Access to mental health services remains a key challenge in Africa

KAMPALA,  – As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.
Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

The post-MDG era

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond”

Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

Poverty and mental illness

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Putting mental health on the agenda

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

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NGO denounces the suspension of antiretroviral (ARV) drug treatments

BRAZZAVILLE,  – A human rights NGO based in the Congolese capital Brazzzaville has denounced the suspension of antiretroviral (ARV) drug treatments for thousan ds of HIV/AIDS patients in Congo.

“As we speak, Congo is totally lacking ARVs. We’ve been to enquire at the Outpatient Treatment Centre [which supports patients]: It has no Atripla, Efavirenz or Nevirapine,” Pan African Association Thomas Sankara (APTS) chairman Germain Cephas Ewangui told IRIN.

“The situation could cause a rise in the number of deaths, the development of resistance [to ARVs administered later] and the recurrence and development of opportunistic infections. The situation is serious: we are facing very serious violations of human rights and particularly the right to life,” said Ewangui.

“It is indeed a form of irresponsibility that we equate to an organized crime, requiring not only administrative sanctions, but also… prosecution because the situation is serious, intolerable and unacceptable,” Ewangui added.

According to the Ministry of Health and Population, some 16,310 patients in Congo were receiving ARVs, while 38,500 are waiting to get them.

The ministry acknowledged that ARV treatment had stopped. “There was a malfunction. There was a break in the supply and distribution chain, but the situation is being corrected,” said Executive Secretary of the National Council for the Fight against AIDS (CNLS) Marie-Francke Puruehnce.

“The situation should not lead to declarations and denunciations,” said Puruehnce.

A consultant from the Ministry of Health, who requested anonymity, told IRIN: “Such failures sometimes happen once or twice a year. But they do not last long.”

Officially Congo spends 2-5 billion CFA francs (US$4-10 million) a year on providing free treatment to HIV/AIDS patients.

According to the ministry, HIV prevalence fell from 4.2 percent in 2003 to 3.2 percent in 2011. The prevalence of pregnant women with HIV/AIDS fell from 3.4 percent in 2009 to 2.8 percent in 2012.

Congo, where per capita income in 2011 was estimated at $4,600, committed in 2001 to allocate 15 percent of the state budget to health, but it is currently earmarking only about 9 percent, according to the World Bank.

Interruption of ARV therapy risks patients developing resistance to the drugs and can hasten progress to AIDS and death.

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Comprehensive HIV prevention – hopes on female condom

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.

Mainstreaming

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.”

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Mental health problems

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.”

Task-shifting

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.”

End

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HIV still on the – not yet inside the comfort zone

Photo: Brendan Brady/IRIN

Sound science, but no thank you

KATHMANDU,  – Despite years of scientific advances in HIV treatment and prevention, more than two million people are newly diagnosed with HIV annually, demonstrating how community-driven approaches to prevention are still needed to curb the epidemic, experts say.

For years evidence has mounted that anti-retroviral therapy (ART) – virus-suppressing drug combinations that are the primary treatment for HIV – can also be used effectively in prevention.

However due to the complications associated with ART procurement, distribution, uptake, adherence, and potential behaviour change in patients (some studies have linked increased risk-taking behaviours in HIV patients post-treatment), a fresh local approach to implementing ART-based prevention programmes is needed, new research argues.

“Research in HIV prevention needs to get out beyond its comfort zone and meet with the people who have very different ideas about what HIV means,” Jim Pickett, the project director for Mapping Pathways, an international research and advocacy project, told IRIN.

Despite international research and policy developments that have boosted awareness and popularity of
what is known as “treatment as prevention”, local-level implementation of it remains murky and piecemeal.

“We talk a lot about the results of science and figuring out how to `make it make sense’ in local contexts. But science is itself a process that should involve communities from the very beginning,” Pickett said.

From efficacy to effectiveness

According to Mapping Pathways, the ideal approach to implementing treatment as prevention should consider not only the clinical goal of efficacy (works in a lab), but also effectiveness (how to apply the solution in a community).

“I know that if you get anti-retroviral drugs into someone’s blood, they suppress the virus. We have amazing proof of that – it’s a major scientific breakthrough in the history of humankind,” said Linda-Gail Bekker, chief operating officer of the Desmond Tutu HIV Foundation, based in South Africa.

“But now we have to put this together so it works, which means engaging with a wide range of human beings who live very different lives than those of us who run these programmes might imagine,” she said.

Effectiveness requires behaviour change and, therefore, varies across cultures, governments, and communities based on “the firms that produce the drugs, the healthcare clinics that deliver the drugs, the community centres that provide education, and the partnerships developed,” according to Mapping Pathways.

“Human beings will behave like human beings. What does that mean? Well, social sciences have been trying to figure that out for centuries and don’t have one single theory, so why should our HIV programmes?” asked Bekker.

“The notion that in HIV programmes `one size fits all’ has backfired on us and it has been a humbling moment for those of us who work in this field.”

“Local” science

According to Molly Morgan Jones, a researcher at the international public policy think tank Rand Corporation and lead author of Mapping Pathways’srecent report, the varied applications of science must be taken into account when designing programmes: “Uptake of new ideas or products is contingent on a lot of factors that might have nothing to do with what’s created in a lab or recommended by policy experts…

“ART has been around for a while, the innovation at this point is how we are going to use the drugs – a new way of thinking about how communities access, understand, and employ this technology,” she explained.

