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Breast-Feeding and HIV-1 Transmission—How Risky for How Long?

Grace C. John-Stewart, University of Washington School of Medicine,
Seattle

EDITORIAL COMMENTARY. The Journal of Infectious Diseases
2007;196:1-3

Reprints or correspondence: Dr. Grace C. John-Stewart, University of
Washington School of Medicine, Seattle, WA, 98195.
(http://gjohn@u.washington.edu).
--------------------

Breast milk transmission of HIV-1 continues to present enormous
challenges for prevention of infant HIV-1 infection. Breast milk
confers a variety of benefits to infants but can also be a vehicle
for HIV-1 transmission. Determining the amount of risk due to breast-
feeding, duration of risk, and cofactors for risk is useful for
designing efficient interventions to decrease the incidence of infant
HIV-1 infection.

In this issue of the Journal, Taha et al. [1] evaluated late
postnatal transmission in cohorts of Malawian mother-infant pairs who
participated in 2 previously published clinical trials of
antiretrovirals to prevent mother-to-child transmission (the
nevirapine-zidovudine studies) [2, 3]. Overall, 1256 infants without
HIV-1 infection at 1.5 months were monitored for 24 months to
determine the risk of late postnatal transmission. The risk of HIV-1
acquisition in this group was 9.7%, and the vast majority (87.4%) of
late infections occurred after 6 months of age. The study was large,
yielded a fairly precise risk estimate, and included a 2-year follow-
up, which enabled comparison of risk estimates for serial intervals
of 6 months. Interestingly, the 1.5–6-month age interval was the one
with the lowest risk of HIV-1 transmission (1.22%). Finally,
utilizing the cohort's size and long follow-up period, the authors
were also able to identify several significant correlates of late
postnatal transmission.

How do these late postnatal transmission risk estimates fit into what
is currently known about breast milk HIV-1 transmission, and what are
the implications? As pointed out by the authors, these data confirm
previous studies and add to the growing evidence that late postnatal
transmission of HIV-1 can be substantial.

The transmission risk was 9.7%, which is similar to an estimate from
a large multisite meta-analysis (9.3%) and slightly lower than what
was seen in a Zimbabwean cohort (12.1%) [4, 5]. The data support
current guidelines from World Health Organization/Joint United
Nations Programme on HIV/AIDS that HIV-1–infected women should stop
breast-feeding when infants are 6 months of age [6].

At the same time, there is worrisome evidence from ongoing studies
suggesting that cessation of breast-feeding at 6 months may be
associated with increased morbidity and nutritional compromise.

Together, these observations point to an urgent need for realistic
strategies to support nutrition and prevent diarrhea in infants or
HIV-1–infected mothers who stop breast-feeding at 6 months.

A few caveats regarding denominators are important to consider
regarding risk of breast milk HIV-1 transmission.

First, the term "late postnatal transmission" only includes infants
who survived to 1.5 months without becoming infected. Although this
cut-off clearly excludes in utero or intrapartum infection, it also
excludes infants infected by breast milk HIV-1 transmission before
1.5 months of age. This leads to inconsistencies in statements
regarding the proportion of breast milk HIV-1 infection
occurring "early" or "late." Because infant HIV-1 infections detected
during the first 6 weeks of life may be due to in utero, intrapartum,
or early breast milk transmission, the only way to determine early
breast-feeding transmission risk would be in a randomized comparison
with a non–breast-feeding cohort. Although both groups in such a
trial would have in utero and intrapartum infections, with
randomization, transmission risk difference between the groups at 1.5
months could be ascribed to breast-feeding HIV-1 transmission. In a
randomized trial comparing breast- and formula-feeding infants,
overall risk of breast-feeding HIV-1 transmission was 16.2% between
birth and 24 months, with 75% of the risk difference occurring by 6
months of age [7]. If late postnatal transmission cut-offs were
applied to this randomized trial, breast-feeding transmission risk
was 10.2% before 1.5 months, 6.0% between 1.5 and 24 months, and 4%
between 6 months and 24 months; hence, among the infants uninfected
at 1.5 months, 67% of risk occurred after 6 months.

Two conclusions thus remain true and noncontradictory: early breast
milk transmission of HIV-1 infection is substantial (before 1.5
months), particularly if mother-infant pairs do not receive
nevirapine, and "later late" (after 6 months) breast milk
transmission of HIV-1 infection is substantial (among infants who are
uninfected at 1.5 months).

A second caveat is that peripartum maternal nevirapine not only
affects early breast milk HIV-1 transmission but may also affect
estimation of late postnatal transmission risk.

For example, Taha et al. noted evidence of persistent effects of
maternal nevirapine on late transmission risk during the 1.5–6-month
interval.

Thus, the baseline peripartum antiretroviral intervention should be
kept in mind when comparing late transmission risk estimates.

Finally, the risk estimates between studies for late transmission
would be expected to be lower in some settings because
immunocompromised women, who have the greatest risk of late postnatal
transmission, may receive highly active antiretrovial therapy
(HAART). Thus, in countries such as Botswana with a longer history of
HAART provision, late postnatal transmission rates would be expected
to be lower than in Zimbabwe or Malawi, where HAART provision may not
yet be as widespread.

Taha et al. noted interesting differences in transmission risk
between intervals over the 2-year postpartum period—particularly, a
relatively low risk between 1.5 and 6 months, followed by a much
higher risk.

The authors also observed that mothers who received nevirapine had
significantly lower likelihood of having detectable breast milk HIV-1
between 1.5 and 3 months than women who did not receive nevirapine.
Persistent nevirapine effect may explain some residual decreased risk
between 1.5 and 6 months, despite the observation in this cohort that
nevirapine levels were almost never detectable in breast milk or
plasma after 1.5 months. Little is known regarding the origin of
breast milk HIV-1—the source could be locally HIV-infected
replicating cells or HIV-1–infected cells and free virus that migrate
from the systemic circulation.

The persistent suppression of breast milk HIV-1 despite drug absence
in this study is consistent with findings of other studies and
suggests compartmentalization of breast milk HIV-1 [8, 9]. The
authors also speculate that if the viral population in breast milk
takes months to revert from nevirapine resistance to the preexisting
wild type, the drug's residual effects on transmission may be
enhanced if resistant virus is less transmissible. Population studies
such as this one complement in vitro studies on infectiousness and
could be extended to discern effects of antivirals on infectivity
that may persist after intervention.

Three factors in this study predicted increased risk of late
postpartum transmission: maternal plasma viral load, primaparity, and
clinical mastitis. Transmitters were also noted to have significantly
higher likelihood of detectable breast milk HIV-1 than
nontransmitters. Although associations of plasma HIV-1, breast milk
HIV-1, and mastitis with breast milk HIV-1 transmission have been
reported previously, this study was larger than previous studies [10,
11]. Primaparity may have been a surrogate for inappropriate
lactation techniques or likelihood of subclinical mastitis.

Several interventions may address these correlations. Improved
lactational counseling would be expected to decrease mastitis.

Maternal viral levels of HIV-1 in breast milk can be decreased with
HAART; this is an ideal strategy for women who meet criteria for
HAART initiation, but it is less appealing for women who would not
otherwise start HAART.

Interventions to "sterilize" breast milk without systemic
administration may also be useful, but the process of expressing and
sterilizing breast milk before feeding may be cumbersome.

Infant antiretroviral prophylaxis is a particularly appealing
strategy to allow prolonged breast-feeding in settings where breast
milk substitutes are clearly suboptimal for safety and growth of
infants, and studies are under way to evaluate this approach.

In summary, Taha et al. have demonstrated in a large study that
breast milk transmission of HIV-1 persists into the very late
postnatal period and that the risk after 6 months postpartum
contributes the majority of risk between 1.5 and 24 months.

To put this in context, the risk of mother-to-child HIV-1
transmission is 30%–40% without any interventions; with peripartum
antiretrovirals, this risk declines to 10%–20% when breast-feeding is
limited to 6 months, which could increase by 8% if breast-feeding
continued to 24 months. Thus, with peripartum interventions to
prevent mother-to-child transmission, breast-feeding would contribute
to 30%–50% of infant HIV-1 infections if the breast-feeding period
were extended to 2 years.

Ultimately, new strategies such as vaccines that enable prolonged
risk-free breast-feeding by HIV-1–infected mothers would offer an
ideal solution. In the meantime, better ways to implement peripartum
interventions and either safely stop breast-feeding at 6 months or
reduce breast-feeding transmission risk after 6 months are critical
to decreasing infant HIV-1 infection.

References

1.  Taha TE, Hoover DR, Kumwenda NI, et al. Late postnatal
transmission of HIV-1 and associated factors. J Infect Dis 2007;
196:10–4 (in this issue). First citation in article

2.  Taha TE, Kumwenda NI, Gibbons A, et al. Short postexposure
prophylaxis in newborn babies to reduce mother-to-child transmission
of HIV-1: NVAZ randomised clinical trial. Lancet 2003; 362:1171–7.
First citation in article | PubMed | CrossRef

3.  Taha TE, Kumwenda NI, Hoover DR, et al. Nevirapine and zidovudine
at birth to reduce perinatal transmission of HIV in an African
setting: a randomized controlled trial. JAMA 2004; 292:202–9. First
citation in article | PubMed | CrossRef

4.  Coutsoudis A, Dabis F, Fawzi W, et al. Late postnatal
transmission of HIV-1 in breast-fed children: an individual patient
data meta-analysis. J Infect Dis 2004; 189:2154–66. First citation in
article | Full Text | PubMed

5.  Iliff PJ, Piwoz EG, Tavengwa NV, et al. Early exclusive
breastfeeding reduces the risk of postnatal HIV-1 transmission and
increases HIV-free survival. AIDS 2005; 19:699–708. First citation in
article | PubMed | CrossRef

6.  World Health Organization. HIV and infant feeding: guidelines for
decision-makers. 2003. Available at: http://www.who.int/child-
adolescent-health/New_Publications/NUTRITION/HIV_IF_DM.pdf. First
citation in article

7.  Nduati R, John G, Mbori-Ngacha D, et al. Effect of breastfeeding
and formula feeding on transmission of HIV-1: a randomized clinical
trial. JAMA 2000; 283:1167–74. First citation in article | PubMed |
CrossRef

8.  Chung MH, Kiarie JN, Richardson BA, Lehman DA, Overbaugh J, John-
Stewart GC. Breast milk HIV-1 suppression and decreased transmission:
a randomized trial comparing HIVNET 012 nevirapine versus short-
course zidovudine. AIDS 2005; 19:1415–22. First citation in article |
PubMed | CrossRef

9.  Becquart P, Petitjean G, Tabaa YA, et al. Detection of a large T-
cell reservoir able to replicate HIV-1 actively in breast milk. AIDS
2006; 20:1453–5. First citation in article | PubMed | CrossRef

10.  John GC, Nduati RW, Mbori-Ngacha DA, et al. Correlates of mother-
to-child human immunodeficiency virus type 1 (HIV-1) transmission:
association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA
shedding, and breast infections. J Infect Dis 2001; 183:206–12. First
citation in article | Full Text | PubMed

11.  Semba RD, Kumwenda N, Hoover DR, et al. Human immunodeficiency
virus load in breast milk, mastitis, and mother-to-child transmission
of human immunodeficiency virus type 1. J Infect Dis 1999; 180:93–8.
First citation in article | Full Text | PubMed

Dear FORUM and Dr.Rajesh,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7334

Thank you very much for your encouraging support and guidance.

We would like to thank GSACS for their steps. MSACS is very very supportive and
MSACS PD Mr.Sabde has personally wrote  a letter to Nanded Collector that made a
very positive impact and support for the entire campaign.

We personally would like to thank MSACS, NARI, WHO and all local government team
for supporting this cause.

This campaign is just a beginning and now in coming six months we are doing this
campaign in each districts of Maharashtra.

We request all the forum members to be part of this campaign by providing us any
legal information which will support this "Action Against Quacks Campaign".

We thank all the forum members for their support and encouragement.

