One Geek

The Women and Child Development Minister of India Renuka Chowdhury, has just told a profound truth.

You cannot trust men or your husbands…
If you believe that men will be careful, then you can forget about protecting yourself.
Men will not buy a condom when they come staggering home while drunk.
Women need to get condoms to protect themselves; let the men be suspicious.

Hindustani Times

This minister is making very blunt but useful statements. She also goes on to talk about the need for more sex education and a need to get over it..

I just read about a group of parents in an Indian village trying to get all the possibly HIV positive children kicked out of their school. They think that they are a risk to their own children, which is so false. In the newspaper article the parents admitted to knowing very little about HIV. Thankfully the state education board has not headed their demands. I guess this story highlights the need for more and better HIV/AIDS and other education.

You can read more about it here.

In India a women living with HIV has been trying to sell her baby. Interestingly people were interested in buying the baby until they found out the baby had HIV. You can read more about it here.

The thing that gets me most from this story is mother-child transmission of HIV can be prevented with pretty high success rates with the correct treatments. They aren’t even that expensive.

The government is increasing the AusAID HIV/AID budget by $400 million in the Asia Pacific region. The money is for awareness and education which is interesting. I think that is good, but I find it interesting that there is no money there for prevention. If you are going to educate people on HIV and Sexually Transmitted Infections then you might want to have money so people can get needles and condoms. Unless of course the education is 100% abstinence based which has many issues.

Bono is speaking out about the poor performance of G8 nations in poverty reduction in Africa. He points out America’s good work on HIV/AIDS and Malaria. Though USAID has some interesting policies regarding abortion they do fully support ABC programs and give out condoms. I must say I also quite like Bill and Melinda Gates foundations work on HIV/AID.

The groups in G8 committed to increasing funding to $US5.4billion since Gleneagles and have only increased it by $US2.3 billion. That is one nice thing about Australia not being big, I know that us failing to meet our targeted 0.7% of GDP has less affect then countries in the G8.

Over 30% of new HIV/AIDS cases outside of Africa are people who inject drugs. Only 8% of injecting drug users have access to HIV Prevention programs. These programs are usually about clean needles and drug substitution. I find this lack of HIV protection programs for injecting drug users very disappointing.

I wonder if the problem is that many people don’t like to:
a) admit that people use illicit drugs,
b) that harm minimisation methods are thought to encourage or condone the use of drugs.

In addition, access to antiretroviral therapy is “unacceptably low” among IDUs because of a “lack of information, exclusion and widespread stigma and discrimination,” according to UNAIDS.

I was interested to see if TEAR had much on their website about TB. Google gave me 103 hits from TEAR on TB. Pretty good I reckon.

I received a link to this very good website on TB the TB Survival Project. If you want to know more about TB it is a fantastic place to start.

You owe it to yourself to read some of the stories they have here, this one in particular is quite interesting.

Today is World TB Day.

According to a recent WHO the global tuberculosis (TB) epidemic has levelled off for the first time since the World Health Organization (WHO) declared TB a public health emergency in 1993. The Global Tuberculosis Control Report released today by WHO finds that the percentage of the world’s population struck by TB peaked in 2004 and then held steady in 2005.

Some interesting messages of hope are coming from the WHO which you can read here.

UN Secretary-General, Ban Ki-moon

“We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease’s ongoing burden. Almost 60 per cent of TB cases worldwide are detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners.”

The Global Fund to Fight AIDS, Tuberculosis and Malaria, Executive Director, Sir Richard Feachem

“More than 1 million people are alive today thanks to the hard work of national tuberculosis programs who receive Global Fund resources and are supported by strong partners like the World Health Organization, Stop TB Partnership, the Global Drug Facility and the Green Light Committee. However, TB still kills 1.6 million people each year. We must step up the fight by mobilizing even more resources in order to expand and improve the quality of existing programs to treat both ordinary and drug resistant TB, and to make greater investments in HIV/TB co-infection interventions.”

