Dec 1, 2009, World AIDS Day, was celebrated in India with much gung-ho; the health ministry of the Government of India patted itself on the back for the overall drop in the number of HIV positive people in the country – by around 400,000, while the drop in new HIV cases came down to 100,000 per year,.

While this news is indeed encouraging, the question is India in a AIDS-safe zone? India is the third largest nation with HIV AIDS after South Africa and Nigeria, being home to 2.3 million AIDS victims.

How can we fight this debilitating disease? What are the facts on this deadly condition called AIDS that we must know.

AIDS, the abbreviated form of Acquired Immune Deficiency Syndrome, is the advanced stage of infection by Human Immunodeficiency virus.

AIDS is a global pandemic, and nations across the world are fighting it.

How AIDS spreads: You can contract the infection by having unprotected sex with an infected partner, transfusion of infected blood, or sharing of infected needles. It can pass on to the unborn child of a pregnant mother, who has tested positive for the HIV virus; or after childbirth through breastfeeding;

Signs and symptoms of AIDS may not appear immediately after one contracts the HIV virus infection; in fact, it may take as many as ten long years for the HIV virus to manifest into AIDS, and destroy the body’s immune system completely.

Can AIDS be treated completely? No, it cannot. But it is possible to survive if detection is early by administering antiretroviral therapy as advised by doctors.

Once tested positive for the HIV virus, the victim must make contact with ICTC (Integrated Counseling and Testing Centers).

For almost 20 years, Thailand has been the focus of an intensive effort to stop the spread of HIV/Aids among the population of approximately 65 million.

A survey in 1988 found that 44% of sex workers in Chiang Mai in northern Thailand were already infected with HIV. But it was not until 1991 that the government got serious in its efforts to curb the spread of the infection.

Eventually greatly increased budgets led to a massive public information campaign on the dangers of AIDS. The government also introduced a “100 percent condom program” in which condoms were distributed free to brothels and massage parlours, and sex workers were required to use them. Brothels that did not comply were closed.

As a result of these and other programs, the number of new HIV infections was reduced from 140,000 in 1991 to 21,000 in 2003. Still, 1% of the 65 million people in Thailand are infected with HIV, and AIDS has become the leading cause of death.

It is projected that more than 50,000 Thais will die each year from Aids-related causes, at least until the end of 2006. More than 90% of these deaths will be young people aged 20-44.

So although a concerted effort has been made to stem the tide of HIV infection in Thailand, the success rate has only been moderate. And little has been done to stop infection amongst injecting drug users (IDUs) who share needles.

Most new infections still start with sex trade workers or IDUs and within two years are passed on to spouses.

Thailand to donate 50,000 condoms to Africa

In a move consistent with their own moderate success at fighting HIV/AIDS with condoms, the Thai government announced they were donating 50,000 condoms to seven African countries as part of their “forward engagement” program to help with the UN effort to fight HIV/Aids in Africa.

The condoms will be provided by Thailand’s foreign and health ministries and shipped by the United Nations Development Programme to Burkina Faso, Ghana, Kenya, Gabon, Mali, Nigeria and Uganda.

Sub-Saharan Africa is the most heavily infected area in the world. An estimated 25.8 million people had been infected by HIV at the end of 2005 and approximately 3.1 million new infections occurred during last year.

Apart from abstaining from sexual contact altogether, the use of condoms is the only effective means to help prevent the spread of HIV/Aids and other sexually transmitted diseases.

Donation of condoms condemned by Nigerian Archbishop

In an announcement that underscores the debate taking place in many countries over tactics being used to fight the spread of HIV/AIDS, a leading Thai Catholic Archbishop voiced strong opposition to ongoing distribution of condoms.

In spite of its endorsement by the U.N. the condom donation annouced by the Thai government has been vigorously condemned by Nigerian Archbishop Anthony Cardinal Okogie. He described the move as immoral and quite likely to promote irresponsible sex and promiscuity.