Please support local district level HIV positive peoples group and be a part in
the campaign.

Warm Regards

Manoj

Manoj Pardesi
e-mail: <manojpardesi@...>

Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7330

A personal reaction to the news article:

I really do not understand this sudden ‘alarm’ in the health officials regarding
prevalence rates in Bihar and Uttar Pradesh as if it has come as a big surprise.
The epidemic in Bihar was always threatening to spin out of control. The
vulnerability factors were always known, the socio-political situation was a
given.

The issue is there was always a lack of will and drive at all levels to push and
persist against these odds. The national AIDS programming and the donor funding
has always been skewed towards high prevalence regions. The special will and
attention required in keeping a low prevalence state where it is, when one is up
against a prevalent low risk perception, has no where been near the levels
required.

It takes a lot of advocacy, time, energy, persistence to get a point across in
these states. It can be extremely frustrating and de-motivating at times for
persons working in these states. But there is no option but to persist.

It is not enough to say that migrants are coming back infected from Surat,
Mumbai etc, the issue is what has been done to inform and equip these vast
numbers of predominantly male population before they migrate out.

It will probably take more effort to keep a low prevalence state low than
reverting the epidemic in high prevalence states.

Vandana Nair
e-mail: <nair_vandana@...>

Mainstreaming Project state level positions announcements


We have advertised the state level positions, to support SACS in Bihar, U.P.,
Chhattisgarh, Rajasthan and Orissa for Mainstreaming HIV.

NACO/SACS will be recruiting Teams of five for each state and issuing the
contracts. The announcements have been made in local papers according to the
schedule given below. Have also attached the same for easy reference.

Times of India, Lucknow 23 May; HT Patna 22 May, Central Chronicle, Bhopal 22
May, Orissa Times, Bhubaneswar.23 May, Rajasthan Patrika, Jaipur 23 May

JOB DESCRIPTION

Sector Coordinator (CBO/ NGO Sector)
(NACO-UNDP, Multiple Locations)

1. Position Vacant:  Sector Coordinator (CBO/ NGO Sector)
(SCNGO-NACO)

2. Background/ Organization:  With an estimated 5.2 million persons living with
HIV/AIDS, India ranks second only to South Africa in terms of numbers.

The complex developmental causes, consequences and challenges associated with
HIV/AIDS, are beginning to make an impact in all spheres of people’s lives. In
the last 20 years, the epidemic has spread from concentrated pockets of high
prevalence into the general population. Infection in women is rising and the
number of children orphaned by AIDS is growing, indicating the need for a
multi-sectoral response.

Mainstreaming HIV/AIDS into the existing responses of various development
processes and government/ non-government responses, has emerged as a key
strategy to address the direct and indirect causes and impact of the epidemic.

The National AIDS Control Organization (NACO) in partnership with UNDP has
designed a project, "Support to the National Response for Mainstreaming HIV”.
This project is expected to lead to a definite change in the way partners
execute their functions. By promoting mainstreaming in India and greater
planning and implementation of HIV related work in different sectors, it is
hoped that ultimately this project will play an important role in reducing HIV
prevalence and incidence in India.

The Sector Coordinator is being recruited under this project to support the
State AIDS Control Society in taking forward the mainstreaming agenda.

3. Position Accountabilities:  The Sector Coordinator (CBO/ NGO) will report to
the Project Officer in the State Mainstreaming Unit (SMU) in the SACS.  The SMU
will in turn report to the Project Director, SACS.

The Sector Coordinator will be expected to undertake the following
responsibilities:

(1) Provide technical inputs relating to project
(2) Develop a database of possible partners from the civil society
(3) Undertake regular advocacy with the identified partners
(4) Undertake needs assessment/mapping in the identified sectors
(5) Provide technical support to SACS for coordination of the mainstreaming
initiatives with CSO
(6) Develop need based IEC materials for use by partners
(7) Coordinate between NACO/SACS, UNDP and implementing agencies among
government
(8) Contribute to the yearly work plans of the State Mainstreaming Unit
(9) Ensure smooth functioning and progress of the civil society initiatives
through technical back-up and site visits
(10) Ensure regular and quality reporting and proper documentation of the
initiatives.

4. Qualifications and Experience:  Qualifications:
Advanced university degree in social sciences, public administration,
management, or any other relevant field.

Experience:
(1) Minimum experience of 7-8 years of experience in or with civil society
(2) Significant understanding of the National and State HIV/AIDS program and the
social and economic dimensions of HIV/AIDS.

5. Skills and Attributes:  (1) Strong management and negotiation skills
(2) Sound understanding of civil society response to the HIV epidemic
(3) Ability to work independently and as a team player in a multi-cultural
environment
(4) Working knowledge of computers including MS Office package is essential
(5) Thorough understanding of the HIV/AIDS epidemic.

6. Compensation and Benefits Offered:  Competitive, based on qualifications and
salary history.
The SMU will be governed by SACS entitlements with regard to local/outside
travel and leave.
7. Duration of Contract:
	 One year
8. Location of Posting:
	 Lucknow, Patna, Raipur, Jaipur, Bhubaneswar

9. Reference: SCNGO-NACO

10. Contact Information:  Senior Consultant
Strategic Alliance Management Services P Ltd.
B 372 New Friends Colony
New Delhi 110 025
Email: scngo-naco@...

11. Last Date for Applications:  Please apply in the prescribed application form
available at www.sams.co.in to the above email id, by or before June 5, 2007.




JOB DESCRIPTION
Sector Coordinator (Private Sector)
(NACO-UNDP, Multiple Locations)

1. Position Vacant:  Sector Coordinator (Private Sector)
(SCPS-NACO)

2. Background/ Organization:  With an estimated 5.2 million persons living with
HIV/AIDS, India ranks second only to South Africa in terms of numbers.

The complex developmental causes, consequences and challenges associated with
HIV/AIDS, are beginning to make an impact in all spheres of people’s lives. In
the last 20 years, the epidemic has spread from concentrated pockets of high
prevalence into the general population. Infection in women is rising and the
number of children orphaned by AIDS is growing, indicating the need for a
multi-sectoral response.

Mainstreaming HIV/AIDS into the existing responses of various development
processes and government/ non-government responses, has emerged as a key
strategy to address the direct and indirect causes and impact of the epidemic.

The National AIDS Control Organization (NACO) in partnership with UNDP has
designed a project, "Support to the National Response for Mainstreaming HIV”.
This project is expected to lead to a definite change in the way partners
execute their functions. By promoting mainstreaming in India and greater
planning and implementation of HIV related work in different sectors, it is
hoped that ultimately this project will play an important role in reducing HIV
prevalence and incidence in India.

The Sector Coordinator is being recruited under this project to support the
State AIDS Control Society in taking forward the mainstreaming agenda.

3. Position Accountabilities:  The Sector Coordinator (CBO/ NGO) will report to
the Project Officer in the State Mainstreaming Unit (SMU) in the SACS.  The SMU
will in turn report to the Project Director, SACS.

The Sector Coordinator will be expected to undertake the following tasks:

(1) Develop a database of possible partners from the private sector for
collaboration in the Programme Implementation Plan (PIP) under NACP-III
(2) Identify sectors and enterprises for public-private partnership to support
the PIP
(3) Undertake regular advocacy with the identified sectors/enterprises
(4) Undertake needs assessment/mapping in the identified sectors/enterprises
(5) Provide technical support to enterprises to facilitate inclusion of HIV in
their activities under Corporate Social Responsibility (CSR)
(6) Provide technical support to SACS for coordination of the public-private
partnership
(7) Develop and support enterprise-based HIV/AIDS interventions (internal
mainstreaming) in public and private sector enterprises
(8) Develop need based IEC materials for use by partners
(9) Develop and support innovative intervention projects for workers in the
informal economy
(10) Organize sensitization orientation programmes on HIV/AIDS for the officials
of department of labor in the state, and developing projects based on
integration of HIV/AIDS in the existing programmes of labor department such as
labor welfare boards, labor welfare funds and other related boards/organizations
for specific categories of laborers etc.
(11) Contribute to the yearly work plans of the State Mainstreaming Unit
(12) Ensure smooth functioning and progress of the private sector initiatives
through technical back-up and site visits
(13) Ensure regular and quality reporting and proper documentation of the
initiatives.

4. Qualifications and Experience:  Qualifications:
Advanced university degree in management, public administration, social
sciences, or any other relevant field.

Experience:
(1) Minimum experience of 7-8 years of experience in or with the corporate
sector
(2) Significant training experience on HIV/AIDS and of proposal development
(3) Experience in development of proposals and in ensuring facilitating
implementation.

5. Skills and Attributes:  (1) Excellent understanding of the HIV/AIDS epidemic
(2) Good understanding of the National AIDS Control Programme, the State PIP,
and the social and economic dimensions of HIV/AIDS
(3) Strong management ability and negotiation skills
(4) Sound understanding of the corporate sector response to HIV epidemic
(5) Ability to work independently and as a team player in a multi-cultural
environment
(6) Working knowledge of computers including MS Office package, essential
(7) Proficiency in spoken and written English and spoken Hindi is essential.

6. Compensation and Benefits Offered:  Competitive, based on qualifications and
salary history.
The SMU will be governed by SACS entitlements with regard to local/outside
travel and leave.

7. Duration of Contract: One year
8. Location of Posting:  Lucknow, Patna, Raipur, Jaipur, Bhubaneswar

9. Reference: SCPS-NACO

10. Contact Information:  Senior Consultant
Strategic Alliance Management Services P Ltd.
B 372 New Friends Colony
New Delhi 110 025
Email: scps-naco@...

11. Last Date for Applications:  Please apply in the prescribed application form
available at www.sams.co.in to the above email id, by or before June 5, 2007.



JOB DESCRIPTION
Project Assistant (NACO-UNDP, Multiple Locations)

1. Position Vacant:  Project Assistant (2 vacancies)
(PA-NACO)

2. Background/ Organization:  With an estimated 5.2 million persons living with
HIV/AIDS, India ranks second only to South Africa in terms of numbers.

The complex developmental causes, consequences and challenges associated with
HIV/AIDS, are beginning to make an impact in all spheres of people’s lives. In
the last 20 years, the epidemic has spread from concentrated pockets of high
prevalence into the general population. Infection in women is rising and the
number of children orphaned by AIDS is growing, indicating the need for a
multi-sectoral response.

Mainstreaming HIV/AIDS into the existing responses of various development
processes and government/ non-government responses, has emerged as a key
strategy to address the direct and indirect causes and impact of the epidemic.

The National AIDS Control Organization (NACO) in partnership with UNDP has
designed a project, "Support to the National Response for Mainstreaming HIV”.
This project is expected to lead to a definite change in the way partners
execute their functions. By promoting mainstreaming in India and greater
planning and implementation of HIV related work in different sectors, it is
hoped that ultimately this project will play an important role in reducing HIV
prevalence and incidence in India.

The Project Assistant is being recruited under this project to support the State
AIDS Control Society in taking forward the mainstreaming agenda.

3. Position Accountabilities:  The incumbent will report to the Project Officer
in the State Mainstreaming Unit (SMU) in the SACS.  The SMU in turn will report
to the Project Director, SACS.

The Project Assistant (PA) is expected to undertake the following tasks:

(1) Provide administrative support to project staff in the state
(2) Backstop arrangements for meetings and workshops
(3) Coordinate project-related travel/ accommodation for project staff
(4) Dispatch letters/ documents/payment; ensuring accuracy of enclosures of
supporting documents and addresses
(5) Follow-up with implementing partners for financial as well as progress
reports
(6) Collate and consolidate reports for further sharing
(7) Collect, maintain and update data/ files relevant to the project
(8)Assist in preparation/ formatting of documents, PowerPoint presentations,
etc.
(9) Facilitate documentation and dissemination of lessons learnt.


4. Qualifications and Experience:  Qualifications:
Masters degree in Social Sciences or related field.

Experience:
(1) Minimum experience of 3-4 years in the area of HIV/AIDS
(2) Familiarity with working in an international organization on development
aspects of HIV/AIDS.