UNFPA Executive Director/UN Under-Secretary-General, Ms Thoraya Ahmed Obaid

“We call on all countries to scale up TB diagnosis and treatment, especially as a key component of their maternal health services. Tuberculosis is taking a heavy toll on women, affecting them in the prime of their lives, threatening their health security and that of their families. We at the United Nations Population Fund (UNFPA) call on all countries to scale up TB diagnosis and treatment, especially as a key component of reproductive and maternal health services.”

World Bank, Vice President for Human Development, Joy Pumaphi

“Given the world’s commitment to halve TB deaths by 2015, the development community must do more to better finance TB control interventions, and the health systems necessary to reduce the deadly impact of this disease and others. While welcoming progress in better TB detection and treatment in a growing number of countries, the World Bank is re-doubling its efforts to help poor countries strengthen their health systems as its best contribution to combating TB worldwide, while encouraging donors to commit to long-term predictable donor assistance for health. In this way, the Bank is committed to help developing countries achieve better TB results in Africa and other regions that are not currently on track to meet their 2015 TB goals, a task complicated by TB’s co-epidemic association with HIV and AIDS, and the emergence of extensively drug-resistant forms of the disease.”

Just read some interesting information on Multiple Drug Resistant(MDR) and Extremly Drug Resistant TB(XDR). Here are some quotes from one of the pages I was looking at.

10%
Proportion of all new cases of active TB resistant to at least one anti-TB drug

420,000
Estimated annual prevalence of MDR-TB (2005)

10,000$
Cost of curing one case of MDR-TB

6-59%
Range of cure rates for MDR-TB treatment

39%
Reported prevalence of MDR-TB in South African study

80%
KZN TB patients also infected with HIV

“I’ve been to some of the worst places in the world dealing with TB. This is the worst epidemic I’ve seen.”
- Dr. Jim Yong Kim, Partners in Health, following recent trip to Lesotho

“We are dealing with a type of TB that is virtually untreatable.”
- Dr Paul Nunn, WHO Stop TB Department

[XDR-TB is]…a manifestation of failure of good practice in TB control
- Dr Mario Raviglione, Director, WHO Stop-TB Department

We need to pay attention to XDR-TB, but we do not need to panic
- Dr. Anthony Fauci, Director of the National Institutes of Health (US)

“This [XDR TB] is very
worrying, especially when mixed with HIV
- Dr Paul Nunn,
WHO

“XDR TB is very serious - we are potentially getting close to a bacteria that we have no tools, no weapons against”

- Paul Sommerfeld,
Stop TB

One in Ten Page

I know it all seems a bit depressing but I think it’s important to be informed. I think that being aware about MDR and XDR TB is useful if you are doing any lobbying about the Millennium Development Goals or against drug company patents.

I heard yesterday about a district in Nagaland where 19 out of 19 women tested for Sexually Transmitted Infections tested positive. This is seriously disturbing in itself but introduce HIV into this environment and you end up with serious problems. Having an STI actually increases your risk of contracting HIV as it lowers your natural defences.

From this and other reports I have heard and read, Nagaland on the verge of a HIV epidemic to rival Africa.

This is an emergency. Every day we fail to act more people will get infected. There is no cure for HIV, only treatment, prevention is what we really need.

Prevention of STI’s and STD’s requires people to move out of their comfort zones. To accept that people have both pre and extra-marital sex and not judge them for it. To accept that people do drugs, and not judge them for it. To help people understand their risks. To provide the means to enable people to minimise their risks, be it condoms or needle exchange, or protection from forced sex. To work to empower women to be able to make their own choices regarding their reproductive and sexual health. To challenge issues of gender inequality and sex. To encourage people to get tested for STI’s.

None of this is easy, it is all highly cultural specific. There are no shortcuts. It is vital work and hard work. Most of the work is in the field and in country.

What can I/we do?

I do not really know at the moment.

Challenge assumptions.

Support the MDG’s

Support efforts to bring gender equality.

Keep the safe sex and safe needle message alive. I am scared about the new trends in Australia towards unsafe sex.

Be aware.

Today is International Women’s Day.

I would like a day like this to be about celebrating the great things that women do everywhere. However it is not really like that, it is a day of social action. It is about action to promote gender equality.

There is a real need for gender equality, particularly in developing nations.