Development of the Mapping Pathways model relied on research carried out with partners in the US, UK, South Africa and India.

In each of the locations, local stakeholders – including clinicians, researchers, policymakers, the medical industry, patient advocates and coalition groups – interpreted scientific evidence differently, which had “profound” effects on how HIV prevention and care was carried out, the researchers noted.

“Here’s all this science – now what?” said Pickett, referring to the conventional top-down approach to HIV interventions, which often assumes that scientific proof a drug works will be enough to convince patients to use it.

“We need these processes to be local from inception,” he said, echoing arguments from the UN special rapporteur on the right to health that the participation of affected populations in decision-making is key to successful interventions.

However promising, concerns about putting this theory into practice remain.

The World Health Organization recently published recommendations that call for the number of people enrolled on ART to be increased by up to 25 million worldwide (up from the current 9.7 million). Financing the scale-up while also boosting local buy-in will be a challenge, say analysts.

But, the effort must be made, argued Pickett: “Just because something adds complexity to a methodology or a protocol doesn’t mean it shouldn’t be done – go there, to the places where the results of the scientific endeavour are meant to be utilized, and have a conversation with the people about what it can do, and most importantly, what they need it to do.”

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

 

The HIV/AIDS experience – Africa

NAIROBI,  – Twelve years after African governments pledged in the Abuja Declaration to alloc ate at least 15 percent of their annual budgets to healthcare by 2015, just six countries have met this goal.

Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia have met the target, and five other countries are spending at least 13 percent of their annual budgets on health, according to data compiled by the UN World Health Organization (WHO).While on aggregate spending on health has increased – up to 10.6 percent from 8.8 – about a quarter of African Union (AU) member-states have regressed and are now spending less on health than they were in 2001, adds the WHO data.

Recently, the AU held another special summit on HIV/AIDS, tuberculosis (TB) and malaria in Abuja, Nigeria, dubbed Abuja +12, which provided an opportunity for African governments and other stakeholders to review progress made and to discuss what should be done to ensure health funding targets are met before 2015.

The HIV/AIDS experience

“A renewed and bold commitment here in Abuja is essential as, drawing from experiences in the AIDS response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa,” said Michel Sidibé, the executive director of UNAIDS, in a press statement.

At present, funding for healthcare remains short of requirements and is very unevenly spread across countries. According to UNAIDS, an additional US$31 billion per year will be needed to meet the continent’s 15 percent health funding targets.

As of 2011, at least 69 percent of the world’s 34 million people estimated to be living with HIV/AIDS were in sub-Saharan Africa.

But there are encouraging signs. The number of new HIV infections fell to 25 percent in 2011 compared to a decade earlier.

“The main challenge in the fight against HIV and AIDS globally is how to ensure universal access to prevention, treatment, care and support, and… ensuring zero transmission of new HIV infections in children,” wrote Ghanaian President John Dramani Mahama in a blog article in May.

Among 21 priority countries in Africa, the number of children newly infected with HIV has fallen by 38 percent since 2009, according to a joint AU-UNAIDS report launched at Abuja +12.

Malaria and TB burden

Africa is also lagging behind in reducing cases of – and deaths from – TB and malaria.

Globally, Africa is the only region not on track towards halving TB deaths by 2015, and it accounts for almost a quarter of the global caseload, according to WHO.

Inadequate TB detection and drug-resistant strains of the disease, which can be 100 times more expensive to treat, pose significant challenges in Africa. About 40 percent of TB cases in Africa go undetected, adds WHO.

Malaria is also a serious health problem. Eighty percent of the world’s cases and 90 percent of malaria-related deaths occur in Africa.

“We are at a turning point for making historical gains in Liberia’s health sector – where no child dies of malaria and every mother living with HIV can give birth to HIV-negative children while living healthy lives themselves,” wrote Liberian President Ellen Johnson-Sirleaf, in a statement to the Global Fund.

Liberia allocates 18.9 percent of its annual budget to healthcare, the second highest proportion in Africa; Rwanda spends 23.7 percent.

Health for development

According to the AU/UNAIDS Abuja +12 report, there is an economic case to be made for further investment in healthcare: For every year that life expectancy rises across the continent, it argues, GDP will increase by 4 percent. The average life expectancy in Africa is 54.4 years, the lowest globally.

“A sick population cannot generate the productivity needed to maintain the acceleration of our economy,” said Ghana’s President Mahama.

More funding for health could also mean more jobs within the health sector. In 2012 for example, the AU approved a business plan to increase the output of the local pharmaceutical industry.

“Focusing on three things that Africa needs to do urgently – decrease dependency by growing African investments, deliver quality-assured drugs sooner to the people who need them, and leadership – the blueprint will help African countries to build long-term and sustainable solutions,” stated Mustapha Sidiki Kaloko, the AU Commissioner of Social Affairs, in a statement, ahead of the Abuja +12 summit. “Africa’s health and our prosperity are inextricably linked.”

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

Photo: UN Photo/Louise Gubb

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.

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Surgical circumcision is more complex than PrePex

Photo: Edward Echwalu/IRIN

Surgical circumcision is more complex than PrePex

KAMPALA,  – In May, the UN World Health Organization (WHO) announced the prequalification of PrePex, the first non-surgical device for adult male circumcision. Compared to surgical circumcision, the device has fewer complications and is easier and quicker to use, allowing lower-cadre medical workers to be trained to perform the procedure.