5. Skills and Attributes:  (1) Ability to work independently and as a team
player in a multi-cultural environment
(2) Working knowledge of computers including MS Office package is essential
(3) Proficiency in spoken and written English is essential. Knowledge of one or
two Indian languages, will be an asset.

6. Compensation and Benefits Offered:  Competitive, based on qualifications and
salary history.
The SMU will be governed by SACS entitlements with regard to local/ outside
travel and leave.
7. Duration of Contract:
	 One year
8. Location of Posting:
	 Lucknow, Patna, Raipur, Jaipur, Bhubaneswar

9. Reference: PA-NACO

10. Contact Information:  Senior Consultant
Strategic Alliance Management Services P Ltd.
B 372 New Friends Colony
New Delhi 110 025
Email: pa-naco@...

11. Last Date for Applications:  Please apply in the prescribed application form
available at www.sams.co.in to the above email id, by or before June 5, 2007.



JOB DESCRIPTION
Project Officer (NACO-UNDP, Multiple Locations)

1. Position Vacant:  Project Officer, (PO-NACO)

2. Background/ Organization:  With an estimated 5.2 million persons living with
HIV/AIDS, India ranks second only to South Africa in terms of numbers.

The complex developmental causes, consequences and challenges associated with
HIV/AIDS, are beginning to make an impact in all spheres of people’s lives. In
the last 20 years, the epidemic has spread from concentrated pockets of high
prevalence into the general population. Infection in women is rising and the
number of children orphaned by AIDS is growing, indicating the need for a
multi-sectoral response.

Mainstreaming HIV/AIDS into the existing responses of various development
processes and government/ non-government responses, has emerged as a key
strategy to address the direct and indirect causes and impact of the epidemic.

The National AIDS Control Organization (NACO) in partnership with UNDP has
designed a project, "Support to the National Response for Mainstreaming HIV”.
This project is expected to lead to a definite change in the way partners
execute their functions. By promoting mainstreaming in India and greater
planning and implementation of HIV related work in different sectors, it is
hoped that ultimately this project will play an important role in reducing HIV
prevalence and incidence in India.

The Project Officer is being recruited under this project to support the State
AIDS Control Society in taking forward the mainstreaming agenda.

3. Position Accountabilities:  The Project Officer will report to the Project
Director (SACS) for all administrative purposes and to the Team Leader
(Mainstreaming), NACO, for all functional purposes. The incumbent will be
expected to undertake the following responsibilities:

(1) Day-to-day management of the project
(2) Ensuring responsiveness, involvement and activities of the Government
departments in the mainstreaming process
(3) Coordinating between NACO/ SACS, UNDP, implementing agencies among
government, private sector and civil society
(4) Mobilizing key stakeholders such as the Department of Labor, education,
rural development, PRI, tourism, tribal affairs and related departments, private
sector enterprises, employers’ and workers’ associations, resource
organizations, and any other relevant organizations including PLHA networks
(5) Setting up a viable network between SACS and the key stakeholders
(6) Facilitating the formation of State AIDS Council
(7) Facilitating the formation of District Aids Prevention Control Units (DAPCU)
(8) Facilitating situational analysis of districts, in consultation with the
District Collector/CEO, ZP
(9) Facilitating identification of Technical Support Institutions
(10) Coordinating and monitoring field activities in all the identified
districts
(11) Coordinating state-level training programmes in partnership with the
resource agency/ies
(12) Organizing state-level steering committee meetings, state level workshops
and meetings
(13) Ensuring convergence with ongoing NACO/SACS programmes
(14) Assisting SACS in advocating for mainstreaming
(15) Monitoring the progress of the various project partners
(16) Ensuring smooth functioning and progress of the project
(17) Ensuring timely flow of funds to the project partners
(18) Ensuring timely submission of progress reports by project partners
(19) Conducting visits to project sites for effective monitoring
(20) Facilitating technical resources to the project partners as and when
necessary in consultation with NACO, SACS and UNDP.

4. Qualifications and Experience:  Qualifications:
Advanced university degree in management, public administration, social
sciences, or any other relevant field.

Experience:
(1) Minimum experience of 7-8 years in middle managerial level
(2) Significant understanding of the National and state HIV/ AIDS program and
the social and economic dimensions of HIV/ AIDS is highly desirable
(3) Familiarity with working in government, international organization on
development aspects.

5. Skills and Attributes:  (1) Strong management and negotiation skills
(2) Ability to work independently and as a team player in a multi-cultural
environment
(3) Working knowledge of computers including MS Office package
(4) Proficiency in spoken and written English essential. Knowledge of one or two
Indian languages will be an asset.

6. Compensation and Benefits Offered:  Competitive, based on qualifications and
salary history.
The SMU will be governed by SACS entitlements with regard to local/outside
travel and leave.



7. Duration of Contract:
	 One year
8. Location of Posting:  Lucknow, Patna, Raipur, Jaipur, Bhubaneswar

9. Reference: PO-NACO

10. Contact Information:  Senior Consultant
Strategic Alliance Management Services P Ltd.
B 372 New Friends Colony
New Delhi 110 025
Email: po-naco@...

11. Last Date for Applications:  Please apply in the prescribed application form
available at www.sams.co.in to the above email id, by or before June 5, 2007.


Hari Mohan Ph.D.
Programme Officer
HIV & Development Unit
United Nations Development Programme
55, Lodhi Estate
New Delhi - 110003, India
91-11-46532338. Direct
91-11-24628877 Ext 338
91-11-24627612 Fax
www.undp.org.in ; h.mohan@...

Dear FORUM,

Orissa is a poorest state in the country. The tragic thing is that, according to
the survey report of OSACS  it is the highly vulnereble state to HIV/AIDS. But
in reality the picture is some thing different.

Due to huge migration, IDUs it might be higher HIV prevalent state in the
country very soon.

Earlier we have talked about other forms of trafficking, but now HIV trafficking
has become a major problem in spreading HIV/AIDS.

There are many people in Orissa who are positive but getting married without
knowledge of their spouses. This need to be surveyed and controlled. Otherwise
we don't know how many are going to be infected in near future?

Saswati Nayak
e-mail: <nayak_saswati@...>

AIDS Awareness Group, (AAG), a Delhi based NGO is  working in the field of HIV /
AIDS awareness at a Resettlement (JJ)  Colony in South Delhi and has another
programme in Central Delhi with  migrants.
We have the following vacancies at present: -

1. A part time lady Doctor MBBS GP with RCH  experience for work in a JJ Colony
in South Delhi.

Age 40 +, with minimum 2 years hands on  experience in a slum or JJ Colony.

2. Lady HIV / AIDS  Counsellor
Age 30 +, with a thorough knowledge of pre-,  post test and Ongoing counselling.

Incumbent should be mature with at least 2  years active experience in
counselling.

3. Field Supervisor

Wanted  immediately one Delhi based male Field  Supervisor, to work in Central
Delhi on a project on  HIV/AIDS.
Age 30 years, BA  (Soc.) / BSW

Good  interpersonal skills, English writing skills and fluency in spoken Hindi
and  English essential. Must have 3-years field experience in HIV / AIDS
awareness, with  a grass roots NGO.

4. Out Reach Staff

Wanted  immediately one Delhi based lady  outreach staff, with minimum 2 years
experience on HIV/AIDS issues in the  field.

Education: Preferably  Graduate in Sociology / 10+2, with writing &
interpersonal skills. Fluency  in Hindi and English essential.

Work Area: Central Delhi for posts at  serials 2, 3, & 4

For all posts walk in interview will take place on 7.6.2007 at 11.00 am. Contact
at: -  email:- aagindya@...
and india.aag@... or
Tel. No: 011-26187953 / 54.

Siddhartha,
Programmes Manager,
AIDS Awareness Group, (AAG)
119D Humayun Pur,
Safdarjung Enclave,
New Delhi    110 029
e-mail: <aagindya@...>

CHANDIGARH: It's not even a month since CITCO started the Condom Bar
at Kalagram and already Baithak is witnessing a rise in sales,
rebuffing the initial apprehension about couples finding the place
uncomfortable.

While the sales figure of Baithak Bar till May 20, 2006, was Rs
31,653, the Condom Bar alone crossed Rs 1 lakh mark. And this
increase in revenue is accompanied by a global attention that the
bar is drawing.

Elated with the success of the bar, CITCO MD Jasbir Singh Bir,
said, "Couples are thronging the bar. It seems youngsters have shed
inhibitions about sex and like to discuss safe sex in a place like
this." In fact, with the bar's clientele growing, CITCO has decided
to add more number of seats as well.

Bir added that visitors curiously enquire about different types of
condoms and happily take home free condoms that are given in lieu of
change.

The bar has attracted some distinguished international guests and
patrons too. A key member of International Condom Projects Council,
Frank D Rose, has expressed a desire to promote the bar across the
world. The council spreads the message of safe sex in countries like
China and Ethiopia.

http://timesofindia.indiatimes.com/Cities/Chandigarh/Chandigarh_raises_condom_ba\
r/articleshow/2073064.cms

Sandeep Mittal

NGO Advisor
Chandigarh State AIDS Control Society
Govt. Multispeciality Hospital Complex,
Sector 16-A, Chandigarh - 160016
Phone: 0172 - 2544589, 2783300
Mobile: 094175-79664
Fax: 0172 - 2700171
e-mail: <sandeep.ngoadvisor@...>

Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7328

HIV patients unite to battle AIDS quacks, O WOW!  Three cheers for the
initiative. Let me report two from the state of Punjab.

First one is based in a village called Chetanpura about 10 KMs from Amritsar
towards Majitha. I know about this from my many patients who have gone to
him-initially he used to give free medicines but of late has started charging
too. Once thru one Dr.Mrs RAM or may be a patient from Tarantaran I could get a
sample of his medicine. When tested by one of doctor friends Dr.Jatinder Singh,
unofficially of course, the medicine was found to contain steroids and Morphine.
Many patients from rural areas of Amritsar can tell about this patient, right
now one of his victim's family is facing the wrath of HIV encephlitis and is
admitted with me in EMC Hospital, Amritsar.

The second has the guts to advertise right outside the gate of Golden Temple,
Amritsar. The photo was taken by Ms. Preeti kaur Rajpal last year, when she came
for a training with me from University of Minesotta,USA.

Dr.Rakesh Bharti,
Bharti Derma Care and Research center,
27-D,Sant Avenue,The Mall,
Amritsar143001,Punjab INDIA
Email-rakesh.bharti1@...
Tel:   9814044213  / 01832277822 /01832278522

Dear All,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7328

It is a very positive development.

The provisions of revised Drugs and Magic Remedies (Objectionable
Advertisements) Act (in 2002) can be very effectively utilized to take suitable
actions against the quacks claiming cure of AIDS.

I would like to mention that through the intervention of the GSACS (in the year
2001), a quack claiming AIDS cure in Gujarat was restrained from duping the
already marginalized and financially overburdened section of the society, viz.,
people living with HIV/AIDS (PLWHA) . The quack was finally put behind the bars.

The utilization of available legal provisions and my personal interactions with
the law enforcing authorities at the grassroots had facilitated the safeguarding
of rights of PLWHA in that instance.

I had difficulties( being a government officer and a technical person
exclusively working for containment of HIV/AIDS) in filing an FIR with
practically no support from govt. pleaders/public prosecutors etc.

In the absence of any other legal provisions available in the Indian
jurisprudence in the year 2001, the action was initiated under section 420 of
the Indian Penal Code (IPC) which includes, inter alia, enticing people with
malafide intentions.

A subsequent amendment of the Drugs and Magic Remedies (Objectionable
Advertisements) Act in 2002, which has included AIDS in the list of the
ailments/disorders for which a claim for cure cannot be advertised, has made
things a lot easier now and the various
stakeholders including the NGOs and the network of PLHA need to be apprised
accordingly and facilitated regarding similar actions as per the requirements.

We all must optimally utilize DMR(OA)Act to take effective action against such
notorious and anti-social elements.

