HIV TEST-The bigger picture

Deccan Herald
Bangalore, Karnataka
3 May 2007

HIV TEST
The bigger picture

By Bobby Ramakant

[The test must be part of a comprehensive rehabilitation strategy].

Karnataka has proposed mandatory HIV test for couples. Another state Andhra Pradesh favoured mandatory HIV test before marriage. Goa too proposed the testing ‘by law’ in April 2006. But will this mandatory test alone check new HIV infections? Public health experts disagree. "We need to create an awareness about HIV, and the stigma associated with HIV, especially the stigma within healthcare which keeps people away from accessing these services (which often help to extend one’s life and contribute towards prevention of the disease), strengthen primary healthcare services and enhance sensitivity to issues of confidentiality and the dignity of life of those living with HIV," said health rights' advocate Jashodhara Dasgupta of Sahayog.

We have not been thinking of prevention/treatment in its entirety. States are seen to be promoting HIV prevention strategies completely ignoring the treatment, care and support provisions for people living with HIV.

Andhra Pradesh Chief Minister Y S Rajasekhar Reddy said last month: "I fail to understand the reasons behind the objections raised by some human rights activists on the government's initiative for making HIV/AIDS tests mandatory for couples before marriage."

What human rights' advocates would like to tell Dr Reddy is that the impact of HIV positive diagnosis on an individual's life is enormous. The combination of stigma, discrimination and denial associated with HIV, thwarts an individual's life in a myriad ways. What are the plans for people who test HIV positive? Will they have to face life without even access to primary healthcare services? In violation of NACO's (National AIDS Control Organisation) confidentiality guidelines, the HIV positive status becomes public knowledge in communities of the would-be bride and groom. Are we prepared to meet the healthcare needs of people who test positive, and ensure that they will not be forced to lead a life adversely hit by HIV-associated stigmas, discrimination and denial?

A United Nation's Programme official has said that Karnataka should think about the issue again as mandatory HIV testing will prove to be counter-productive. It not only violates privacy but also affects the entire family with a stigma tag, and 'tends to create a blackmarket in false HIV test results'.

Senior Advocate Colin Gonzalves said that "any mandatory testing is wrong. Couples should rather be counselled and educated. If they want to get a testing done by choice after that, it's their business. But a mandatory test can't be imposed on them".

NACO guidelines say that "testing for HIV is more than merely biological for it involves ethical, human and legal dimensions. The government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach can be counter productive as it may scare a large number of suspected cases from being detected." The HIV test alone will not result in behavioural changes. It should be a part of a comprehensive control programme which helps in the individual’s behaviour.

Providing social support, means and skills to reduce or eliminate risk behaviour. NACO official further adds that "Otherwise such testing can drive the target people underground and make it more difficult for launching intervention." As access to antiretroviral treatment is scaled up, there is a critical opportunity to simultaneously expand access to HIV prevention, which continues to be the mainstay of the response to the HIV epidemic. Without effective HIV prevention, there will be an ever increasing number of people who will require HIV treatment. Among the interventions which play a pivotal role both in treatment and in prevention, HIV testing and counselling stands out as paramount. The current reach of HIV testing services remains poor. The reality is that stigma and discrimination continue to stop people from having an HIV test. To address this, the cornerstones of HIV testing scale-up must include improved protection from stigma and discrimination especially within healthcare settings, as well as assured access to integrated prevention, treatment and care services. Just earlier this month, a pregnant woman with HIV died after being denied medical attention in Indore . Undoubtedly public health strategies and human rights promotion are mutually reinforcing. It is clear that India has a long way to go before we have a public health system strong enough to deliver effective healthcare to most underserved communities. And mandatory HIV testing alone is certainly not the short-cut.

(The author is a senior health and development journalist writing for newspapers in Asia, Middle East and Africa

online available at - http://www.deccanherald.com/deccanherald/may32007/panorama21333200752.asp

Stripe ban gaya gentleman

Don't Forget Workers on Intetnational Labor Day

May 1 2007

View- Don't Forget Workers on Intetnational Labor Day

By Bobby Ramakant Public Health Writer

Today (May 1, 2007) as the world observes International Labour Day (or May Day), countless millions of workers on the frontlines of unorganized sector toil hard completely oblivious of today's significance. How is it possible to usher in a change for social justice when those most under-represented are not engaged and their voices not heard, especially today?

THE SEOUL TIMES went to capture concerns of most under-represented voices.

International Labour Day is observed to pay homage to the workers who had laid down their lives for Labour rights in Chicago on 1 May 1886. It commemorates the historic struggle and efforts of working people.