Randomized, controlled trials in 2006 found that male circumcision reduced a man’s risk of contracting HIV through vaginal intercourse by as much as 60 percent.

Fourteen African countries in eastern and southern Africa plan on circumcising a total of 20 million men by 2016 in an effort to curb the transmission of HIV. A number of these countries are lagging behind on their targets, and feel the PrePex device will give their programmes a much-needed boost, while others are more cautious.

Studies continue

Malawi’s Ministry of Health plans to adopt and roll out the PrePex device once it has completed safety and acceptability studies targeting 2,000 clients in the districts of Nsanje, Lilongwe and Mulanje. The studies are due for completion in August.

“We hope that the results will assist us to scale-up the services, because already more males have been asking for this device,” said Henry Chimbali, health promotion and communications officer for HIV prevention and behaviour change at the Ministry of Health. “It is also most likely going to reduce costs of providing VMMC [voluntary medical male circumcision], because currently we use VMMC disposable kits, as well as costs of human resource and also perhaps adverse events.”

As of March 2013, a total of 42,700 Malawian men had been circumcised since the October 2011 start of the programme – an estimated 350,000 adult males were circumcised prior to the programme. The ministry aims to reach some 1.8 million adult males by 2015.

In Kenya, the Male Circumcision Consortium (MCC), in collaboration with the National AIDS and STIs (sexually transmitted infections) Control Programme (NASCOP) and the Nyanza Reproductive Health Society (NRHS), welcomed the approval of PrePex, but called for more studies to assess its acceptability and safety in local healthcare settings. The organizations are currently conducting the second phase of study to assess the efficacy of PrePex-assisted male circumcision among 425 men in routine health-care settings in western Kenya’s districts of Kisumu and Rachuonyo; results are expected by September.

“The outcome will provide the government with information and recommendations on the adoption of this device,” MCC project manager Mathews Onyango told IRIN. “There are some issues that have not been addressed by the WHO prequalification, such as cost, acceptability… These might vary from country to country and, thus, like in Kenya, our study will address its safety and acceptability, especially within a larger population.”

“Different countries have varying needs and they would need to ensure that they introduce the non-surgical devices to fit within their context,” he added.

The first phase of the Kenyan study assessed 50 men to ascertain the safety of the device in Kisumu. The committee of independent experts reviewed the results, found no safety concerns, and recommended that the study proceed to the second phase.

Kenya’s programme aims to reach 80 percent of men between 15 and 49 years old – some 860,000 men. Since the programme was launched in 2008, it has reached more than 420,000 men.

In Rwanda, the government plans to roll out the device and scale it up to health facilities, following its successful trials at Nyamata and Kanombe military hospitals. Officials say it saves both time and money. Following the research, Rwanda announced in 2011 that it would be rolling out its VMMC programme using PrePex.

Photo: PREPEX

PrePex promises less pain and less time

“We believe that the PrePex is the only circumcision method that will allow us to meet the goal of [circumcising] over 1.5 million men in two years,” Vincent Mutabazi, lead investigator in the Rwandan PrePex studies. “Several campaigns and numerous training[s] of new PrePex healthcare providers have taken place. Some 5,000 men were circumcised outside of [the] clinical environment in Rwanda since [February 2012]… In the upcoming months, more than 200,0000 procedures are expected.”

“Safer, faster and reduces discomfort”

In Botswana, the health ministry, in collaboration with the US Embassy, the African Comprehensive HIV/AIDS Partnership (ACHAP) and Jhpiego, an affiliate of the US’s Johns Hopkins University, are carrying out pilot research at Nkoyaphiri Clinic, Mogoditshane and Block 8 Clinic in the capital, Gaborone. The study targets 1,000 HIV-negative men aged 18 to 49 to evaluate the effectiveness and safety of PrePex; so far 330 adults have been circumcised in the study, which ends in September.

“The results of this study will determine its roll out in the country. There is no doubt that the PrePex and any other acceptable and safe circumcision device will boost circumcision not only in Botswana but in all countries involved in the programme,” said Benjamin Binagwa, VMMC programme manager at ACHAP. “The advantage of having these devices is that they can be used by other health staff other than doctors.”

He continued: “Any device that makes a surgical procedure safer, faster and reduces discomfort or pain is always a welcome component of the health service. From current experiences with the PrePex, the device provides the aforementioned to a great extent. Therefore its incorporation in the Safe Male Circumcision programme… is a welcome development.”

“Training of both nurses and doctors on use of the PrePex device is less technically demanding since it does not involve use of injections to prevent pain, there is no cutting of live tissues and thus no need to control bleeding, and no need for stitches,” Adrian M Musiige, safe male circumcision programme manager for Jhpiego, told IRIN. “The same technical properties of the device also address some important barriers to male circumcision for some men who still associate conventional male circumcision surgery [with] pain because of the involvement of injections, surgical blades, some bleeding and stitches.”

A total of 75,604 men aged 13 to 49 years have been circumcised in Botswana since the campaign was launched in 2009; the national target is 385,000 men by 2016.

Operational challenges

In Tanzania, where some 415,000 people out of the targeted 2.8 million had been circumcised as of March 2013, participants in one ongoing study in the country’s central-western region of Tabora are already showing high levels of acceptability. But rolling out the procedure using PrePex may face operational challenges.