Best wishes,

Dr. Rajesh Gopal, MD
Joint Director,
Gujarat State AIDS Control Society (GSACS),
O/1 Block, New Mental Hospital Complex,
Meghaninagar, Ahmedabad, Gujarat. PIN 380016
Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214
e-mail: <dr_rajeshg@...>

Dear Forum,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7324

Kindly note that "Current WHO recommendations state that HIV positive mothers
should  avoid breastfeeding when safe feeding alternatives are
available. But in regions where mothers cannot afford the cost of infant formula
or where water is contaminated, the WHO recommends mothers should  exclusively
breastfeed their babies up to six months
of age.". This information is obsolete now.

At present the WHO,UNICEF,NACO,BPNI and all other UN agencies and affiliated
organizations unequivocally recommend exclusive breast feeding for the children
born to all HIV positive women for initial four months. Details may please be
obtained and shared accordingly.

Best wishes,

Dr. Rajesh Gopal, MD
Joint Director,
Gujarat State AIDS Control Society (GSACS),
O/1 Block, New Mental Hospital Complex,
Meghaninagar, Ahmedabad, Gujarat.
PIN 380016
Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214
e-mail: <dr_rajeshg@...>

Dear All,

As our Sexual Health Programme for Street and Slum Children in India
is gradually expanding its reach and scope, there are two new
CONSULTANCY OPPORTUNITIES in our project, each for a duration of six
months. Please see the information below.


POSITION 1.
Developer-designer of Intervention Modules (Games and other creative,
interactive Exercises) for groups of Teenage Street and Slum Children

Starting date: latest by August 1, 2007 (if possible somewhat earlier).

Job Description:
(Co-)Develop the Children's Activities Workbook: a series of 120
creative and interactive, `FUN' intervention activities on sexuality,
sexual health and life skills for small groups of teenage street and
slum children (non-literate!);
(Co-)Write the Workbook/Manual, in (almost-)ready-for-publication
quality;

Time Investment, Logistics & Remuneration:
This consultancy will be for the period August 2007 (or somewhat
earlier) to the end of January 2008 (six months), and requires a time
investment of three days a week continuously;
The consultancy may involve working from home, but requires working
in APSA Bangalore ("Nammane") for at least one day per week (with the
other team members). Candidates therefore must be based in Bangalore
(or at maximum three hours travel from Bangalore by bus/train)
throughout the period of the consultancy;
The total remuneration will not exceed Rs. 1,02,000/-
(non-negotiable).


POSITION 2.
An experienced Writer of Training Manuals – to:
(co)write our NGO Staff Training Manual "Working on Sexuality,
Sexual Health and Life-Skills with teenage Street and Slum Children", and
professionally edit the Children's Intervention Workbook

Starting date: October 1, 2007  (Note: August 1, if combined position
1&2).

Job Description:
(Co)Write the training modules for NGO field staff on: (teenage)
sexuality, sexual health, sexual rights, related life skills, and
working effectively with street and slum teenagers on these issues;
Professionally edit the Children's Intervention Activities Workbook
(a workbook with over 120 small-group exercises aimed at positive
behaviour change).

Time Investment, Logistics & Remuneration:
This consultancy will be for the period October 2007 to the end of
March 2008 (six months), and requires a time investment of four days
per week continuously;
This consultancy may involve a reasonable amount of working from
home (preferably using your own computer), but requires you to come to
APSA Bangalore ("Nammane") at least once per two weeks for one day.
Candidates therefore must be based in Bangalore (or at maximum three
hours travel from Bangalore by bus/train) throughout the period of the
consultancy;
The total remuneration will not exceed Rs. 1,50,000/- (non-negotiable).

Note: the two consultancies can be combined, if the candidate has the
required qualities to effectively do both consultancies
simultaneously, and is willing to work fulltime on these tasks (=
five-and-half days / 44 hours per week) for the entire period August
2007 to end of March 2008. Remuneration: maximum Rs. 31,500/- per
month, depending on qualifications and experience (non-negotiable).

PLEASE DO CHECK THE LINK BELOW (copy into your browser) for FULL
DETAILS on the Qualifications and Experience required, and
INSTRUCTIONS on HOW TO APPLY:

http://www.streetkids-srh.org/show_news.php?id=36#read


For further information: email to jobs@...


With best regards,

Shadakshari.T.S.
Assistant Programme Manager.
APSA Bangalore
e-mail: <antriksha_nakshatra@...>

FXB India Suraksha is a non-profit company working for the cause of
HIV-AIDS affected and infected orphans.

It is substantially funded by FXB International  (www.fxb.org) , an
international  philanthropic organisation with headquarter in Geneva,
Switzerland. It is engaged in advocacy, dissemination of information,
psycho-social support and delivery of medical services at State and
local levels. FXB India Suraksha is looking for bright, innovative
and committed professionals for occupying the position of Director in
the areas of: Programme Management; Finance, System Management and
Company Affairs; and Advocacy and Communication & External Relations.

Director Programme Management:

Required Qualifications: Minimum- good Bachelors degree; preference
will be given to candidates with MBA, Master of Social Welfare,
Diploma in Rural Development, etc.

Experience: Minimum of five years; experience in developing & writing
project proposals and monitoring / overseeing of project
implementation, will be preferred.

Other desirable skills: working knowledge of computers, direct
supervisory experience over a team and experience in team- building
and leadership development.

Director Finance, System Management and Company Affairs:

Required Qualifications: Minimum- good Degree/Diploma in Management,
with specialisation in Financial Management, or Chartered Accountant.
Experience: Minimum of five years of direct supervision over the
financial wing of an organisation; must possess analytical skills and
experience in raising of resources, system development and monitoring
of programme expenditure.

Other desired skills: working knowledge of computer, particularly
Microsoft Office, Tally, Excel, etc. Experience in procedures under
the Indian Companies Act, experience in carrying out statutory duties
under the Indian Companies Act and skills of drawing up Board Minutes.

Director Advocacy and Communication & External Relations:

Required Qualifications: Minimum- Master's Degree in Mass
Communications, Journalism, or any other related discipline.
Experience: Minimum of five years in Advocacy and Communication
Sectors in an NGO, or similar experience in Journalism relating to
the Social Sectors, specially programmes relating to HIV/AIDS.
Experience in production of print and other communication materials
and dealing with media, is required. The position will also require
initiative in development of such minimum skills in the field offices.

Other Skills:  working knowledge of computer, experience in
development of web sites and desk-top printing, will be an added
advantage.

Candidates who would like to come on deputation for a minimum period
of three years while retaining their lien with their parent
organisation, would also be welcome.

Emoluments: Rs. 45,000-60,000 (gross); starting emolument is
negotiable depending on experience and skill.

Candidates are requested not to send long resumes – they may send a
brief and crisp note indicating what they can offer to the
organisation, and their areas of strength which can be of use to our
organisation.

Interested candidates are encouraged to send your application with CV
to Javed Hasan Executive Assistant to CEO at javed.fxb@... by
10 June 2007.

Candidates applying from outside Delhi will be provided with to and
fro first class train fare and one day lodging and boarding in Noida/
Delhi


Mr.Javed Hasan
Executive Assistant to CEO
FXB India Suraksha
e-mail: javed.fxb@...

Indian HIV patients unite to battle fake AIDS cures

29 May 2007, Source: Reuters

By Krittivas Mukherjee

MUMBAI, May 29 (Reuters) - A network of HIV-positive people in India
has launched a national campaign against thousands of illegal
backstreet clinics and quacks who cheat patients with the promise of
curing AIDS.

Patients often end up going to quacks and witch doctors who use fake
herbal, homeopathic and drug treatments because the government health
system is widely seen as offering poor treatment while private care
is costly.

Health experts say discrimination against infected patients at
hospitals as well as social stigmas also force HIV-infected people to
turn to quacks who advertise in newspapers and through posters,
fliers and graffiti.

"The quacks are not only a stumbling block in the fight against AIDS
but also they cheat unsuspecting patients, often poor and
uneducated," said Shabana Patel, a representative of the Indian
Network of People Living With HIV and Aids in the western state of
Maharashtra.

The network of people who are HIV-positive or living with AIDS has
chapters in almost every Indian state and thousands of members.

India has the world's highest number of HIV-positive cases with an
estimated 5.7 million people infected, according to the United
Nations. But only around 100,000 people get treatment.

Quacks step in to fill some of that gap.

Estimates vary on how much a quack charges for "curing" AIDS, but
anti-quackery campaigner Nayna Raut says it could be more than $3,000
a year per patient, a fortune for India's poor.

"They don't even do a blood test. Just on the basis of some fake
clinical diagnosis they prescribe their miracle cure for AIDS," Raut
said.

Patel's group received more than 100 complaints in April from HIV-
positive patients who said they had been cheated by quacks.

India has approved a plan that envisages spending around $2.8 billion
over the next five years for AIDS prevention and increasing the
number of people on first-line AIDS drugs.

http://www.alertnet.org/thenews/newsdesk/SP244741.htm

Shunned HIV-hit widow turns to begging

An HIV positive widow has been reduced to begging for survival in Orissa after
villagers ostracized her and her son out of fear that the disease can be passed
on by social contact.

And after her own parents also refused to provide support to her, Sukanti (name
changed), only 30 years of age, and her younger son Dipun, 4, now beg for food
in Mehendipur village in Cuttack district, 50 km from here.

Life became hell after her husband Sarat Das, a plumber in Mumbai, died of AIDS
March 15 last year in this eastern Indian coastal state. Sukanti realized then
that she was HIV positive, and so was her younger son.

Villagers and even her in-laws immediately began boycotting her. Dilip Kumar
Parida, a social activist, said the locals believed that AIDS is transmitted
even if one interacts with an infected person.

Abandoned by her in-laws, a villager said, Sukanti and her son took refuge in a
deserted grain storehouse.

'The villagers did not allow her to use the common tube well and stopped their
own children from playing with her infected son,' Parida told IANS.

She also became an object of disdain at her own parents' house at Nagaspur.

Although Sukanti's father Biswanath Das accepted her disease-free elder son, he
refused to give shelter to her and her infected younger son.

This was just the beginning of Sukanti's ordeal. She was forced to work as a
labourer for food after charity gradually eased.

Eventually, unable to work due to deteriorating health, she was reduced to
begging. She is unable to buy medicines because she cannot afford them at Rs.500
a month.

No one is ready to help her, not even the local administration.

Bramarabara Ojha , block developement officer (BDO) of local Nischintakoili
block, pleaded ignorance about the case. But he promised to investigate and
submit a report to his seniors.

(Hemant Kumar Rout can be contacted at hemantrout@...)
By Hemant Kumar Rout (Staff Writer, © IANS)

http://www.indiaenews.com/health/20070529/53821.htm

Dear FORUM,

"We find audacious ways to restore justice to children and the poorest of the
poor," declares the website of Restore International, a Christian evangelical
organisation. The recent episode of trying to rescue a 13-year-old girl in
Miraj, twin city to Sangli, who was at 'high risk' of being initiated into
prostitution is perhaps a sinister example of such audaciousness gone awry.

IN THE NAME OF RESCUE

A REPORT of  The Fact-Finding Committee Investigation into the Alleged
Molestation/Rape of a Minor Girl by a Decoy Customer in Uttam Nagar, Miraj,
Sangli District, Maharashtra 12 May 2007

Fact Finding Committee
Manisha Gupte          Women's rights activist, Pune
Vidya Kulkarni          Senior journalist, Pune
Asim Sarode          Human rights lawyer, Pune
Vijaya Kadam          Child rights activist, Pune

Acknowledgment: We wish to thank Bishakha Datta, Point of View, Mumbai for her
invaluable inputs.

THE 'RESCUERS'

"We find audacious ways to restore justice to children and the poorest of the
poor," declares the website of Restore International, a Christian evangelical
organisation. The recent episode of trying to rescue a 13-year-old girl in
Miraj, twin city to Sangli, who was at 'high risk' of being initiated into
prostitution is perhaps a sinister example of such audaciousness gone awry.

