INVITATION  AIDS_ASIA e FORUM.

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If you are already a member of this FOURM please forward this message to your
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[AIDS_ASIA e FORUM] is an experimental occasional electronic newsletter. An e-
forum committed to the development of an Asian perspective on AIDS prevention
and care issues. HIV/AIDS does not recognize national boundaries. As Asia-
pacific countries are increasingly interconnected through migration and trade,
it is imperative to generate a regional perspective on HIV/AIDS related issues.

A forum for critical analysis of issues, events and programs, which has
implications on, our ability to address HIV/AIDS prevention and care issues
across the region. More than 4,000 subscribers are using this FORUM.

Strategic HIV information and communication support to promote the capacity of
Asian leaders, activists and people living with HIV/AIDS, to facilitate their
engagement and networking, to highlight their experiences and the solutions they
are offering to address HIV/AIDS issues in this region.

A cross cultural discourse on issues and concerns of Asia- Pacific countries
(regions): Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China,
East Timor, Fiji, India, Indonesia, Japan, Kiribati, Laos, Malaysia, Marshall
Islands, Micronesia, Mongolia, Myanmar, Nepal, New Zealand, North Korea,
Pakistan, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon
Islands, South Korea, Sri Lanka, Taiwan, Thailand, Tonga, Tuvalu, Vanuatu and
Viet Nam will be presented and promoted on this forum.

Please review the archived messages on the following url

http://health.groups.yahoo.com/group/AIDS_ASIA/

Workshop on  the scope of Internet Mediated Communication (IMC) in HIV/AIDS Work
in Jakarta

On May 30, 2005, CWS Indonesia conducted a workshop on Internet Mediated
Communication (IMC) in HIV/AIDS work in CWS Indonesia office in Jakarta.

Ten participants attended the workshop, including CWS Indonesia's partner
organisations from NOMAD – Manado, PKBI – Central Sulawesi, YTB – SoE, dan
Yayasan Gaya Celebes – Makassar, as well as CWS staff from Central Sulawesi,
West Timor and Manado.

The workshop, facilitated by Joe Thomas, began with seeking the expectations of
the participants of the workshop. Some wanted to acquire the skills of basic use
of  internet, as well the most finding out the most cost-effective way to access
the internet. some others wanted to find out the scope of internet as an
HIV/AIDS advocacy tool.

Out of the seven-session workshop, the session on assessing the reliability of
an internet site as information source was most fascinating for many of the
participants. A tool was presented to the participants to assess the quality and
reliability of the information presented on the web. This was very vital as in
HIV/AIDS work, people are provided with many information but most of the time
they have limited time and skill to check the reliability of the information.

The following issues/themes were discussed in the workshop.

Workshop on the Scope of Internet Mediated Communication in HIV/AIDS work in
Jakarta, Indonesia. 30 May 2005

AGENDA

Introduciton to the concept and practice of Internet Mediated communication
(IMC) in HIV/AIDS work

How IMC can assist you in enhancing your capacity in HIV/AIDS work?

Intrduction to popluar e FORUMS as a soruce of HIV/AIDS knowledge.

Introduction to the direcvtorty of HIV/AIDS websites in Asia Pacific region.

How to assess the reliability and credibility  of information on the internet?

How to use e-groups as a source of HIV/AIDS information and communication?

How to integrate IMC into you day-to-day work?

Follow-up plan & Introduction of Reading Materials

At the end of the workshop, Maurice Bloem, Regional Director CWS Indonesia /
Timor Leste, offered an exercise as a follow up for all of the participants,
where they will have to send an email to once a week to report on the 
reliability of the sites they have visited.

"Betti Siagian"
E-mail:  <bettiiss@...>

India launches 'smart card' to fight AIDS

Indo-Asian News Service
New Delhi, May 26, 2005

India is testing a new smart card system that will electronically
keep track of its HIV/AIDS patients and is expected to facilitate
medication through antiretroviral cocktails as well as track their
potency.

The cards, launched on Thursday, would be given to more than 300
patients receiving anti-retroviral drugs. They would need to bring
the cards each time they come to the hospital for anti-AIDS drugs or
for any other medical problem.

The cards would help health workers keep track of India's more than
five million HIV/AIDS affected patients and act as a portable
medical record. They fast-track treatment and medical response in
emergencies, provide greater security to medical records and ensure
immediate access and easy storage of data.

"These cards would revolutionise AIDS treatment," said Shubhashis
Gangopadhyay of India Development Foundation, which along with the
Confederation of Indian Industry (CII) and Indian Business Trust for
HIV/AIDS, is conducting the trials.

There are many uses of the health smart card in dealing with
HIV/AIDS when most of the affected population is mobile. For
instance, constant monitoring is necessary to prevent drug
resistance and the need to keep information confidential due to
social stigma.

The scheme has been praised by former US president Bill Clinton, who
is on a three-day visit to the country to oversee tsunami
rehabilitation and push for more efforts on the AIDS battle.

"The smart card idea is fantastic and I think that it would be
adopted by every country in the world," said Clinton.

With 5.1 million patients, India is the world's second largest
HIV/AIDS affected country after South Africa, which has 5.3 million
infections.

http://www.hindustantimes.com/news/181_1377563,0050.htm

The Cambodian Tenofovir Trial Controversy: Lessons to be learnt

Joe Thomas

Solidarity + Volume 1 Issue No. 1. May 2005. Bi-Monthly Newsletter
of the Asia Pacific People's Alliance for Combating HIV/AIDS
(APPACHA)http://health.groups.yahoo.com/group/AIDS_ASIA/files/Solidarity%20%2B/


This article will examine some of the political and ethical issues of clinical
drug trials using the NRTI (nucleotide reverse transcriptase inhibitor) drug,
Tenofovir DF, which was licensed to treat HIV-1 infection by the Department of
Food and Drug Administration (FDA), United States in October 2001 (Clinical
Trials Gov 2005).

Since some scientists believed that Tenofovir also could serve as a pre exposure
prophylaxis for HIV infection, a research project was initiated by the
researchers from the University of California, San
Francisco (UCSF) and the University of New South Wales, Sydney in order to prove
this hypothesis. They selected Cambodia as a potential site for this clinical
experimentation and sex workers in Cambodia as the potential clinical trial
participants.

The Ethics Review Committees (ERC) of the University of California, San
Francisco in the United States of America and the University of New South Wales
in Sydney, Australia, endorsed the trial as it complied with the global
standards of ethics of clinical trails.

However, under intense pressure from the representatives of the sex workers in
Cambodia and the advocates for ethical trials on vulnerable populations, the
Cambodian government withdrew support to these clinical trials, clarifying that
the trial protocol did not adequately address ethical concerns.

Likewise, similar studies planned by other researchers in Thailand and Cameroon
came under intense pressure from the potential trial participants for better
compliance with ethical standards. Community
groups from Thailand staged agitations to protect the interests of
clinical trial participants in Thailand and pressed for modifications to the
protocol of the clinical trial proposed to be conducted there. (Jack, A and
Kazmin, A. 2005)

This clinical trial raises several issues related to the ethics and politics of
international research involving researchers from the resource-rich countries,
initiating and implementing research in resource-scarce settings and in
selecting vulnerable populations as
their potential clinical trial participants. In this context, this
brief commentary examines the following issues of the proposed clinical trial in
Cambodia.

• The nature of informed consent

• The interpretation of the 'risk and benefit' of participating in
the trial
• The options for treatment after the trial, in the event of any long-term
after-effects arising from the trial itself

• The extent to which the researchers were willing to disclose the
risk associated with the study

• The methods adopted by the researchers to assess the risks and
benefits of trial participants expected to participate in clinical trials.

The role of multi-centric ethics review committees and the scope of
community-based ethics review committees also came under the spotlight as part
of this controversy.

This article is based on extensive reviews of literature, interviews
with the activists, sex workers and their representatives in Cambodia, and
summarises some of the lessons to be learnt from the
controversy.

Obligations and responsibilities of the researchers

This controversy provided an opportunity to revisit the issue of
the 'obligations and responsibilities' of the international clinical
researchers. Researchers must not use an approval of an International research
protocol (a research protocol approved by a home country ERC, to conduct a
clinical trial in another country) by an ERC from the researcher's home
institutions as an excuse to minimise their responsibilities towards the
participants of the research.

In some instances, the 'obligations and responsibilities' of the international
clinical researchers are legal obligations. For instance, the legal obligations
and responsibilities of US based
researchers are listed under the Code of Federal Regulations (CFR)
(Title 45. Public Welfare) of the Department of Health and Human Services,
Office for Protection from Research Risks. They are meant to ensure compliance
with regard to research conducted, supported, or otherwise subject to regulation
by the Federal Government outside the United States.