“I am definitely sure that the use of device in Tanzania will be approved,” said Jackson Lija, head of biomedical prevention in Tanzania’s Clinical STI, HIV and Circumcision Services. “Our main problem to scale it up will be funding. We are struggling. Currently, we have a funding problem that is affecting the conventional male circumcision. PrePex is likely also to be affected with the same.”

In South Africa, the health department plans to have “formal talks” with traditional leaders about the possibility of introducing a Prepex device to circumcision ceremonies, Thobile Mbengashe, national HIV director, told the Mail & Guardian.

He said the country was behind on its male circumcision targets – 4.3 million men by 2016 – and was “unlikely to achieve its goals if additional modalities that can help to scale up the medical circumcision process are not introduced”.

Ugandan officials say WHO prequalification of PrePex was anxiously awaited and will boost the country’s programme, which has, since 2010, reached 380,000 men – a fraction of the 4.2 million men it aims to have circumcised by 2015.

“The National Task Force [on safe male circumcision] and the ACP [AIDS Control Programme] welcomes the approval and will go through the process of including its use in the guidelines,” said Alex Ario, programme manager for the ACP. “The device will definitely lead to increased access and acceptability of safe male circumcision among young males.”

so/kr/rz source http://www.irinnews.org

 

“The world won’t end AIDS without PEPFAR”

Photo: Eva-Lotta Jansson/IRIN

“The world won’t end AIDS without PEPFAR”

ADDIS ABABA,  – Ten years ago, a shipping container was converted into Ethiopia’s first HIV treatment centre, in Addis Ababa, the capital. Created in response to a dramatic rise in new HIV infections and AIDS -related deaths, the centre offered the only hope for HIV-positive Ethiopians, who had to pay to access the life-prolonging antiretroviral therapy (ART).

When US Global AIDS Coordinator Ambassador Eric Goosby joined other US and Ethiopian officials at the centre on a recent trip, they found a state-of-the-art facility, where thousands of clients receive free, comprehensive HIV treatment. The centre, a wing at the Empress Zewditu Memorial Hospital, has just added an outpatient annex.

“At least 350 clients will be seen daily in this new facility, some of whom have not been able to receive the services they need and deserve elsewhere. I particularly applaud Zewditu for its tremendous effort to build the first site in Ethiopia that offers counselling and testing services for the deaf and blind,” Goosby said at the inauguration ceremony.

The centre is now one of 900 sites across the country where over 290,000 people are receiving ART. The new centre, like thousands across Africa, was funded by the US government-run President’s Emergency Plan for AIDS Relief (PEPFAR).

Established in 2003, PEPFAR was the product of a rare bipartisan deal between former US president George W. Bush and lawmakers spearheaded by the Congressional Black Caucus. It was first a commitment of US$15 billion in funding to fight the global HIV/AIDS pandemic; at the launch of the plan, only 50,000 Africans were accessing ART, according to Eric Goosby who heads PEPFAR.

In 2012, an estimated 8 million people were receiving treatment in low- and middle-income countries – of which PEPFAR directly supported 5.1 million. This was a 20-fold increase in treatment coverage since PEPFAR was created in 2003. In 2012 alone, the emergency plan helped carry out 46 million HIV tests, preventing 230,000 babies from being born HIV-positive, Goosby said in an interview with IRIN.

Funding cuts versus AIDS-free generation

But experts are concerned that consistent budget cuts in PEPFAR funding could make reaching the goal of an HIV-free generation difficult, if not impossible.

Chris Collins, a vice president and director of public policy at the Foundation for AIDS Research (amfAR), argues that despite impressive gains made in the AIDS response now is not the time for funding cuts.

“Funding for PEPFAR has fallen 12 percent since 2010 in the State Department HIV bilateral budget line. Last week, the White House proposed an additional $50 million cut for 2014. When the mandated sequestration cut is taken into account, the programme is now at its lowest funding level since 2007,” Collins noted in an April editorial.

“The honest truth is that the world won’t end AIDS without PEPFAR. Some will say: judge PEPFAR on its outcomes, not its funding. But when PEPFAR’s own Blueprint calls for rapid scale-up of effective services in order to show tangible gains, it’s hard to understand why now is the time to cut back,” Collins argued.

But Goosby explained the cuts are being made for three reasons. The first is because they are “getting better and smarter” in service delivery, such as procuring and shipping commodities like condoms and test kits at cheaper costs and favouring less expensive generic drugs over pricey brands.

“We also started a dialogue (this… was an attempt to try to make these services sustainable, not just dependent on one funder) with governments around what their contribution was now to these services and what they could be. And governments all heard this and [began] to pour… their own money into the service pot,” he told IRIN. “So, again, it would be additives, so we can build on what we have already started… with a donor-start but it is a government finish.”

The US is also looking to more cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria to raise funds to pay for the HIV prevention and treatment programmes, according to Goosby, who says the US donates a third of the money that goes to the Global Fund.

“So we think of it as a shared responsibility… We see our ethical obligation to the patients that are using these services… We will not renege on that. But we also feel that in order to make sure these services continue, we need to diversify the fund portfolio so others are contributing.”

Chipping in

But whether poorer countries in the region will be able to take over the ongoing programmes is a concern for many.

According to the African Union commission, a number of countries have begun to implement innovative AIDS financing measures intended to reduce dependence on external funders such as PEPFAR.