One doesn't have to go very far from India's capital New Delhi. Employees of a company called Wow Information Solutions Private Limited have alleged that their employers (especially Mr Sohrab Khan, Human Resource Manager) are threatening them on emails and phone, so as to dissuade them by intimidation from asking their dues like salary, form-16 or provident fund papers. Rajeshwar Ojha and Vishal Anand, two ex-employees of this company while showing copies of threatening emails, say that Mr Sohrab Khan has even denied Form-16 to them.

Moving away from the India's capital Delhi to a village Lalpur in Hardoi district, people voice similar concerns. Ram Babu, a native of Natpurwa village, said that despite of the fact that National Rural Employment Guarantee Act (NREGA) promises 33% of job cards to women, only 12 women have been able to get job cards under NREGA out of 10,000 job cards distributed so far. When people of these villages conducted a social audit in end of November 2006, they uncovered massive irregularities in the muster rolls. Money was shown to be paid for many days (at the rate of Rs 58 per day) in names of people who weren't even aware of such a scheme leave aside getting work or money! During the social audit the workers got to know that the actual due wage is Rs 58 per day, whereas they were being paid arbitrarily anything between Rs 30-40 per day before.

Chandralekha, who hails from Natpurwa village, infamous for 350 years old sex-work trade in Hardoi district, laments that despite of lobbying for more than 7 years, she got no response from authorities. Most of the population of natpurwa village will qualify to get BPL (Below Poverty Line) cards and therefore be entitled to get free rashion from public distribution system (PDS) under Antodaya Scheme. In reality, not even a single person has got BPL card or rashion supply under antodaya scheme so far in Natpurwa.

This is a dangerous trend, where we do have special days on calendar like International Labour Day, but while observing May Day today forget to involve the most important stakeholder – the workers' themselves. With vast majority of people working in unorganized sector, it becomes all the more important to raise awareness about rights of these workers so that they are not subjected to abuse or exploitation, says Dr Sandeep Pandey, noted social activist and recipient of Ramon Magsaysay Award 2002. It is also important to provide security to these workers, like landless farmers for example. If they stop growing food, what will we eat then, asks another activist Mahesh Kumar of Kanpur.

A senior government official on condition of anonymity says that it is a huge challenge to talk of rights and regulations in unorganized sector. Not only corporate powers are slowing down the process, but also those whose vested interests are at stake. Real democracy and end of feudalism will only happen when we are able to restore dignity of life for every landless labourer, said he.

Let's hope the policy makers are listening!

online available at- http://theseoultimes.com/ST/?url=/ST/db/read.php?idx=5239

From cigarettes to agri products

April 30 2007

News - From cigarettes to agri products

[ITC is committed to sustaining its position as one of India’s most valuable corporations].

When YC Deveshwar addressed his first annual general meeting of shareholders of ITC Ltd in 1996, his 3000-plus word speech dwelt solely on tobacco and cigarettes. In fact, the word tobacco appears around a 100 times and cigarettes around 50.Over the past six years, the company has forayed into several new areas. And, last year, when he addressed his 11th AGM, cigarettes and tobacco had vanished from his talk. The most frequently used word seemed to be “vision”.Well, ITC still makes cigarettes and exports tobacco, but these no longer play the dominant role of over 85% in revenues or profits as they used to do even a few years ago when segment reporting became mandatory. ITC is now playing out a vision that Deveshwar has developed over the years, implementing it steadily and methodically.

The vision is about empowering the Indian farmer by giving him the tools for a better life and linking him to world markets. Of making Indians proud of having an Indian company making world-class products. And of course, of making ITC’s shareholders proud to be part of a company that does things like growing forests and managing watersheds not to win awards for corporate social responsibility, but to mesh business and life in a socially responsible fabric.

As Deveshwar told FE, “ITC is committed to sustaining its position as one of India’s most valuable corporations through world-class performance and creation of growing value for its stakeholders and the Indian economy.”

Today, as ITC’s vast and deeply rooted network of over 6,500 e-choupals covering nearly 400,000 villages across nine states, begun way back in 2000, generates inward and outward business for ITC, every big company with extra cash is dreaming of food retail, of creating a farm-to-table chain. But as the likes of Reliance open their big stores with fanfare, ITC is not worried. It has been running some unique rural malls quite successfully for a few years now—and is ready to provide the backend supply chain to any new player in retail.

“ITC has facilitated agro extension services on a large scale, and this has led to better crops and better yields. With our experience in agro-procurement and the development of quality agro-products, ITC is open to providing back-end support to other non-competing retail units,” Deveshwar told FE.

