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Archive for January 3rd, 2013

Low prevalence, high stigma in Bangladesh

Posted by African Press International on January 3, 2013

DHAKA,  – Even though HIV prevalence in Bangladesh is as low as 0.1 percent of the 160 million population, experts fear that widespread discrimination towards people who test positive for HIV may leave infections unreported.

“It is possible that due to social stigmatization towards HIV-positive people, people with HIV can go unreported,” said Munir Ahmed, a social mobilization adviser at UNAIDS in Bangladesh.

Migrant workers, injecting drug users, sex workers and men who have sex with men are most vulnerable to HIV infections in Bangladesh, according to various medical studies.

Despite years of HIV awareness programming by the government and NGOs, a number of people with HIV told IRIN they face unabated discrimination in their homes, communities, jobs and health facilities.

“It’s not possible for me to let my friends, family and colleagues in my workplace know that I am HIV-positive because they will simply oust me from society,” said an HIV-positive male from Noakhali District in southern Bangladesh. He travels 165km monthly to the capital, Dhaka, to receive free anti-retrovirals (ARVs) from local NGO Asar Alo Society (AAS).

Turned away

Rejection started in the home for Mohammad Ferdous Sikder, 36. “When I let my family know that I was infected with HIV, my father kicked me out,” said Sikher, who was infected when he went to Saudi Arabia to work in 2004. “I requested my father to return some of the money I sent back home from Saudi Arabia, but he replied that you don’t need money to die,” Sikder recalled.

Health facilities were not much better. He waited a year to remove his wisdom teeth because “no doctor in the capital was ready to operate when they knew I was HIV-positive. The pain was unbearable but I had to live with it.”

M. Razibul Islam Razon, a doctor practising in the private sector in the capital, said lack of knowledge about HIV/AIDS among health staff is the main problem. “This is simply unacceptable and it needs to change because such behaviour towards HIV-positive [people] is contrary to the basic principle of the medical profession, which is to serve a patient,” Razon said.

Despite tens of millions of donor dollars going to HIV prevention and service provider training in recent years, accurate information about the risk of HIV transmission is still scarce.

Poor messaging

One problem, said Abdul Waheed, director of the government’s National AIDS/Sexually Transmitted Disease Programme, has been the government’s messaging.

“We acknowledge that messages used in the AIDS campaigns were put wrongly… For example, we used to propagate AIDS as a predatory disease,” he said, adding that some anti-HIV campaigns warned how people could be infected “due to unethical relationships or through other behaviours… against the moral code of Bangladeshi society.”

As a result, a negative perception about HIV and persons infected by it was created, spurring stigmatization. “We already identified this problem and are working to address this through more thoughtful messaging,” Waheed said.

“If you have HIV/AIDS in Bangladesh, the society here will make sure in every possible way that you feel that you are a dirty person who committed heinous sin,” Sikder said. “I became invisible [with] shame and guilt.”

Experts say stigma suppresses reporting, and as a consequence, treatment and prevention efforts.

“I know I was HIV-positive but I got married because I was lonely,” said Anwara Begum, a former sex worker. “Now my husband is also HIV-positive, but we both are happy as we are not alone.”

Company was poor consolation for China Begum, 23, whose husband knowingly infected her. “How can he do that to me?” China asked.

Stigma hits not only people infected with HIV, but also those who work with them, said Momtaz Parvin Jolly, an NGO social worker who works closely with HIV-positive people. After years on the job, she said friends still say her work exposes her to infection.

“No friends came to attend my baby’s birthday as they think me and my baby might be infected with HIV as we both are friends to many HIV-positive [people],” Jolly said.

Confidentiality breaches

As of 2010 there were some 105 voluntary counselling and testing (VCT) centres nationwide operated by NGOs and the government, which offer confidential counselling before and after HIV testing.

But according to Sanwar Hossain, a project coordinator with AAS, many centres fail to protect client confidentiality. “As a result, in the fear of social discrimination, people with HIV might not go to the VCTs,” said Hossain.

Mohammad Ali, a counsellor at a VCT facility in Dhaka, said many counsellors do not understand the importance of protecting clients’ privacy.

The government is considering legislation to protect people infected with HIV from discrimination, said the government’s Waheed. “We are now holding meetings with the lawmakers in this regard.”