“Zimbabwe and Kenya now earmark a portion of domestic tax revenues for an AIDS Trust Fund, while countries such as Benin, Congo, Madagascar, Mali, Mauritius, Niger, Rwanda and Uganda have established special HIV levies on mobile phone usage or airfares,” said the commission in a statement issued on May 26. “Taking a different approach, South Africa reduced its spending on antiretroviral medications by 53 percent by reforming its tender process to increase competition among suppliers.”

“Our continent is demonstrating strong political commitment and action by embracing transformative reforms to address AIDS, TB [tuberculosis] and malaria,” said the commission’s chairperson, Nkosazana Dlamini Zuma.

PEPFAR’s Goosby agrees it is not yet time to scale back the fight against HIV/AIDS. “If we pull back on what we are doing for HIV, it will come right back, without any doubt. We see that in just about every infectious disease, but HIV is notorious for this. So keeping this going becomes the challenge. That’s why we want to emphasize the shared responsibility.”

kta/kn/rz  source http://www.irinnews.org

 

Mozambique’s first HIV vaccine trial underway

Photo: Zadylmg/Flickr

HIV vaccine trial underway

MAPUTO,  – Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country’s increased HIV research capacity.

Last month, Researchers at Mozambique’s Polana Cancio Centre for Research and Public Health completed a trial evaluating the safety of an HIV vaccine candidate. The study was conducted through the UK HIV Vaccine Consortium’s Tanzania and Mozambique HIV Vaccine Programme (TaMoVac). Preliminary results from the Phase I trial indicated the vaccine was safe, but researchers say it will be months before they know if the vaccine produced an immune response in participants.

The country also launched its second HIV vaccine trial, this one of a Phase II HIV vaccine candidate, also through TaMoVac, this week. As part of this multi-site study, which is taking place in both Mozambique and Tanzania, Mozambique will recruit 20 percent of the 200-patient sample.

According to Ilesh Jani, director general of Mozambique’s National Institute of Health, the studies, while small, mark important first steps towards bolstering clinical trial and research capacity for diseases such as HIV and malaria. These diseases, along with malnutrition, continue to drive death rates in the country.

“We should be in the driver’s seat, not sitting in the back of the car waiting for someone to find the answer,” Jani told IRIN/PlusNews. “We need to get involved and take leadership to find the solutions.”

“Maybe we don’t yet have the capacity to develop these products in the lab, but we have the capacity to test them and accelerate discovery,” he added.

Larger HIV vaccines trials in the pipeline

The centre – which is located on the outskirts of the capital city, Maputo – aims to help the National Institute of Health understand the health concerns of the country’s increasingly peri-urban population.

“Maybe half of Mozambique will be living in peri-urban areas in the next 10 years,” Jani said. “It’s a setting where we don’t completely understand the determinants of health.”

Understanding these determinants will require household mapping and an HIV prevalence study. Researchers at the centre expect that this study will show an HIV prevalence rate of at least three percent in the local community.

If this is true, Polana Cancio could become a clinical research site for larger, more advanced HIV vaccine trials. Nationally, Mozambique has an HIV prevalence rate of about 11 percent, according to UNAIDS.

The centre will also be conducting a study into common causes of fever.

Jani added that, while it might not be possible for the all the products tested by the centre to enter the market patent-free, he hopes that products tested at the centre – and found to be effective – will be affordable for use in countries like Mozambique.

llg/kn/rz source http://www.irinnews.org

Undocumented migrants struggle to access healthcare

NAIROBI,  – Europe’s financial crisis and rising xenophobia are complicating access to medical treatment for undocumented migrants, according to a&nbs p;new report by the international NGO Médecins du Monde (MdM).

“Soaring unemployment rates, rising child poverty, people losing their homes because of insolvency every month… The social systems in Europe are quaking under the strain,” the authors say. “The crisis has generated austerity measures that have had a deep impact on all social safety nets, including healthcare provision.”

“The economic crisis, rising unemployment and lower levels of social protection all too often lead to the finger being pointed at groups that were already facing social exclusion before the crisis, eg, sex workers, migrants and Roma [a marginalized ethnic community,” they added.

Because migrants from countries with high HIV prevalence represent a significant number of diagnosed HIV cases in the European Union (EU), analysts fear that their exclusion from healthcare could lead to public health problems. In 2010, the European Centre for Disease Prevention and Control (ECDC) reported that approximately 35 percent of new heterosexual infections in the EU were diagnosed in migrants from sub-Saharan Africa; around 60 percent of these cases were reported in Belgium, Sweden and the UK.

Poor access to care

“Undocumented migrants with HIV/AIDS are one of the most vulnerable groups in Europe today. Undocumented migrants have very limited access to healthcare services, receiving only emergency care in many EU member states,” Elisabeth Schmidt-Hieber, communications officer for the NGO Platform for International Cooperation on Undocumented Migrants, told IRIN. “Those with HIV/ AIDS often face insurmountable barriers to accessing prevention, diagnosis and treatment, both of the virus and of other illnesses arising from their health condition.”

Language barriers, integration problems and poor socioeconomic status make migrants even more prone to exclusion from healthcare.

