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Danger of ignoring to know: Less than 1 percent of people in the Philippines have tested for HIV.

Posted by African Press International on July 10, 2013

Less than 1 percent of people in the Philippines have tested for HIV

MANILA, – Consistent increases in HIV infections in the Philippines cannot be reversed without appropriate interventions, say health experts, following the recent release of the country’s highest monthly infection rate recorded thus far.

In May 2013 415 new HIV cases were recorded, with 55 percent of cases being among those aged 20-29.

Since 2007, the Department of Health’s National Epidemiology Centre (DOH-NEC) has noted a steady increase in HIV cases. In 2000, there was one case registered every three days; in 2011, this number grew to one case every three hours.

“The nature of the HIV epidemic has changed. Transmission is still primarily through unprotected sex, but infections are now mostly through same sex transmission whereas previously, it was heterosexual,” said Teresita Bagasiao, the Joint UN Programme on HIV/AIDS (UNAIDS) country coordinator in the
Philippines.

Concentrated epidemic

Part of the problem is that current interventions have not kept pace with change.

“Most interventions are still focused on heterosexual transmission. There is an opportunity for focused interventions [on men having sex with men and injecting drug users] to reach the recommended 60-80 percent of key affected populations,” said Bagasiao.

But even with these interventions, any drop in HIV infections would not occur for another 3-5 years, she added.

Though Philippines is a low-prevalence country with less than 1 percent of the nearly 95 million population infected, Bagasiao said the epidemic is “concentrated” with an average 4-5 percent rate of infection among what donors call “key” populations, including sex workers, men who have sex with men and injecting drug users.

Since 1987 when HIV was first discovered in the Philippines, DOH-NEC has registered 13,594 infections.

“Tip of the iceberg”

But others say this official number is just the “tip of the iceberg”. Stigma continues to surround HIV and with less than 1 percent of the general population getting tested for HIV, officially recorded cases most likely do not accurately reflect the epidemic.

“We project that the number of infected will reach 39,000-50,000 by 2015,” said Jonas Bagas, executive director of The Library Foundation Sexuality, Health and Rights Educators Collective, Inc (TLF-Share), an NGO member of the Philippine National AIDS Council (PNAC), the country’s central advisory body on HIV/AIDS.

“HIV is still considered a gay disease and equated to a death sentence. Prevention messages are mostly scare tactics making people afraid of getting tested. They’d rather not know their status, especially the young people,” said Bagas.

Barriers discouraging testing among youths include a provision in the 1998 Philippine AIDS Prevention and Control Act that requires parental consent for anyone under 18 to be tested for HIV.

Advocates are fighting to amend the requirement.

Rather, added Bagas, an appropriate response to halt the spread of HIV is to give youths sex education that focuses on prevention strategies such as delaying first sexual encounters, as well as a nationwide publicity campaign on HIV information and services.

“We have yet to have a nationwide campaign on HIV on the scale that we have for other diseases like dengue,” Bagas said. As of early June there have been at least 42,000 dengue infections reported in 2013 nationwide, with nearly 200 deaths.

Concerted effort needed

But budgets for such an HIV prevention campaign are hard to secure.

Though government agencies such as DOH and the Department of Social Welfare and Development have increased spending in recent years for HIV prevention, funds from international agencies for HIV have shrunk dramatically.

In 2009, international donors funded almost 73 percent of the country’s budget for HIV prevention and control; in 2010, the contribution barely reached 40 percent.

The 2008 Commission on AIDS Report recommended US$1 per capita annual spending for HIV prevention and control – nearly $95 million based on the current estimated population.

According to the Philippines National AIDS Council 2012 report, $37 million was spent on HIV from 2009-2011, or an average of about $12.4 million per year.

“We need the help of the LGUs [local government units, the country’s smallest unit of government] in appropriating funds in their local budgets for HIV and STI [sexually transmitted disease] prevention and information. The DOH cannot do it alone,” said Genesis Samonte, the department’s chief epidemiologist for HIV.

