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Archive for August 6th, 2013

Mental health problems

Posted by African Press International on August 6, 2013

KATHMANDU,  – Gaps in mental health care for men who have sex with men (MSM), a population disproportionately affected globally by HIV, are limiting effective treatment and care for both HIV and mental illness, experts say. 

Mental health problems are an underappreciated barrier to successful treatment and prevention of HIV, and this is doubly true in low-income countries, and even more so for marginalized populations who are dealing with layers of stigma,” Brian Pence, an epidemiologist at the University of North Carolina (UNC)-Chapel Hill in the US, told IRIN.

“Every additional layer of social marginalization increases complexity and raises barriers to treatment for HIV and mental health,” he added.

According to experts, MSM are disproportionately affected by both HIV and mental illness, including depressive, anxiety and substance-abuse disorders.

Yet HIV prevention and treatment programmes fail to address adequately mental health, while mental health programmes often ignore HIV. HIV programme staff often lack training to spot or discuss the symptoms of deteriorating mental health with clients. Mental health programmes may neglect to see HIV status as a possible trigger for significant mental health conditions such as depression.

Advocates are calling for “wrap-around” care and task-shifting to community-based care providers to bridge the oft-siloed fields of care, experts say.

Heavy hidden burden

“Hidden groups like MSM are in many countries – and it is even worse when they are criminalized in some way – more vulnerable to mental health issues,” said Vikram Patel, professor of international mental health and at the London School of Hygiene and Tropical Medicine and director of the Centre for Mental Health at the Public Health Foundation of India.

The UN special rapporteur on the right to health has written that the criminalization of same-sex conduct contributes to deteriorating mental health for sexual and gender minorities, including MSM.

“State-sanctioned criminalization or pathologization of people for their sexual attractions or behaviour can only be seen as damaging in terms of mental health, and deteriorating mental health can certainly be a risk factor for HIV infection,” Patel said, adding that research on MSM and mental health in many countries is a “blind spot”.

Weak overlap

A 2012 global survey by the Men Who Have Sex With Men Global Forum (MSMGF), a US-based advocacy group, identified competent mental health care as a key aspect of successfully getting MSM to access HIV services.

“Although some men did not name their pain as a form of poor mental health, when other men described feelings of depression, all the men recognized and endorsed an urgent need to address this phenomenon,” the survey reported.

In addition to weak mental health care being a barrier to effective HIV testing and treatment for people living with HIV, mental health problems can also significantly impair their ability to continue treatment, experts say.

“We know that depression has high prevalence in people living with HIV, but the integration of mental health treatment into HIV treatment services, which are often peoples’ principal or even sole health care access point, is often minimal or non-existent,” said Pence from UNC-Chapel Hill.

Research from South Africa, where nearly 10 percent of MSM are living with HIV, suggests these gaps in care may be exacerbated by mental health providers’ stigma against HIV, and similarly, by HIV providers who stigmatize mental health illness.

According to Pence, “Poor referral mechanisms and practices between HIV treatment services and mental health services mean many HIV patients miss out on getting the mental health diagnoses and treatment they need.”


The World Health Organization (WHO) has recommended integrating mental health care into primary care for more than 30 years. However, progress remains piecemeal and even where integration has taken place at a policy level, cross-training is patchy.

But there are signs integration works.

“There is a good evidence base for the integration of psychiatric care – even staff who are not psychiatrists – into a wide range of medical settings, including HIV treatment settings,” explained Pence, referring to a method of integration known as “task-shifting” where primary care and community health workers take on specialized duties.

WHO’s 2013 comprehensive mental health action plan calls for better integration into HIV services and programmes.

According to Patel from the London School of Hygiene and Tropical Medicine, the first step should be to approach civil society groups helping MSM access HIV services “to start a conversation about mental health”.

But, he warned: “Such interventions need to speak the language of the communities they are intended to help. We have to avoid foreign psychiatric labels, for example, and talk about stressors in the environment – that way these men can connect the way they feel to their lives and their environment rather than some sense of shame.”


kk/pt/cb  source

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Zimbabwe elections marred by irregularities

Posted by African Press International on August 6, 2013

Norway is pleased that the elections in Zimbabwe passed off peacefully, in contrast to the previous elections in 2008. This is a step in the right direction. But unfortunately there are clear indications that these elections were marred by so many irregularities that they cannot be called open and fair,” said Minister of Foreign Affairs Espen Barth Eide

Presidential and parliamentary elections were held in Zimbabwe on 31 July. The results were announced yesterday. According to the Zimbabwe Electoral Commission, current President Robert Mugabe (ZANU-PF) received 61 % of the votes in the presidential election, while Prime Minister Morgan Tsvangirai (MDC-T) received 34 %. In the parliamentary election, ZANU-PF is reported to have won 196 of 270 seats.

Election observers from the African Union (AU) and the Southern African Development Community (SADC) have identified a number of serious flaws. The voters’ roll was not made public before the election, many people in the cities were not able to register and on election day many were turned away, which could indicate that the electoral roll was incorrect. Some 35 % more ballot papers were printed than there were voters. Contrary to the law, there was a persistent pro- ZANU-PF bias in the state media.

“After many years of insecurity and poverty, the people of Zimbabwe deserve a better life. Unfortunately, these election flaws make it difficult to view the election results as an expression of the will of the people,” said Minister of International Development Heikki Eidsvoll Holmås.

The African election observers have not yet published their final report. The opposition MDC-T will consider whether to take legal action and demand new elections.