On May 11, 2007 at around noon , the Miraj City Police raided a room in Uttam
Nagar (aka Prem Nagar) in Miraj on the information that a girl of minor age was
being trafficked into prostitution. Shyam Kamble, a member of the Ooty-based
Freedom Firm, who also represents Restore International as per information from
the Miraj police, provided the information to them.

Both Freedom Firm and Restore International are Christian evangelist groups
working at the national and international level. On one website, Freedom Firm,
which is a project of the Valley of Praise Charitable Society is described as an
organisation that rescues underage Indian girls from prostitution, restores them
in Christ and prosecutes the perpetrators. Its founder Greg Malstead, was
previously the Mumbai director of the International Justice Mission, which also
works closely with Restore International as per the information provided by the
Miraj police station.

In 2005, the International Justice Mission (IJM) had conducted a similar raid in
Sangli, in the area where VAMP, the reputed collective of women in prostitution
is located. On that occasion, Greg Malstead, then of IJM had also used the name
of Restore International, which was then, allegedly an unregistered body.

The accusations and counter-accusations during this episode have been documented
in press reports and are available on the Internet. These Christian evangelists
position VAMP as a collective of brothel owners who are themselves involved in
trafficking – even though the police themselves admit that women from the VAMP
collective inform them when young girls are trafficked into the area. VAMP is
not against adult women entering the trade by their own volition. They believe
that all prostitution is not through trafficking and conversely, all trafficking
is not for prostitution. They have always opposed child prostitution and child
sexual abuse in any form.

11 MAY 2007
THE INCIDENT

On May 11, 2007 at 10 am a decoy customer from Freedom Firm by the name of Raju
Williams met Surekha (alias Renuka) Kamble, a sex worker from Uttam Nagar,
Miraj. Raju was a client she had serviced a few days ago for Rs. 50. According
to Surekha's statement to the police on Saturday12th May 2007, Raju said he
would be back with another friend at 12 noon . What follows is based on
interviews with various people - the adolescent being 'rescued'; community
members, VAMP community-level workers and the police.

At 12 noon , Raju Williams (who had visited Surekha earlier) and James Verghese
came into the sex workers' community with two marked notes of Rs. 500. They gave
the money to Surekha, asked her for sex and also asked her to get a girl for the
other man. Surekha went to find a girl [4] and after 10 minutes of futile
searching, returned to find her room was locked. She waited in her mother's room
in the opposite row.

The police arrived after a while and started banging on the door of the locked
room. Raju Williams opened the door and came out. He was followed by a
13-year-old girl who was sobbing. The community had gathered by then and a
ruckus followed. A VAMP staff member reported that ASI Sadashiv Vaidya pulled
the 13-year-old towards the police van by her hair.

In another version, Surekha said that when she returned, the police were already
outside the door of her own rented room. The police maintain that Surekha did
not go anywhere at all, but just waited in her mother's room while Raju was in
the room with the 13-year- old.

There is a possibility that Surekha was part of the decoy action or was trying
to set up the girl. As long as the police 'need' her statement for the
anti-trafficking angle, it will be difficult to prove her innocence or guilt.
There is also a possibility of Surekha being made a scapegoat in this process,
especially if the official decoys have to be protected and the embarrassment to
the police avoided.

How did the 13-year-old girl get in the room with Williams? Since she did chores
for the community, apparently she went into Surekha's room with water she had
filled from the basti (community) tap. As soon as she entered, Raju locked the
door, started molesting her and gagged her with his hand. He flung her on the
bed and tried to undress her.

Hereafter, there are numerous speculations as to what may have happened.

· The young girl consistently maintains that Raju Williams raped her (she gave a
graphic description of penetration).
· The police maintain that it was impossible to rape her in the 3-4 minute time
slot between the closing of the door and the police banging on it.
· The report of physical examination in the Miraj civil hospital states that no
recent penetration had occurred and that even matting of the pubic hair was
absent.

Vaginal swabs from the 13-year-old girl have gone for examination as also the
bed sheet and undergarment of the young girl. The police have promised to send
these clothes, along with Raju Williams' semen sample for DNA testing. These
garments were retrieved by the community and not by the police, as the latter
say they were not aware of the 'rape angle' until the girl spoke to the
community, later on the afternoon of 11 May.

The police's omissions
The police did not ask the obvious questions related to sexual assault when a
minor girl is closeted in a room with a man and when she comes out looking upset
- this is a grave act of omission on their part.

Whether or not it is a rescue operation, the police cannot be blind to sexual
molestation, assault or rape. Since the decoy was operating with police support,
the molestation/rape of the girl amounts to custodial assault and the police are
unquestionably answerable for the behavior of the decoy.

The media's role
Newspapers published details of the raid. Daily Lokmat [ a Marathi daily] even
had photographs of the operation, indicating that the press was also present
during the raid. The girl was declared to be a prostitute and her photograph was
part of the newspaper report.

We find this gender insensitive and sensational way of reporting to be damaging
to the girl. Besides, if the girl has actually been raped, then the press has
violated ethics and law by disclosing her name and showing her face to thousands
of readers.

The aftermath
In the meanwhile, hundreds of angry sex workers from Miraj and Sangli gathered
in the Miraj police station and had a sit out there until late night. When the
police prevailed upon them to go back, they did, but returned in even larger
numbers the next day. That is the scene the fact-finding team saw when we
reached the police station on 12 May at 10:30am .

12 MAY 2007
THE FACT-FINDING
The fact-finding team was constituted on the late evening of 11 May as soon as
we heard about the happenings in Miraj. Though all of us are aware of VAMP's
work, and the work of SANGRAM, which seeded VAMP, the team was formed by Manisha
Gupte, a Pune-based women's rights activist and not by any of the two mentioned
organisations.

We reached Sangli in the early hours of 12 May. We first went to Miraj civil
hospital, where we met Dr. Hulbansar as well as the young girl and her mother.
The girl narrated her story to us through an interpreter (she speaks only
Kannada - she can understand a small bit of Hindi and Marathi). The doctors on
duty could not tell us much as they hadn't been on duty when the girl had been
admitted.

After that, we visited the sex workers' lane in Uttam/Prem Nagar. This area is
vastly different from brothels one sees in Mumbai or in Pune. The homes are
single storied (mostly single rooms), there are no cages and one can see older
as well as younger women standing or walking about on the street, doing their
daily chores (it was probably too early for sex work).

The community showed us the room in which the girl had been locked up. It is a
nondescript room, with a large single bed, a few vessels, some colourful clothes
on a line and a photo of James Anthony, Surekha's father who passed away in
2004. Hardly anything else meets the eye in the room. We saw that the mud wall
outside had been damaged, perhaps due to the altercation that had taken place
during the raid. The girl's mother's room was almost opposite this room.

Though the rooms have weak ceilings, no one heard the girl's screams in
Surekha's room, because the two rooms close to this one were empty at the time
of the molestation.

The police version
Most of our day was spent at Miraj police station with Dy. SP. Dr. Digambar
Pradhan and PSI Bajirao Patil. The police version of the episode is as follows:

Shyam Kamble of Freedom Firm had contacted the police with news of a young girl
being trafficked into the local brothel. The police kept mentioning him as being
from Restore International (RI), perhaps because that was the name of the group
when Greg Malstead and his team had raided the brothels in Sangli in 2005. They
also knew Mr. Malstead; in fact, PSI Patil spoke of the decoys as 'our punters'.

On Kamble's tip-off, the police set out with the decoys from RI/FF into the
community on 11 May around noon . The decoys (Williams and Verghese) went to
give the marked money to Surekha, while the plainclothes police waited around.
Surekha took the money and went to her mother's room, which is opposite where
the young girl was held by the decoy.

As soon as Williams went into the room with the girl and closed the door, the
police banged on it and got the two people outside.

According to them, the time lapse was barely 3-4 minutes, during which some "
zhapta-zhapti" (molestation) at the most could have taken place, but rape wasn't
possible. However when we spoke to the sex workers, they said that sexual
contact is easily possible in 3-5 minutes.

The moot question - time
The moot question in the evidence (if ever the case goes to court), is to
establish whether the time lapse was barely 3-4 minutes (as the police say), or
whether it was more than that.

What we constructed from various conversations was that the time period was
between 7-10 minutes. It would also be important to prove whether the police
were right outside the room or whether they were at some distance. Since most
policemen (even in plain clothes) are known to the sex workers' community, it
may be more likely that that they were not waiting exactly outside Surekha's
room. Perhaps they were outside the community and came in after being informed
that money had exchanged hands.

Men, being clients of the sex workers, are of professional interest to the
community and therefore the presence of men hanging around the room could not
have gone unnoticed here. If the police were away, then their theory (of rape
being impossible, since there were only a couple of minutes available then),
doesn't hold any more.

Meenakshi, a SANGRAM volunteer reported that she had gone to attend a meeting of
the organisation in Sangli. Then she went to a wedding in Miraj. She came to
know about the raid while at the wedding and immediately went to Uttam Nagar.
She was present when the police dragged Rekha by her hair. It would have taken
at least 15-20 minutes for her to reach Uttam Nagar.

These various constructs cast doubt on the police's assertion that the whole
episode took just a few minutes.

Other issues
a)Taking the community into confidence
The police say that they have numerous informers within the community and even
accept that the sex workers from VAMP themselves bring trafficked women and
children to the police station It is therefore surprising that the police did
not take VAMP or SANGRAM into confidence when Freedom Firm contacted them about
a minor girl being in the sex trade in Uttam Nagar. This lapse is even more
serious since the police are aware of the well-known old antagonism that Restore
International and their extended parivar have towards this prostitutes'
collective.

b)The girl's presence in the community
The reasons for the young girl living in this community are complex. First, her
mother, Shivbai, has been living there for the past 8-10 years. The mother was
at one time in the trade. She gave it up many years ago, when she found a '
malak' (regular lover), who works in Kolhapur as a mason and has been sending
money (Rs 5000-15000) at regular intervals.

Shivbai has three daughters and a young son. The girl in questions refers to her
mother's malak as her father – perhaps he is her biological parent as well. As
the young girl started growing up, the mother started sending her to their
village in Karnataka, partially in order to stay away from the sex workers'
community and partially to keep an eye on the village home and bring the
fortnightly ration from there.

Shivbai's younger sister who also lives in Uttam Nagar has never been in the
trade herself, but she keeps two rooms and her two adult daughters are sex
workers. Shivbai and the young girl make their living by doing chores for the
community and get paid on a daily basis. The narrations regarding the malak were
contradictory – Shivbai said he died a few months ago, but the young girl said
that he was in Kolhapur .

It is possible that Shivbai may have plans of putting her own daughter in the
trade – some VAMP members said that they had warned Shivbai about this and had
explicitly advised her not to initiate her daughter so soon. Thus, one may ask
the obvious question: Was the girl at potential risk of being initiated into
prostitution? Yes, she was. But was she at immediate risk? No, not as long as
she lived in Uttam Nagar where VAMP has a strong presence.

Ironically, the police tried to rescue someone who wasn't even in the trade from
a place where the local surveillance of VAMP was keeping the girl safe from
being sold or initiated into prostitution as a minor. Once more, the mix up
between being anti-trafficking (which is an illegal and unethical act that also
violates human rights of people) and being anti-prostitution (which is a
moralistic position) has created the present mess. Prostitution is not illegal
in India , but soliciting and living off a prostitute's earnings is.

In this episode, we need to find out how much of the raid by Freedom Firm was
due to a clearly anti-trafficking position and how much was due to their mission
of 'redeeming' prostitutes. We would therefore ask whether they also rescue
people who are trafficked into child labour, as domestic labour or for other
'non-sexual' labour. Such activities are not evident from their website or from
information available about them.

c)Issues that the 13-year-old girl faces after the raid
VAMP members realized that the young girl who has now been accused of being a
minor in prostitution and is also repeatedly claiming that she has been sexually
violated is at a very real risk from men who have read about her in the papers.
Thus they took a decision to talk to the mother of the child and the girl
herself to look for an acceptable solution for this messy problem.

