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Archive for October 9th, 2010

HIV service providers are now trying to work with churches to keep teens on treatment

Posted by African Press International on October 9, 2010

UGANDA: HIV-positive teens choose religion over ARVs


Photo:Amncio Miguel/PlusNews

KAMPALA, 7 October 2010 (PlusNews) – Ugandan health workers are concerned by the growing number of HIV-positive teens who are abandoning their HIV treatment after turning to bogus religious leaders.

“Over the years we have noticed a growing trend of adolescents and caregivers who have withdrawn from treatment with a belief of having been cured of HIV/AIDS in church,” said Cissy Ssuna, the counsellor coordinator atBaylor College of Medicine Children’s Foundation Uganda, which treats more than 4,000 HIV-infected children, 750 of whom are adolescents.

Rebecca Nakityo, 17, spends every free moment watching gospel TV, reading the Bible or praying in church. The soft-spoken teen – who has lived with her aunt and uncle since her parents’ death several years ago – told IRIN/PlusNews she believed she was cured by God six months ago.

According to Nakityo, as the pastor’s voice reverberated through the church hall, she felt filled with the healing power of God. Nakityo now regularly gives testimonies about her “healing” and has stopped taking her ARVs.

By the time many young people find their way back to the health system, it is too late. “We had a client who was in church; they brought her and dumped her at Baylor – we tried to treat her but it was too late,” Ssuna said.


She noted that the practice was more common among Pentecostal churches than other religious denominations; while teens often made the decision to abandon treatment on their own, peer pressure was also a factor.

A 2007study by Uganda’s Makerere University’s Infectious Disease Institute found that 1.2 percent of 558 respondents initiating ARVs discontinued therapy because they believed they had been spiritually healed. Four out of six restarted therapy, but three required much more expensive second-line salvage therapy.

One spiritual leader told IRIN/PlusNews that patients were misled by unscrupulous pastors. He advises HIV-positive believers to pray for healing but continue with their medication.

“The missionaries knew that very well – that is why they built churches alongside hospitals,” said Bishop Dunstan Bukenya from the central district of Mityana.

According to Mary Kiwanuka, who has an adolescent daughter living with HIV, the influence of television evangelists should not be underestimated. “These children are exposed to too much television which shows people being healed,” she said. “In their circumstances, with too much peer pressure and the pill load, if there is an alternative they take it.”

Ssuna said rather than criticizing the church, her organization was trying to work with spiritual leaders to encourage teens to stay on treatment rather than abandon it for religious reasons.

Reaching out

“We have gone to some churches where our clients go and we want to start having dialogues so that we and the spiritual leaders speak the same language,” she said. “We want them to come in and support us.”

''We had a client who was in church; they brought her and dumped her at Baylor [clinic] – we tried to treat her but it was too late''

Between March and October 2009, Baylor enlisted trained spiritual leaders after they noticed that many people – especially adolescents – had quit treatment. The adolescents returned piles of drugs to Baylor and officers on home visits found patients were not taking drugs.

During that period, Baylor brought two spiritual leaders to the clinic twice weekly to counsel the adolescents and caregivers.

Counselling involved prayer, rationalization of the clients’ status, the role of ARVs, the importance of adherence and coping mechanisms. Prayers were held for groups or individuals.

Clients said the visits were uplifting and alleviated distress.

“However, many clients also asked ‘why is God punishing me?’, ‘what did I do wrong?’ or ‘why me?’,” Ssuna said.

Baylor and other HIV service providers now want spiritual counselling to be a standard part of the HIV package offered to patients.

“Spiritual care has a role to play in HIV/AIDS care and treatment programmes – spiritual leaders should be brought on board to provide this support,” she added.

en/kr/mw source.irinnews



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Well-trained health workers can improve health-seeking behaviour

Posted by African Press International on October 9, 2010

KENYA: Training health workers on HIV prevention for positives


Photo:John Nyaga/IRIN

BONDO, 4 October 2010 (PlusNews) – Kenyan health workers have been missing the opportunity to prevent HIV-positive people from infecting others because they lack the skills and knowledge to counsel this population, say specialists.

