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Archive for August 22nd, 2013

Comprehensive HIV prevention – hopes on female condom

Posted by African Press International on August 22, 2013

KAMPALA,  – As Uganda continues to struggle with condom shortages and inconsistent use, an ongoing campaign hopes to encourage more young people to use condoms and to raise the profile of the little-used female condom.

The multimedia campaign, dubbed “If it’s not on, it’s not safe“, is run by local health group Uganda Health Marketing Group (UHMG) with funding from the UN Population Fund (UNFPA), and is designed to reduce the rate of sexually-transmitted infections (STI) and unplanned pregnancies among people aged 18-34.

It includes broadcasting of radio and TV spots on female and male condoms, DJ mentions, as well as TV talk-show discussions, billboard ads and posters.

Research shows that while high-risk sex is common in Uganda, male and female condom use is fairly erratic. Meanwhile, HIV prevalence in Uganda is rising, going from 6.4 percent in 2005 to 7.3 percent in 2012, making effective HIV prevention campaigns more urgent than ever.

Supply chain problems – including a requirement for post-shipment testing on imported condoms – have led to regular nationwide male condom shortages in the country, which requires some 240 million annually but only receives about half that through the public sector.

Uganda has had numerous condom drives over the past three decades, but according to Daudi Ochieng, head of communications at UHMG, the placement of the female condom at the front and centre of this campaign is what could make the difference.

“The positioning of the female condom is `Power is now in your hands’ and this is intended to portray the woman as having the power to say, `look man, I have a condom too so go away with your excuses of why we can’t have safe sex’,” he told IRIN. “The other point of positioning is now we have a female condom that can be worn 12 hours in advance of sexual intercourse. This way it doesn’t get in the way of the heat of the moment, also… in times of poor negotiating for sex the woman can guard herself from unintended pregnancies and HIV by wearing it in advance.”

The female condom is a 17cm-long polyurethane sheath with a flexible ring at each end. It provides about the same protection from sexually transmitted infections – including HIV – and unwanted pregnancy as the male condom, but unlike the male condom, can be used with oil- and water-based lubricants without the risk of breakage.

The FC2 can be worn up to 12 hours in advance of sex

Since the campaign began in June, more than 10,000 female condoms and 360,000 male condoms have been distributed free of charge, with another 120,000 condoms sold.

A hard sell

Earlier efforts to popularize the female condom in Uganda failed. In 2007, the government stopped distributing the original female condom, FC1, on the grounds that women had complained it was “noisy” during sex. The FC2 was introduced in 2009, but has not, until now, been promoted publicly. While it has done better than its predecessor, it continues to lag well behind the male condom.

Another barrier has been cost – when it is sold, the female condom costs significantly more than its male counterpart.

According to baseline research conducted by UNFPA and UHMG in 2011, myths and misconceptions were the biggest hindrance to female condom uptake, with only a small minority of those interviewed ever having seen or used the condom.

“I see the condom, but even me as a medical doctor I don’t know how to use it. I wonder how the ordinary women can insert it in. The condom looks big and scary. I fear to use it,” a female doctor at Kampala’s Mulago Hospital, told IRIN.

Vastha Kibirige, the national condom coordinator at the Ministry of Health, told IRIN that a study was planned to establish the current use of FC2 in the country.

“The uptake of female condoms has slightly improved. Since people are picking them, we need to have a follow up study to know whether they use it or not,” she said. “You can’t tell whether they are using it or not. Some people may pick and take them for curiosity.”

A 2011 study by UNFPA found that female condoms were slowly gaining popularity around the world, largely as a result of successful partnerships between governments and technical agencies advocating their use and increasing their availability.

Comprehensive HIV prevention

HIV activists have welcomed the campaign, but some warn that other HIV prevention methods – in addition to condom use, Uganda relies on messages of abstinence, faithfulness and on biomedical methods – must remain in the frame as well.

In addition, they say any campaign to boost female and male condom use must be met with a significant improvement in their supply, in order to ensure consistent availability and use.


According to Alice Kayongo, regional policy and advocacy manager at Uganda Cares, a programme of US-based NGO AIDS Healthcare Foundation, there is a need to bring on board non-traditional partners including religious groups, cultural leaders and men to encourage all sections of the population to use both male and female condoms responsibly.

