“People there are also not open at all about their status”

SOUTH AFRICA: Nonqaba Jacobs, “She says it’s from Satan that you are positive”

Photo: Lee Middleton/IRIN

“People there are also not open at all about their status”

KHAYELITSHA, 31 May 2011 (PlusNews) – Nonqaba Jacobs, 28, comes from a rural community outside East London; both parents were HIV-positive and she tested positive in 2004. In 2005 she moved to Khayelitsha, near Cape Town, where she found treatment and attitudes towards HIV to be a world away from what she experienced in the Eastern Cape. These days she is doing well, but is worried about her mother, who has gone off her antiretrovirals in favour of “faith healing” at the Christ Embassy church.

“I tested in East London. I had come in for another STI, and the nurse suggested the test. I didn’t suspect anything, but I knew everything about HIV because my mom and dad were both positive. My dad died in 2004, two months after I found out my status and my mom is still alive and supported me with everything.

“I stayed in the rural areas where there are no clinics. It’s totally different between the rural areas and here. Here I just walk from my house to the clinic. In Eastern Cape I must spend 50 Rand [US$7] to go to the clinic, and then you stay the whole day because there’s only one doctor in the ARV site, and after 12 o’clock you are only seen by nurses because the doctor has to go see other patients in the hospital.

“People there are also not open at all about their status. If you go to the ARV site, they hide themselves. If you see someone you know she’s not friendly when you’re around the clinic. Here people know their rights and they talk openly about their status, especially in Khayelitsha. There, they’re really scared of people with HIV.

“I’ve disclosed to everyone in my house so if I forget my pills, they remind me. I don’t find any difficulties with adherence – it’s like drinking water. I met my boyfriend in 2007, just before I started ARVs. He did a test and was negative. There are a few challenges though. When I come to the TAC [Treatment Action Campaign] office, he thinks I’ll meet someone who’s HIV-positive and I’ll fall in love with that person. Because he’s negative and I’m positive, he’s worried that I want to be in a relationship with someone who’s also positive. I think he’s a bit insecure when I’m around HIV-positive people.

“I’m okay, but there’s one thing that’s been upsetting me. My mom attended the healing school in the Christ Embassy and she has stopped her pills since then. She was on second-line. She says it’s from Satan that you are positive. She believes she’s been healed, so she has nothing more to do with pills. She’s just praying when she feels down. Her CD4 is 98, so that’s stressing me, because I can’t do anything to change her mind. She’s the one who first encouraged me to take my pills and do everything right, but now she’s turning back. We end up fighting about it, because she says she’s saved, and I believe in medicine.”

lm/kn/mw source www.irinnews.org

Cholera beds in an emergency centre in Zimbabwe – outbreaks are occurring with increasing frequency and severity

HEALTH: Predicting cholera outbreaks

Photo: Flickr

Cholera beds in an emergency centre in Zimbabwe – outbreaks are occurring with increasing frequency and severity

JOHANNESBURG, 1 June 2011 (IRIN) – A new study into the linkages between rain, temperature and cholera shows scientists may be able to predict epidemics in time to save people from the life-threatening disease.

After analysing several years of disease and weather data from cholera-endemic areas of Zanzibar, Tanzania, scientists from the International Vaccine Institute (IVI) in Seoul, Korea, found that if a more than one degree Celsius increase in the average monthly minimum temperature and a 200mm increase in monthly rainfall were recorded in a month, a cholera outbreak was imminent in the following month.

“A mere one degree Celsius increase in the average monthly minimum temperatures was a warning sign that cholera cases were likely to double within four months,” said Mohammad Ali, a senior scientist at IVI, and one of the authors of the study published in the June 2011 issue of the American Journal of Tropical Medicine and Hygiene.

Rita Reyburn, a research associate at IVI and the study’s lead author, said in a statement: “Our work validates the notion that rainfall and temperature increases are often precursors to cholera outbreaks in vulnerable areas.”

Climate experts have predicted that hotter and wetter climate in many cholera-endemic areas could see higher caseloads.