The researchers also have obligations to apply rigorous scientific analysis and
methods in all aspect of the clinical trial. It appears that in the context of
the proposed 'Tenofovir trial' in Cambodia, the researchers' commitment to
scientific rigour was restricted only to the research aspect of the trials.
There was no indication that they were even aware of the need for careful
analysis of the risk and benefit of the trial from a participant's perspective,
or that they owed a greater commitment to the welfare, rights, beliefs and
customs of the communities under study. A far more rigorous and scientific
analysis was essential to understand the risk associated with the participation
of vulnerable populations in clinical trials in Cambodia. A greater measure of
pragmatic efforts was also essential to demonstrate the 'principal of
beneficence' when such research is carried out.

In this case, even as the researcher claimed that Tenofovir had 'minimal
toxicity' (Shafer, 2004), the product information provided by the US Department
of Health and Human Services revealed
quite the contrary: 'Adverse events reported in patients receiving
Tenofovir DF included abdominal pain, anorexia, asthenia, diarrhoea, dizziness,
dyspnea, flatulence, headache, hypophosphatemia, lactic acidosis, nausea,
pancreatitis, renal impairment, rash, and vomiting'.

In yet another instance of research aberration, the principal investigators of
the Cambodian trial turned out to be non-clinical epidemiologists, in violation
of regulations that stipulate that only experienced and qualified clinicians are
competent to undertake research in complex anti-retroviral (ARV) regimes.


The researchers claimed that the rationale behind their selection of
Cambodia as a clinical trial site had to do with 'altruistic intentions', in
response to the high prevalence of HIV disease in the country. However, the real
motivations for the selection of Cambodia may well be less altruistic than
opportunistic, since there
is clearly a higher statistical probability of proving the research
hypothesis in a higher rather than lower HIV prevalence setting.


Informed consent is an ongoing dialogue

Informed consent has increasingly been interpreted as 'an ongoing
process of dialogue' between the researcher and the research participants (CFR
45). Compliance with 'informed consent' is also a
legal requirement (45 CFR 46.116) for US based researchers. The
documentation of informed consent must comply with 45 CFR 46.117.

According to the 'Code of Federal Regulations' of the United States
of America, informed consent is a process, not just a form. Information must be
presented to enable persons to voluntarily
decide whether to participate as a research subject. It is a
fundamental mechanism to ensure 'respect for persons' through
the provision of thoughtful consent for a voluntary act. The
procedures to be used in obtaining informed consent should be
designed to educate the subject population, in terms that they can
understand. Therefore, informed consent language and its
documentation (especially explanation of the study's purpose,
duration, experimental procedures, alternatives, risks, and
benefits) must be written in 'lay language', (i.e. understandable
to the people being asked to participate). The written presentation
of information is used to document the basis for consent and for the
subjects' future reference. The consent document should be revised
when deficiencies are noted or when additional information will
improve the consent process' (CFR 45).


It was evident from the field observations, that the principal
researchers of the proposed trial in Cambodia had demonstrated a
blasé attitude towards facilitating the process of 'informed
consent' among the potential trial participants. For instance, none
of the 'informants' interviewed for this article had ever even seen
a copy of the informed consent form.

The limitations of the mechanisms for the review of ethics of
clinical trials

This controversy brought to attention the need to strengthen local
ERC systems and the question of the effectiveness of transnational
ethics review mechanisms.


One of the key issues overlooked by the researchers of the proposed
Cambodian clinical trial was the need to consolidate local ethics
review systems, including the creation of the community-based ethics
review committees, as part of their extended responsibility. While
researchers may argue that such responsibilities go beyond the
immediate scope of their proposed research, the fact remains that
resources have to be allocated for the strengthening of local ethics
review systems as part of any complex clinical research project.

The research protocol for the Tenofovir trial had previously been
approved by ethics review committees of two prominent Universities,
comprising experts on ethics issues. Nevertheless and ironically
enough — serious lapses in ethical compliance were detected by a
group of impoverished sex workers in Cambodia. Despite their obvious
lack of training in analysing the ethical complexities of clinical
trials, they raised core questions of ethics of clinical trials and
the responsibilities of the researchers.

Thus, this controversy also exposed certain inherent limitations of
the international ethics review procedures, seen as characteristically high on
rhetoric but notoriously low in commitment to enforcing the ethical principles
that they preached.

The Tenofovir trial controversy is a warning note for the community
groups that the approval of a trial by an ERC associated with high-
profile institutions is not essentially a guarantee for an ethically
sound research. In addition, this is a reminder to the ERCs
approving such trials of the need to be more vigilant in their
responsibilities.

Methods of assessing risk and benefits of clinical trials

When the principal investigator of a research study claims that the
trial involves 'little risk' for the participants, he/she is not
only expected to be candid and precise about the nature and extent
of the risk, but also owes the participants an explanation as to how
this risk (including possible long-term repercussions) was
calculated.

Apropos the Tenofovir trial, Cambodian sex workers and their
representatives had themselves identified several categories of
risks (AIDS_ASIA E-Forum 2005). Furthermore, the methods and tools
used for assessing the risk and benefit also need to be disclosed as
part of the description or validation of the research methods.
However, based on the available documentation, the researchers did
not demonstrate the use of rigorous scientific methods of assessing
risk and benefits of clinical trials as applied to their proposed
trial.

Negotiating for minimum standards of 'Duty of Care'

Researchers are bound by the principle of 'duty of care', which
ensures that their decisions and actions do not harm the short and
long-term well-being of people and resources. According to UNAIDS
Guidance for HIV Vaccine Trials (2000), care and treatment for
HIV/AIDS and its associated complications are mandatory for
participants in HIV preventive vaccine trials, as is the 'minimum'
requirement of adhering to the highest standards of health care
achievable in the host country.

The process of negotiating for a comprehensive care package should
be agreed upon through a host/community/sponsor dialogue, which
reaches a consensus prior to the initiation of a trial (UNAIDS
2000). Researchers need to acknowledge the right of the trial
participants to negotiate for 'minimum standards' of care (which, in
turn, will be fixed after a systematic assessment of the risk and
benefits) both during and after the trial. However, it appears that
the potential Cambodian trial participants, efforts for
negotiating for a higher standard of 'duty of care' was ridiculed by
the researchers.

Health Equity: The criteria for prioritising clinical trial research
questions

Adequacy of research must also be justified on principles of justice
and equity. In a country like Cambodia, where vast health inequities
exist, researchers who carry out projects that may not produce
immediate benefits for the 'researched' community, have an
additional obligation to maximise the benefits and
reduce the risk associated with these trials, while assisting in the
development or facilitation of a strategic clinical research agenda.
Considering the high HIV disease burden prevalent in Cambodia, it is
imperative that an HIV clinical research must contribute towards
health equity benefits that are immediate.

Conclusion

In 1997, UNAIDS convened an 'expert group' to identify ethical
issues in AIDS vaccine trials (UNAIDS 1997). This group recognised
that 'thoughtful people of goodwill' can disagree on
ethical interpretations of the guidelines and that most of the
current guidelines will be applicable in their present form to the
ethical questions of AIDS vaccine research (Bloom 1998). Further
guidelines were proposed by UNAIDS in 2000 with specific emphasis
on the 'duty of care' (UNAIDS 2000).

By way of a response to the present controversy, a process of
further consultation, albeit less transparent and less participatory
in nature, has been initiated with the aim of developing a further
consensus on these issues. It is appropriate and timely that the
UNAIDS responded to the call to mediate to break the impasse.

However, at the same time, mediators should take care not to convey
the impression that they are trying to 'clean up the mess' created
by inconsiderate researchers. Considering the gravity of the ethical
dilemmas posed by the Tenofovir trial controversy, the mediatory
efforts undertaken by UNAIDS must be guided by the
deliberations of its own ethics review committees. It follows that
more concerted efforts are crucial both to create awareness of and
adherence to national standards as also to revise them at regular
intervals, based on prevailing local and international standards.

The case of the Tenofovir trials has also forced us to ask the
critical question of whether ethical guidelines should remain mere
guidelines or be made mandatory as legal obligations as well.

In conclusion, this controversy has sounded a clarion call for
heightened community vigilance with regard to the ethical aspects of
clinical trials, since it has become apparent that the mere approval
of a trial by an ERC is not in itself a sufficient promise of a
sensitive and ethically reliable study.

References

AIDS_ASIA E-Forum. (2005) Unethical Tenofovir trial: Cambodian sex
workers' Concern. Message 278.
http://health.groups.yahoo.com/group/AIDS_ASIA/message/278
(Accessed on 17 March 2005)

Jack, Andrew and Amy Kazmin (2005) Thai Aids campaigners question
new clinical trials. Financial Times. 12 March 2005 (Accessed on 12
March 2005) http://news.ft.com/cms/s/0bcd9024-929b-11d9- bca5-
00000e2511c8.html

Shafer, Kimberly Page (2004) Use of ARV in prevention of HIV
infection in high-risk populations. Women & HIV Research Directions,
International AIDS Conference, Bangkok, Thailand 2004.