“We are at a tipping point. We have a choice [to determine] how big this problem will be, but we cannot go back any more. It is our response to HIV that will now dictate its magnitude,” Samonte concluded.

as/pt/cb source http://www.irinnews.org

 

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Reasoning as to why roads matter in Nepal

Posted by African Press International on July 10, 2013

Getting out is the problem

HIGHLIGHTS

  • 23,000km of roads – still not enough
  • Lack of roads boosts food prices
  • Roads key to development, not a “panacea”

KATHMANDU,  – In Nepal, where rugged mountainous terrain isolates millions of people from life-saving health care, markets and education, experts say the country’s roads are in sore need of more focus and investment.

Nepal has built about 7,000km of roads nationwide over the past decade, according to the World Bank, but this still leaves more than half the population without access to all-weather roads in a country where millions struggle to reach safe, nutritious food, and which ranks as one of the world’s worst places for a child to fall ill (out of 161 countries evaluated by NGO Save the Children) due to women’s and children’s poor access to health care.

Nearly half of Nepal’s 27 million people live in rugged hill and mountain areas. People living in the mountains (roughly 7 percent of the population) report some of the weakest development indicators nationwide. The national average for children under the age of five who are chronically malnourished is 41 percent; this figure exceeds 60 percent in the mountains.

Mountains and markets

According to a 2010 report by the World Food Programme (WFP), transportation costs are the most significant factor for food prices in the mountains, and road access the primary determinant of those costs. Furthermore, food wasted in transit due to lack of roads, or poor quality ones, can impact the market value of agriculture products.

According to recent market indicators, a kilogram of coarse rice that costs the equivalent of 39 US cents in Kathmandu, can cost three times that amount in mountain markets of Dolpa District (in western Nepal’s Karnali Zone) that lack road access.

Though Nepal has 23,029km of roads and construction is steadily increasing, experts are calling for not only more roads, but also quality ones.

According to the government’s most recent Nepal Living Standards Survey in 2011, Nepalis living in rural areas – especially in hills and mountains – report roads in their areas are unsatisfactory.

Only 12 percent of Nepalis, including those living in urban areas, consider the roads where they live “good”.

Just 42 percent of Nepal’s roads are blacktopped, with the rest a combination of gravel, which can survive some harsh weather, and earthen, which can wash away during seasonal rains, government figures show.

Health fallout

Travelling across difficult terrain has been cited by HIV service providers as one reason patients fail to adhere to treatment regimens. Due to the lack, or poor quality, of roads in rural Nepal, maternal healthcare facilities may be more than a day’s walk away which, practitioners say, can be deadly.

“If women can’t get to a healthcare facility in time, they either die or have a fistula,” Shirley Heywood, a gynaecologist who has been working in rural Nepal for a decade with the International Nepal Foundation, told IRIN.

Obstetric fistula is a condition caused by prolonged and obstructed labour resulting in a hole in the birth canal which leads to continuous leakage of urine. According to the UN Population Fund an estimated 4,602 women in Nepal are living with fistula; there are up to 400 new cases annually.

“I have had patients who are carried for more than two days to us for fistula treatment. I hear all the time how we need to increase capacity for fistula surgery in Nepal, but I don’t think that’s the whole picture – access is a huge issue, and roads are a vital part of that,” Heywood said.

Analysts have also pointed to the lack of reliable road access as a factor inweak education achievements, including the 35 percent of Nepalis who remain illiterate.

The boons of access

“Roads connect people to markets, which has shown improvement in local economies,” Marco Cavalcante, head of programmes for WFP in Nepal, told IRIN.

Research has shown that roads benefit farmers by slashing transportation and farm-to-market time periods, meaning that with less food wasted during transit, more can be sold at market.

Clearing a mountain path in the country’s Far West

The World Bank and UN Food and Agriculture Organization have identified well-constructed and well-maintained roads as a crucial aspect of creating an “enabling public environment” for development and a safeguard against food wasting.

But, Cavalcante pointed out, there are other benefits that come with roads reaching people.
“There is also a social protection component. People connected by roads can access a better life – hospitals, ideas, technologies. It’s not always quantifiable,” he said.

A two-way street

“Road building opens a two-way process,” said Cavalcante. “Once the road is complete, people have access to markets, and modern commodities and technologies and ideas have access to the people,” which may have unexpected negative impacts, warn experts.