“We are getting very close to developing a reliable forecasting system that would monitor temperatures and rainfall patterns to trigger pre-emptive measures – like mobilizing public health teams or emergency vaccination efforts – to prepare for an outbreak before it arrives,” she added.

Every year mostly African and Asian countries record 3-5 million cholera cases and 100, 000-130,000 deaths because of the disease, according to the World Health Organization (WHO).

The IVI study supports a growing number of findings that establish a link between cholera incidence and climatic factors, though research does not discount the significance of factors such as poverty and access to clean drinking, Ali said.

Peter J. Hotez, president of the American Society of Tropical Medicine and Hygiene, pointed out, however: “Cholera outbreaks are occurring with increasing frequency and severity. We are seeing month-long outbreaks now.”

Every year mostly African and Asian countries record 3-5 million cholera cases and 100, 000-130,000 deaths because of the disease

The Zanzibar study was an “innovative approach that if used in conjunction with other preventive measures could significantly reduce the needless suffering and deaths of thousands of people,” he said.

Deadly outbreaks in Cameroon, and in Haiti after the 2010 earthquake, have claimed thousands of lives. “We could have saved these lives if we had vaccinated vulnerable people,” said Hotez.

An epidemic in Zimbabwe, which began in August 2008, lasted almost a year and spread throughout the country as well as to neighbouring Zambia and South Africa, said WHO in its position paper on vaccines in 2010. At the end of July 2009, more than 98,000 cases and 4,000 deaths had been reported in the region, it said. The number of cases reported could drop because of poor surveillance, WHO warns.

Vaccines

The mounting evidence of links between higher temperatures and cholera incidence should add a sense of urgency to efforts to make cheap cholera vaccines available to poor communities in cholera-endemic countries, he said.

Hotez pointed out that there are only two oral vaccines available in the world: Dukoral manufactured in Sweden, which costs US$60-80 (for the required two doses) and the much cheaper and very new alternative Shanchol or mORCVAX, manufactured in India, which costs around $2.

An injectable vaccine is manufactured in some countries, but is not recommended by WHO because of its limited efficacy.

Shanchol was developed in collaboration with IVI, with funding from the Bill & Melinda Gates Foundation by modifying a vaccine used in Vietnam, said Ali. After trials in Vietnam and India, the vaccine was approved in India in 2009. “We are awaiting approval from WHO to allow its purchase by UN agencies and internationally.”

Hotez said the world needed to enhance production of the vaccines to maintain a global stockpile as cholera cases mount.

Cholera is endemic in poor, tropical areas mostly in sub-Saharan Africa and South and Southeast Asia – where poor sanitation and lack of clean water help the spread of the disease, mainly through faecal contamination of food and water.

Cholera is particularly feared for its ability to cause such a sudden and intense onset of diarrhoea that a victim can go from seemingly healthy to death in 24 hours. Also, when outbreaks occur, the number of people infected increases dramatically and the case fatality rate can skyrocket; rates of up to 50 percent are being reported in complex emergencies with limited resources, according to the researchers.

Previous studies

In its last assessment, the Intergovernmental Panel on Climate Change (IPCC), an authoritative global scientific body, cited research in Bangladesh, led by US scientist Rita Colwell in the late 1990s, that established the link between the cholera bacterium, sea surface temperature and phytoplankton (microscopic plant-like organisms that live in the ocean). 

Warmer surface temperatures increase the abundance of phytoplankton, which support a large population of zooplankton (animal-like micro-organisms), which serves as a reservoir for cholera bacteria, a waterborne disease.

Colwell and her colleagues also traced the source of the cholera bacterium to the plankton in rivers and estuaries.

”Our study also followed Dr Colwell’s work, but we were unable to pick up the phytoplankton off the Zanzibar coast, but we were able to establish the link between higher temperatures and rainfall,” said Ali.