In a press release he said, “Do they know the effect of the production to the youths and the nation? The government should fight poverty, hunger, sicknesses, diseases, and the lack of social amenities plaguing the nation, instead of fighting AIDS with condom production,” he stated.

He also opposed any NACA (National Action Committee on Aids) Bill before the Nigerian National Assembly that included manufacturing of condoms in Nigeria, saying; “it will encourage immorality, sex on demand, promiscuity, irresponsibility and prostitution. Condom, knowingly and intentionally, offends the ends of marriage, which is procreation and says no to the bearing of children but promiscuity.

“It is unfortunate that while other embassies are promoting trade, bilateral relations, we are encouraging cheap money and cheap production of condoms to encourage our youths on immorality.”

Rick Hendershot publishes Linknet News. See how to promote your website with articles [http://www.linknet-promotions.com/linknet-news.php] and blog posts.

Although Bangladesh continues to be a low prevalence area, it is surrounded by high prevalence countries (High prevalence of HIV/AIDS in neighboring India). We however must not adopt a complacent attitude in respect as our country has all the determinants for an explosive outbreak of HIV/AIDS epidemic. Curses of poverty, illiteracy, ignorance, proximity of Bangladesh to the so-called ‘Golden Triangle’ & high prevalence of STDs, make our country seriously vulnerable. Drug use increases the HIV risk and can start very early-for example, glue-sniffing by youngsters living or working on the streets. The danger of becoming infected with HIV by sharing injecting equipment is well known, and real. Unemployment, slum housing, family fragility, frequent cross-border movement of people, lack of information, unsafe blood transfusion, physical and sexual abuse-that create a “risk environment” of violence for many young people in the region. In addition increased number of migrant workers, unsafe practice in health service, unsafe sex practice etc. movement of population, less use of condom, polygamy, homosexuality, extra-marital relations, further increases the susceptibility.

In Bangladesh, the intravenous drug users (IDU) are the most potential carriers of HIV/AIDS among the vulnerable groups in the country. The fourth round of national HIV and behavioural surveillance report showed that the HIV infection rate among the injection drug users (IDUs) is now 4 per cent, up from 2.5 per cent previously which is just short of the 5 per cent mark of a concentrated epidemic. About 93.4 per cent IDUs in central Bangladesh admitted that they share same syringe while taking drugs. Even they use the same syringe several times for taking drug.

UNCDP estimates that between 500,000 and 1,00,000 people in Bangladesh are addicted to drugs. Although HIV rates are comparatively lower (one per cent) among the sex workers but Sexually Transmitted Infection (STI) rates are still quite high (20 per cent) among this group.

On the other hand, brothel-based female sex workers in Bangladesh report the highest turnover of clients than anywhere in Asia (an average of 18.8 clients per week).

Meanwhile, most of the people of country are unaware about the deadly disease. The 1999-2000 Bangladesh Demographic and Health Survey found that only 31 per cent of married women and 50 per cent of newly married men had heard of AIDS. Over 90 per cent of rickshaw pullers could not identify a single method of HIV prevention.

About 13,000 to 17,000 people are living with the incurable virus in Bangladesh, according to the UNAIDS report 2001.

According to the National AIDS Committee and surveillance team members and experts, the rate is quite alarming as it remains one per cent less than the highest five per cent HIV epidemic index. The rate of HIV/AIDS remains less than one per cent among the other vulnerable groups — truckers, migrant workers, gay, hijras (hermaphrodites), professional blood donors, heroin smokers and, hotel, brothel and street based commercial sex workers.

Bangladesh is bordered with India, the second largest HIV infected country in the world; the country is therefore at high risk for the HIV epidemic, said Morten Giersing, UNICEF’s country representative.