“Outside influences change major aspects of peoples’ lives, and they can be a shock to the system,” said Jagannath Adhikari, an agricultural scientist and author of several books on development in Nepal, adding that villagers in Nepal’s Far West region had told him they noticed their children became more popular as marriage prospects once their village was connected by a road.

A debate in 2012 over the introduction of Monsanto-manufactured hybrid maize seeds in Nepal spotlighted issues of local ownership and the influence of subsidized foreign products on rural farmers.

According to Ramesh Adhikari, paediatrician and author of a US Agency for International Development literature review on nutrition in Nepal and expert on the Karnali region, one of the most food insecure areas of the country, “isolated villages can show better nutrition indicators than those connected to the road network because not having access to a market means people eat the nutritious food they grow rather than sell it for cash.”

He added it is crucial that road development is coupled with education to prepare communities for access long denied.

“Just because isolated villages might have better nutrition indicators doesn’t mean we shouldn’t build roads to them – it means the government should have strong education programmes and policies to regulate corporations that want to sell products all over the country to newcomer consumers,” he concluded.

WFP Nepal runs small agriculture and business development projects in communities, simultaneous with road construction, to prepare them for their new levels of access.

For WFP “roads are not a panacea,” but rather one component in developing markets, livelihoods and food security – as well as options.

“In the past, a sick person’s family would need to appeal to local political leaders for a loan to pay for a plane ticket to Kathmandu or even just to schedule the flight, now they have a road – there’s competition, there are options,” said Adhikari, the agriculture scientist.

Recent reports from Jumla, a remote district in Karnali region, chronicled the decline in demand for donor-delivered rice. Officials attributed the change to the district now being connected to a road, which has created competition by boosting consumer access to other products.

kk/ds/pt/cb source http://www.irinnews.org

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“Sudan’s Third Civil War: In Medias Res,” Dissent Magazine, July 10, 2013

Posted by African Press International on July 10, 2013

      By Eric Reeves

In December 2011 I wrote for Dissent about “the early history of Sudan’s third civil war.” Some judged my comments gratuitously pessimistic, others shared my concerns (if more privately), and still others worried about self-fulfilling prophecies. But in fact the war had already begun, battle lines were taking shape, and on at least two subsequent occasions Sudan and newly independent South Sudan came perilously close to renewed all-out war. An incident in April 2012 in the highly volatile oil region along the border between Unity State (South Sudan) and South Kordofan (Sudan) led to major fighting between the Khartoum regime’s Sudan Armed Forces (SAF) and the Sudan People’s Liberation Army (SPLA). For over a month violence flared, including Khartoum’s repeated, indiscriminate aerial attacks on Bentiu, capital city of Unity (the South has no meaningful military air force).

But the actors in this third civil war are not simply on two sides, except insofar as all armed movements in greater Sudan have the Khartoum regime, as well as its SAF and security services, as their target. This has resulted in a loose and probably untenable alignment of forces known as the Sudan Revolutionary Front (SRF); it includes the increasingly potent Sudan People’s Liberation Movement/Army-North (SPLM/A-N, based primarily in the Nuba Mountains of South Kordofan); it also includes several Darfuri rebel movements, most notably the well-armed Justice and Equality Movement and factions of the Sudan Liberation Army. The geography of conflict has greatly expanded, and the SRF attacked a major town (Umm Rawaba) in North Kordofan this past April, a northern state that had heretofore seen no fighting. A rebel force in eastern Sudan has also made cause with the SRF.

Heightening military tensions is Khartoum’s decision to halt the flow of oil from land-locked South Sudan to Port Sudan in the north, denying both economies desperately needed foreign exchange currency. Hyperinflation is poised to strike, although its consequences for the more developed, import-dependent, and integrated northern economy may well be greater than in the south. A range of other agreements between Khartoum and Juba, the capital of South Sudan, have come to nothing, including the most recent agreement (made in March) to resume oil transit.