According to the most recent UNAIDS estimate, some 7,700 people in Bangladesh are living with HIV.

mh/pt/cb  source



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Cholera – lessons learned

Posted by African Press International on January 3, 2013

DAKAR,  – The cholera epidemic that struck Guinea and Sierra Leone in 2012 is winding down. What to do now? Start preparing – for cholera.

That’s part of the message from donors, aid workers and health officials after the most serious cholera outbreak in years that infected some 30,000 people and killed 400 others in the two countries – mostly in Sierra Leone. They say there should be better preparations for cholera, based on lessons learned and on a strategy in Guinea that was put to the test in 2012.

Since 2009 the UN Children’s Fund (UNICEF), Action Against Hunger (ACF), the Guinean government, the European Union aid body ECHO, and the US Agency for International development (USAID) have taken steps to prepare for an outbreak – including setting up community detection sites, public information campaigns and drills.

“Cholera thrives on disorganization,” said Christophe Valingot, water, sanitation, and hygiene (WASH) specialist with ECHO. “Cholera spreads very rapidly – it can go from 30 cases to several hundred cases per week in a very short period. When there is little to no preparation, we’ve lost the chance to avoid all those infections.”

But preparation is hardly a motivator for governments and donors. “We had a very difficult time justifying funds for this preparation work in Guinea,” Valingot said.

Strategies needed

Data from the past decade in West Africa show that a country can go several years with few to no cases of cholera then be hit with thousands of cases. “Donors, NGOs, and governments go all-out during a serious epidemic then it’s as if that all disappears completely with a couple of calmer periods,” Valingot said. “What this means in the end is meagre progress against cholera.”

Health workers said UNICEF’s strategy proved effective in Guinea this year and ECHO and UNICEF are looking to replicate it across the region.

So why did Guinea still see some 7,300 cases? For one, the strain found in the region is far more virulent than past strains, said François Bellet, WASH specialist with UNICEF’s West and Central Africa regional office.

“Of course we can’t possibly know what the situation would have been in Guinea in the absence of this strategy,” he told IRIN. “But given the virulence of this strain we might well have avoided a Zimbabwe 2008-09.” In that period cholera infected some 100,000 people in Zimbabwe and killed more than 4,000.

As of mid-December Sierra Leone had 22,345 cases and 286 deaths in a population of 5.6 million; Guinea, whose population is nearly double that, registered 7,321 cases and 121 deaths.


WASH and health experts say the use of GPS in Guinea’s capital Conakry was critical. Plotting clusters of cholera cases on a map helps health workers better target WASH activities. GPS also facilitates follow-up visits to identify high-risk practices that accelerate the disease’s spread. Mapping and GPS were not systematically used in Sierra Leone, say UNICEF and ACF.

Bellet said the sentinel sites in Guinea were vital because they facilitated rapid health, water, and sanitation responses. The first cases of cholera in Guinea, in February, were detected and signalled at these community sites by people trained as part of the preparedness strategy. One of these community members contacted health officials, saying: “That thing has come back.”

“They knew it was cholera before any biological tests,” Bellet said.

They also knew it was more aggressive than usual. One traditional leader in the Guinean seaside village of Kaback told UNICEF he had witnessed six major epidemics but had never seen such a virulent illness. For Bellet this underscores the importance of community engagement and local wisdom.

At an 11 December meeting of ECHO, UNICEF, and ACF to recap this year’s outbreak and response, one recommendation was to create sentinel sites in Sierra Leone. Participants also noted the importance of maintaining the sites in Guinea, where state funding is lacking and trained workers often move on.

Safe water, proper sanitation

While preparation and hygiene education must be a year-round affair, above all what needs to be constant is the availability of safe water and proper sanitation. Only in Africa – and primarily West Africa – are cholera cases on the rise each year. This correlates to the poor progress on water and sanitation infrastructure, ECHO’s Valingot said.

“Cholera is a disease signalling loud and clear that something’s wrong,” he said. “If there is a high rate of cholera, this likely means there are a lot of children dying of other diarrhoeal diseases. Vibrio cholerae is not constantly present – often it is brought in. And if there are no barriers – proper sanitation, safe water – it explodes.”