UNAIDS (1997). Ethical Considerations in Clinical Trials of
Preventive HIV Vaccines. Proceedings of meeting held from 23 24
September 1997 (UNAIDS, Geneva, Switzerland, 1997).

UNAIDS (2000) Vaccine Research, UNAIDS Guidance Document. UNAIDS,
Geneva, Switzerland, 2000.

Code of Federal Regulations. Title 45. Public Welfare. Department Of
Health And Human Services, National Institutes of Health, Office For
Protection From Research Risks. Part 46. Protection Of Human
Subjects. Revised, November 13, 2001, Effective December 13, 2001.

www.ClinicalTrials.gov. Daily Tenofovir DF to Prevent HIV Infection
among Sex Workers in Cambodia.
http://www.clinicaltrials.gov/ct/show/NCT00078182 (Accessed on 12
March 2005)

http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm#46.114 th
(Accessed on 9 March 2005)

Bloom, Barry R. (1998) The Highest Attainable Standard: Ethical
Issues in AIDS Vaccines. Science Magazine January 9, 1998, Volume
279, Number 5348.American Association for the Advancement of Science.
______________________________

Dr. Joe Thomas is associated with APPACHA
(joe_thomas123@...)

Solidarity + Volume 1 Issue No. 1. May 2005
Bi-Monthly Newsletter of the Asia Pacific People's Alliance for
Combating HIV/AIDS

http://health.groups.yahoo.com/group/AIDS_ASIA/files/Solidarity%20%

Announcement of the Third Asia Pacific PLWHA Congress
                     "Bangkok + 1"
              30 June 2005, Kobe, Japan

We are delighted to announce that the 3rd Asia Pacific PLWHA Congress willbe
held on the 30 June 2005 in Kobe, Japan at 9 am, just prior to the  ICAAP. The
Congress is open to any person living with HIV/AIDS who is a residenceof any
country in the Asia Pacific Region.

Objectives:

To assess the progress of the 2004 Bangkok Declaration by PLWHA and discuss way
forward
To discuss and finalize the draft regional advocacy strategic action plans and
agenda prepared by APPRC with APN+ and INP+ based on the results of the Second
PLWHA Congress.
To discuss messages to be delivered at a dissemination  session as well as a
press conference

As this is a closed session only for positive people from the Asia
and Pacific region, prior registration is required.  Please send an
email to Mr.Manoj Pardesi (manojpardesi@...), the new coordinator of the
AsiaPacific PLWHA Resource Centre for further information and registration by
JUNE 3 (FRIDAY) latest.

Information about the venue (if not available, indicate that details
will be sent in due course).

About the PLHWA Congress

As part of the Asia Pacific PLWHA Coalition for Advocacy and Capacity
Transfer, an initiative started by the UNDP Regional HIV and
Development programme together with its partner APN+ (Asia Pacific Network of 
People Living with HIV/AIDS) and INP+ (Indian Network for People Living with
HIV/AIDS) to develop and strengthen the capacity of PLWHA for their meaningful
involvement in the HIV/AIDS responses in the region.

The Asia Pacific PLWHA Resource Centre (APPRC) based in New Delhi, India, 
together with the implementing partners, will be  organizing three annual Asia
Pacific PLWHA Congresses. The Congresses are to assist in  formulating  the Asia
Pacific PLWHA Advocacy agendas and regional strategic action  plans  tobe
implemented by the APPRC in the following areas:

1. GIPA and Empowerment
2. Access to treatment
3. Human rights

First PLWHA Congress

The first Congress was held on the 11 January 2004 in Bangkok in
conjunction with the Asia Pacific Community Forum (12th -14th January 2004) with
about 50 PLWHA participants from across the Asia Pacific Region.

Participants discussed various issues affecting their lives and came up with 
priority areas that require urgent attention and action.

Second PLWHA Congress Held in conjunction with the World Aids Conference in
Bangkok, July 2004 and attended by more than 100 PLWHA from Asia Pacific Region.
The  Congress  was
focused on developing an advocacy action plan which will be carried
out  by PLWHA groups across the region. A Declaration was also issued which  has
the voices of PLWHA from the region.

Contact Person:

Mr. Manoj Pardesi
APPRC, J-50 BK Dutt Colony
Jor Bagh Lane
New Delhi-3
India
Tel- +91-11-24652297/98
Email- manojpardesi@...
Website- www.plwha.org

shiba
E-mail: <shiba.p@...>

3 Questions to Richard Feachem by PLWHAs in Nepal

THREE QUESTIONS TO THE EXECUTIVE DIRECTOR OF THE GLOBAL FUND TO
FIGHT AIDS, TB AND MALARIA FROM PEOPLE LIVING WITH HIV/AIDS IN NEPAL

To,
The Executive Director
Global Fund

CC: Chair & Executive Board of the Global Fund

Respected Sir,

We the people living with and directly affected by HIV/AIDS from
different parts of Nepal would like to bring into your notice a few
issues that has been overtly neglected by our government and all the
donors working in Nepal – including the Global Fund to fight AIDS,
TB and Malaria.

Nepal has a concentrated epidemic with around 100,000 estimated to
be living with HIV/AIDS. However, among injecting drug users the
prevalence is staggering 50% - 70%, among sex workers 20% and so on
and so forth. A raging conflict and political unrest for the past
several years has fuelled the HIV epidemic.

Due to the concentrated epidemic scenario in Nepal donors get an
excuse not to fund treatment and care programs as they believe that
prevention should remain the mainstay in a low prevalence context.
This has also influenced the National AIDS strategy which fails to
even mention the word treatment let alone set strategies to treat
and care people living with HIV/AIDS. As a minority, we the
community of people living with HIV are discriminated by the
government and donors. Our needs and our priorities are often
disregarded because we are small in numbers. We are often told that
we will only receive treatment and care services when more people
come out. When we heard about the global fund and its mission 3
years back we had hoped that the fund will address our needs.

However our hopes were shattered when country coordinated proposal
failed to address our needs and priorities as they were based on the
national plan which focuses on prevention because of the reasons
mentioned already. Those who contributed to the proposal were the
NGOs who had experience only on prevention programs. Though Nepal
received funding from the global fund in 2003 the programs are yet
to be implemented. Another major barrier to this delay was instable
political scenario, weak national AIDS coordinating body and limited
international pressure. Again on the other hand we were told that
there are other pressing issues than HIV and AIDS.

Whenever we raise this issue with our own government or the donors
we are told that they are doing their best. Whenever we raise this
issue to the Global Fund, UNAIDS or WHO we are told that it is our
government who is `not working and is not their fault.'

Is it then our fault that we have a raging conflict?
Is it our fault that there is a political unrest?
Is it our fault that our government is in denial?
Is it our fault that we have a weak national plan?
Is it our fault that we have a passive international community?
Is it only our problem that we are living with and affected by HIV&
AIDS?

If yes, then we have nothing to say. However we would like to put
forth a few questions to the Global Fund that had promised not to do
business as usual.

1. What is the fund's strategy to deal with countries in conflict
and political unrest?
2. How does the fund facilitate the process in countries to ensure
that people living with HIV have access to treatment and care
through the GF resources?
3. When a country excludes people living with HIV and vulnerable
communities to apply through the country coordinated proposal how
will the fund help the communities to develop and submit a proposal?

(The government of Nepal has adopted a policy to only accept
applications from organizations that are registered for five years
which excludes several organizations run by people living with
HIV/AIDS, drug users and sexual minorities to apply for funding.)
With these questions laid down for you we hope that the fund will
encourage and assist the communities to develop and submit a
proposal for the 5th round.
_______________
Rajiv Kafle, Former Board Member GNP+, Advisor APN+, Communities
Delegation GFATM, Board Member International Treatment Preparedness
Coalition & National Association of People living with HIV/AIDS
(NAPN)
____________

"Rajiv Kafle"
E-mail: <rajhiv2002@...>

WHO's in charge of world health?

The World Health Organisation is the chief body of the United
Nations responsible for global health problems. It is charged with
monitoring the state of the health of the six billion citizens of
Earth, and with stepping in with cures, remedies and preventatives
when warranted. The health of the world is far from excellent, and
the same may be said of the WHO. Today is the start of the UN body's
annual meeting. It is discouraging to see that instead of coming to
grips with the agency's problems and shortcomings, its bureaucrats
are set to discuss a series of relatively unimportant matters which,
at best, will make a relatively few healthy people more healthy.