Mohammad Khairul Alam Executive Director ‘Rainbow Nari O Shishu Kallyan Foundation’

24/3 M. C. Roy Lane Nowbabgonj- Section Post Cod- 1211, Dhaka Bangladesh Tel: 88-02-8628908 Mobile: 0171344997 Email: Rainbow.Foundation@gmail.com Web: [http://www.plusbangla.com/shaheen]

MSS (Master in Social Science) Subject- Social welfare, Dhaka University

Father’s Name : Al-Haz Dr. MD. Abdul Matin

Mother’s Name : Ms. Kadija Matin

Date of Birth : 29th October, 1970

Nationality : Bangladeshi (by birth)

Specialization synopsis

HIV/AIDS program consultant

-Have a sound experience in research and development field. -Good competency in research, planning, monitoring and evaluation; Participated in a number of International Seminars, Training Programs and Workshop. -Smoothly participates in PPME (participatory Planning, Monitoring and Evaluation) -Proficient in Non- Formal Education, Technological Based Education, Gender, HIV/ AIDS Project Proposal writing, Reporting, Project Design, Strategic Planning etc.

The range of social, economic and political issues concerning HIV and AIDS is vast and complex. The impact of this pandemic will only be known in future generations. It is an established fact that HIV/AIDS has significantly reduced life expectancy, educational gains have been reversed, poverty increased, and it has eroded economic growth.

Other longer-term effects concern urban-rural disparities in terms of all aspects of service and development. Conversely, the concerted efforts to deal with all these issues has increased awareness and efforts concerning gender equity, primary health and capacity, and mobilised diverse organisations in the pursuit of common objectives. If anything else, profound change – both negative and positive – has, and is, occurring as a direct result of HIV/AIDS.

1. In my view, there are a number of options available to not only accelerate the attainment of the various MDG objectives, but also to improve the effectiveness of diverse efforts. Probably the most important is a re-evaluation of the fundamental value bias of primarily Western-based agencies: In Africa specifically, the foundation of social norms is a group-mindedness, whereas Western-based social norms are focused primarily upon attainment of individual actualisation. This may not appear significant, but this bias has impacted upon delivered programs and methods in profound ways: The ethics of confidentiality in individual testing and counseling, versus relationship or group-based procedures, is such an example. Without the structures of individual confidentiality – both in counseling and medical treatment – the scope of efforts could be significantly broadened, and the relational basis of the pandemic could be more effectively – and rapidly – addressed. Recent research concerning concurrent relationships clearly indicates that it is not sexual frequency that is driving the pandemic, but rather the nature of sexual relationship networks. I believe it is time we deal directly with those relationships, versus its’ individual parts, in both testing, prevention, and treatment.

How do you apply group-mindedness in practice? Setting aside the implied legal changes required, what I would like to see is: Couples counseled and tested for HIV, together, not separately; Family units treated medically, such as with ART. Quite literally, a family – such as the husband and wife – going through the medical testing for CD4s and viral load together, knowing each other’s results, and then being treated with the full knowledge (and counseling) of both persons. This should address many of the non-adherence problems, including the rise of drug-resistant strains of HIV. More controversially, the Zero Grazing (Uganda) model should be revived, where family, friends and neighbours are encouraged to name-and-shame community members who are being unfaithful to their primary relationship, thus reducing the ease of engaging in concurrent relationships. Essentially I am proposing behavior-change methodology that focuses upon group and relationship dynamics, versus individual decision-making.

Recommendations:
(a) VCT: Redesign/expand protocols to include couple/family HIV testing and pre/post-test counseling. I.e., all stages of the process conducted in the presence of both persons (or family members);
(b) ART: Medical examinations, diagnosis, explanations conducted in the presence of a family member/spouse.
(c) Prevention: Revive/adapt the Zero Grazing model to focus upon reducing multiple concurrent relationships.
(d) Create processes that enhance relationships including but not limited to increasing levels of intimacy, communication, trust and combined future dreams/plans that both partners desire.
(e) Adopt mandatory counseling sessions within the workplace with opt-out testing.

