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Uganda Steps Backward with Anti-Gay Legislation

News from Uganda that the government is seeking to reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality” will only serve to drive people of same-sex orientation underground. The implications for public health efforts are dire, and there is no doubt that if the bill is passed into law, it will deal a body blow to HIV prevention efforts.

In Uganda, as in many parts of Africa, the health of Lesbians, Gays, Bisexuals, Trans and Intersexual Peoples is marginalized. This sub-group is already faced many challenges including HIV, STDs and STIs, and mental health problems due to lack of access to services.

“This bill is a blow to the progress of democracy in Uganda,” said David Kato of Sexual Minorities Uganda. “Its spirit is profoundly undemocratic and un-African.”

According to the International Gay and Lesbian Human Rights Commission the Ugandan Parliament is now considering a homophobic law that would reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality.”

The Anti-Homosexuality Bill of 2009 targets lesbian, gay, bisexual, and transgender (LGBT) Ugandans, their defenders and anyone else who fails to report them to the authorities whether they are inside or outside of Uganda.

The proposed law will effectively criminalize homosexuality, and consequently bar any person of same-sex orientation from seeking public health services. Read the rest of this entry »

Lack of HIV Prevention Services for the Displaced

The power of education in fostering a better and effective response to HIV and AIDS is undeniable.

Education promotes knowledge and with knowledge about HIV and AIDS, individuals, families and communities have the ability to make informed choices about their behavior.

However, governments and international donor organizations often underplay this important intervention, particularly in the emergency phase of the cycle of displacement, says a report recently issued by UNHCR and UNESCO on the importance of education to populations that find themselves victims of displacement due to conflict, disaster or other emergencies.

Education can play a key role in helping refugees and internally displaced persons (IDPs) cope with the negative excesses of their circumstances, such as ignorance, exploitation, violence and the risk of HIV infection.

Many factors combine to put IDPs and refugees at the risk of HIV infection, including loss of livelihoods, lack of access to basic services, poverty, alcohol and drug abuse, and violence. Read the rest of this entry »

The Great Vasectomy Fear

For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.

According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.

“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report.  But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”

The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.

The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Read the rest of this entry »

In Jamaica and Globally AIDS Stigma Barrier to Progress

In 2005, Jamaica – a country notorious for homophobia predominantly channeled through musical lyrics – received global attention for the killing of Lenford “Steve” Harvey, a gay man and an AIDS activist.

Harvey’s murder was blamed on stigma and discrimination against gays, and led to a huge outcry within the AIDS community.

The witch hunt against homosexuals in the country is regarded as a factor contributing to the spread of HIV, the virus that causes AIDS.

According UNAIDS, the national HIV infection rate in Jamaica is 1.5 percent among an estimated 2,700,000 people, and AIDS is the leading cause of death among 15- to 44-year-olds. Predominant modes of HIV transmission include multiple sex partners, history of sexually transmitted infections, drug use, and unprotected sex among men who have sex with men.

It is estimated that 33 percent of gay men in Kingston, Jamaica’s capital city, are HIV positive, but many of them opt to stay underground, away from public health services due to fear of stigma and discrimination. Read the rest of this entry »

A Question of the Cutting Edge: Male Circumcision & HIV

Male circumcision (removal of the foreskin of the male penis) is increasingly gaining currency as an alternative method to reduce HIV-infection. In sub-Saharan Africa, the worst affected region in the world, male circumcision (MC) could prevent six million new infections, researchers say.

In fact, evidence from observational studies in sub-Saharan Africa has shown that circumcised men have a lower risk of acquiring HIV infection than uncircumcised men. A study in South Africa showed that male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The study focused on 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Of these, half were randomly selected for circumcision while the other half remained uncircumcised and served as a control group.

For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study.