Although a few countries, such as Italy, make a clear commitment to providing life-prolonging antiretroviral drugs (ARVs) to undocumented HIV-positive migrants who need them, most countries do not. A 2012 ECDC report notes that antiretroviral therapy (ART) is not available to undocumented migrants in 16 EU and European Economic Area countries. According to the MdM report, in 2012, the Spanish government reduced public health expenditure from 10.6 percent of the national budget in 2009 to 6 percent in 2012. Spain has since excluded adult undocumented migrants from public healthcare. The country no longer provides HIV/AIDs, cancer, renal failure or hepatitis treatment for undocumented migrants.

In Sweden, HIV and AIDs testing and treatment is only available to undocumented migrants after the full cost has been paid. There is also no access to hepatitis testing or treatment. However, after many complaints from human rights groups, the Swedish government decided to review its healthcare regulations for undocumented migrants and asylum seekers.

There are a few exceptions. In Portugal, antiretroviral drugs are considered so important that they are immediately available to everyone, including undocumented migrants. By contrast, healthcare in general is available only after three months of residence. In 2012, the UK changed its policy on the provision of ARVs to include all people living in the UK, regardless of immigration status.

According to the MdM report, healthcare is being used by some countries to regulate migration flows. In Germany, although access to HIV treatment is provided, civil servants are required to report undocumented migrants seeking health services to the immigration department. Because of this, many avoid any treatment for themselves or their children, even though they are entitled to it. MdM reported that between 22 and 36 percent of vulnerable patients –including undocumented migrants, sex workers and drug users – had quit looking for medical care.

Photo: Zoriah/Flickr

Undocumented migrants have limited access to healthcare (file photo)

The European AIDS Treatment Group (EATG), an organization focusing on drug development, treatment literacy and treatment advocacy, told IRIN that there are signs in some countries that migrants – even those living with HIV – are being deported more actively than before. Through a joint project called REVA, the Swedish police have joined hands with the Migration Board and the Prison and Probation Service to increase the number of deportations. Random identity checks have made many migrants afraid to leave their homes – further limiting their access to care.

Anti-immigrant sentiment, policies

“There is a more active policy of sending back. This [is] clearly to avoid paying [for] HIV drugs… especially if the country of origin has access to certain drugs,” Koen Block, the executive director of EATG, told IRIN.

Rising unemployment due to the economic crisis has also led to an increase in anti-immigrant attitudes. In 2012, the Racist Violence Recording Network reported 87 incidents of racist violence against refugees and migrants in Greece, for example.

In February, the Belgian Public Centre for Social Welfare in Antwerp, headed by a member of the right-wing N-VA party, decided that it would no longer automatically reimburse undocumented migrants living in the city for ARVs, unless they promised to return to their country of origin as soon as possible. Civil society groups who oppose the plan say it is against the law.

Analysts say that these measures, aimed at cost-saving, are counterproductive. “Indirect costs are rising as illnesses become aggravated and chronic as the result of delayed treatment, overcrowding of emergency services and inefficient public health policy,” Frank Vanbiervliet, MdM’s European project coordinator, told IRIN.

According to the EU Agency for Fundamental Human Rights, in 2012, irregular migrants were entitled to emergency healthcare in 20 out of 27 EU member states. Portugal and Greece consider HIV an emergency.) In nine out of the 20 countries – Cyprus, Estonia, Lithuania, Luxembourg, Malta, Romania, Slovakia, Spain and Slovenia – irregular migrants are provided with access to emergency healthcare free of charge. In Austria, Bulgaria, the Czech Republic, Denmark, Finland, Greece, Hungary, Ireland, Latvia, Poland and Sweden, undocumented migrants are entitled to emergency healthcare, but have to pay for it.

In Greece, undocumented migrants have no access at all to healthcare except for emergency care, but only until the condition has been stabilized. Although HIV is considered an emergency, it is unclear what “stabilization” means, says the MdM report.

However, critics say that the term “emergency” is too vague and is already causing confusion. “Do you merely define it as a life-threatening condition that needs attention within the hour to prevent death? What about the woman that is six months pregnant and comes to the hospital with heavy cramps – she also mentions that she has already lost a child before. What about someone with type II diabetes and high blood pressure who risks a serious cardiovascular complication within the next months?” Vanbiervliet asked.

“Merely allowing access to ’emergency care’ puts us in an impossible position as health professionals. We ask for all EU member states to implement the opinions of the EU Fundamental Rights Agency, which means changing restrictive legal frameworks so that everyone can access all forms of essential preventive and curative healthcare,” he added.

lam/kr/rz  source http://www.irinnews.org

 

There is a seven billion dollar gap in global HIV funding

Photo: VladKol/Shutterstock

There is a seven billion dollar gap in global HIV funding

NAIROBI,  (PlusNews) – Private philanthropists in the European Union and the US spent some US$644 million on global HIV/AIDS programmes in 2011, a 5 percent increase from 2010, largely driven by funding from a small number of large donors, a new report has revealed.
In their annual report, two groups – the US-based Funders Concerned About AIDS (FCAA) and the European HIV/AIDS Funders Group (EFG) – reported that US funders spent $491 million in 2011 while EU funders spent $170 million. Although the amount of money donated by private funders grew, the growth could be attributed to a few large donors; several other donors had, in fact, reduced their funding.
“We look at it as level growth; we’ve identified a few new funders, but the growth is mild,” Sarah Hamilton, of the FCAA, told IRIN/PlusNews. “The Bill and Melinda Gates Foundation and a few others are the main donors driving the growth. If you take them out, there was actually an overall decrease in private philanthropy for HIV. The donor field is concentrated at the top; the top ten donors in the US contribute about 80 percent of total funds, while in the EU they contribute about 82 percent.”
“The decrease could be a result of the economy, but we’ve also seen donors become more focused on other areas, some related to HIV, such as maternal health, health systems and reproductive health,” she added.