Whether it is the main segments like hotels, paper & paperboard and agribusiness, ITC is creating businesses that, if treated as standalone companies, could equal or outrank industry peers.

Deveshwar is clear about this: “ITC’s performance has to be judged in the business segments we are engaged in - and in each, we are leaders either in top-line or in bottomline growth.”

Recently, ITC got talking about cigarettes again after a long gap, in the notes to its results for the quarter to December 31, 2006. (Of course, cigarettes find a mention in the annual report every year.) The trigger this time? The green signal for states to impose value added tax on cigarettes and tobacco products other than bidis, for which the hated foe so far had been excise.

For Deveshwar, the future is clear: “ITC would like to be the most trusted and the largest food company in the country today. In agri business and in each of the branded food segments that we are engaged in, ITC has achieved leadership positions within a very short time since we have launched these businesses.”

online available at- http://www.financialexpress.com/fe_full_story.php?content_id=162679

Indian Govt to set up tobacco regulatory body

Spiritindia.com
April 28 2007

News - Indian Govt to set up tobacco regulatory body


[Smokers across the country are expected to face curbs on their habits as the government is planning to set up a regulatory authority for effective implementation of anti-tobacco laws].

Despite a ban on smoking in public places, people are seen puffing away at restaurants, hotels and theatres raising serious health concerns. The Health Ministry is setting up a National Tobacco Regulatory Body under the 11th five year plan to enforce the anti-tobacco Act strictly."It will be an independent body and will coordinate between states and the industry," Health Minister Anbumani Ramadoss said.He said a stringent enforcement of the Act was necessary because 40 per cent of the country's health problem was due to tobacco.

"We want people to smoke in their homes and only when their spouses allow it," he said at the first-ever Journalist 'Boot Camp' on India's growing thr eat -- Cancer and Tobacco yesterday, organised by the American Cancer Society and the US Centres for Disease Control Foundation."Bhutan is the only nation where no tobacco products are found.

We want to make India tobacco free," Ramadoss said.He said a survey showed in the Bollywood movies of the 1950s, fifty per cent of heroes smoked, which grew to 71 per cent in the 1990s and 86 per cent currently."The heroes are smoking and not the villains," he said.

online available at- http://www.spiritindia.com/health-care-news-articles-8916.html

India's Delhi, Mumbai to become smoke free

Peopl's Daily online

27 April 2007

News - India's Delhi, Mumbai to become smoke free

In an attempt to protect the citizens from second-hand smoke, the Indian government has announced that New Delhi and Mumbai would go smoke free, New Delhi Television (NDTV) reported on Friday.
Both the cities are expected to prohibit smoking in public places by 2009, including workplaces, the report said.
The new measure means Mumbai should be smoke-free by 2009 and Delhi will be smoke free by the time when it's ready to host the Commonwealth Games.
The news channel also reported that every eight seconds, someone in the world dies of a smoking-related disease.
According to the World Health Organization, tobacco causes one in 10 deaths worldwide.
By 2010, it is estimated that the annual global cost of tobacco use will be half a trillion dollars. This is more money than the combined Gross Domestic Product of 174 of the 192 member countries of the United Nations, NDTV reported.

online available at- http://english.people.com.cn/200704/27/eng20070427_370412.html

‘Multiplex Mobile Medical Units’: Responding to diverse HIV healthcare needs

‘Multiplex Mobile Medical Units’: Responding to diverse HIV healthcare needs

Bobby Ramakant from Ahmedabad (Gujarat)


[E.X.C.E.R.P.T.S... Healthcare needs of underserved communities are diverse and manifold. With HIV pandemic ravaging through India, and appalling healthcare systems, the need is compelling to integrate different tenets of healthcare services to make effective comprehensive HIV prevention, treatment, care and support a reality. Bobby Ramakant writes on such a model intervention which brings together different healthcare services under one ‘Multiplex Mobile Medical Unit’ moving through Gujarat villages in India] .


Gujarat AIDS Prevention Unit (GAP) collaborated with The Brooklyn Hospital Center, USA and American Indian Association (AIA) to respond to these needs by coming up with a Multiplex Mobile Medical Unit, which is reasonably well-equipped bringing together medical, nursing, psychosocial counselling and pastoral care services for thousands of people from underserved communities in rural Gujarat (many of them living with HIV). The Brooklyn Hospital Center (USA) has sent a team of senior medical experts as well.