The argument is that the inner surface of the foreskin contains Langerhans celles, which have HIV receptors, and is also vulnerable to traumatic epithelial disruptions during intercourse. Second, an intact foreskin exposes a man to a greater risk of ulcerative sexually transmitted infections, which in themselves are a risk factor for HIV acquisition. Furthermore, the virus’ chances of survival might be higher in a warm, wet environment like the one under the foreskin. Read the rest of this entry »

Young Zimbabweans Face HIV Risk As Hard Times Hit

Like many young people growing up in Zimbabwe today, Linda Kuterera (not her real name) was forced to drop out of school because her mother could no longer afford the spiraling school fees.

Soon after she stopped going to school, Linda’s mother fell sick and had to be hospitalized.

“They told me to pay for my mother’s medication, and being the eldest in the family the responsibility fell on me. I hate what I am doing but I am forced to sleep with men so that I can raise money to pay for the hospital bills,” said Linda choking back tears.

Poverty has left many young girls and women with little choice but to sell their bodies in order to cope with the economic struggles and food shortages.

According to the Zimbabwe 2008 National Youth Shadow report, girls as young as 12 are being forced to sell their bodies to raise money for sustenance or just to get a day’s meals. Unfortunately, young Zimbabweans are often likely to be left out of HIV and AIDS programmes, adds report.

The report, which seeks to measure the country’s progress on the 2001 UNGASS Declaration on HIV and AIDS states that young people continue to be overlooked in the implementation of programmes. Read the rest of this entry »

It’s so sad, as her death was avoidable

By Godsway Shumba

Guest Blogger

 

“Lord! Give me another chance. I want to live and look after my children. They are still very young.”

 

Vimbayi (not her real name) repeated this prayer for several nights during her last days. In spite of her desperate prayers, she died at the age of 28, leaving behind two children.

 

Perhaps the saddest part is that her death was avoidable if she had had the correct information and people to support her.

 

A relative of Vimbayi, I finally got a chance to see her five months after hearing of her failing health. By that time, she was very weak. I asked her husband whether she had been tested for tuberculosis. He handed me her medical records.

 

At first, I thought that this was a breach of confidentiality. Later, I realised time was running out and we needed to do our best from an informed position. In my community, before HIV/Aids, people easily shared medical records.

 

But the Aids stigma changed the way people share information about their health.

 

The records confirmed that two sputum tests for TB had produced negative results. Unlike her husband, I also realised that Vimbayi had tested positive for HIV. As someone who was working in the HIV/Aids field, I knew the meaning of phrases such as “patient referred to OI (Opportunistic Infection) Clinic” and “post-test counselling done and positive living discussed”.

 

Prophylaxis treatment had been prescribed but I could not see any signs of it. She told me she stopped taking it two months previously because there had been no improvement.

Read the rest of this entry »

Food, Food, Food: Making Sense of A Global Crisis

Nothing could be as much a mirror of poor people’s food plight as Thai farmers reportedly conducting armed vigils in their rice fields at night to prevent thieves from reaping the crop.

 

As a measure against nocturnal rice thefts, Thai authorities introduced a 6 p.m. curfew on combine harvesters, vehicles used to harvest the crop.

 

In Thailand, as in many parts of Asia, the price of rice has gone up dramatically in recent months tempting greedy and corrupt dealers to use any means available to get a hold of the pricey grain for either sell or hoarding. In fact, the hoarding of rice has been blamed for the price spirals forcing governments to impose buying rations.

 

According to the Asia Development Bank (ADB), approximately 1 billion Asians need assistance to cope with soaring food prices and shortages.

 

The purchasing power of many of Asia’s poor has been seriously eroded reversing previous gains made in fighting poverty.

 

The International Herald Tribune describes rice, a staple food for half of the global population, as one of the “world’s most politically fragile crop.”

 

Like the price of rice, general food prices are on the rise in many parts of the world, forcing poor people to protest — sometimes violently — against governments.