In the year of tsunami recovery, with its anti-malaria programme
faltering and the most important Aids initiative on the brink of
failure, the WHO will focus this week on quite different matters.
There is a Global Initiative to kick off, for example _ on diet,
physical activity and health. This is a project for middle-class
people with wide choices, and will provide recommendations on meals
and exercise. Then there are the projects on road safety, destroying
smallpox samples, finance and relations with non-governmental
organisations. There will be an entire conference session on the
health conditions in Israel-occupied territories, but there will not
even be one for all of Africa, the centre of the two most important
and failing WHO policies.

The WHO has spent untold funds _ perhaps to be accounted this week _
on a much-needed Aids programme called 3 by 5. The aim, when this
project began several years ago, was to have three million diagnosed
HIV/Aids victims in developing countries taking effective, anti-
retroviral drugs by the end of 2005. It sounded like a realistic
goal, given that five million new patients are diagnosed each year
with the virus or syndrome. But it hasn't worked out that way. A
devastating article in the current edition of the British medical
journal Lancet lists a few of the shortcomings. Just 30 of the
targeted 50 nations have been covered at all. The needed 400 WHO
staff currently stands at 112. Dr Jim Yong Kim, WHO director of the
Department of HIV/Aids, predicts recalcitrant governments in India,
Nigeria and _ of course _ South Africa make it almost impossible
even to achieve the modest goal of three million patients.

But here is the worse news. Of four million HIV/Aids victims in
Africa, just 325,000 or 8% will be under effective medical treatment
in the unlikely case that the 3 by 5 programme suddenly accelerates
to success by New Year's Eve. Without South Africa on board, tens of
thousands of Africans will be doomed to death by Aids because of the
failure of the WHO project. And now officials have determined the
knock-off anti-retroviral drugs from Indian firms are not at all
``bio-equivalent'' to the expensive, patented drugs they copied.
This will not be a subject for discussion at the WHO gathering this
week.

Nor is the deeply troubled anti-malarial programme called RMB, for
``roll back malaria''. Experts including, again, the Lancet have
harshly criticised RMB, centred in Africa as are most of the million
deaths to malaria each year. They say RMB has been such a failure it
may even have increased the number of victims. WHO teams were found
pushing outdated, ineffective drugs such as chloroquine and
sulphadoxine-pyrimethamine. Malaria does not appear on the WHO
meeting's agenda.

After the Dec 26 tsunami, the WHO began its work only on Jan 18, and
then in conjunction with a US government field team. There are
profound health problems throughout the African continent, where two
of the most prominent and important basic health-care plans are
floundering and facing failure. Yet the annual WHO assembly
beginning today is to focus on issues such as ``social health
insurance'', breastfeeding and an examination of the plight of the
Palestinians. These and dozens of other issues are important in
certain ways, and deserve national or regional attention. But the
WHO is, literally, the world's health organisation. Its Geneva
meeting gives the impression the WHO is either, willy-nilly,
flitting from issue to issue, or ignoring its most important
mandates.

http://www.bangkokpost.com/News/16May2005_news26.php

Shanghai plans responses to AIDS

The Lancet 2005; 365:1524-1525 [DOI:10.1016/S0140-6736(05)66435-5]

Scott Burris   a,   Joanne Csete b,   Xia Goumei c,   Zhou Dan d
and   Bebe Loff e

On Dec 15, 2004, a meeting was convened in Shanghai, China, to
discuss options for laws dealing with HIV/AIDS at the provincial and
municipal levels. The primary agencies responsible were the Shanghai
Academy of Social Sciences, the Shanghai Law Society, and the
Institute of Legislation and Temple University in the USA. With a
population of some 13 million, Shanghai is China's largest city and
enjoys a legal status equivalent to a province, enabling it to
create its own law. Participants in the meeting were mainly leaders
of the municipal government (including members of the Municipal
People's Congress and the health department), and researchers from
the Shanghai Academy of Social Sciences and other research
institutions. The meeting showed Shanghai's commitment to effective
HIV/AIDS legislation and the challenge of steering HIV/AIDS policy
through the shoals of fear and moral disapproval of drug use and
prostitution.

Both the content and process of law reform were addressed. A law-
reform exercise in Australia in the early 1980s was offered as an
example of a consultative process in which affected populations were
encouraged to share their experiences. Over 2 years, non-
governmental organisations were encouraged to come forward to help
shape the law, law that in turn supported an environment of
partnership between government and community.

At the Shanghai meeting, three important areas of concern were
identified, each tied to a different legal strategy for HIV/AIDS
control. First, there remains a great deal of anxiety in some of
those in the legislative process about low-risk exposures and
attempts to intentionally transmit HIV. Speakers and participants
offered anecdotes about vengeful people with HIV deliberately trying
to infect others, and robbers using infected needles to intimidate
victims. Similarly, some speakers alluded to the necessity of
testing hospital patients to protect medical staff, and disclosing
HIV test-results to employers to allow safety-related job
reassignment.

Fears about deliberate exposure to HIV have elsewhere come to be
regarded as exaggerated. Mandatory testing and disclosure as a means
of protecting individuals from exposure to HIV is elsewhere seen as
unnecessary and even counterproductive.1 The universal precautions
approach, in which workers are trained and equipped to manage
occupational exposure to blood or infectious body fluids, is now
well established. The Chinese Centres for Disease Control plans to
promote this approach, but it does not yet appear in Chinese
HIV/AIDS legislation. Including a universal precautions approach in
Shanghai's legislation, and providing the support for the necessary
training and equipment, could set a valuable example.

A second important theme was the need to enhance the involvement of
non-governmental organisations in HIV/AIDS prevention and care in
China. People in vulnerable populations, such as drug users and sex
workers, have begun to organise in China to advocate for policy and
law that respects their rights. The Shanghai meeting was notable for
the participation of an openly gay lawyer, Zhou Dan. Although
Chinese law formally contemplates a vital role for non-governmental
organisations in HIV/AIDS prevention and response, there are many
legal and social barriers to the development of a vigorous sector
for non-governmental organisations in China.2 The requirements for
establishing non-governmental organisations are set for the most
part at the national level, and include provisions requiring such
organisations to have a government or official sponsor, and that
allow only one non-governmental organisation on a topic for each
jurisdiction.3 Partnerships between Chinese non-governmental
organisations and non-Chinese funders and providers of technical
assistance are also limited. Whilst eliminating these barriers would
require national legislation, local governments can encourage the
participation of non-governmental organisations by providing greater
funding to these organisations and actively involving them in
planning and evaluation of HIV policies and programmes, including
the development of good law. Creative legal work might identify ways
in which provinces and municipalities can reduce bureaucratic
barriers to non-governmental organisations in the absence of reform
at the national level. Representatives of the Shanghai
administration reported that the problem of non-governmental
organisations will be addressed in the municipal legislation.

Finally, the meeting also highlighted the importance of policy
implementation. The approval of needle-exchange and drug-treatment
programmes on paper, or the passage of privacy and discrimination
protections, is not sufficient to assure that services are actually
delivered in a way that meets policy goals. Legislative planning
must include funding for training and monitoring of performance. The
implementation problem is particularly great in the area of privacy
and antidiscrimination law. Vitally, there was no disagreement that
people with HIV should be protected from discrimination and from the
inappropriate release of their medical information. At the same
time, however, it was also widely accepted that China lacks an
effective system for the enforcement of these basic human rights. An
enforcement mechanism, such as a Human Rights Commission charged
with investigating discrimination cases and promoting compliance, as
well as legal services, will be necessary to provide real protection
that people with HIV can rely on.

We declare that we have no conflict of interest.

References

1. World Health Organization. UNAIDS/WHO policy statement on HIV
testing.
http://www.who.int/hiv/pub/vct/statement/en
June, 2004 (accessed March 14, 2005)(accessed March 14, 2005)

2. State Council of China. Chinese national medium-and long-term
strategic plan for HIV/AIDS prevention and control (1998–2010).
State Council Document GF (1998) 38.
http://www.usembassy-china.org.cn/sandt/hivpolicypr98-2010.h...
Nov, 12, 1998 (unofficial translation, accessed March 8, 2005)
(unofficial translation, accessed March 8, 2005)

3. State Council of China. Regulations for registration and
management of social organizations. Order number 250.
http://www.humanrights-china.org/zt/NGOs/..%5CNGOs/200412004...
Sept, 25, 1998 (unofficial translation, accessed March 8, 2005)
(unofficial translation, accessed March 8, 2005)


Affiliations

a Temple University Beasley School of Law, Philadelphia,
Pennsylvania, PA19122, USA; Johns Hopkins School of Hygiene and
Public Health, Baltimore, Maryland, USA; and Center for Law and the
Public's Health, Johns Hopkins School of Hygiene and Public Health,
Baltimore, Maryland, USA

b Canadian HIV/AIDS Legal Network, Montreal, Quebec, Canada

c Centre for Public Policy Study of HIV/AIDS, Shanghai Academy of
Social Science, Shanghai, China

d Richard Wang & Co, Shanghai, China

e Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia

http://www.thelancet.com/journals/lancet/article/PIIS0140673605664355
/fulltext

US AIDS Policy: More Harm Than Good, Says Brazil

In an unprecedented move, the Government of Brazil yesterday refused
a $40 million grant from the United States to fight AIDS, saying its
ideological conditions were too severe.