Epidemiologist Stanislas Rebaudet, who analysed the cholera strain found in Guinea, says the fact that it was probably imported and not present in the environment sends an important message: the disease is not inevitable and it pays to put up those barriers.

np/ob/cb  source



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Princeton Lyman Resigns as U.S Special Envoy for Sudan: A Grim Legacy

Posted by African Press International on January 3, 2013

With much contrived celebration by President Obama, U.S. special envoy for Sudan Princeton Lyman this month resigned—without explanation, and without discernible success. As he retires, he leaves uncounted hundreds of thousands of civilians at risk of starvation in the Nuba Mountains of South Kordofan and in Blue Nile, both embattled regions of Sudan facing ruthless campaigns of annihilation by the regular and militia forces of the Khartoum regime. Darfur also remains the scene of a grim genocide by attrition, having been relegated to the diplomatic back-burner by Lyman and others in the Obama administration—this despite Obama’s impassioned rhetoric about “genocide in Darfur” during the 2008 presidential election. And greater Sudan—Sudan and South Sudan—are perilously close to renewed war; violence earlier this year flared up along a contested border in the richest region of oil production, nearly tipping the two countries into much wider fighting.


The contested region of Abyei—seized militarily by Khartoum early in Lyman’s tenure—remains a dangerous flash-point for renewed conflict, as does the so-called “Mile 14” band of land south of the River Kiir in Northern Bahr el-Ghazal State (to the west of Abyei). Nearly all issues left unresolved following Southern independence in July 2011—issues stipulated specifically in the 2005 Comprehensive Peace Agreement (CPA)—continue to pose threats of further violence, even full-scale war. The economies in both Sudan and South Sudan are in a dangerous free-fall that creates immense pressures on political and military actors in both Khartoum and Juba. Khartoum refuses to abide by an agreement on oil transport signed under the auspices of the African Union on September 27, 2012—and subsequently endorsed by the AU Peace and Security Council. The economic meltdown consequent upon a loss of oil revenues brings a host of threats to both countries, mainly that of a massively destabilizing hyper-inflation.


Lyman’s tenure began in early 2011 as the issue of Abyei was coming to a boil. Failure to resolve the issue symbolized larger failures by both the Bush and Obama administrations to see through implementation of the CPA signed by Khartoum and the South. Although the issues involved in Abyei’s status had been definitively resolved—both in the CPA’s “Abyei Protocol” and in a “final and binding” ruling by the Permanent Court of Arbitration (2009)—Lyman and Obama administration officials pushed the South to “compromise” yet further over Abyei with Khartoum. The regime rightly saw this as a sign of expediency and concluded it could militarily seize Abyei without significant consequence. This is precisely what happened on May 21, 2011, despite several months of visible military build-up. More than 100,000 indigenous Dinka Ngok were displaced, and the vast majority remain displaced in South Sudan a year and a half later.


Not coincidentally, following feckless condemnations of the Abyei seizure by Lyman and other international actors, Khartoum launched another massive military campaign two weeks later in South Kordofan, this time against the African tribal groups of the Nuba Mountains. Although nominally targeting indigenous rebel forces, Khartoum’s butchery fell primarily on Nuba civilians. Killings, torture, rape, and mass internment defined June 2011 for Nuba in Kadugli, capital of South Kordofan. Mass graves, capable of containing tens of thousands of bodies, were confirmed both by satellite imagery and multiple eyewitness accounts, many reported by a UN human rights team that was stationed in Kadugli during this grim month of Rwanda-like violence. Lyman expressed skepticism, despite the evidence, and in at least one case denied realities on the basis of U.S. “intelligence” that was either erroneous or fabricated.


Khartoum’s brutal assault continues in the form of relentless aerial bombardment throughout the Nuba, including systematic destruction of foodstocks and agriculture. Hundreds of thousands of people are slowly starving to death, hundreds of thousands more have been displaced (a great many to South Sudan)—and yet Khartoum refuses all humanitarian access. Despite a proposal on access for relief organizations made by the Arab League, the African Union, and the UN—February 2, 2012—Khartoum adamantly refuses to accept the proposal except in the abstract (the indigenous rebel group, the Sudan People’s Liberation Movement/Army-North, signed immediately in order to protect civilians). The reality is that no food, medicine or shelter is reaching the Nuba except by surreptitious means, and these are not remotely adequate to the scale of the crisis. The entire duration of this barbaric refusal to allow humanitarian access has occurred during Lyman’s tenure.


Part of the problem is that Lyman initially refused to credit the many reports of what was occurring in South Kordofan, and scoffed at claims of a repeat of the well-documented genocide in the Nuba Mountains during the 1990s: “Nuba Mountain people are fighting back and I don’t think the North is capable of dislodging large numbers of people on an ethnic basis…. That’s the reality on the ground. Second, I’m not sure that’s the objective of the government….”


