 1993, they are not yet available as widely as one would have wished. What could have delayed their optimal utilization to meet the unmet prevention needs: was it because female condoms were not rolled out under a robust enough and well resourced comprehensive programme and strategy, or potential users didn't prefer using it? The delegates of the XIX International AIDS Conference (AIDS 2012) vote for female condoms sending a clear message that female condom introduction must be supported by strong, well resourced and strategic scale up programmes in countries and communities where unmet need is acute. Carol Nawina Nyirenda, from Zambia CITAM Plus, has been living with HIV for several years. She shared her perspective about using the female condom. It makes her "feel sexy" and she can wear it even five hours before sex, she said.

In communities where sharing of injecting equipment drives the HIV epidemic, a parallel epidemic of hepatitis C virus (HCV) often lurks quietly. A couple of days before the World Hepatitis Day, 28 July, Dr Victor Lo Re, an infectious disease researcher at the University of Pennsylvania, presented data on the impact of HIV and HCV co-infection at the XIX International AIDS Conference (AIDS 2012). His work shows that, despite effective antiretroviral therapy, people co-infected with HIV and HCV remain at higher risk of liver deterioration and other liver-related complications than those with HCV alone.

Washington DC is the host to the 19th International AIDS Conference (AIDS 2012) with about 24,000 registered delegates coming from all around the world. International conferences such as this one is an opportunity and a venue to get updates, innovations and new strategies in addressing HIV and turn the tides to achieve the 2015 targets of zero HIV infection, zero HIV related death and zero HIV related stigma and discrimination. US President Barack Obama had earlier made a call that AIDS free generation is possible. The conference provided loads of information on practices that worked in communities all over the world, including bio-medical breakthroughs and the latest innovations on treatment for people living with HIV (PLHIV).

One of the clear messages from the XIX International AIDS Conference (AIDS 2012) in Washington DC is that HIV prevention research is progressing ahead with thrust to meet needs of most at risk populations such as sex workers, men who have sex with men (MSM), transgender populations, injecting drug users, women and men with high risk behaviours, among others. However a lot more needs to be done in the regional, country and local contexts to bring in unique perspectives of most at risk populations so that their prevention needs can be met. One such initiative that brings in African regional voices of those women, men and transgender women who practice anal sex into main discourses on HIV prevention research and advocacy is Project ARM (Africa for Rectal Microbicides).

At home, Bhekizitha Sithole, a Swazi student at the Stellenbosch University based in Cape Town, South Africa, and currently on TB treatment for extrapulmonary TB, was fortunate to be awarded a scholarship by the John Hopkins University through American Foundation for AIDS Research (AmfAR). It was his first time to attend the International AIDS conference in Washington DC. Like many other delegates, he was elated to be greeted by AIDS 2012 opening ceremony marked by the presence of great people like veteran actress Sharon Stone and other United Nations and political figures. This year’s conference has attracted about 24,000 registered delegates and about 2000 accredited journalists.