Nearly 700,000 individuals are inflicted with HIV/AIDS in Brazil,
many of whom are living in poverty. The Bush Administration's grant
would have imposed scientifically unverifiable, ideological clauses,
such as one that asks the country to officially condemn
prostitution. Signing such a clause would have impeded AIDS
interventions within Brazil, which orchestrates open relationships
with prostitutes, homosexual men, intravenous-drug users and other
high-risk groups in order to fight the pandemic.

"It is a simple fact that in order fight AIDS, it's crucial to work
with the populations that face the greatest risk. It would be a
gross human rights violation to deny them life-saving assistance
based on moral grounds." said Atila Roque, Executive Director of
ActionAid USA, and himself a Brazilian. "That's why we should praise
the Brazilian government's decision, which will help to raise the
stakes of international debate concerning the Bush Administration's
ideological influence over foreign aid policies."

Added ActionAid International USA policy analyst, Rick
Rowden, "HIV/AIDS needs to be battled through a public health
approach which requires close working relationships with the most
vulnerable communities. You can't have a cooperative working
relationship with, say, prostitutes' associations that starts off
with a blanket moral condemnation of them. You might think you've
taken the moral high ground, but that is not the same thing as an
effective anti-HIV/AIDS strategy. From this point on, the US is
going to need to decide if it is going to be moralistic or
effective."

According to Dr. Paul Zeitz,Director of the Global AIDS
Alliance, "In turning down the US grant, the Government of Brazil is
actually protecting people at risk by ensuring science-based
prevention programs are implemented rather than ideologically-based
prevention programs that have no basis in scientific reality. This
is a phenomenal development by Brazil, a sovereign government which
is finally standing up against policies that are doing more harm
than good."

Interestingly, there are no Federal laws within the United States
banning prostitution. As a result, prostitution is legally condoned
within some Nevada counties. According to a 10-year UCLA study, the
occurrence of AIDS within condoned rather than condemned brothels is
significantly lower than that of the general population.

States Almir Pereira Jr, program coordinator for HIV/AIDS at
ActionAid International Brazil, "more than the refusal of accepting
the US grant, the Brazilian government's attitude represents its
commitment towards maintaining a democratic and progressive AIDS
program, as opposed to the conservative vision of the United States.

Unfortunately, it seems that the US policy is taking advantage of
the great poverty and high vulnerability of developing nations to
impose its conservative agenda as a condition for the countries to
receive the financial aid they desperately require."

NOTES TO EDITORS
ActionAid International works in Africa, Asia, Europe and the
Americas to fight global poverty and tackle the injustice that
causes it.

For Immediate Release, April 16, 2005
Sandy Krawitz of ActionAid USA
202-835-1240 or 202-492-7207 (cell),
sandy.krawitz@...
or Tony Durham of ActionAid UK,
44 20 7561 7636 or 44 7957 870314 (mobile) or
tony.durham@...

INVITATION  AIDS_ASIA e FORUM.

Hi,

If you are already a member of this FOURM please forward this message to your
colleagues who may find this FORUM useful.

[AIDS_ASIA e FORUM] is an experimental occasional electronic newsletter. An e-
forum committed to the development of an Asian perspective on AIDS prevention
and care issues. HIV/AIDS does not recognize national boundaries. As Asia-
pacific countries are increasingly interconnected through migration and trade,
it is imperative to generate a regional perspective on HIV/AIDS related issues.

A forum for critical analysis of issues, events and programs, which has
implications on, our ability to address HIV/AIDS prevention and care issues
across the region. More than 4,000 subscribers are using this FORUM.

Strategic HIV information and communication support to promote the capacity of
Asian leaders, activists and people living with HIV/AIDS, to facilitate their
engagement and networking, to highlight their experiences and the solutions they
are offering to address HIV/AIDS issues in this region.

A cross cultural discourse on issues and concerns of Asia- Pacific countries
(regions): Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China,
East Timor, Fiji, India, Indonesia, Japan, Kiribati, Laos, Malaysia, Marshall
Islands, Micronesia, Mongolia, Myanmar, Nepal, New Zealand, North Korea,
Pakistan, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon
Islands, South Korea, Sri Lanka, Taiwan, Thailand, Tonga, Tuvalu, Vanuatu and
Viet Nam will be presented and promoted on this forum.

Please review the archived messages on the following url

http://health.groups.yahoo.com/group/AIDS_ASIA/

Vacancy Announcement

The Office of the Resident Coordinator of the United Nations System's
Operational Activities for Development in Thailand

Term of Reference

Post Title:  Manager of the Secretariat of the United Nations
Task Force on Mobility and HIV Vulnerability Reduction
Type of Appointment  Local ALD – A4

Salary: Up to USD 101,164 per annum depends on level of experience
Duty Station:  Bangkok, Thailand
------------------------------------------------------
Job Summary:
To manage the Secretariat of the United Nations Task Force on
Mobility and HIV Vulnerability Reduction, reporting to the Resident
Coordinator and working in close co-ordination with the Steering
Committee of the Task Force.

Duties and Responsibilities:

1. Manage the secretariat and coordinate the Task Force.
	 Manage and account for project funds.
	 Develop and finalize, under the direction of the SC and Task
Force, the annual Work Plan, facilitating and monitoring the
implementation.
	 Ensure continued communication and information flow between
and among the SC and Task Force members in order to develop close
working relationships, shared ownership, and achieve Task Force
objectives and goals.
	 Prepare and disseminate progress reports to the RC, SC, and
Task Force members and donors.
	 Prepare and disseminate semi-annual, annual and final
project reports of the Task Force, which should include financial
reports, results achieved, and lessons learned.
	 Provide administrative and technical backstopping support as
required by the SC and Task Force.
	 Facilitate and organize meetings of the SC and TF, including
preparation of agenda, substantive focus, progress reports, and
financial reports.

2. Identify and mobilize financial and technical resources as
well as resources persons to facilitate and support the
implementation of the Work Plan.

3. Carry out advocacy activities with governments and regional
bodies in concert with the SC and TF in pursuit of the Work Plan.

4. Ensure that all relevant information generated by the Task
Force is gathered systematically and communicated to the public,
including maintaining and updating a website.

5. Liaise with other relevant organizations of the UN system,
regional/international inter-governmental organizations, NGOs,
agencies and governments to ensure that programmed activities are
carried out in a timely manner.

6. Facilitate evaluation of the Task Force

7. Other related duties as required.

Psychological and/or Attitudinal Skills:
• Holding high regard for integrity
• Well-developed professionalism, personal discipline and
impartiality;
• Flexible and open to learn and develop personally and
professionally;
• Adaptability to constantly changing Country Office
leadership;
• Commitment to customer service: meet internal and external
customer needs promptly;
• Responsive to changing circumstances and adaptive to
requirements at short notice;
• Excellent stress management skills;
• Competent in meeting inflexible deadlines and in resolving
difficulties while maintaining composure;
• Ability to take initiative, priorities and work
independently to cater for a wide range of stakeholders;
• Commitment to gender equality;
• Ability to work as part of a team, sharing information and
coordinating efforts within the team and the office community.

Qualifications:
• Post graduate academic degree in public health, social
science, or equivalent
• 5-10 years experience in mobility and/or HIV/AIDS with at
least 5 years of managerial experience
• In-depth knowledge on mobility and/or HIV/AIDS in Southeast
Asia
• Strong leadership, coordination and interpersonal
communication skills
• Fluency in oral and written English; knowledge of regional
languages an asset
• Familiarity with the UN system would be an advantage

Interested candidates should submit a detailed resume, a recent
photo, and UN Personal History Form (P11) along with a cover letter
clearly stating the position and respective reference number by 3
May 2005, to:

Human Resources Associate
G.P.O. Box 618, Bangkok 10501
or e-mail to : hr.thailand@...
Competitive salaries and benefits (such as pension, medical
insurance, and 30 days annual leave) will be offered according to
the UN General Service scales applicable in Thailand. Only short
listed candidates will be notified.