 

Food riots have erupted in countries such as Haiti, Cameroon, Egypt, Indonesia, Senegal and Somalia, among others, threatening national stability or exacerbating conflict. Poor people, particularly children and those living with diseases, face the risk of malnutrition or death due to inadequate diets.

 

“It’s the worst crisis of its kind in more than 30 years,” Jeffrey Sachs, and economist and UN special adviser recently told The New York Times. “It’s a big deal and it’s obviously threatening a lot of governments. There are a number of governments on the ropes, and I think there’s more political fallout to come.”

 

Experts say that food reserves are at their lowest in 35 years, and there is a systemic imbalance between the forces of supply and demand that cannot be fixed in the short term. UN statistics show that global food prices have risen by 65 percent since 2002 to levels increasingly beyond the reach of the poor.

 

The current food quagmire has been festering over the years with little to no media attention.

 

“In the seven of the last eight years consumption has exceeded production, which can happen only if we draw down our stocks. The carryover, the grain in the bin when a new harvest begins, is the seminal indicator of food security, and it’s now down to 54 days consumption, not much than is needed to fill the supply line,” says Lester Brown, president of the Earth Policy Institute.

 

Nearly 1.7 billion people in Asia — three times the population of Europe — live on less than US$2 a day, and to them the spiraling food prices are like a shockwave.

 

“The world’s food import bill will rise in 2007 to $745 billion, up 21% from last year, the FAO estimated in its biannual Food Outlook. In developing countries, costs will go up by a quarter to nearly $233 billion,” reports Time Magazine.

 

Asia’s poor are particularly vulnerable to rising food prices for staples such as rice because 60 percent of their spending goes toward food and the figure rises to 75 percent if transport costs are included, according to the ADB.

 

Many countries in the region have resorted to banning food exports and imposing price controls; however, the ADB warns that this could worsen the crisis, as farmers will stop growing crops that bring a negative return on investment.

 

An assortment of causes have been cited for the ongoing food crisis from climate change, population growth, increased consumption of meat in Asia, particularly India and China, a ballooning oil price, focus on bio-fuels to greed and corruption.

 

According to experts, the transportation of specific commodities over long distances chews up a lot of oil, which in a context of a skyrocketing oil price is responsible for the food price hikes.

 

Also, the fact that many people in Asia and other parts of the world now eat like North Americans is also an underlying factor for the upward spiral of food prices. The more people eat meat, the less food will be available to satiate empty bellies of the poor because grains meant for human beings go to fattening chickens and animals for meat. Continued growth in meat output is dependent on feeding grain to animals, creating competition for grain between affluent meat-eaters and the world’s poor, says the World Watch Institute.

 

In addition, the increased commercialization of agriculture has negatively impacted the productivity of small farmers. Consequently, small farmers opt to abandon the land, and trek to urban areas in search of proverbial greener pastures.

 

According to a United Nations Population Fund (UNPFA) report between 2000 and 2030, Asia’s urban population is expected to increase from 1.36 billion to 2.64 billion, putting pressure on urban areas which are already incapable of meeting everyone’s food needs.

 

As the Asian food story reveals, to avert a global food crisis requires a multi-disciplinary and multi-dimensional approach that employs short term and long-term measures.

 

In the short term, bilateral and multi-lateral agencies can lend monetary support and food aid to help seriously affected countries cope with the food crisis. While government subsidies can help the poor to withstand the food crisis, it is not a sustainable strategy in the long-term.

 

National governments will need to invest in agricultural systems in a manner that keeps small farmers engaged in the production of food with a guarantee of support, fair compensation and improved access to market information.

 

The ADB recommends that farmers need to have access to reliable and affordable seed, fertilizers, pesticides and credit.

 

In the long-term, agricultural research, improvement of irrigation systems and the development of new technologies, including improved seed and crop varieties suited to specific climatic conditions, are essential to improving yields.