It is difficult to find evidence of progress anywhere in greater Sudan since South Sudan became independent in July 2011; African Union (AU) mediators dutifully present various “agreements” that Khartoum refuses to sign, or signs and then violates; there is no effective international support for negotiations. An agreement to permit critical humanitarian access to the Nuba Mountains and Blue Nile—proposed in February 2012 by not only the AU but the UN and the Arab League—has gone nowhere: the SPLM/A-N signed on almost immediately, but Khartoum has dithered, reneged, and finally declared the agreement “superseded.” Meanwhile, more than 1 million people in South Kordofan and Blue Nile states are in increasingly desperate condition; hundreds of thousands have suffered acute malnutrition for almost two years, and more than two hundred thousand have fled to refugee camps in South Sudan, often in locations that are poorly situated for water and sanitation. Tens of thousands of civilians from Blue Nile have fled to Ethiopia.

                                                            ***

The situation in Darfur—until very recently almost totally absent from news coverage of the region—is especially shameful, given the appalling conditions that have prevailed so long within the displaced persons camps, the steep rise in the number of internally displaced persons (IDPs) and refugees, and the escalating violence and insecurity. Relief organizations are withdrawing expatriate workers and suspending many operations. UN and nongovernmental organizations are increasingly restricted by both Khartoum’s Military Intelligence and expanding violence. The UN/AU “hybrid” Mission in Darfur (UNAMID) has failed abysmally. The UN Department of Peacekeeping Operations—already vastly overstretched and funding three separate peacekeeping forces in greater Sudan—is looking to draw down UNAMID, but rather than speak honestly about its failure, the UN has made the disingenuous claim that “circumstances on the ground” permit such a withdrawal of forces. This at least was the judgment of Hervé Ladsous, head of UN peacekeeping—a judgment he now refuses to defend publicly.

International journalists have been almost completely excluded from Darfur for many years, as have independent human rights investigators. According to humanitarians on the ground, Khartoum has made of Darfur a “black box genocide.” There has been only one significant dateline from rural Darfur in several years, a story by the New York Times in February 2012; it declared on the basis of a single, tightly controlled visit to a “Potemkin Village” in West Darfur that “peace had settled on the region.” So-called “returns” of refugees and IDPs were a “sign that one of the world’s most infamous conflicts may have decisively cooled.” In fact, every available indicator of human security and well-being was, in aggregate, deteriorating, and the level of violence in various regions accelerated sharply. “Returns”—nominally safe and voluntary—have mostly been neither.

Violence has ebbed and flowed in Darfur for more than ten years now. A dramatic surge began following the December 2010 defection from Khartoum by Minni Minawi, the only Darfuri signatory to the ill-fated 2006 Darfur Peace Agreement; the authoritative Small Arms Survey (Geneva), on the basis of courageous and detailed ground-based research, reported an escalation of violence against the (non-Arab) Zaghawa, the tribal group from which Minawi came. In the latter half of 2012, violence exploded in North Darfur, particularly near the Jebel Amir region, which has significant gold mines. The regime, desperate for a source of foreign exchange to buy parts and supplies from abroad, gave free rein to the Aballa tribal groups from which the Janjaweed, infamous for carrying out attacks in Darfur in the first decade of the twenty-first century, had been so heavily drawn. This meant attacking the Beni Hussein, the Arab group within whose administrative area Jebel Amir lies. The fighting killed hundreds, perhaps thousands—including a number of UN peacekeepers traveling to Hashaba town, site of reported mass killings by Khartoum’s forces. Peacekeepers themselves were clearly targeted by Khartoum in order to forestall such an investigation.

Militias have became increasingly aggressive, especially the notorious Abu Tira—nominally the “Central Reserve Police,” but now little more than a semi-autonomous fighting force that has attacked and extorted IDP camps and sexually assaulted countless women and girls. An even greater problem is seizure of the lands of African farmers by Arab militias and armed groups—some clearly from Chad, Niger, and Central African Republic. Farmers attempting to return are violently warned off or simply killed; women working their former lands have been raped and killed. The “returnees” that the UN celebrates are constantly being forced to return to IDP camps.