HIV gradually subdues the immune system of people living with the virus so that opportunistic infections (OIs) such as candidiasis, meningitis and tuberculosis can then exploit the body’s weakened defences. People living in poorer parts of India often have no access to clean water and sanitation, have bad nutrition and already weak health status, and are constantly challenged by a variety of infectious diseases. These factors place them at greater risk of HIV-associated OIs and are believed to significantly shorten the interval between initial HIV infection and the onset of AIDS-related conditions. As a result, HIV/AIDS is often called the ‘quintessential disease of poverty’.

Stigma associated with HIV prevailing in communities is enormous and has impeded the AIDS response of India considerably, said Dr Radium Bhattacharya, President of Indian Network of NGOs on HIV/AIDS (INN) and Chairperson of Gujarat AIDS Prevention Unit (GAP).

People with high-risk lifestyles or those living with HIV have to confront huge levels of stigma at every step – even within the healthcare settings. This makes it all the more difficult for them to have access to existing health services including HIV testing, detection of sexually transmitted infections (STI), STI treatment, regular screenings for opportunistic infections (OIs) and treatments (especially TB which continues to be the largest killer of people living with HIV despite of the fact that TB treatment is available free of cost and TB is curable!), nutritional counseling and food security, and not-to-forget other specialized medical care including antenatal care, paediatric care, and general medicine as well.

Quality counseling of people (with or without HIV) is very important. Most of the people with high risk behaviours in their lives have been craving for compassion and deprived of access to information and services as well. It is vital for counselors to establish a rapport with individuals before trying to redress their problems. Nothing is more therapeutic than compassionate shoulder, says Dr Radium.

Multiplex mobile medical unit is a response to the needs of the community in rural areas. The challenge was to provide high-quality medical care, which is free of cost (affordable), within the reach of people in their own communities (mobile clinics are accessible) and provide for an array of services from counseling, testing, medical care and provision of medicines as well. All the staff working in these mobile clinics demonstrated high sensitivity to issues around HIV, and people living with HIV have themselves taken leadership in putting up the camp as well.

India at least has more than 5 million people living with HIV. The incidence of HIV in rural India is rising. With gravely inadequate healthcare system to fall back upon, it is critically important to bolster our public education and health literacy programmes in rural India, said Dr Radium Bhattacharya, who also volunteers for AIDS CARE WATCH global campaign (www.aidscarewatch.org).

With inadequate treatment programmes especially those of anti-retroviral (ARV) therapy, the number of people requiring 2nd line drugs is alarming. GAP is providing 2nd line ARV therapy to 5 patients who had developed resistance against 1st line ARV therapy earlier.

Jogender Upadhyay, a force behind community mobilization at GAP, said that Multiplex Mobile Medical Unit is a resultant of a survey on the needs of medical services carried out in the last 3 years in 20 villages of Prantij Taluka in Sabarkantha district (Gujarat). Total population of these three villages is around 60,000. These mobile medical units are providing family health counseling, reproductive and sexual health counseling, free condom demonstration and distribution, pre-test voluntary counseling, check up for opportunistic infections, sexually transmitted infections and reproductive tract infections and appropriate treatment, nutritional support, TB counseling, drug adherence counseling and treatment literacy, gender and foeticide awareness by multiple ways including poster exhibitions, street plays, games and inter-personal communication with the expert counselors.

There are some simple approaches to keep people with HIV alive. Many of them are already readily available, affordable and effective:

- Voluntary counselling and testing for HIV as the entry point for access to all health care services and self management
- Prevention and treatment of tuberculosis (TB) in people living with HIV
- Drugs to treat/prevent other opportunistic infections (e.g., cotrimoxazole, fluconazole etc)
- Home- and community-based care approaches
- Tackling HIV-related stigma, especially in health care settings, which often keeps people away from health services
- Pharmacotherapy (e.g., methadone) for recovering injection drug users
- Traditional healing and treatment approaches
- Promoting food security and micronutrient provision.

People living with HIV often become entry points to communities in the provision of integrated AIDS-related services. This initiative is also effective in community education and delivery of a broad range of AIDS care services at the doorstep of the people in rural India. Community members are glad that quality healthcare services have been brought home for them.
‘HIV is not a death sentence’ said a person living with HIV who came to this mobile medical unit. He firmly believes that AIDS-related conditions can be prevented and treated with established forms of care, support and treatment.

Such initiatives bring hope to people living with HIV. With 70% of Indian population in rural areas, the massive challenge is to make such interventions sustainable and replicable across the country.

Bobby Ramakant

(The author is a health and development journalist writing for newspapers in Asia, Middle East and Africa. He is a Key Correspondent to HDN (www.TheCorrespondent.org). He can be contacted at: bobbyramakant@yahoo.com)