 

The use of low cost technologies such as drip kits and treadle pumps can also help farmers to make optimum use of land and water in the face of global warming. Labor-saving technologies that will adapt agriculture to new conditions generated by rural-to-urban migration can help to compensate for the depletion of labor.

 

As UN Secretary General Ban Ki-moon succinctly put it, the longer-term challenge is to boost agricultural development, particularly in Africa and other regions most affected.

 

With increased political will, fair trade and investments into agricultural systems, hopefully rice farmers in Thailand will, once again, have nights filled with sleep unafraid of waking up to a bare rice field harvested by some unscrupulous characters bent on making a quick dollar.

 

New Moms in Africa Fight Postpartum Depression

Across sub-Saharan Africa, new moms are at risk of falling into depressive states that can potentially damage their own mental health and well-being of their new born child.

 

In many parts of the continent, public health systems are ill-equipped to deal with post-partum depression which affects a significant number of women after giving birth. The situation is made worse by the absence of psychiatrists or clinical psychologists trained to help women cope with the condition.

 

According to researchers, post-partum depression (also called post-natal depression) affects as many as one in five women, particularly during the first year of motherhood. Less than 2 in 1,000 women are also at risk of developing postpartum psychosis.

 

The condition causes mothers to feel exhausted and emotionally empty and can potentially destroy the bonding between a mother and her new-born baby.

 

“Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth,” reports the Scientific America journal.

 

According to the journal, dramatic hormonal fluctuations that occur after delivery may contribute to postpartum depression in susceptible women, but causes of the disorder are not fully understood.

 

“A longer term consequence of not diagnosing and treating postpartum depression is the effects it can have on the family, including the parental relationship and the development of the child. Children of depressed women have been found to have attachment problems, higher rates of behavioural problems and lower vocabulary skills,” states a report titled Postpartum Depression: A Literature Review.

 

For some new moms, the situation can be so severe it can lead to cases of infanticide and suicide.

 

However, among African women, little to no studies have been conducted to better understand the condition, and the way that women cope in the absence of appropriate public health services.

 

It is possible to surmise from existing data from other parts of the world the general experience of African women following childbirth.

 

A study by the University of Iowa revealed that low-income women are much more likely to suffer from postpartum depression than wealthier women.

 

The research revealed that women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills.  

 

The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman’s ability to cope with these already difficult circumstances, according to the study.

 

The study which focused on a sample of 4,332 new mothers from four Iowa counties showed that that compared to white or Latino mothers, African-American mothers are more likely to experience depression after having a baby.

 

Furthermore, the study revealed that African-American women tend to have weaker support networks, a major predictor of postpartum depression.

 

Like African-American women, African women that give birth are also affected by low incomes and high levels of general and live in stressful contexts which increases the onset of depression.

 

While there is clearly  a need for more research into the coping methods of African women, simple screening methods can be utilized to identify women that are at risk of postnatal depression. Nurses in public health settings need to be provided with training so that they are able to detect and assist new mothers from post-partum depression. The use of a simple tool, the Edinburgh Postpartum Depression Scale, translated into local language, can assist nurses, family members and new moms to detect depressive symptoms.

 

If anything, public educational and awareness raising programs or simple pamphlets and posters describing the condition need to be displayed in ante-natal clinics so that women are mentally prepared to deal with the problem.

 

As research shows, social support networks can also play a key role in helping women deal with postnatal depression.

 

Overall, it is essential for national government throughout the world to guarantee that new moms have access to clinical and maternal services that can help to avert the emotional upheavals associated with giving birth.   

How US could save lives with Female Condoms

 

Although the female condom has been heralded as a way for women to protect themselves from HIV and STI infections, its impact has been severely limited due to several reasons including its design, cost, access, stigma, and lack of political will.

 

Given the fact that women are the most affected and infected by HIV (in 2007, women represented half of all HIV infections worldwide, and 61% of HIV infections in sub-Saharan Africa) it is an imperative that evidence-based measures be undertaken to reduce their vulnerability.