Researchers in Africa, led by Miguel Ángel Luque Fernández from the Institute of Health Carlos III, based in Madrid, were the first to show a link between higher temperature and rainfall and the incidence of cholera over a three-year period from 2003 in Zambia, in a study published in the Transactions of the Royal Society of Tropical Medicine and Hygiene, in the UK.

jk/cb source www.irinnews.org

“Biomedical strategies can only have a limited impact if MSM live in fear, live hidden or have limited access to safe and effective clinical care”

SOUTH AFRICA: MSM still sidelined in HIV programming

Photo: Mujahid Safodien/PlusNews

“Biomedical strategies can only have a limited impact if MSM live in fear, live hidden or have limited access to safe and effective clinical care”

CAPE TOWN, 27 May 2011 (PlusNews) – South African men who have sex with men are twice as likely to be HIV-positive as heterosexual men, but spending on research, prevention and treatment for this group remains low, delegates at a conference on MSM and HIV in Cape Town heard.

“We see HIV incidence rates for MSM continue to increase in all studied countries; we must advocate for more research,” Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre, said in a statement.

Bekker called for the introduction of specific HIV packages tailored to the needs of particular groups, including one for MSM.

Studies show that the risk of contracting HIV during anal sex is 18 times higher than during penile-vaginal sex.

According to research whose results were revealed at the conference, held on 23-25 May, more than one in 20 men taking part in the survey reported consensual participation in a sexual act with another man and MSM were twice as likely to be HIV-positive as their heterosexual peers.

The survey of 1,737 men – conducted by South Africa’s Gender Health Research Unit (GHRU) and the Medical Research Council (MRC) in the Eastern Cape and KwaZulu-Natal provinces – also revealed that MSM were more likely to be poorly educated and suffer from food insecurity than non-MSM. Across the board there was no difference between the various race groups in South Africa.

“MSM are at risk [of HIV] because of the nature of their activities, which is underground,” said Kristin Dunkle, co-author of the study and assistant professor of behavioural sciences at the Emory Rollins School of Public Health in Atlanta.

The term MSM refers to men who engage in sexual activity with other men but who may also have sex with women; they do not necessarily consider themselves to be homosexual. MSM are considered to be a bridging population for HIV into the general population.

Three-quarters of the study participants who reported being MSM had a female partner; one-third had a male partner; 20 percent had both and half those questioned had children. One in 10 MSM had also been sexually assaulted by another man.

According to Glenn de Swardt, director of the Cape Town-based Health4Men, which established the first clinic in Africa dedicated to MSM, gay people have a sense of identity that is formed through their sexuality, while MSM often view themselves as heterosexuals who take part in same-sex sexual acts purely for pleasure.

No one really wants to talk about anal sex and what is the safest way to practise it, even though the risks associated with it are huge

“Hidden group”

“Men who engage in this activity try to keep it a secret from most people in their communities; they are a hidden group in our society,” he told IRIN/PlusNews.

“No one really wants to talk about anal sex and what is the safest way to practise it, even though the risks associated with it are huge,” he added. “For instance, in the townships people use substances like butter, margarine and cooking oil as a lubricant when having anal sex, but these substances are harmful to condoms.

“We are trying to get the message out there that water-based lubricants need to be used, but then the question for most people is, where do you get it?”

Training health workers

Delegates were told one of the main barriers MSM encountered when trying to seek HIV-related care was the attitude held by many medical and healthcare providers who were not trained properly to deal with this group.

Nelis Grobbelaar from the public health NGO, Anova Health Institute’s West Coast Winelands Project, said his experience of training health professionals was that they were initially uncomfortable talking about sex to their patients.

“When we started some of the MSM sensitivity training, the clinic staff were very clearly very opposed to the idea of [homosexual] sex and were not comfortable talking openly with their patients about their sexual practices,” he said. “Through MSM training we are changing people’s minds – not just about homosexual sex but about sex in general.”

Stefan Baral of the Centre for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health noted that HIV prevention strategies needed to happen in a stigma-free environment.

“Biomedical strategies can only have a limited impact if MSM live in fear, live hidden or have limited access to safe and effective clinical care,” he said.

bc/kr/mw source www.irinnews.org