Moreover, figures for new displacement in Darfur dwarf even the most optimistic UN/UNAMID estimates for returnees. UN data, supplemented by that of NGOs, provide strong evidence that more than 1.5 million people have been newly displaced since January 1, 2008, when UNAMID officially took up its mandate. The head of UN humanitarian operations was recently obliged to report that 300,000 Darfuris had been newly displaced between January and mid-May of this year alone. The refugee surge into Chad is again growing: the figure had remained at approximately 280,000 for a number of years, but in the past half year 50,000 more people have fled to Chad, according to Doctors Without Borders/Médecins Sans Frontières—nearly all in desperate condition.

Human Rights Watch reported on June 18 satellite photographic confirmation of Janjaweed attacks on villages in South Darfur—attacks led by Ali Kushayb, the Janjaweed “colonel of colonels” indicted by the International Criminal Court for massive crimes against humanity:

Satellite images confirm the wholesale destruction of villages in Central [formerly South] Darfur in an attack in April 2013 by a militia leader sought by the International Criminal Court….The images show the town of Abu Jeradil and surrounding villages in Central Darfur state almost completely burned down….Villagers who fled the area told Human Rights Watch in May that Sudanese government forces, including the militia leader Ali Kosheib, had attacked the area. More than 42 villagers are believed to have been killed and 2,800 buildings destroyed.

Darfur teeters on the edge of a complete humanitarian collapse and uncontrollable violence. Rebel fighters have recently gained the upper hand in many areas of fighting, and the callous leaders in Khartoum seem willing to let Darfur sink into destructive chaos, so long as gold from Jebel Amir continues to make its way to the capital.

                                                                ***

Satellite photography has also revealed a great deal about Khartoum’s conduct of war in the Nuba Mountains and Blue Nile, the latter the most inaccessible of the three contested areas between north and south (including Abyei). According to an important report recently released by Amnesty International,

New satellite imagery and eyewitness testimonies from rebel-held areas in Sudan’s Blue Nile State show that Sudanese military forces have resorted to brutal scorched earth tactics to drive out the civilian population….“We had no time to bury them”: War crimes in Sudan’s Blue Nile State documents how bombings and ground attacks by Sudanese military forces have destroyed entire villages, left many dead and injured, and forced tens of thousands to flee—with many now facing starvation, disease and exhaustion.

None of this should be surprising, given Khartoum’s May 2011 military seizure of Abyei, now the most dangerous flash-point for renewed war along the entire north/south border. The Satellite Sentinel Project (SSP) provided detailed satellite photography showing a steady build-up by the SAF and its Misseriya Arab allies over several months in early 2011. The scale of destruction in Abyei town was also made clear by follow-up satellite images.

Subsequent photography indicated that South Kordofan would be the next site of major violence, and on June 5, 2011 the SAF struck again. The nature of this assault was immediately apparent, and clear patterns emerged in early reports. Human Rights Watch confirmed that Khartoum’s regular military and militia were undertaking a campaign of house-to-house roundups of Nuba (African) civilians in the capital city of Kadugli. Many of these people were hauled away in cattle trucks or summarily executed; dead bodies littered the streets of Kadugli. Nuba were also stopped at checkpoints grimly similar to those in Rwanda; those suspected of SPLM/N or “southern” political sympathies were arrested or shot. One aid worker who escaped from South Kordofan in the first weeks reported on militia forces patrolling further from Kadugli: “Those [Nuba] coming in are saying, ‘Whenever they see you are a black person, they kill you.’” Another Nuba aid worker reports that an Arab militia leader’s orders were “to just clear.”

Charges of “ethnic cleansing” and “genocide” were coming ever more insistently from Nuba civilians, observers on the ground, and church groups with strong ties to the region. News reports confirmed that some 7,000 Nuba had been moved forcibly by Khartoum’s security services (disguised as Red Crescent workers) from the UN security perimeter in Kadugli to a soccer stadium; they were never heard from again. Mass graves were later confirmed both by UN human rights reporters who had observed events from the ground in June 2011 and by satellite photography from SSP.

At the same time, Khartoum renewed its blockade of humanitarian assistance to the people of the Nuba, hundreds of thousands of whom had already fled into the mountainsides. Two years later the blockade continues in the Nuba Mountains and rebel-controlled areas of Blue Nile. In Darfur and these two areas, Khartoum is denying adequate food, water, and medical care to more than 3 million people. Moreover, bombing of civilians and civilian agriculture has largely destroyed the last two harvests in both the Nuba and Blue Nile; malnutrition indicators long ago reached the emergency level; children and the elderly have begun to die, and many more will die soon. The trip to precarious safety in South Sudan is too arduous for many, and many more will not leave family members to starve alone.