According to Ochieng, campaigns like the current one will help make female condoms a more mainstream part of people’s sexual lives. “We need to continue the promotion and demonstration so that we can move this from a trial proposition to a habit.”

so/kr/cb  source

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Tun Aung Kyaw says his TB was misdiagnosed

Posted by African Press International on August 22, 2013

Tun Aung Kyaw says his TB was misdiagnosed

WANGPHA,  – Struggling to breathe, Burmese migrant Tun Aung Kyaw sits up slowly in bed for a routine check-up at a Thai tuberculosis (TB) clinic along the 1,800km Thai-Burmese border.

This is the third round of treatment for the 29-year-old, who believes Burmese health workers misdiagnosed him with regular TB twice when he actually had multi-drug-resistant TB (MDR-TB), a form of the infectious disease harder to diagnose and cure.

“Even though I was on TB treatment I got weaker and eventually I was bed-ridden,” Tun Aung Kyaw told IRIN.

After 14 months of treatment, Tun Aung Kyaw’s condition never improved as the disease had destroyed his left lung. He now faces a two-year regimen of care to see if he can finally defeat the MDR-TB strain, which has a treatment success rate of almost 60 percent in South-East Asia, according to the Global Tuberculosis Report 2012 by the World Health Organization (WHO).

Inadequate detection and treatment are major obstacles and can result in cases of drug-resistant TB (DR-TB) such as MDR-TB, say health experts.

“Drug-resistant TB is a very significant health concern for Myanmar,” Peter Paul de Groote, the country’s head of mission for Médecins Sans Frontières (MSF), told IRIN.

Around 8,900 new cases of DR-TB are reported each year, but only 800 patients had access to treatment at the end of 2012, he said.

TB burden

Myanmar is among the world’s top 22 TB-burden countries with a prevalence rate of 525 cases per 100,000 people, more than three times the global average.

It is also a high burden country for MDR-TB, a complex strain immune to first-line drugs that requires two years of treatment, four times longer than non-resistant TB.

MDR-TB treatment costs nearly US$5,000 per patient, roughly 100 times more than the regular strain, according to an October 2012 WHO report.

From 22 to 23 August, WHO, along with MSF and Myanmar’s Ministry of Health, plan to hold a DR-TB symposium in Yangon aimed at ramping up services throughout the country, including neglected border regions.

“There are immense challenges in providing DR-TB treatment, and health care in general, to the remote border areas of Myanmar,” de Groote said.

Health experts fear countless more cases remain hidden in rural eastern Myanmar where armed conflict, rough terrain, lack of awareness and scarcehealth care can discourage TB-infected people from seeking care.

Proposed approaches for battling DR-TB include counselling to help patients cope with long and toxic courses of treatment, decentralized care in home communities, and rapid diagnosis to treat patients correctly and prevent further cases.

To do this, Thandar Lwin, manager of Myanmar’s National TB Programme, has urged the Burmese government to step up efforts to support TB measures, 94 percent of which are donor funded.

TB-infected patients live in these huts for the duration of their treatment at the Wangpha TB clinic

“The government budget is not enough and it is difficult to increase more than the previous year,” she said during an international TB workshop earlier this year. “There is a need for evidence to persuade the government that investment in health is worthwhile.”

In 2013, Myanmar is projected to have a US$22 million funding gap for TB care and control services, the WHO report said. On the other hand, rapideconomic growth may help ease the problem in the longer term.

Border run

Many Burmese are forced to seek TB care at donor-funded clinics along the Thai border, home to roughly one million migrants and displaced persons.

Two health clinics run by Shoklo Malaria Research Unit (SMRU), a Mae Sot-based field station for the Mahidol University-Oxford University Tropical Medicine Research Programme in Bangkok, offer free treatment and are inundated with patients.

From 2010 to March 2013, SMRU supported more than 810 TB patients, but had to refer 70 percent of them, and pay for their care at local Thai hospitals due to limited capacity.

About 18 percent of patients tested for first-line drug susceptibility at SMRU clinics had some form of DR-TB. Almost half have already been successfully treated, with others still on the regimen.

In June 2013, SMRU opened a specialized TB clinic in the village of Wangpha, near the Thai border town of Mae Sot, to handle the overflow. Plans are also under way to expand in-patient care at the second clinic since 60 percent of TB patients, especially those with drug resistance, need to be supervised by clinic staff.

Sein Sein, manager of the TB clinic, said several patients initially came in after showing symptoms for several months, when treatment should be sought if persistent coughing lasts for at least two weeks.

“Many patients only come for treatment when they are really sick, so they stay in the community and continue to spread the disease,” she said.

According to WHO, there were an estimated 650,000 cases of MDR-TB among 12 million TB cases worldwide in 2012.

sk/ds/cb source

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