(Internal candidates will be given first priority)
____________________
Petcharamporn Siriut
Administrative Secretary
UNDP Regional Centre in Bangkok
3rd Floor, UN Service Building
Rajdamnern Nok Avenue, Bangkok, Thailand
Tel.: +66 (2) 288 2153
Fax: +66 (2) 280 2700
URL: http://regionalcentrebangkok.undp.or.th
E-mail: petcharamporn.siriut@...

Dear FORUM,

I had requested for a country wise break from the WHO regarding achievement of
the target in '3X5' project of the WHO but subsequently I found the information
from the WHO site (http://www.who.int/3by5/progressreport05/en).

Initially, the data was so unbelievable that I went through a little carefully.
First, the whole data is essentially based on the government supplied
information possibly reflecting the information coming from the US Department of
State which claimed that by the end of September 2004, the USA was supporting
treatment of 15 the HIV sufferers in fifteen focus nations.

The total number of people receiving treatment between the months of June till
December 2004 is 567900. By the end of December 2004, the number of people
having access to HIV treatment has come to 78000 (high estimate of the WHO)
which has been moderated down to 700000. The number given by different countries
are so precise that it has been given even in 1s and 2s.

Normally you would expect these numbers to be on exceptionally high
side as each and every government wants to claim that it is providing
extraordinary service to its citizens suffering from HIV. However, a little
closer scrutiny of these numbers suggests a different story. Botswana has been
regarded a success story. The number given for Botswana who are receiving HIV
treatment is 32839 in September 2004, a very precise number which grew to 39000
by the end of December 2004, approximately by 6000 i.e. 50% of approximately 75-
80000 people requiring HIV treatment are receiving it.

A look at the graph on page 18 of the WHO Report suggests a different story. As
per the graph, the number of people receiving ARV therapy in September 2004 is
approximately 18000 and if you add one quarter receiving treatment through
private facilities possibly through the so called public private partnership
(the African Comprehensive HIV/AIDS Partnerships, with the Bill and Melinda
Gates foundation, The Merck Company foundation and the pharmaceutical company
Merck & Co.), the number of people receiving ARV treatment
would be 22-23000, and not 32839 a very precise figure which jumped to 39000 in
December 2004. We are talking about miracles not access to medicines or to be
precise access to ARV therapy.

A look at Indian figure is more staggering. India is providing ARV therapy only
to 2841 HIV sufferers in November 2004. In December 2004, Indian access to ARV
therapy has been shown to be 36000. In one month, the access has jumped from
2841, a very precise figure to something like 12 fold.

Where did they get this information from? Number of countries providing ARV
treatment to more than 40% of the HIV sufferers needing treatment is an
interesting reading.

These countries are Argentina (90%), Botswana (50%), Brazil (86%), Mexico (74%),
Thailand (44%), Uganda (40%), Uruguay (100%) and Venezuela (51%). Countries that
appear to be total failures are Zimbabwe (8000 (9000) out of 295,000), Zambia
(13636 (22000) out of 149000), Tanzania (2880 (3500) out of 263000), South
Africa (14922 in Sept. 2004 to 62000 in December, 2004) out of 837000) Nigeria
(13579 (15000) out of 558000) Kenya (16952 (33000) out of 220000) Ethiopia (3836
(4500) out of 167000).

From the data it appears that Latin America has absolutely no HIV problem at all
whereas two African countries, Uganda and Botswana, closely aligned with the USA
have nearly covered half of the HIV sufferers.

Uganda is an exceptional case where the anti-AIDS medicines are most expensive.
So you are going to get a research literature from PhRMA spokespersons such as
Amir Attaran, Peter deMarios, Henry Grabowski that cost of the drugs is not
responsible for access to medicines although it may be entirely opposite of Amir
Attaran's mouth opening research that it is the poverty which is responsible for
non-access
to medicines. It does not matter which shoe you are using till you are able to
beat HIV sufferers.

For the year 2004, the budget for health in Uganda was US$ 180 million with an
approval from Global Fund of $137 million with a signed grant agreement for $36
million. (Charles Wendo, Ugandan Officials Negotiate Global Fund Grants:
Government Limits on Health-sector Spending may jeopardise funding agreement,
Lancet 363 Jan. 17, 2004, p 222). As per Charles, it costs $30 per patient per
month in Uganda to provide a triple antiretroviral combination.

Uganda has spent only 18 million dollars to treat 50000 people per year and if
we take 114, 000, then it has to spend only 41 million dollars per year.

The most interesting reading of all is the cost of ARV treatment worked out in
casse of Malawi at $300 per year.

Even if we accept the higher number of people provided ARV treatment, the total
cost works out to be only $210 million.

It is comparatively a very small amount and it appears that money is not a
problem as far as the WHO target is concerned.   Even accepting 3 million
target, all that is required, is only 900 million per year and accepting 5.8
million currently needing treatment, total yearly cost works out to be 1.74
billion dollars. One does not have to go to any other source and the much touted
Global Fund should be able to take care of all these minor requirements. You can
discount any other source of fund including those from the governments.

To top its report, the WHO has approvingly mentioned about The AIDS Medicines
and diagnostics Service) AMDS, essentially a constituent of the WHO (UN
Agencies-WHO (EDM, EHT, CPS, Essential drugs and HIV RA in Regional offices),
UNICEF, World Bank, UNAIDS,  UNFPA, UNDP; Technical organizations and donor
agencies-CCAR, CHAI, CPA, Crown
Agents, EPN, Esther, FIP, GFATM, IDA, JSI, MEDS,MSH;Observers-MSF, US State
Department ( PEPFAR),  USAID) whose one focus is on the tiered pricing system. I
had mentioned in my previous note regarding tierce pricing and the involvement
of the WHO in this scandal.

The whole report while talking of its achievement on the basis of sheer cooked
up data and the promotion of tiered pricing, a demand
from the US-EC pharmaceutical industry and promoted by the American Enterprise
Institute through Patricia Danzon, an alumnus of American Enterprise Institute,
(Patricia M. Danzon, 1997, Price discrimination of Pharmaceuticals: Welfare
Effects in the US and the EU, International Journal of the Economics of Business
301-321 (1997) Patricia M. Danzon, Testimony of the U.S. Senate Committee on
Health, Education, Labor and Pensions, 13th June 2000, available at
<http:www.senate.gov/~labor/hearings>; Patricia Danzon,

Differential Pricing for Pharmaceuticals: Reconciling Access, R&D, and Patents,
CMH Working Paper Series, Paper No. WG2: 10, Commission on Macroeconomics and
Health (A WHO Commission examining the Interrelations among investments in
health, economics growth and poverty reduction, 2001, Danzon argued that
“Implementation required the adoption of policies to prevent low prices in
low-income countries from “leaking� from the low-income countries to higher
income countries, thereby undermining the potentially higher
prices in these high income countries.

Such leakages occur due to parallel trade or “external referencing.��),
John Barton from Stanford University, (John Barton, Differentiated Pricing of
Patented Products, Working Paper
NO. 63, Indian Council for Research on International Economic Relations, March
2001), Juan Rovira from the World Bank (Juan Rovira, A Trade Framework for
Intellectual Property Rights, Equity Pricing and Market Segmentation, The World
Bank, Health, Nutrition and Population, World Bank Workshop, June 2, 2003;  Juan
Rovira, Meeting on the Role of Generics and Local Industry in Attaining the
Millennium Development Goals (MDGs) in Pharmaceuticals and Vaccines,
Washington Ds, June 24-25, 2003 June ), Jayashree Watal of the WTO and a new
convert F. M. Sherer (The Economics of Parallel Trade in Pharmaceutical Products
(WTO-WHO Hosbjor Conference) (2001)from the Harvard University is to consolidate
the control of the US-EC pharmaceutical industry on access to medicines to the
world’s poorest countries.

The WHO has become nothing but a captive agency of the USTR and through the
USTR, a captive agency of PhRMA, the research based pharmaceutical industry.
(“AMDS has pursued dialogue and negotiations with the research-based
pharmaceutical industry with a view to ensuing adequate supplies of affordable,
high-quality HIV/AIDS treatments.

One focus is one the tiered pricing and expanding the lists of countries
eligible for low and intermediate prices.� P. 34fo the WHO Report, 2004) Where
did this list of countries eligible for low and intermediate price has come
from? In all probability it is the list prepared by the EC to help poor so that
Glaxo can supply them at differential price.

(EC, Trade and Development: Access to Medicines available at
http://europa.eu.int/comm/trade/csc/med08qa_en.htm (q.4. Is
there any link between this regulation and the Trade related Aspects of
Intellectual Property Rights (TRIPs) discussions on enabling developing
countries to use of compulsory licenses to manufacture the drugs they need?