The meeting with the mother resulted in the girl being taken to the police
station by the mother and VAMP members on 15 May 2007 . She was taken there with
another young girl, barely 13, who was brought to the Miraj community on 14 t
May 2007, by a man who asked to be given a room for the purpose of having sex
with her. VAMP members collected other community members and threatened the man
who subsequently ran away.

This minor was also taken to the police station but the police could not provide
a female constable as protection. So the police themselves sent her back to the
community deciding that VAMP was the safest place for her till she could be
committed to the remand home!

Both these girls were then taken to the government facility for young girls and
committed there with the help of the police. This ironic end to the fact-finding
reveals the love-hate relation that the police have with the prostitutes'
collective.

An Interview
As part of the fact-finding, we interviewed Meena Seshu, general secretary,
SANGRAM on SANGRAM and VAMP's position on young girls in the sex trade and on
raids.

Q: What do you feel about the raids?

MS: We are opposed to raids as a method to stop young girls from entering the
trade. Prostitution is a system that exists in a society fraught with
inequalities. Gender inequalities, economic inequalities, caste, class and race
contribute to a social fabric that is abusive of women's rights and the rights
of the girl child, and to a culture that does not value the girl child.

The girl child is thus sacrificed at the altar of male-dominated patriarchal
systems that believes they exist to be moulded to accept sexuality within and
outside marriage that is actually detrimental to their health. Abject poverty,
drought, famine, and economic inequalities complete the picture. These
structural issues need to be kept in mind while we search for a solution that is
best for the `child in need of care and protection'.

Q: How can young girls be protected then?

MS: What is the best solution for a 'girl child in need of care and protection'?
A simplistic solution - such as raid and rescue- only offers patchwork relief,
and takes away the rights of the girl child by inflicting untold violence on her
in the process.

The 'raid, rescue and rehabilitation' model blames the community, pushing it to
a corner of no return. Such strategies that have violated the rights of the
women in prostitution have not yielded good results for generations.

We need solutions that are long term and those that can be implemented
effectively. We need strategies that will strengthen women to resist being
pushed into those corners and build the will to reject the unacceptable and
illegal violation and sexual abuse of the girl child.

Q: What kinds of strategies do you mean?

MS: The collectivisation of women in prostitution, which is a rights-based
approach, is one such strategy. It creates a space for women in prostitution to
collectively look for solutions to their problems. It helps them to access
information and education about rights and to take informed decisions.

VAMP has made the women realise that collective strength can be used against
goondas and other anti-social elements who were exploiting them. Lately, the
VAMP mohalla committee has also tackled brothel owners who are abusive and who
extort money from the girls. This has been a slow process and has taken a long
time to implement.

This collective works on the understanding that the way to stop young
girls/minors from entering prostitution is to strengthen and educate women in
prostitution to stop child sexual abuse. The strategy therefore is to build
collectives that will teach them dignity and strengthen them to stop the menace
of child trafficking and child sexual abuse. Communities need to be taken into
confidence to ensure that minors do not replace the ones rescued by the police.

We need to help collectives appoint mohalla committees to watch over such women
who break the law and pressurise them to remain within the law and to work with
the police to keep anti-social elements outside the communities. The most
important intervention is to teach women their rights and help them fight for
the same.

CONCLUSION
Reaching a consensus on facts
Various versions of people's stories (except the 13-year-old girl's) changed so
much over the fact finding, that it became almost impossible to make complete
sense out of the events. What we did agree upon however is as follows:

1. Freedom Firm acted on inaccurate information and the police did not verify
the truth before they hastily jumped into the rescue operation.
2. It seems likely that PSI Bajirao Patil knew more about the lacunae in the
rescue operation and that he hadn't adequately informed his superior, Dy. SP.
Dr. Digambar Pradhan about this.
3. The police are embarrassed as their own decoy raped/molested the girl and
that the entire exercise of rescue went haywire. Perhaps they were uneasy that
the rescuers would label them as pro-sex workers; therefore they chose to ignore
the narration of the young girl and did not detain the decoy on the preliminary
charge of molestation. Now, their inaction in detaining Raju Williams has cast
them in a suspicious light.
4. The person who had been sent as a decoy customer had been sent for a specific
purpose and with special authority. The decoy customer sent by the police was
acting under their instructions was helping the police maintain law and order.
For that purpose Raju Williams was acting as a 'government servant'. The taking
of law and order into his own hands, misuse of law to commit an atrocity on the
minor girl are serious offences. Yet the police, which was the State agency on
whose behalf Raju was acting, have not lodged any offence against him .
5. The sex workers' community would not have taken so much umbrage unless they
were convinced that the girl was set up and that she wasn't already part of the
trade.
6. The police themselves agree that the girl wasn't in the sex trade.
7. The police did not do their homework before they carried out the rescue
operation; this lapse resulted in the human rights violations of the young girl.
8. The police colluded with Freedom Firm, in spite of the controversy
surrounding their earlier raid (carried out by the same leadership as Restore
International / International Justice Mission) and did not take the local
collective in confidence in spite of their 'excellent relationship' with the
latter.
9. Freedom Firm may have beguiled Surekha, perhaps through financial and/or
evangelist tactics. According to VAMP members, there is a strong possibility of
a lot of money having exchanged hands – Rs. 1000 would be too little to accept
if you're selling a young girl for the first time.
10. The girl could have been set up by Surekha – she may have been manipulated
into going in the latter's room while Raju Williams was waiting there for her.
11. This episode brings to light how a poor minor girl was framed for the
purpose of enacting an adventurous rescue operation and how another sex worker
might have been used to set her up. The rescuers, who violated human rights of
the 'rescued' and basic ethical principles of being decoys, are not made
answerable to the girl, the community as well as to society. We need to look at
all the violations that happened in the name of rescue and make the violators
answerable.
12. The police agree that the girl was not in the sex trade, nor was she
'habituated' to sex. The medical report also corroborates this belief.
13. A young girl who was not in the sex trade was set up (with the purpose of
initiating her into the trade) in the very attempt of the police trying to
rescue her from the trade!
14. A 13-year-old girl went through physical and emotional trauma because
someone wanted to rescue her, even when she wasn't in the trade – but just
because she was 'high risk'.
15. The police earlier declared her a prostitute, the local newspapers splashed
this news and one paper even printed her photograph as a rescued prostitute. She
was then made to undergo a traumatic physical examination and police
investigation on the strength of which the police have now declared she was
never in the trade.
16. The doctors in the Miraj Government Hospital did not give a discharge card
and sent the minor girl to the police station on 12 May, without conducting the
prescribed sonography test on her.
17. It is unfortunate that the girl's statement about molestation/rape did not
find any veracity in the eyes of the police.
This narration has been ignored and appropriate action averted. Thus the State
has failed in the principle of due diligence of preventing and prosecuting this
act of violence.
18. Is it ethical for decoys to have sex with informants? Could the earlier
sexual encounter with Surekha have been to 'soften her up'?
19. Is it acceptable that a decoy customer closets himself with a minor girl and
attempts to molest her/actually rape her in the name of rescue?
20. Even if the police did not have actual evidence of rape, they should have
detained Raju Williams on the girl's statement that she was raped/molested, as
per the law of the land.
21. There is an urgent need for ethical guidelines in a rescue process and
established protocols for the same. These need to be sensitive in terms of
gender, poverty, caste, age and so on. The State should give directions
regarding the appointment of decoy customers. Similarly, rules and guidelines
for the police should be made when they conduct raids, especially in the attempt
to rescue victims / survivors of atrocities.
22. What clout do the various avatars of the rescue groups based in Ooty and
Mumbai (with board members from the USA ) have in India ? Why do they have this
clout even with the police? They work in Uganda , another southern, poor country
– but what is the kind of work they do in their own countries? Do problems exist
only in developing countries?
23. The websites of some of the above, while working for "Christ's mandate",
also 'orientalise' India and sell products such as Nilgiri tea, amongst others.

http://www.sangram.org/currentevent.htm

Meena Seshu
e-mail: <sangram.vamp@...>

Dear forum,

Greetings from BNP+.

From BNP+ side we believe we should reach our issue from class to mass, if you
realy want to win the battle. I can remember once in a meeting Mr. Naresh
yadav(The President of UPNP Network) shared it. Realy it was a very very
valuable word.It is not only the issue of PLWHA but it is aplicable also for
mass. Because we and the general people are belonging in a same society,so
everyone includes with our issues. We want to covey our voice against such
stigma and discrimination among them.

With this expectation we called a meeting for Making Action Plan Regarding
Denial Treatment in Medical College and Hospital, Kolkata. The venue of Meeting
was at  KNP+ Office, 63A/2, Hari Ghosh Street, Kolkata-700006. Date: 28/05/2007
Time: 2:30p.m.

Total  19 people participanted in the meeting. The agenda for the meeting was:-

To Raise the voice Against the denial for treatment in Govt. Hospitals
Protest Movement/ Deputation and Demonstration
To file up such cases under PIL against entire health services system.
A press conference will be organized

Out comes:-

1. All T.I Partners, Support Groups and Friendly Minded People want to raise
their voice against treatment denial
2. T.I. Partners, Support Group members and Friendly Minded People want to start
a protest movement regarding This.

3. To make a Charter Of Demand which will give to the Health Secretary and it
will be CC to Health Minister, Chief Minister, NACO, IMA, Central Health
Minister and others

4. A press briefing will be organized at Manas Bangla Project office.
5. BNP+ will file up PIL against the Entire system of govt.health services where
PLWHAs faced denial for treatment and care-support.
6. DLNs of BNP+ will fill the PIL regarding such cases in their own districts.
7. The aforesaid task will be organized after the protest movement and sharing
the action plan with the media

Activities :-

1. Sensitization Programmes will be held in the various department of the Govt.
Hospital. All T.I. Partners will sit and will make a decision, what will be done
and in which department. Its follow up is also essential.

2. To make that  record that how many sensitizations  had happened, how many
cases of denial were documented

3.. The organizations will sit on 31st May 2007, at BNP+ H.O., at 2:00p.m. and
will make an Action Plan what we will do on the date.

4 Tarit will give few of demands which were raised in treatment adherence
workshop and Saathii will give the same thing from their resources. On that day
it will discuss with the partners and will make the final draft.

5. On 11th June 2007, the protest movement will come to the limelight. The
different Organizations will help the movement through their manpower. An
informal letter of will be sent to the police regarding our movement.

6.  We will give the statistics of the denial cases by govt hospital /case
studies will be given  to the press and also will tell them about our protest
movement. Subhodip and Debdut will take the responsibilities regarding this.

7. An opinion poll will be arranged in FM Channel ,Print Media, and Electronic
Media regarding the denial for treatment  .

8. To raise our voice nationally and internationally against such denial for
treatment cases in Govt Hospitals.

Venue:-

1. Sensitization programme:- In various departments of medical colleges  and
other govt hospital.  The task will be done Within Two Weeks.

2.  To make out plans :- BNP+ H.O., at 2:00p.m.,Thakurpukur Bazaar, Kolkata -63
at 2 p.m.

3. Protest movement :-Swastha Bhavan 11th June 2007,11p.m.

4 .Press briefing : Manas Bangla Project office, E-31, Shree Nivas Appartment,
Rajdanga,, Nabapally,Kol-107. 2nd  June,07, at 12 o clock to 2 p.m

5. File up PIL:-DLNs of BNP+ after filing the PIL of BNP+

6. Press conference :- People of various networks as well as organizations,
Members of the Support groups and friendly minded people, after filing the PIL
of BNP+ ,not fixes up yet.

Name of the participants

Bromho, Bhulu Basak.Kari Saha.Maluncha Dutta Majumder.Sujit Das. Of KNP+; Tarit
Chakraborty,Biswajit Das.,Farzana Begum.,Khitis Mondol. Debdut Saha, Bimal
Sarkar. of BNP +Anushri Das Bannerjee ,Rajashree Chakraborty, Jaideep Jana,
MANAS BANGLA , Mangala Pradhan, Panch Rani Ghosh, DMSC;  Hran Basak, Mr. Sambhu
of SPARSHA , Sidipta Panja of BHoRUKA ; Pawan Dhall of SHAATHII of Sanjoy Ram of
KOSIS.