2. Secondly, with exceptions, leadership at the macro-political leadership level is weak or absent in terms of setting the social normative tone for the changes that are required. Instead, leadership tends to be overly concerned with being seen to be cut from the same cloth as their constituents, versus leading those constituents through difficult changes. The need for popularity supercedes the desire for effectiveness. This is partly associated with the post-colonial desire to build identity and esteem through adherence to cultural values, some of which directly impede the attainment of the MDG objectives. This is particularly the case with gender-related social norms, and the role of women in positions of authority. Although great strides – legally and constitutionally – have been made in this regard, it is simply not enough, and certainly not implemented with great vigour.

It is a fact that one of the primary drivers of the spread of HIV is concurrent relationships, which has many roots, some cultural (polygamy), and some economic. However, this form of open-ended polygamy results in a radical increase in transmission of HIV during the acute infection stage, the Window Period. Regardless of our desire to be value-neutral in this regard, we have few options in eliminating this wide-spread practice. We have almost no chance of changing this practice when our leaders openly have multiple partners, some long-term, and some casual. Until they – the leaders – change, the populace will resist monogamy. The alternative is to legalise and normalize multiple partnerships in such a way that the responsibility to economically support and care for a second or third partner is legally enforceable, similar to closed polygamy, but with the emphasis upon full economic responsibility. This approach should resonate with many people who refer to ‘traditional values’ – which included polygamy – with penalties for breaking the rules. This should, if done carefully, reduce the casual sex, and also the Sugar-Daddy (or Sugar-Mommy) and similar situations, which is based upon attaining economic support. A simple avenue to implement this would be to reduce the period of time required for a relationship to be recognized as Common Law marriage, increase the amount of spouses permitted per person, and then implement an advocacy campaign educating people about their rights under this system. The bottom-line with this proposal is: If you want more than one partner, then you’d better be ready for the economic and legal consequences.

Recommendations:
(a) Implement a scorecard for politicians and community leaders which includes knowledge level of HIV/AIDS, and also the number of public statements/projects delivered – personally – regarding HIV/AIDS, poverty, and other MDG goals.
(b) Evaluate traditions and customs that enhance and reduce the attainment of MDG goals. Facilitate public discourse on these beliefs, customs and traditions.
(c) Evaluate the existing legal framework regarding multiple partnerships. Consider legal changes to strengthen the economic and legal rights of concurrent partners, to bolster the level of responsibility of the common partner, in order to close what is currently an open polygamous system.
(d) Conduct a public advocacy campaign to make concurrent partners aware of their legal and economic rights, with respect to the common partner.
(e) Revisit current legislation on the paternal laws that hold men accountable for their off-spring to lessen the burden on State systems.

3. The third major factor concerns the urbanisation of our populations, and the economic power of these urban areas: Rural areas are simply neglected or given token attention. The reality is that many governments and businesses are applying an utilitarian approach to the rural areas: It is – per person – more expensive to develop rural areas, compared to the more densely populated and economically active urban areas. The current focus is primarily upon job creation – which mainly focuses upon urban areas – and the needs of urban populations, while the food production, education, medical care in rural areas are given second place, consistently. The general situation – at least in terms of HIV and AIDS – is that if you are employed in an urban area and have HIV, you will be okay. However, if you live in a rural area, the outcome is dire. This does not only apply to HIV and AIDS – it is a generalised scenario in terms of education, medical care, and service delivery of basic services. As a result, the migration from rural to urban areas continues relentlessly, with a resulting decrease in food production, for example. We sorely need greater attention for the development of rural areas to counter this increasing marginalisation and impoverishment of large sections of our populations. Young people in particular would prefer to be unemployed and living in fringe suburbs, than work on land inherited from their family. This is a direct result of social marketing, which depicts farming and food production as the domain of the poor and uneducated. We need the social status of rural areas to be increased and enhanced, making activities such as farming a desired career and future, particularly with younger people.