In principle, no. The discussion on compulsory licensing at the WTO TRIPs
Council is a separate exercise. However, in practice it’s clear that if poorer
countries get the medicines they need under tiered pricing arrangement, they
won’t need to use compulsory licenses.�) The fraud we have seen in the case
of Dowelhurst v. Glaxo where the sale by Glaxo to local persons were claimed to
be for export and was used to install ban on reexport of the medicines as well
as the Doha solution of 30th August, 2003.

The tierced pricing is meant for removal of Article 6 of the TRIPS Agreement and
the compulsory licensing option for developing countries which becomes clear
when we examine John Barton’s article financed by the WHO. John Barton,
observed that “Such a price differentiation appears unambiguously good, since
it makes the product available to those who would not otherwise be able to
afford it, and allocate the cost of research in an equitable way, without
harming patients in the developed world.� (p.1).

Barton also suggested amendment of Article 6 of the TRIPS agreement to prohibit
import of products subject to the ability of the patent holder to choose not to
exercise its rights, so that it could serve regions of several nations and
several prices. (It is clearly wise to slow reverese flow, which is probably,
but not necessarily. readily achieved by use fo intellectual property rights. In
the most
dramtic form, this would be an aagreemnt to amend Article 6 fo TRIPS to require
that patent rights on pharmacetuycal products be defined in such a way as to
probihit import of prodoucts lawfully marketed in another nation.�). Barton
went to the extent of suggesting that tiered pricing be made mandatory through
the International Drug Equity and Orphan Drug Development Treaty. (John Bartoon
,p. 21). No wonder, Bruce Lehman of IIPI put John Barton’s article on its web
site instantly.

Barton discussed the issue of export to fulfill the obligations of compulsory
licensing under Article 31 and found the legal issue “quite unclear� while
quoting the European Commission Study, “Arguments by smaller developing
countries that their right to issue compulsory licenses would be meaningless if
they could not grant a license to a foreign manufacturer should be taken
seriously, but TRIPS does not seem to give any legal certainty on this issue.�
(European Commission, Issue Group on Access to Medicines,
Legal Issues related to compulsory licensing under the TRIPS agreement, (2001)
available at
http://europa.eu.int/comm/trade/pdf/med_lic.pdf )

Sometimes you wonder whether these academics should be allowed to use their
academic appellations to prostitute themselves.

The World Health Organization's data cooking and its action as an USTR captive
agency give one the impression that the figure of 40 million HIV sufferers is
false and it may be much higher and it would not be a surprise that it is not
less than 100 million. Only sad part is that all of the HIV sufferers are on
their own teaching their youngsters how to dig graves.

Does one think that even one word of this report is not fraudulent?

Daya Shanker
E-mail: ds20@...
_______________________________________________
Cross posted from Ip-health mailing list
Ip-health@...
http://lists.essential.org/mailman/listinfo/ip-health

Subject: Malaysia: Do we want to be banished to an island??

Friends,

By now I am sure that most of us have heard about the statement made
by our learned mufti of Perak about wanting to banish those who have
infectious diseases and HIV/AIDS is definitely in it. Frankly speaking
this is not an unheard statment before.

If I have my way I could just laugh over it but this is not a laughing
mattter...

Lot's of things could be derieved from this irresponsible statement
which clearly points to the speaker is one ignoramus guru that needs
to be told so. We cannot allow this kind of thing go on any longer.
Why should we need to suffer in silence while others throw this kind
of blantant statement to us.

Is there a way out of this???

Come monday a briefing will be held in Malaysian AIDS Council (MAC) at 1.00pm
and followed by a press conference at 3.00pm.  It is not an MAC project but ours
PLWHAs.

MAC are kind enough to facilitate it for us. The point person from
the community will be Roslan Salina. Few of us will be on the panel to
speak our hearts out against the statement.

The only reason I agree to do this is simply I know it's something
that I have to do.  I am willing to speak up because I don't want to
be send to an island and be treated as an outcast.

For the last 3 years I have work so very hard by God's grace just to stay clean
and alive.

I am not going to allow anyone to make me feel I do not deserve
a second chance.

This press conference is our way to say that we are hurt and we want
to be treated as a human being. Roslan gave a very good statement in
the star. Please look at it.  This effort that a handful of us is
taking this monday won't means nothing if we don't have all of our
communty come to stand alongside with us. And do take comfort MAC and
other allies will be behind us and GOD will be there to protect us.

Please come in drove to make our stand...WE WANT TO LIVE

in solidarity,
Marh Mansor
E-mail:<pakaiotak2003@...>

Transvestites get ''married''

Apr. 21, 2005
Full moon acting as witness, the sounds of music, laughter and
tinkling anklet bells in Tamil Nadu heralded the marriage of thousands
of transvestites from across India to normal men - only to be widowed
the next day.

The annual four-day festival to Aravan, a deity locally known as
Koothandavar, started Tuesday on the full moon night or Chitra
Pournami in the Indian month Chitra. At a small Krishna temple in the
Koovagam village in Villipuram district, the transvestites underwent
the age-old ritual, replete with gaiety, pomp and splendour, inspired
out of an excerpt from the Hindu epic Mahabharata.

The temple priest, K. Shanmugam, says he has lost count of the
weddings he performed; at least 10,000, he estimates. According to
mythology, Aravan was one of Arjuna's many sons, sacrificed so that
the Pandavas could win the battle of Mahabharata. As a last wish, he
desired to get married, causing Lord Krishna to take the form of a
beautiful woman so that Aravan could marry him. Aravan was then
beheaded, and Krishna became a widow.

Known as Aravanis, the worshippers that include transvestite community
and many normal men, whose families have undertaken vows at the temple
for some boon, undergo the complete ritual - from marrying to getting
widowed. Weddings are performed by tying the mangalsutra, or symbolic
wedlock, under the full moon.

The day after the weddings, the married men go through a consummation
ritual, following which their "spouses" go through a ritual rubbing
off their vermilion from their forehead, donning white garb like widows.

Since 2003, the rituals have been held in an organized manner with
many NGOs partaking in the activities.

A rights conference takes place every year to assure participation of
Aravanis from different states. "We take our annual holiday this time
and come home," said Meena, a transvestite, who is part of a
filmmaking effort on their lives by the Don Bosco Institute of
Communication Arts.

According to state estimates, Tamil Nadu alone has 140,000
transvestites. The South India Aravanigal Rights and Rehabilitation
Centre, Tiruchirapally, is appealing to the government to legalise the
"third gender" in all India's forms and official documents so that
they are not forced into the "male" or "female" categories.

"If we don't get jobs, we are forced into prostitution. Give us a
livelihood opportunity," says Chandra, a transvestite activist working
with the South India AIDS Action Programme.

The organisation is also imparting vocational training to the Aravanis
to wean them away from begging and prostitution. Special cultural
events are organised by NGOs. Actors, who enact the Aravan story from
the Mahabharata, also act out AIDS-care and awareness skits. Films
related to gender issues are shown and a beauty pageant for "Miss
Koovagam" is being held for the transvestite community since 2003.

http://www.indiadaily.com/breaking_news/32414.asp

International Training Programme:
Policy Concerns, Planning and Management in HIV / AIDS
June 20-24, 2005

Organised by
Indian Institute of Health Management Research
A WHO Collaborating Centre for District Health System
1, Prabhu Dayal Marg, Sanganer Airport
Jaipur-302 011 (Rajasthan), India

Sponsored by

Management and Training Service Division (MTSD)
Commonwealth Secretariat. Through the
Commonwealth Fund for Technical Co-operation (CFTC)

BACKGROUND

HIV/AIDS has emerged as a major threat to mankind in the last few decades. The
disease, after reaching epidemic proportions in the western world and ravaging
several African countries, has taken root in the Asian region. UNAIDS has
estimated that more than 90 percent of all adult HIV infections are in
developing countires : about 800,000 children are living with HIV; and at least
43 percent of all infected adults are women.

In many developing countires the HIV/AIDS epidemic is spreading rapidly.
According to available UNAIDS reports, South and South-East Asia is the
epicenter of the HIV epidemic with the majority of new infections expected to be
occurring here. Within this region, India is estimated to have the largest
burden of the epidemic with about 3-5 million infections.

Evidently, AIDS has taken an immense and growing human toll. The Heads of the
Commonwealth countires have emphasized the need for creating an appropriate
policy environment and management of HIV/AIDS in the member countries. The
governments of the member countries and other stakeholders have taken steps to
actively confront the epidemic. However, it is important for the people working
in the field of HIV/AIDS Prevention and Control, Care and Support, to have a
better understanding of the policy environment and enhanced understanding of
related issues/dimensions. Resources are limited and the expansion of the
disease is menacing. Thus it becomes essential that the policy makers and
programme managers develop skills to manage and think strategically to make the
best use of the resources and to effectively implement the programme.