With Regards,
Tarit Chakraborty

Tarit Chakraborty
Regional Co-ordinatore(INP+)
President of BNP+(West Bengal)
e mailtarit34@...
Hallo-09836258928

Homespun technology provides HIV-free breast milk

Michael Malakata, 25 May 2007
Source: SciDev.Net. [LUSAKA] Researchers have devised a simple and
cost-effective method of preventing breast milk transmission of HIV
from mother-to-child by 'flash-heating' infected milk to inactivate
the free-floating HIV virus.

A study, published online in the Journal of Acquired Immune
Deficiency Syndromes (21 May), provides hope that breastfeeding in
developing nations could become safer.

National banks that collect, store and disperse human milk already
pasteurise it, but commonly use a method that relies on thermometers
and timers that can be hard to obtain in resource-poor communities.
The new method involves simply heating a glass jar of expressed milk
in a pan of water over a flame or single burner, so can easily be
applied by mothers at home.

The research began in 2004 and was driven by HIV-positive mothers
from Zimbabwe wanting to know how they could make their milk safe for
their babies, according to Kiersten Israel-Ballard, from the US-based
Berkeley School of Public Health, who coordinated the study.
Of the 700,000 children who become infected with HIV each year, the
study says an estimated 40 per cent contract the virus from prolonged
breastfeeding that continues for more than six months.

The World Health Organization (WHO) recommends heat-treating HIV-
infected breast milk, but so far there has been sparse research into
a simple method that could be used by HIV-positive mothers in
developing countries.

"We wanted to be sure that there was scientific evidence that flash-
heated milk was truly free of HIV and immunologically beneficial,"
Israel Ballard told SciDev.Net.

Infants in developing countries at risk of potentially fatal
illnesses such as diarrhoea can't afford to lose antibodies or the
optimal nutrition found in breast milk.

In the study, 84 HIV-positive women contributed breast milk to the
research. Tests on flash-heated breast milk showed that the process
kills bacteria and the HIV virus, while retaining most of the milk's
nutritional and antimicrobial properties.

Canisius Banda, a spokesperson from the Zambia Ministry of Health,
told SciDev.Net that the challenge would be to educate mothers on how
to heat the milk.

Current WHO recommendations state that HIV positive mothers should
avoid breastfeeding when safe feeding alternatives are available. But
in regions where mothers cannot afford the cost of infant formula or
where water is contaminated, the WHO recommends mothers should
exclusively breastfeed their babies up to six months of age.

Link to abstract in Journal of Acquired Immune Deficiency Syndromes

Reference: Journal of Acquired Immune Deficiency Syndromes doi:
10.1097/QAI.0b013e318074eeca (2007)


Flash-Heat Inactivation of HIV-1 in Human Milk: A Potential Method to
Reduce Postnatal Transmission in Developing Countries.

BRIEF REPORT
JAIDS Journal of Acquired Immune Deficiency Syndromes. POST
ACCEPTANCE, 17 May 2007
Israel-Ballard, Kiersten MPH *; Donovan, Richard PHD +; Chantry,
Caroline MD ++; Coutsoudis, Anna PHD [S]; Sheppard, Haynes PHD +;
Sibeko, Lindiwe MSC [//]; Abrams, Barbara DRPH *

Abstract:
Background: Up to 40% of all mother-to-child transmission of HIV
occurs by means of breast-feeding; yet, in developing countries,
infant formula may not be a safe option. The World Health
Organization recommends heat-treated breast milk as an infant-feeding
alternative. We investigated the ability of a simple method, flash-
heat, to inactivate HIV in breast milk from HIV-positive mothers.

Methods: Ninety-eight breast milk samples, collected from 84 HIV-
positive mothers in a periurban settlement in South Africa, were
aliquoted to unheated control and flash-heating. Reverse
transcriptase (RT) assays (lower detection limit of 400 HIV
copies/mL) were performed to differentiate active versus inactivated
cell-free HIV in unheated and flash-heated samples.

Results: We found detectable HIV in breast milk samples from 31% (26
of 84) of mothers. After adjusting for covariates, multivariate
logistic regression showed a statistically significant negative
association between detectable virus in breast milk and maternal
CD4+T-lymphocyte count (P = 0.045) and volume of breast milk
expressed (P = 0.01) and a positive association with use of
multivitamins (P = 0.03). All flash-heated samples showed
undetectable levels of cell-free HIV-1 as detected by the RT assay
(P< 0.00001).

Conclusions: Flash-heat can inactivate HIV in naturally infected
breast milk from HIV-positive women. Field studies are urgently
needed to determine the feasibility of in-home flash-heating breast
milk to improve infant health while reducing postnatal transmission
of HIV in developing countries.

Sub: Comment of the Health Secretary of West Bengal on treating dead boady of
HIV positive person

Dear forum,
Greeting from BNP+!

Last week we posted a report on Nitai Adhikari, Who faced stigma, discrimination
in medical college when he came to MCH for his treatment.

The health service providers didn’t provide any kind of care and support at
first, he was denied treatment. After a long battle he was admitted in the MCH
but the picture and the mentality of the service providers was not changed yet.
He was treated as sub human in the hospital.

At last he died in the hospital and nobody touched his body to bring him out
from the hospital.

Though a numerous sensitization programme were held in the govt.hospitals
including MCH. In MCH only at least 2 sensitization programmes were held in the
surgery department in this year. What is the result of that Programmes?

You will be stunt when you heard the comment of the Health Secretary of West
Bengal, Ms.Sanchita Boxi.

Yesterday she gave a statement in a leading Bengali newspaper,  The Ananda
Bazaar Patrika, that it is more dangerous when the fluids comes from the body
after death of a HIV positive person. So no one will come to help the family of
the person. She added that so the govt.hospital authority release the patients
from  at that time the hospital and tell his family to take away him / her from
the hospital.

We don’t know it is true or false. We have no guide line regarding this. But one
thing you think if the statement is true then it already came to the limelight.
Because it is a serious thing to think that. But no one can tell about it. On
the other hand if it is false then you can understand what was the impact of the
sensitization? All the money and effort was gone in vein.

If you all know about this please send your valuable feed back .We are waiting
for your comments.

With Regards,

Tarit

Tarit Chakraborty
Regional Co-ordinatore(INP+)
President of BNP+(West Bengal)
e-mai: tarit34@...
Hallo-09836258928

Kerala SACS request Educatiion Department to ban unauthorised books on
adolescent education

Dear forum

I am herewith attaching a news story publlished by the New Indian
Express on 20th May for your information

Training module on adolescent education

T'PURAM: Kerala State AIDS Control Society (KSACS) has written to
Education Department to instruct the educational institutions to
avail themselves of the technical inputs regarding adolescence
education from KSACS.

In a letter sent to Additional Chief Secretary (Higher Education),
Secretary (General Education), Directors of Vocational Higher
Secondary Education and Directorate of Higher Secondary Education,
the KSACS has urged them to avail themselves of the training module
on adolescent education, prepared by experts and distributed free of
cost.

KSACS has also assured that it could provide trained resource persons
to conduct sessions of adolescent education.

The KSACS has taken the action following the Express report which
appeared on Friday that the book blacklisted by the National AIDS
Control Organisation was being used for an awareness campaign among
the NCC cadets in the state.

KSACS has instructed all these departments to prevent the
distribution of the book 'HIV/AIDS Handbook for Young People' written
by Gracious Thomas in the educational institutions of the state.

The Society has also forwarded a copy of the letter and review report
on the book, received from K Sujatha Rao, Director General, National
AIDS Control Organisation to these departments.

''We have also informed them that we are working closely with the
Education Department, Directorate of Public Instruction and SCERT to
implement the Adolescent Education Programme in the schools across
the state,'' Dinesh Arora, Project Director, KSACS said.

''We have also written to the Director, Directorate of NCC,
forwarding the copy of the letter and review report on the book, and
informed them that Kerala State AIDS Control Society is willing to
join hands with NCC to provide technical inputs regarding adolescence
education and provide training module,'' he said.
--
S.Ajai Kumar
Programme Officer IEC
Kerala SACS, Red Cross Road
Thiruvananthapuram - 35. Kerala
e-mail: <ajai.ksacs@...>

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7317

Try TARSHI – their two books linked below are excellent!

THE BLUE BOOK (ENGLISH 1999)NEELI KITAB (HINDI 1999)
  <http://www.tarshi.net/downloads/blue-book.pdf>

Easy to understand, matter-of-fact information on Sexuality for those aged 15
years and older. Cost: Rs.45

THE RED BOOK (ENGLISH 1999) LAL KITAB (HINDI 1999)
  <http://www.tarshi.net/downloads/red-book.pdf>

Easy to understand, matter-of-fact information on Sexuality for 10-14 year
olds.Cost: Rs.45


Revati Chawla
e-mail: <revati.chawla@...>

Dear All,

Re: http://health.groups.yahoo.com/group/AIDS-INDIA/message/7312

This is in addition to the reported activities at Rajkot(Gujarat)as posted by
Dr.Avnish Jolly.

The useful interventions for facilitating outreach of services to the affected
and infected children have been strengthened in Gujarat.

Three day camps were organized to initiate the process of HIV testing and CD4
testing of children in 9 different cities having teaching hospitals/large civil
(district) hospital(s). They were preceded by a
fortnight long field surveys/activities involving the volunteers from the GSNP+.

The activities were carried out by the GSACS and the GSNP+ with the active
support of the Clinton Foundation and the UNICEF. The Clinton Foundation
provided Rs.200 per young patient to cover the transportation costs from
anywhere in the state.

About 300 children had their CD4 tests done and 135 had their HIV testing done
at the ICTCs functional at the respective centre on 22nd to 24th May,2007.

The outsourced CD4 testing facilities are supplementing the only CD4 testing
facilities in the public sector at the Civil Hospital,Ahmedabad.

The activities have to be carried out on a regular basis and should not be seen
and facilitated as just a one time activities as the regular and sustained
continuum of these services are a must.

Best wishes,
Dr.Rajesh Gopal.


Dr. Rajesh Gopal, MD
Joint Director,
Gujarat State AIDS Control Society (GSACS),
O/1 Block, New Mental Hospital Complex,
Meghaninagar, Ahmedabad, Gujarat.
PIN 380016
Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214
e-mail: <dr_rajeshg@...>

Dear Friends,

On 18 May, the Sankalp Rehabilitation Trust, an organisation that provides
treatment and rehabilitation support for injecting drug users, filed a
post-grant opposition against Roche's patent for the hepatitis-C drug
peg-interferon á2a, marketed by Roche as Pegasys.

The patent for Pegasys was the first product patent granted in India under the
new TRIPS-mandated product patent regime, and is only available from Roche at
the price of Rs 2.25 lakh (US$ 5,625) for a 6-month course.  In the hope that an
absence of patent protection will spur generic competition to bring down the
price of this much-needed drug, Sankalp decided to file an opposition against
Pegasys.

Hepatitis-C represents a huge public health problem in India.  An
estimated 12.5 million people in India are infected with the hepatitis-C virus
(HCV).  Left untreated, hepatitis-C can lead to liver cirrhosis, liver cancer or
liver failure.  Hepatitis-C is especially pernicious for those co-infected with
HIV, as several studies have shown that HIV-HCV co-infection leads to increased
rates of disease progression.  Injecting drug users are especially vulnerable to
HIV-HCV co-infection.

For instance, a study in the Northeastern state of Manipur reported HIV-HCV
co-infection rates as high as 93% among injecting drug users. However, due in
part to its high cost, hepatitis-C treatment is not available in government
hospitals.

Indeed, we have been told that treatment programmes are not even bothering to
screen for HCV due to the unavailability of treatment.