                                                             ***

As these events unfolded, the Obama administration has been engaged primarily in diplomatic damage control. Policy has focused on the realization of southern independence at the expense of other issues, including critical and unresolved implementation disputes arising from the 2005 Comprehensive Peace Agreement. The administration has essentially abandoned Darfur—“de-coupled” was the word chosen by a senior administration official. It has remained largely mute on the military takeover of Abyei, and initially refused to credit reports of genocide in the Nuba Mountains.

On PBS’s NewsHour in 2011, Obama’s special envoy to Sudan Princeton Lyman scoffed at the idea that the Nuba Mountains might become “another Darfur”: “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….” Two years later, we know that Khartoum is not only destroying the civilian base of support for the SPLM/A-N, but doing so deliberately. The same is true in Blue Nile. The SPLM/A-N have no weapons that can defend against high-flying Antonov cargo planes, which need aim only at sorghum fields to be effective (they have no militarily useful bombing precision).

A second comment by Lyman has proved more dangerous. When asked in a December 2011 interview with the important pan-Arab news outlet, Asharq al-Awsat, about whether the United States would welcome the Arab Spring in Sudan, Lyman declared, “This is not part of our agenda in Sudan. Frankly, we do not want to see the ouster of the regime, or regime change. We want to see the regime carrying out reform via constitutional democratic measures.”

But all true democratic forces—in Sudan and in exile—are committed to regime change, including those who insist that the change must be effected by nonviolent means. Lyman made clear that this broad-based democratic ambition is not consistent with U.S. goals and policy. Did he really believe that the National Islamic Front/National Congress Party regime could preside over the “democratic” transformation of Sudan via “constitutional measures”? After twenty-four years of ruthless and comprehensive tyranny, the idea is preposterous.

Sudanese overwhelmingly want regime change, while a repressive security apparatus keeps the current cabal in power. But its survival also depends upon acquiescing before the decisions of key hardline generals—concerning the seizure of Abyei, the refusal to negotiate with the SPLM-N or allow for humanitarian access in the Nuba Mountains and Blue Nile, the abandonment of Darfur to chaos and increasing destruction, and—in an act of economic self-destruction—halting the transit of oil from the south to Port Sudan. President Omar al-Bashir has survived by siding with the most ruthless and militaristic elements in the regime (see my 2011 Dissent post “Creeping Coup in Khartoum”).

No real or just peace can emerge from negotiations with such a regime, as evidenced by the feckless efforts of the AU and the absence of unified international commitment. In the case of the Obama administration, the reasons for keeping the regime intact are all too clear: Khartoum’s putative provision of counterterrorism intelligence. The U.S intelligence community clearly puts tremendous value on the new embassy in Khartoum as a listening post (it was completed in 2010). Although we have no ambassador to Sudan, we do have a $175 million embassy, with nine buildings and more than 200 staff—and that’s before “top-shelf” spying equipment and personnel had been moved in.

Former Senator Russ Feingold, while chair of the Africa Subcommittee of the Senate Foreign Relations Committee and a senior member of the Senate Intelligence Committee, was ideally positioned to assess the price we were paying for intelligence from Khartoum. In May 2009, he said:

I take serious issue with the way the report [on international terrorism by the U.S. State Department] overstates the level of cooperation in our counterterrorism relationship. A more accurate assessment is important not only for effectively countering terrorism in the region, but as part of a review of our overall policy toward Sudan.

For those wondering why U.S. policy toward Sudan has been so ineffective during the Obama years, why special envoys have been so inept and disingenuous, why so little has been said about ongoing atrocity crimes and genocide, and why Khartoum feels no need to abide by agreements it has signed, Senator Feingold’s comment provides the most authoritative glimpse at what is done—and ignored—in the name of “national security.”

Eric Reeves is author of A Long Day’s Dying: Critical Moments in the Darfur Genocide and Compromising with Evil:  An Archival History of Greater Sudan, 2007—2012.

 

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