• Where has the money gone?

An estimated 44 percent of US funding was targeted at programmes with a global aim. East and Southern Africa received $69 million – the most of any region outside the US – followed by South Asia and the Pacific, which received $40 million, and East and Southeast Asia, which got $22 million.
About half of all EU funding in 2011 was targeted at projects in countries and regions outside western and central Europe, while one-third went to programmes with a global aim. Twelve percent of EU funding was spent in western and central Europe.
Much of the funding was directed towards research; the top target populations for US funding were medical research teams and projects focusing on women, men who have sex with men, and youth. The EU funders mainly targeted orphans and vulnerable children, youth, and women.
“Private philanthropy has the advantage of being better able to support programmes that may not receive adequate government funding or support. Some of the areas with gaps in funding are, in the US, men who have sex with men, and worldwide, prevention of mother-to-child transmission,” Hamilton said.
She noted that trends towards “non-restricted” and “multi-year” funding indicate donors have confidence in the accountability and impact of the programmes they support.

• Shared responsibility

The report’s authors note that 2012 funding is forecasted to remain level. Experts are calling for greater funding, not only from the private funders but also from western governments and beneficiary nations.
Low- and middle-income countries are increasing their contributions to the HIV response, investing  some $8.6 billion in 2011, an increase of 11 percent compared to 2010, according to a UNAIDS reportreleased in July.

The donor field is concentrated at the top; the top ten donors on the US contribute about 80 percent of total funds, while in the EU they contribute about 82 percent

The international community contributed $8.2 billion.
“We are in an era where shared responsibility for the AIDS response is vitally important. Countries are stepping up their domestic investments for HIV, but there is still a $7 billion gap between what is needed and what is available,”

Paul De Lay, deputy executive director for programmes at UNAIDS, said in a statement. “Philanthropic investments for AIDS are extremely important, particularly in supporting civil society-led engagement, which can often be missing from larger-scale donor-funding plans.”
Hamilton said the FCAA and the EFG were working to identify new funders, both in the west and around the world.
“Regardless of the numbers, we are proud of and excited by the funders’ support, especially in these economic times,” she said. “As the report notes, there has been a decline in funding – we need to build on the political and financial commitment to HIV.”

 
kr/rz

source http://www.irinnews.org

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IMF recommends land reforms

Photo: James Hall/IRIN

Cattle grazing on Swazi Nation Land

JOHANNESBURG, – Land reform has been recommended by the International Monetary Fund (IMF) as part of the solution to deepening economic decline in Swaziland, a country where more than two-thirds of the population lives in poverty.
Following a two-week visit by a delegation, the IMF announced, in a 7 November statement, that one of the key challenges facing Swaziland – in addition to high unemployment, rising inequality and the world’s highest HIV/AIDS prevalence – is “improving access to modern financing by an appropriate land tenure reform.”
Dimpho Motsamai, a researcher from the Africa Conflict Prevention Program at the Pretoria-based think tank Institute for Security Studies (ISS), told IRIN, “It is refreshing land [in Swaziland] is being highlighted as part of the solution to poverty” by international institutions.
Swazi Nation Land Swaziland has dual system of land ownership, in which some people have title deeds while the majority live on Swazi Nation Land (SNL). SNL is often referred to as communal land, although communal land practices apply only to non-arable and livestock pastures. Land used for crop production is individually held and allocated by chiefs, who also act as arbiters in land disputes.

SNL is held in trust by King Mswati III, sub-Sahara’s last absolute monarch, forming the bedrock of his power base. The king imposes his authority through a chieftain system in rural areas, which comprise about 60 percent of the country’s land mass.
Those residing on SNL have no title deeds and can be evicted by the chiefs without recourse. Without title deeds, subsistence farmers have no collateral to raise the funds needed to undertake basic improvements, such as irrigation systems, that would increase their yields. As a result, many farming practices are rudimentary, and many people are vulnerable to food insecurity.
Mandla Mduli, a trade unionist and member of the Swaziland Solidarity Network, an umbrella organization of pro-democracy groups, told IRIN, “Land reform as recommended by the IMF will not be done because the system keeps the royal family in power. Seventy percent of Swazis live on these lands that are, in effect, owned by the royal family and run by chiefs appointed by the king. Anyone who joins a [opposition] political party is exiled [from SNL].”
Declining maize production
The preliminary results of the World Food Programme’s (WFP) vulnerability assessment estimated that this year’s harvest of the staple maize was 76,000 tons – over 8,000 tons lower than the previous season.
“About 116,000 people, or 11 percent of the population, will experience food shortages in the lean season before the next harvest in May 2013,” the assessment said.
Swaziland’s maize production has been declining since 2000; previously the country produced about 100,000 tons of maize annually. WFP attributed the slump to “erratic weather, high fuel and input costs, the devastating impact of HIV and AIDS, and a decline in the use of improved agricultural practices and inputs.”
A national land policy was drafted in 2000, outlining a national development strategy for land and rural development, but the policy was never implemented. An agricultural academic at the University of Swaziland, who declined to be identified, told IRIN, “The policy was never adopted, as it would have taken power [over land matters] away from the chiefs, and the chiefs enjoy their power.”
The academic said there is “absolute disorder when it comes to land” in Swaziland. There is widespread corruption, SNL is being sold off without any official documentation by chiefs and “people pretending to be chiefs”, and land allocation is used as an instrument of political patronage.
Problem worsening
A 2010 report published by the University of the Western Cape’s Institute for Poverty, Land and Agrarian Studies(PLAAS) said, “Swazi citizens are increasingly losing their hold over the land as the population increases and the demand for land intensifies. The continuance of poor land administration in the face of the continuing challenges of population growth has already had massively harmful social and economic consequences, which will only worsen until the nettle of land reform is grasped.”