Africa – with South Africa as an example – is hell-bent on economic development, as this generates the revenues for the various services the government is obliged to provide. However, in this process, the ability of the population to support and feed itself through homestead farming is neglected in favour of commercial farming. Tremendous dependency is being created upon industry and government services, with little attention given to increasing the capacity of individuals and families to take steps to improve their own food security (e.g., home gardens), and entrepreneurship (self-employment). These two areas need a great deal of attention, if we are to uplift both rural and urban areas from unemployment and poverty: The current mind-set is that if you are not employed or on a government grant, your prospects are dim. Although programmes exist for developing entrepreneurship, these are weak, half-hearted, and limited. Entrepreneurship should be a key subject of education in the education system.

The rural areas in particular require far more development in terms of quality education for children, skills development (e.g., improved farming methods, homesteading), and adult literacy programmes. Primary health services are in dire need of improvement and expansion. If we could double – even treble – the number of primary health nurses in these areas, and also capacitate them to assume the responsibilities of diagnosing and prescribing medications such as ART, we may start to address the severe shortages of doctors in these areas, thus stopping the worsening poverty cycle caused by removing children from school to take care of sick family members, and also adults who would be otherwise engaged in food production. We bemoan the poverty and dire circumstances of many communities, and ask how we can ‘save them’. However, we fail to recognize that those communities have the inherent ability to ‘save’ themselves, given the necessary information, education, and start-up resources. We need to end the hand-out era, and start the hand-up process: When dependency decreases, so does poverty. When self-reliance increases, so does pride and productivity.

Recommendations:
(a) ‘Create your own job’: Raise awareness and knowledge regarding entrepreneurship at all levels of society, including at secondary schools. Local, regional and national competitions which promote and reward such activities – including in the rural areas – would facilitate such awareness, status, and skills.

(b) Significantly increase the budgets and efforts focusing upon self- and family-sufficiency regarding food security. This would include practical support regarding seed and fertilizer supplies, skills transfer regarding issues such as soil quality, water-wise methods, crop rotation and/or intercropping. Such efforts could be implemented at all primary and secondary schools, not only to provide food to the children, but also to provide the venue for such skills development. Include such activities in annual performance assessments of such schools and personnel.

(c) Expand the role of Dept Agriculture extension workers to support and capacitate homesteads in food security, versus focusing primarily upon commercial farming. Development and research into non-hybrid seed varieties to encourage seed banking, and thus sustainability of such food security methods. Dry-land and permaculture methods (e.g., mulching, recycling used water) to be refined and promoted. I.e., reduce the dependency upon purchasing processed foods of low nutritional value, and increase self-produced home produce.

(d) Raise the awareness of homestead food security methods through the media (television, radio, newspapers), with regular awards to raise the status of homestead food production.

(e) Revise the policy and education structures to expand the capacity of nursing personnel to diagnose and dispense medications such as ART and prophylaxis.

(f) Elevate the status of the nursing and teaching profession to attract more applicants from schools. Make such recruitment a national strategic priority.

(g) Attach conditions to receipt of social grants for the unemployed. For example, attendance of skills training (including entrepreneur-related and food security methods), and demonstrations of application.

(h) Introduce micro-lending systems to stimulate economic activity in rural settings, giving people basic business education to ensure sustainability.

(i) Utilize Post-Test clubs in rural settings to support healthier living through health empowerment programs and education.

It is high time we started having some very challenging, courageous and difficult conversations if we hope to be truly effective. We need to have the courage to challenge so-called ‘norms’ that are sustaining this pandemic once and for all.

A commentary by David Patient- Person living with AIDS since his diagnosis with GRIDS back in March, 1983

David Patient is one of the longest documented people alive in the world today living with HIV.
He was diagnosed with GRIDS, which later became more commonly known as HIV/AIDS.
He has been an activist and advocate for the rights of those living with and affected by HIV/AIDS, initially in the United States from 1983 till 1995, when he returned to Africa where he has worked ever since.
He is an author of several best-selling books and is an international facilitator and program designer in the areas of health, behaviour change and thought leadership.

http://www.davidpatient.com/