“Health workers have certain misconceptions about people living with HIV… many don’t have the training in how to provide messages to those already infected,” said Ann Okoth, the district public health nurse in western Kenya’s Bondo district. “So people who are positive come [to health centres] and the opportunity to give information to them is lost.

“Training and counselling for health workers dealing with HIV-positive people is very important in improving people’s health-seeking behaviour and in turn for the success of prevention with positives programmes.”

According to a 2008report by the Centre for Reproductive Rights and the Federation of Women Lawyers of Kenya, negative healthcare experiences can discourage HIV-positive women from seeking medical care.

Among other violations, the report noted that women living with HIV were frequently turned away from public health facilities or secluded in an area of the hospital away from other patients; reprimanded for bearing children or being sexually active, and denied access to contraception, family planning and maternity services.


National guidelines for promoting prevention among people living with HIV werereleased in May and the government is now partnering withJHPIEGO, an NGO affiliated to Johns Hopkins University, to train health workers across the country to deliver messages about prevention to their HIV-positive patients.

“For instance, when you test a mother who has come to the clinic for antenatal care, the priority would be to have her bring her partner for testing also and to help them in disclosure and to prevent mother-to-child transmission of HIV,” explained Tom Marwa, HIV/AIDS technical officer for JHPIEGO.

So far 1,940 health workers – nurses, clinical officers, counsellors and nutritionists – have been trained in counselling as well as how to prevent unintended pregnancies, and how to screen for and treat sexually transmitted infections.

A 2004study showed that in Kenya, disclosing HIV status to partners was associated with a four-fold increase in reported condom use, but according toJHPIEGO, before the training, 69 percent of HIV service providers in Kenya did not advise their HIV-positive clients to disclose their status, while 32 percent did not discuss HIV prevention with them. Afterwards, 80 percent of health facilities visited were offering prevention with positives messages.

Couples’ counselling

Leonida Ojuok is one of the patients at the Bondo District Hospital who has benefited from the training. When she tested positive during a routine antenatal visit, she was terrified of telling her husband. Women are often divorced and thrown out of their marital homes aftera positive HIV diagnosis.

“I told the nurse that I was not going to tell my husband because he would kill me… but she just told me to tell him to come for the next visit,” she told IRIN/PlusNews. “When we came together, she talked to us and tested us.

“Then she told my husband – I was HIV-positive but my husband wasn’t. I am happy the nurse convinced him to support me… even today we have come to the clinic together.”

Identifying HIV-positive people

“The focus should not only be on those whose statuses are already known and on ART [life-prolonging antiretroviral therapy] programmes or some kind of support,” Marwa said. “The ‘healthy positives’ are out there spreading the virus without knowing it.”

''I told the nurse that I was not going to tell my husband [my HIV-positive status] because he would kill me''

According to the results of a 2010systematic review of behavioural interventions targeting HIV-positive individuals in developing countries, they were useful not only in providing HIV prevention messages but in identifying HIV-positive individuals.

According to government statistics, an estimated 83 percent of HIV-infected people do not know their status.

The authors of the review noted that because many HIV-positive individuals had limited contact with health centres, it would be important to move interventions beyond clinic settings and into the community.

ko/kr/ks/mw source.irinnews



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The practice of seasonal livestock movements has again picked up

Posted by African Press International on October 9, 2010

MALI: Pockets of extreme vulnerability persist

BAMAKO, 20 September 2010 (IRIN) – Good rains in much of northern Mali over recent months have caused pasture to regenerate and animals to begin to recover in parts of Gao, Timbuktu and Kidal regions, but extreme vulnerability persists for Gao-based farming communities, who have exhausted all their coping mechanisms and are unable to recover their livelihoods, say aid agencies.