Roche'2s patent for Pegasys involves combining interferon - a naturally
occurring protein with antiviral effects that has been known for years - with a
structure called polyethelyene glycol (PEG), an inert substance that helps to
prevent the interferon from being broken down by the body, thus allowing it to
remain in the bloodstream longer.  This technology of combining interferon and
other biologically active proteins with PEG had also been known for years prior
to this patent.

In fact, the technology embodied in Roche's patent is essentially identical to
that disclosed in an academic paper that was published a year prior to the
filing of Roche's patent application.

The opposition to the patent for Pegasys was based on these grounds.

Patent protection is only granted to inventions that are new and involve an
inventive step.  Sankalp has argued in its opposition that the patent was
wrongly granted, because given the state of the existing knowledge at the time
of the grant of patent, the "invention" that Roche was claiming was neither new
nor inventive.  Rather, Sankalp has argued, the patent is an attempt to obtain a
monopoly over technology that existed in the public domain.

Sankalp has also invoked some legal provisions that are unique to
Indian patent law, including the assertion that Roche's alleged "invention" is
at most a "mere admixture" of known substances and unpatentable under section
3(e) of the Patents Act, and that it is just a "new form of a known substance"
and not patentable under section 3(d) of the Act.

A copy of the opposition can be found at our website:
www.lawyerscollective.org

Feel free to contact us with any questions.

In Solidarity,

Lawyers Collective HIV/AIDS Unit

Lawyers Collective HIV/AIDS Unit
63/2, 1st Floor, Masjid Road,
Jangpura,
New Delhi - 110014
Phone - 011-24377101, 24377102, 24372237
Fax - 011-24372236
E-mail - aidslaw1@...

Dear FORUM,

There is a lot happening on 3rd National AIDS Control Program (NACP III), we
would kindly request somebody to update us on what is the role of MSM TI
interventions in NACP III with respect to Maharashtra.

Udaan has also been doing intervention programmes with the MSM population since
1992 in Mumbai, Thane, Pune, Raigad, Nasik, Jalgaon and Nanded.

Though we are not supported by any of the three bodies ( MDACS, MSACS and AVERT)
till today,  we have played a very important role in controlling HIV and
empowering the community.

Since Udaan is not on the NACO list for MSM interventions, Udaan has always been
deprived of information on TI interventions, and hence we earnestly request the
CIVIL SOCIETIES, STATE AIDS CONTROL SOCIETY AND THE DISTRICT AIDS CONTROL
SOCIETY AND NACO REPRESENTATIVES  on the list, to provide us with information on
NACP III and also keep us informed of any meetings on this subject.

SHAFIK MANJOTHI
MSM PROJECT CO-ORDINATOR
UDAAN
E-MAIL" <udaantrust@...>

Dear All,

I am  trying to develop a sex education program in some of the private schools
in Kolkata in grade 10-12.

Can anybody, who has done thid before, could provide a brief model, ideas
regarding the parameters I should focues on? or an precautions or suggestions I
need to address? Or some thing about the questionaire to be put on at this
level?

Regards

DR.TOUFIQUE
e-mail: <drtoufique@...>

Dear forum,

A silent candle rally was taken out in Warangal, Andhra Pradesh on
20-05-2007.

The rally was flagged off by Sri.Ponnala laxmaiah, the Major Irrigation Minister
for Government ofandhra Pradesh. The rally was led by Ms.Damayanthi, District
Collector Warangal. Ms.Soumya Mishra,
Superintendent of police; Ms.Swarna, Mayer, warangal Municipal corporation;
Ms.Danvanthi,chair person zilla Parishad Warangal;
Dr.Sampathy Raja Ram, Secretary, IRCS, Dr.Samba shiva Rao, state
secretary IMA, Prof.Seetaram, NGO,CBO, health providers, Nursing
students, police personnel, elected representatives and PLHIV
participated in the rally.

About500 members walked about 2 Km with candle in their hands.

The Candlelight Memorial Campaign involves all sectors of the local community
including NGOs, government, faith-based groups, and community members in the
fight against HIV/AIDS. From the beginning of this movement, the Memorial has
served as a forum to honor the memory of those lost to AIDS, show support for
those living with HIV/AIDS, raise awareness of the disease, and mobilize
individuals around a common goal of responding to the local impact of HIV/AIDS.

The International AIDS Candlelight Memorial is a unique event that promotes
discussion, education, and action around HIV/AIDS with the following four
objectives:

a) Honor the memory of those lost to AIDS;
b)Show support for those living with HIV and AIDS;
c)Raise community awareness and decrease stigma related to HIV/AIDS; and
d) Mobilize community involvement in the fight against HIV/AIDS.

NARASIMHA SWAMY THAMATAM
e-mail: <tnswamy123@...>

Emergence of NNRTI Drug Resistance Mutations after Single-Dose
Nevirapine Exposure in HIV Type 1 Subtype C-Infected Infants in India

AIDS Research and Human Retroviruses
May 2007, Vol. 23, No. 5 : 682 -685

A feasibility study for providing single-dose nevirapine (SD-NVP)
prophylaxis for prevention of mother-to-child transmission (PMTCT) of
HIV infection provided an opportunity to study the emergence of
nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance
mutations as a result of single-dose administration. The study aimed
at the detection of NNRTI drug resistance mutations arising as a
result of SD-NVP. A total of 19 and 13 samples collected at 48 h and
2 months postpartum, respectively, from infants that were given SD-
NVP were studied for the presence of NNRTI drug resistance mutations
by PCR amplification and sequencing of the HIV-1 pol gene using HIV
proviral DNA. The drug resistance mutational analysis of final
sequences was carried out using the Stanford University HIV Drug
Resistance database (http://hivdb.stanford.edu/hiv). Mutations
associated with NNRTI drug resistance were observed in two (10.5%)
and six (46.15%) samples at 48 h and at 2 months, respectively.
K103N, one of the most common mutations, was not observed in any of
the samples. The emergence of NVP resistance must be weighed against
the simplicity, efficacy, and cost effectiveness of SD-NVP
prophylaxis in PMTCT settings in developing countries


Swarali N. Kurle, Department of Molecular Virology, National AIDS
Research Institute, Pune, India.
Raman R. Gangakhedkar, Department of Molecular Virology, National
AIDS Research Institute, Pune, India.
Sourav Sen, Command Hospitals, Pune, India.
Shilpa S. Hayatnagarkar, Department of Molecular Virology, National
AIDS Research Institute, Pune, India.
Srikanth P. Tripathy, Department of Molecular Virology, National AIDS
Research Institute, Pune, India.
Ramesh S. Paranjape, Department of Molecular Virology, National AIDS
Research Institute, Pune, India.

Scientific Affairs Specialist in  USA CDC office at Hyderabad.

Vacancy Notice. American Consulate General, Chennai, is seeking an individual
for the position of Scientific Affairs Specialist in its CDC office at
Hyderabad.

BASIC FUNCTION OF POSITION

Incumbent is recognized by American and Indian public health
practitioners as a reliable and valuable resource for HIV/AIDS in
India. In his/her capacity as Health Specialist with the US
Department of Health and Human Services, Centers for Disease
Control and Prevention's Global AIDS Program, (GAP) in South India
(placed in Hyderabad) the employee provides program, coordinative,
advocacy and some technical input for primary prevention, HIV/AIDS
care and treatment, training, surveillance and laboratory services
infrastructure support,. The incumbent's primary focus is in South
India. However he/she is also expected to provide guidance in GAP
programs established in other states and for expanding activities to
other parts of India.

Incumbent is required to develop and foster relationships with a wide variety of
individuals within India, at both the Government and NGO levels, CDC, Atlanta,
within the US Public Health Service, the US Department of State, and others
involved in HIV/AIDS programs
internationally. Incumbent provides program management and
public health communications and documentation expertise to all
programs, with special emphasis on public private partnership and
institutional capacity building.

Incumbent is expected to perform independently as well as in a team,
and performs a variety of project implementation, support and
planning activities for GAP, India.

QUALIFICATIONS REQUIRED:

a. A Master's degree in health, social sciences or communication.

b. A minimum of 4 years in work involving training, writing and
public health project management and administration. Prior experience in data
analysis, communications (including writing in English) and contact with
organizations representing various government and non-government sectors is
necessary. Prior work in a management position within a large NGO, Government or
Private Industry is required.

c. Level IV (fluency) in English and Telugu is required.

d. Thorough knowledge of public health systems (including health
statistics), politics, economy, society and history of south India.
Understanding of complex social structures and customs, as well as
official protocol is necessary.

e. Ease and familiarity with various software packages and computer
programs, including spreadsheets, PowerPoint and basic statistical
programs.

f. High level of initiative and creativity is essential. Ability to
develop and maintain extensive range of high level contacts in public and
private sector in India ad the U.S. Must be able to synthesize health,
political, economic and social issues and communicate information both orally
and in writing including outlining and drafting accurate and perceptive reports
and research project results.

g. Incumbent must also have keen organizational and management skills in order
to follow and track highly complex and time-limited
activities. Incumbent must be willing and be able to travel
internationally and within India.

SELECTION PROCESS
When equally qualified, and if funding permits, Eligible Family
Members (EFMs) and U.S. Veterans will be given preference.

ADDITIONAL SELECTION CRITERIA
1. Management will consider nepotism/conflict of interest, budget,
and residency status in determining successful candidacy.

2. Current employees serving a probationary period are not eligible
to apply.

3. Eligible Family Members who currently hold a PIT/FMA appointment
are ineligible to apply for advertised positions within the first 90
calendar days on the job.

TO APPLY

Interested applicants for this position should submit the following:
1. Application for Employment, Form HR-01, available on website

http://chennai.usconsulate.gov/employment_opportunities.html

Click on "Application for Employment" hyperlink.

Madhya Pradesh rightwing fuels anti-sex education drive

Posted May 27th, 2007 by TariqueIndia News By IANS

Bhopal : The Madhya Pradesh government may have already banned sex
education in its schools, but rightwing groups have decided to go one
step further by distributing thousands of copies of a book that warns
of its dangers.

Even as India battles diseases like AIDS, over 10,000 copies of the
book titled "Red Alert", published by a Mumbai-based NGO, have been
distributed free of cost in the state.

Rightwing outfits like the Bajrang Dal, often accused of playing
moral police, have jumped in to lend a helping hand.

The book, authored by Jataiyu and published by Viniyog Parivar, not
only cautions readers against sex education in schools but also
describes it as the 'tsunami of Indian culture', said a government
school teacher who said he got the book from a Bajrang Dal activist.

The book emphasizes that a doctor needs to talk about sex, not a
teacher.

Outrage over sex education in schools, mainly among rightist parties,
has been prompted primarily by a flip chart of illustrations used by
teachers to explain the physical changes experienced by teenagers
during puberty.

Information in the curriculum on contraception and sexually
transmitted diseases also provoked anger, compelling the state in
March to stop sex education provided under the adolescent education
programme (AEP) in its present form in schools. The National Aids
Control Organisation funds AEP.

But the Bajrang Dal says the government ban is not enough.

"Awareness among people about the dangers of imparting sex education
to students at a young age is also crucial. Sex is natural and no one
can teach about it to children," said Dal leader Vishal Purohit.

"The book has been written by Ratnsunder Surishwar Maharaj who is
opposed to sex education like we are," said Jayeshbhai Desai, who
deals with the distribution of the book from Indore.

The Congress praty, which had earlier objected to sex education in
schools, has now changed its mind and urged the government to ban the
book.

"It is a serious matter. The government should ban the book. It is
against the union government's decision," said state Congress
spokesperson Manak Aggarwal.

Ironically, the controversy is raging in a state where 2,174 AIDS
patients have been identified. Of this over 40 percent belong to the
age group of 21-30 years. As per reports, nearly 75 percent people
get infected due to unsafe sex.

Said an activist working for the welfare of women and children in the
state: "Today you stop AEP, tomorrow you will say that teaching
biology should also be stopped because the books also contain
pictures of human anatomy more or less similar to the ones in the
study material in question."

http://www.indianmuslims.info/news/2007/may/27/madhya_pradesh_rightwin
g_fuels_anti_sex_education_drive.html