 

The female condom is an essential sexual reproductive health tool that women can control but, disappointingly, it remains confined to the fringes of the response to the global AIDS epidemic.

 

According to a report by the Center for Health and Gender Equity titled “ Saving Lives Now: Female Condoms and the Role of US Foreign Aid” the US has an important role to play in the procurement, distribution and programming of female condoms.

 

As a leading provider of funding for HIV and AIDS prevention, treatment and care, and reproductive health supplies worldwide, the US can promote the wider use of the female condom, including reducing the cost which is beyond the reach of many of the affected women. 

 

The report notes that there is little knowledge among policy makers and advocates about what the current US role is and, thus, a lack of understanding of what more the US should do.

 

“Bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms have significantly hindered the expansion of U.S.-funded female condom distribution efforts,” says the report.

 

“The U.S. government has no policy guidance encouraging missions or contractors to promote female condoms, which has meant that female condom procurement is dependent on a few field-level champions who are committed to the method,” adds the report.

 

Currently, international donors and government are investing millions of dollars and energy into promoting initiatives such as male circumcision, and little attention is being paid to promoting female condoms which allow women to initiate protection.

 

“While the unique nature of female condoms in providing women with their own source of protection should be reason enough for donors and governments to promote the method, female condoms hold other advantages as well. They fill their own niche, as consumers often alternate their use with that of male condoms, thus increasing the total number of protected sex acts,” states the report.

 

“They can be used by women living with HIV who do not wish to become pregnant, to protect against superinfection and to reduce the chance of HIV transmission to seronegative partners.”

 

In addition, female condoms also provide an additional option for protection during anal intercourse for men who have sex with men and heterosexuals, says the report.

 

In spite of the apparent benefits of the female condom, there are still major challenges in promoting its use.

 

Apart from the fact that female condoms are prohibitively expensive in many parts of the world, users find them noisy, physically unappealing, or difficult to use.

 

“However, female condoms are a cost-effective mechanism for HIV prevention when measured against thevcosts of potential HIV infections or other HIV prevention mechanisms. Also, as more and more female condoms are produced and purchased, their cost will drop,” states the report.

 

With greater financial investment and commitment, the design of the female condom can be improved increasing the likelihood of uptake by women.

 

Furthermore, there is need for educational and social marketing programs aimed at reducing the stigma associated with use of the female condom as well as improving consistent and accurate use.

 

According to the report, civil society groups can be extremely valuable in developing effective programming because of their access to populations vulnerable to HIV infection and their experience working with these groups.

 

The report makes the following recommendations to improve US’s role in the distribution and use of female condoms:

 

  • USAID and OGAC should issue policy guidance promoting female condom procurement and programming within US-funded development programs, including PEPFAR. As a signatory of ICPD, the US should promote female condoms as a vital tool to prevent both pregnancy and HIV infection.
  • The US should expand technical assistance for female condom logistics and procurement to additional countries to increase HIV prevention efforts.
  • The US should apply intensive programming efforts to an additional three countries for scale-up and replication. These efforts could be used to create a more realistic assessment of global female condom needs for scale-up.
  • The US should increase HIV prevention efforts by expanding the scope of female and male condom promotion to encompass the general public. Programming for female condoms will depend on each area’s epidemiological profile, and should be free of messages and attitudes that stigmatize condom use.
  • The US should invest more funds in female condom promotion and programming. The US should subsidize female condoms for PEPFAR-funded programs.
  • At the country level, the US should include civil society, especially women’s health and rights groups, in stakeholder meetings and encourage financing mechanisms that increase government-civil society collaboration in female condom programming.
  • Congress should remove all earmarks and funding directives for abstinence-only, abstinence-until-marriage and fidelity prevention programs and fund comprehensive, integrated, and evidence-based HIV prevention programs that include female condoms and that promote and protect women’s health.

 

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