“We are now awaiting the outcome of these processes, which will also affect Norway’s relations with Zimbabwe in the years ahead. It is very important for Norway that countries we cooperate with show a genuine willingness to promote democracy and human rights,” Mr Eide said.



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Anger, lost hope and sometimes newfound happiness

Posted by African Press International on August 6, 2013

Children stretch before class at Najda Now

SHATILA CAMP, LEBANON, 30 July 2013 (IRIN) – The conflict in Syria has killed more than 6,500 children, turned nearly one million into refugees, and left three million inside Syria in need of aid. Some have been disabled, mutilated, sexually abused, tortured in government detention and recruited by armed groups, at as young as age 12. Many have been deprived of their education. Many more have witnessed violence.

“Millions of children inside Syria and across the region are witnessing their past and their futures disappear amidst the rubble and destruction of this prolonged conflict.” – Anthony Lake, UNICEF Executive Director

After a recent trip to Syria and its neighbouring countries, Leila Zerrougui, special representative of the UN Secretary-General for Children and Armed Conflict, said she was “overwhelmed” by what she saw.

“Children in Syria not only are affected [by the violence on a] daily basis – they have lost their family, they have lost their house – but they lost … hope. They are full of anger. And if this continues, we will face a generation of illiterates,” she told a press conference.

The UN Children’s Fund (UNICEF) worries Syria’s children could become “a lost generation”.

In Lebanon, where hundreds of thousands have sought refuge, the NGO Najda Now helps children recover from trauma through theatre and art. Usually, children’s drawings are dark in colour and theme when they first arrive; they become more colorful and positive over time. Most of the time, children draw two things: what they want and what they are afraid of.

IRIN visited Najda Now’s ‘s psychosocial support centre “Tomorrow is Ours”. Here are a few of the children we met.

Ahmed, nine, left Homs because of intense air bombing. He spent some two years in Syria amid the conflict; and this environment became normal for him. He talked about it as if it was just a movie. He was lucky enough not to have seen any violence himself, but had some temporary trauma when he arrived in Lebanon one month ago, psychologists said, mostly linked to noises. In Syria, he lived in a village in the countryside, with vast open spaces. Now, he lives in the crowded Shatila camp for Palestinian refugees in Lebanon. Ahmed drew what he wants: a spacious house, a dog, and the sea.


IRIN: Why did you come to Lebanon?
Ahmed: Because of the war.

What happened?
They hit with planes and cannons.

Do you have friends here in Lebanon?
Ahmad does not answer; he seems stressed by the question.

How do you like it here?
I prefer Syria, because in Syria I have a lot of friends.

What do you remember from Syria?
Before, when there was no war, I could go wherever I wanted and I liked it. Here in Lebanon, when I go out, my Mum is stressed. Before, when there was no war in Syria, and I went out, I had freedom.


Sohah, 12, says she is happy in Lebanon. The centre’s theatre classes have helped her decompress from the stress of seeing guns being shot in the air and people being transported by ambulances. Her Palestinian parents settled in the southern Syrian town of Dera’a when they sought refuge themselves decades earlier. Now, they are displaced once more. She arrived in Lebanon four months ago.


IRIN: Why did you come to Lebanon?
Sohah: There were a lot of problems.

Which kind of problems?
A lot of bombs and clashes with guns.

What do you like to do here in the centre?
I like to draw; I like to do theatre; I like to study. What I like the most is the theatre.

Tell us about your drawing.
This is us when we were acting. Me and my friends are singing. I wrote the song that we were singing.

What is the song about?
It says we want peace; we want to go back to our country; we don’t want war any more.

What do you want to do when you grow up?
I want to be an actress, famous around the whole world.


When Ashraf, eight, arrived at the centre from Hama six months ago, he was aggressive and fought with other children. Psychologists attribute this to what he saw and heard in Syria and stress likely passed down from his parents. Ashraf has not drawn anything; instead he is making a worm out of playdough.


IRIN: Why did you come to Lebanon?
Ashraf: The government attacked the revolutionaries at the entrance of the town. We knew that the others [the rebels] would be upset and answer, and that they [the government] would attack the whole city. And that’s what ended up happening.

What do you miss about Syria?
In Syria, I played with the computer.

But here in the centre there is a computer room.
Yes, but in Syria I had a computer at home and I could play.

And here, what do you like to play?

Do you have a drawing to show us?
No, I don’t like to draw. I don’t like playdough either. I like to play ball.


Faysal’s mother is a nurse. She used to treat people in their home in Rural Damascus. So by the time the 11-year-old came to Lebanon nine months ago, he had seen many corpses, including his uncle who was shot dead by a sniper on a rooftop.


IRIN: Why did you come to Lebanon?
Faysal: I came to Lebanon because there were attacks in my village.

Who do you live with?
My grandmother, my grandfather, my mother, my aunt, my other aunt and her husband, my other grandfather. My uncle was a martyr. Also there are two children on my dead uncle’s side, and two children on my other uncle’s side. I have a little sister. She’s three years old and when she is big enough, I want her to join me at school.

What do you miss about Syria?
My friends, my house, and my uncle.

What do you prefer: Syria or Lebanon?
I grew up in Syria, I prefer Damascus, but here I like the theatre. I prefer here for the theatre because there it didn’t exist. In Damascus, I didn’t know how to sing. Now, I can rap.

Can you tell us about your drawing?
I drew it based on a picture; we copied a photo. My drawings were in an exhibition and I sold two of my three drawings. The girl, she’s a princess.

What do you want to do when you grow up?
I want to be a painter.

ar/ha/cb  source


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