It’s land reform of land owned by one guy essentially

ISS researcher Motsamai said land reform is “very controversial” within the country, as it is not a question of land redistribution “from colonizer to colonized,” but of taking power from the “entitlement of a royal household”.
“It’s [proposed] land reform of land owned by one guy essentially,” she said.
As those living on SNL cannot afford to purchase or lease the land, one consideration could be to nationalize it, but in that scenario, the state would take ownership of the land when the “king is the state,” she said.

 
go/rz

source http://www.irinnews.org

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Media still need training on HIV

NAIROBI, 1 November 2012 (PlusNews) – Scourge. Plague. Killer disease. All are terms still routinely used by Kenya’s media to describe the HIV epidemic more than thirty years after it was first identified. Experts say the media needs to step up to promote a better understanding of the illness.

“The use of words like ‘scourge’ or ‘sufferer’ in the media to refer to HIV/AIDS or to people living with it… shows the disease is such a bad thing, yet there are people living with it, and examples are countless, who are doing normal things and leading normal lives,” Allan Maleche, a human rights lawyer and head of the Kenya Legal and Ethical Issues Network on HIV and AIDS, told IRIN/PlusNews. “Stigma has been one of the issues that helped HIV to spread, and there is need to train the media on how to report HIV in less stigmatizing ways.” Media outlets often concentrate on the more salacious or scandalous details of stories involving HIV rather than the more informative, educational aspects. One woman interviewed by a Kenyan TV station earlier this year told IRIN/PlusNews of her disappointment when the story was broadcast. “The journalists dwelt mainly on how I got infected instead of how I protected my unborn child from infection, which was my main aim of calling the journalist,” she said.

• Difficult to cover

Journalists IRIN/PlusNews spoke to said stories about HIV were more difficult to cover than other news stories, involving in-depth research, a strong understanding of scientific subjects and tough interviews dealing with very personal issues. “Covering HIV and AIDS is… a sensitive area and… you have to look at issues from the [position] of the interviewee… People living with HIV are often misjudged, blamed for ‘getting it’, which in turn leads to their being stigmatized and shunned,” Waweru Mugo, a freelance Kenyan journalist who has written extensively on HIV, told IRIN/PlusNews. “This therefore requires a journalist to be careful with the language [so] that [it] does not discriminate and stigmatize further.”

“I suggest that journalists are trained and retrained in the use of language, for it requires ethical and professional handling,” he added. Jane Thuo, chief executive officer of the Association of Media Women in Kenya, noted that there is a need to ensure HIV continues to receive press coverage amid newer, equally serious

health issues such as cancer and other non-communicable diseases.

• Training

In 2002, the Coalition of Media Health Professionals produced a guide to reporting on HIV for Kenyan journalists in an effort to boost journalists’ sensitivity on the subject. But experts say there is a need for specific training for journalists who write about HIV. One such  training, sponsored by the International Planned Parenthood Federation (IPPF), was recently held in the Kenyan capital Nairobi. Tom Japanni, a senior BBC producer and trainer for the two-day workshop, noted that journalists were well placed to simplify the medical terminologies and disseminate them to the society.

“We are advantaged to be able to interpret health-related research findings, parliamentary bills and other related instruments, even in our local languages,” he said. “That is all the more reason journalists should be well equipped to deliver the correct information to the society. You must be informed for you to inform others.” “There are people in Kenya who still do not understand HIV beyond transmission, prevention and treatment,” Helen Barsosio, a Kenyan-based reproductive health researcher and the technical advisor on HIV programs for the NGO HOPE worldwide, told IRIN/PlusNews. “This kind of training is ideal for journalists to enable them to understand the correct language to use while reporting and to identify the stories within the HIV main story.”

• Having an effect

“We train the journalist on the art of interview, among other areas,” said Anne Mikia, a radio specialist and trainer at Internews, which supports local media around the world. “Interviewing a person living with HIV needs a lot of skill, lest you offend the interviewee.” Although Mikia says it is difficult to measure the impact of their trainings, she noted that stigmatizing language and pictures were on the decline in most major media houses. “The trainings… go for only one week, and that is not sufficient for a journalist to acquire absolute effective skills on HIV reporting,” she added, noting that journalists need to use their own initiative to develop the skills to report on HIV. A local network of HIV-positive journalists is also playing a role in improving reporting on HIV in the media. “We realized that journalists rarely speak about themselves but report only what others have said or done.

As journalists living with HIV, we can easily address HIV issues because we relate with them,” said Elvis Bassudde, chairman of the East Africa chapter of Journalists Living with HIV/AIDS. “A journalist living with HIV and who sits in an editorial committee can [more] easily campaign for a space for an HIV story than one who is not.” lm/kr/rz source www.irinnews.org