Both claims have been spectacularly upended by well-established facts on the ground; eighteen months later, as Lyman resigns, humanitarian access still hasn’t been secured and many hundreds of thousands have been displaced—and continue to be displaced—by Khartoum’s tactics, according to the UN. A similarly brutal campaign of extermination began in neighboring Blue Nile on September 1, 2011. Relentless aerial bombardment of civilians and civilian agriculture, mass killings, rape, village destruction—all familiar tactics in Khartoum’s counter-insurgency warfare were fully in evidence throughout Blue Nile. Here, too, Khartoum has denied all humanitarian access. Interviews with fleeing refugees provide horrific accounts that in aggregate provide the basis for a genocide indictment. Altogether, some 300,000 civilians have fled the Nuba and Blue Nile to South Sudan and Ethiopia; hundreds of thousands of those remaining are displaced and largely without food. And with the advent of the dry season, tens of thousands more are on their way southward—at least those strong enough to make the trek. Many simply die where they are or during the journey to refugee camps.


All of this has occurred during the tenure of retiring U.S. special envoy Princeton Lyman.


As catastrophe was growing along the border and in Blue Nile and the Nuba, Lyman continued the policy of “de-coupling” Darfur from primary U.S. Sudan policy concerns, in particular whether to continue U.S. designation of Sudan as a state sponsor of terrorism. Lyman’s hopelessly incompetent predecessor, Air Force Major General (ret.) Scott Gration, had declared that there was nothing but politics behind this designation. He seemed content to ignore the fact that Khartoum has allowed Sudan to serve as a conduit for weapons from Iran to Hamas in Gaza, many of these recently put on grim display. Lyman simply failed to address the issue.


“De-coupling” Darfur (declared publicly in these terms by senior administration officials in November 2010) has been justified by Lyman on the basis of a meaningless agreement negotiated in Qatar. But the “Doha Document for Peace in Darfur,” signed July 2011, has done nothing to improve human security or humanitarian access in a region that has endured ruthless assault for a decade. Instead, both security and relief access have deteriorated significantly since the agreement was signed. This is unsurprising: virtually all Darfuri civil society groups and rebel factions have bitterly rejected the DDPD, which was signed only by Khartoum and a small, factitious rebel group (the “Liberation and Justice Movement”) cooked up by Libya’s Muamar Gadhafi and Gration. Yet even as Dane Smith, the Obama administration diplomat working until very recently on Darfur, now admits Khartoum has met none of the DDPD’s security or reconstruction commitments, Lyman has pushed the agreement as a viable plan for peace. This was disingenuous and deeply destructive of the chances for real peace or at least an improvement in security and humanitarian access.


Central in Lyman’s policy vision is a perverse insistence on “moral equivalence” between Khartoum and the South, holding each equally responsible for the failure of negotiations as well as for cross-border violence. But the evidence available will simply not support such conclusions. The moral, political and negotiating equities of the two countries are simply not the same—not concerning Abyei, or negotiation of border delineation and demarcation, or in supporting rebels in the territories of the other. Most notably, only Khartoum has an air force, which it uses to conduct relentless bombing attacks on civilian and humanitarian targets throughout Sudan, as well as in South Sudan’s border regions. Both are egregious violations of international law, and the latter attacks are acts of war. It has seemed expedient for Lyman not to make mention of these conspicuous facts.


It was finally an expedient “moral equivalence” that underlay Lyman’s bizarre claim last year: “we do not want to see the ouster of the [Khartoum] regime, nor regime change. We want to see the regime carrying out reform via constitutional democratic measures.” The notion that this brutally repressive regime can preside over reform via “democratic measures” is absurd. There is not a shred of historical evidence to support such a conclusion. Indeed, the most powerful northern rebel political movement (the Sudan Revolutionary Front, which includes the SPLA/M-N) is avowedly working for regime change; the U.S. position as articulated by Lyman is recognized by the SRF as cynical, and perversely motivated.


Indeed, like so much in U.S. Sudan policy, it is a fig-leaf for more ruthless calculations about geopolitical interests in the Horn of African and Khartoum’s perceived usefulness in combatting terrorism. This, sadly, is the essence of current U.S. Sudan policy, and millions of people finds themselves at acute risk because of this moral myopia. It is Princeton Lyman’s grim legacy.



  • [ Eric Reeves, a professor at Smith College


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