The pastoralist crisis is on the point of ending… and the price of animals is rising again, but for non-pastoral communities who depend on a good harvest, we have not yet seen the end. We are still in the peak of crisis, and emergency activities need to continue, said Philippe Conraud, Oxfams West Africa emergency coordinator.

Rains started slowly in June but became more intense in mid-July and August in much of the north, according to Action Against Hunger (ACF), and have continued into September.

The practice of seasonal livestock movements has again picked up in much of the north, and the latest US Agency for International DevelopmentFEWS NET report predicted the 258,000 food-insecure would start to meet more of their food needs in coming months, though they may continue to face moderate food insecurity until the end of the year.

Grain prices have risen to the five-year average, and the price of goats and sheep is rising to pre-crisis levels – up to US$50 from just $10 per animal in the peak of the pastoralist crisis, estimates head of NGO Agronomes et Vtrinaires sans Frontires (AVSF) Marc Chapon.

But sedentary, farming communities in Gao continue to live in a situation of extreme stress as the pre-harvest lean season continues. They lack the option to up and leave to greener pastures, and must wait until harvest to repay debts. Repeat shocks, including the 2008 food price crisis and repeat drought have led households to go into extreme debt, said ACF head in Mali David Kerespars, and Oxfams Conraud.

ACF estimates 40 percent of households in Ansongo, on the Niger river in Gao are in debt and have no means to pay back creditors. Without help, Conraud predicts, in the middle and long-term it could get even worse.

Global acute malnutrition rates among under-fives in Ansongo are 18.5 percent, according to ACFs latest June nutrition assessment, up from 15.9 percent at the same time in 2009.

With UK backing, ACF runs therapeutic feeding clinics through 17 regional health centres, and is providing wider food security interventions to all under fives to prevent them from becoming malnourished. Cases of acute malnutrition with complications are referred to regional health centres.


Meanwhile, across the north, the government is subsidizing grain prices, and aid agencies, including the World Food Programme (WFP), the UN Childrens Fund (UNICEF), the International Committee of the Red Cross, ACF, Oxfam, Save the Children and CARE, continue to support the governments response efforts to treat malnourished children, provide supplementary food, food and healthcare for animals, and help improve stock management.

Variegated vulnerability

Vulnerability is highly variegated among different livelihood groups in the north, say aid agencies.

In areas surveyed in the Kidal and Timbuktu regions, global acute malnutrition is no higher than 10 percent, estimates UNICEFs nutrition manager Katrien Ghoos, though UNICEFs recent malnutrition assessment results are yet to be verified or published.

While pastoralists are also highly vulnerable to shock, given they have milk and animals, but no alternatives, and their acute malnutrition tends to rise sharply in a crisis, their prospects can shift dramatically when grazing land improves as animals are quick to recover milk production.

Semi-sedentary agro-pastoralist populations who settle for months at a time along the River Niger, are slightly more protected from shock, says ACFs Kerespars. They have more ability to cope with shocks such as droughts as they can migrate, find odd jobs, do artisanal work, or borrow money, he said.

But the poorest of these communities in Gao have also exhausted their coping mechanisms, and are finding it hard to turn to short-term construction or labour in the fields, which can supplement over half of their income, given such work opportunities are down by a third this year, according to FEWS NET.

Early recovery

Early recovery efforts must start as soon as possible to help people bring their livelihoods back to pre-crisis levels, says Conraud.

Oxfam hopes to start a cash transfer programme to help households pay off their debts and avoid having to sell grain at rock-bottom prices. The NGO and other aid agencies are meeting donors to try to encourage them to support such middle-term recovery efforts.

The need to get communities back on their feet is all the more important, given the likelihood of northern communities facing more problems in the future, say aid agency representatives. The problems facing northern Mali – including drought, ongoing tension over pastoralist routes, continually growing populations, and ongoing insecurity – are not going to go away, warned WFP head Alice Martin-Dahirou.



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