Out of this inequality much violence comes. This violence can takes many forms physical, sexual, verbal, emotional and economic. Some of the sexual violence is infecting women with HIV/AIDS The statistics on violence against women are so depressing.

I read today that only 50% of women in India and are consulted about decision relating to their own health care.

Female infanticide is still very much alive.

I have heard that TB is the number one killer in India of women of child bearing age. TB is treatable this is really not acceptable.

I hope to explore some of these issues more fully on my blog over the next few weeks and months.

Right now I am tired and it is time to go and watch a DVD. Life is all about priorities.

MSF has done a report on the top 10 under reported Crises of 2006. Have a look at it here.

How many of these stories did you hear about?

I think I can claim about five out of ten, and knowing about at least two of them came directly from me living in India.

I have a few friends who work with some NGO’s on HIV/AIDS issues. Through my discussions with these friends I have found out many interesting things. Two in particular have caught my attention. The first HIV/AIDS and TB co-infection that I have covered a lot in the past and seems to slowly be getting more coverage in mainstream press. The second one is a lot more uncomfortable for people, gender inequality and HIV/AIDS. This seems to be largely neglected by the popular press, it is this I am going to write a little about today.

Women now account for more then half the people living with of HIV. This in its self is alarming but in sub-Saharan Africa young women(15-24 years) are 3 times more likely then young men to contract HIV. I find this very alarming. How can it be that high?

There are 3 factors leading to the higher rates according to the WHO

# Women are probably more susceptible than men to infection from HIV in any given heterosexual encounter, due to biological factors – the greater area of mucous membrane exposed during sex in women than in men; the greater quantity of fluids transferred from men to women; the higher viral content of male sexual fluids; and the microtears that can occur in vaginal (or rectal) tissue from sexual penetration. Young women may be especially susceptible to infection.

# Gender norms may also have an impact on HIV transmission. For example, in many places, gender norms allow men to have more sexual partners than women, and encourage older men to have sexual relations with much younger women. In combination with the biological factors cited above, this means that, in most places where heterosexual sex is the main mode of HIV transmission, infection rates are much higher among young women than among young men.

# Forced sex, which all too many women (and some men) experience at some point in their lives, can make HIV transmission even more likely, since it may result in more trauma and tissue tearing.

Gender and HIV AIDS WHO

I don’t see that there is much we can do about the first biological cause. The other two though are able to be worked on.

Globablly 6-47% of women in different countries have reported being sexually assaulted by intimate partners. It is primarily by people who are known to them that women are assaulted. There are many more statistic regarding this and other violence against women. These other forms of violence include physical, emotional and economical, I am not going to quote them here, but trust me they are not pretty. In fact they are unacceptable to me, and show to me a clear need for change.

One of my friends as part of her HIV/AIDS work is doing gender sensitivity workshops with men and women. The goal of these workshops is to challenge the linking of sex(physical) and gender(the cultural roles of men and women). This is an interesting way to work at trying to bring change and encouraging equality between sexes. This in turn will hopefully reduce violence, and bring empowerment to women. These workshops are of course is only a small part of the work being done and that needs to be done.

This brings me to one of the big criticism I have heard of the Millenium Development Goals(MDGs) is their failure to adaquately address gender issues. Some people on the basis of this suggest that the MDGs are just a big distraction. The argument is that failure to address gender issues means that most of the goals would fail. I think though the problem is just in how the goals are used. I think that the goals should be seen as integrated and inseperable. I don’t think any one of them can truly be achieved in isolation.

I don’t know what this means exactly when it comes to advocacy and the MDGs. I think that from what I’ve seen when I was back in Australia there was a tendency towards believing that you could focus on each goal in isolation. I also think that Goal 3 (premote Gender Equality and Emowering Women) is often neglected. I think part of it is that it requires challenges to other cultures, and even some religious practices which is seen as very difficult politically. I believe though few people today would say female infanticide is acceptable. So I don’t see why we should accept other forms of violence against women.

Two interesting articles today that I’ve found on HIV/AIDS and TB. The first is about Asia, TB and HIV/AIDS. The second is about about the link between AIDS and TB.