The programme has been designed and developed in collaboration with the
Commonwealth Management and Training Division, London, for the policy makers at
the national level, and programme managers at the national, provincial/state
level. In addition, scientists working on HIV/AIDS at the national institutes in
various Commonwealth countries may also be nominated. The nominations will be
done through the Commonwealth Secretariat, Management and Training Service
Division (MTSD), Marlborough House, Pall Mall, London SWIY 5 HX (Telephone: 44
(0) 20 7747 6343, Fax : 44 (0) 20 7747 6540/6335).

  PROGRAMME OBJECTIVES

The main focus of the training programme is on developing an understanding of
the policy review and analysis, and planning and management in HIV/AIDS
prevention and control in the context of Asia Pacific Region. The objectives of
the programme are as follows :

To familiarize the participants with overall policy analysis, planning and
formulation process

To critically examine various dimensions and issues related to HIV/AIDS policies
and programme implementation

To develop basic skills of operational management in the management of the
HIV/AIDS prevention and control programme in the regional perspective

To help develop a matrix of policy issues and strategic management interventions
in their own country’s perspective.

DURATION

The programme will be offered for a period of one week (5 days) during June
20-24, 2005.

PARTICIPANTS

The number of participants is limited to 20. The programme addresses the
competency needs of policy and decision makers and programme managers in policy
review and analysis, and programme management knowledge and skills.

CONTENTS

The course will cover the following broad areas :

Review of the global efforts being mode in HIV/AIDS related policies and
programmes

Approaches to policy analysis and planning

Policy initiatives and programme management issues

Planning, implementation, monitoring and evaluation in HIV/AIDS

Role of non-governmental organizations and the private sector

Financing of HIV/AIDS programme initiatives

Quality of care

Leadership and management in HIV/AIDS prevention and control

TRAINING APPROACH

The training will be participatory and issue-based. There will be an optimal mix
of lecture sessions, group work and discussions.

The participants will be given exposure to field and programme management at the
provincial and district levels. They will be administered selected HRD
instruments to analyze their own leadership and managerial styles. They will be
asked to prepare a policy matrix and plan of implementation for their respective
areas/countries and present it in the group. A pre- and post-training evaluation
will be conducted and expectations of the participants will be elicited.

FACULTY AND RESOURCE PERSONS

The programme will be conducted by highly experienced international experts and
the faculty of the Indian Institute of Health Management Research and programme
managers in India.

The Programme Co-ordinators are : Dr. S.D. Gupta, Director;
Dr. N. Ravichandran, Co-ordinator; Dr. Ch. Satish Kumar, Co-ordinator

COURSE FEE AND TRAVEL

The course fee, board and lodging and travel expenses will be paid by the MTSD,
Commonwealth Secretariat. Accommodation will be provided on twin sharing basis.

VENUE

Indian Institute of Health Management Research (IIHMR)
1, Prabhu Dayal Marg, Sanganer Airport, Jaipur-302 011, India
Tel. : (91) 141-2791431-34, Fax ; (91) 141-2792138
E-mail : iihmr@..., URL : www.iihmr.org, Gram : Healthinst

APPLICATION PROCEDURE AND DEADLINE

The applicants are requested to fill the attached application form. (The
application form may be photocopied or downloaded from the website :
www.thecommonwealth.org OR www.iihmr.org)

Interested persons are encouraged to apply as soon as possible to allow enough
time for visa and travel arrangements.

Please send in the application form by May 15, 2005 to the Commonwealth
Secretariat with a copy to the Director, IIHMR on the following address :

Commonwealth Secretariat IIHMR
Management and Training Service Division (MTSD) 1, Prabhu Dayal Marg
Marlborough House, Pall Mall, London SWIY 5 HX    Sanganer Airport, Jaipur-11,
India

Tel. : 44 (0) 20 7747 6343 Tel. : 91-141-2791431, 32, 33, 34
Fax : 44 (0) 20 7747 6540/6335 Fax : 91-141-2792138
E-mail : sdgupta@...; iihmr@...


International Training Programme on
Policy Concerns, Planning and Management in HIV/AIDS Jaipur, India
June 20-24, 2005

APPLICATION FORM

APPLICANT : Mr.     ,  Mrs.     ,  Ms.     ,  Dr.

Family Name ..............................
First Name ................................

  Home Address ..............................

............................................

Tel. : ..................................... Fax :
......................................

  Workplace Address .....................

...............................

Tel. : ............................... Fax : ................................

E-mail : .................................

City (+city code) ............................ Country
.................................

Citizenship ...................................
Passport No. .........................

Date and Place of Birth ......................

Location (city, country) ....................

  Present Work in HIV/AIDS

Job Title ..................................

Job Description ...........................

..........................................

  Sponsoring Agency/Government

Name ................................
Address .............................

Tel. : ................................ Fax : ................................

E-mail : ...........................

City (+city code) ................... Country .............................

  Date ..........................                        Signature
......................

  Please attach the following to this application form

(Failure to complete this form may result in rejection)

1. Typewritten sketch biography, not exceeding 300 words

2. Please provide a brief description of three challenges in your program that
you plan to address with the skills learned in this course.

The deadline for aplication is May 15, 2005.

`A New Beginning' : A book written by Dr.R.H.Uzgare for HIV infected
persons was released in Mumbai on 10th March 2005 by Mr. Sanjay Suri
(Film: My Brother Nikhil). Other speakers at the function were Mrs.
Sathya Saran (Editor: Femina), Ms. Dipannita Sharma (Model and
Actress), Mr. Arun Kumar Khanna (Director: Emcure Pharma).

The book has foreword by Prof. Suzanne Crowe, Australia.

FOREWORD

The fight against AIDS in India requires an array of approaches, from the
sharing of local experiences between health care workers and their patients and
families, the breakdown of stigmatizing attitudes which prevent individuals
coming forward for testing and counseling, the local development of
cost-effective therapies, right through to in depth and critical analysis by
physicians and government of the knowledge and experiences gained by other
countries during their fight against this global pandemic.

There is a direct relationship between level of knowledge and prevention of
transmission and it is recognized that for education to be successful the facts
must be relevant to the local audience.

Thus this book, written by a compassionate and well-informed physician who
specializes in the care of individuals infected with the human immunodeficiency
virus, will provide an overview of HIV/AIDS which is relevant for people living
with this virus in India. It is written in a very readable style, with Dr
RajshekharUzgare's descriptions of numerous encounters with
his patients  in order to illustrate the points he wishes to make,
the issues which frequently arise in his clinic, the questions
commonly raised by his patients.

Dr Rajshekhar Uzgare covers all the issues so often shirked by other authors
because of their difficulty:
paediatric HIV infection, the HIV-infected pregnant woman, which
vaccines are safe for an HIV-infected person, and when should
antiretroviral treatment commence?   HIV/AIDS is incredibly complex.

Before his untimely death, Jonathan Mann,  the champion for human
rights in the fight against AIDS who established the World Health
Organization's Global Programme on AIDS, often used to quote Sir
William Osler "The physician who knew syphilis, in all of its
manifestations, knew medicine".  The spectrum of clinical
manifestations which may present as HIV infection indeed is so broad
that it  often results in the diagnosis of HIV infection being
missed.

It is an astute physician, with plenty of experience, who
understands HIV-related disease and considers the possibility with
virtually each and every patient who presents to the clinic.  His
thirteen years of experience in India in the practice of HIV
medicine, as well as his training and attendance at conferences
abroad,  has provided Dr Rajshekhar Uzgare with a level of knowledge
which, in the context of an expanding epidemic in rural and urban
India, will go a long way towards the education of both individuals
with HIV infection, and those health care workers treating them.

Suzanne Crowe
Professor of Medicine and Infectious Diseases, Monash University,
Melbourne.
Senior Consultant physician, Alfred Hospital Melbourne.
Head, HIV Pathogenesis and Clinical Research program, Burnet
Institute, Melbourne.

The book has following chapters –Laboratory diagnosis of HIV, Signs
and Symptoms, Counseling, Transmission, Prevention, Immunisation,
When to start treatment, Treatment(HAART and ART)- for HIV patients,
PMTCT, PEP, Paediatric HAART, Salient features of HIV, Diet,
Principles of counseling. Keywords are indexed at the end.

Book is priced Rs. 50/-
Available in Mumbai at Strand Book House (Flora Fountain, Fort),
Ideal book Depot, Dadar(W), Sharayu(R mall), Mulund(W) and other book depots. It
can be obtained by e-mail (druzgare@...) or phone(022-25681628, cell
9821137077)

This book was also presented to Mr. Kenneth Kaunda (Ex-President of
Zambia) on March 11 at a meeting in Mumbai. The book will be useful to
Seropositive persons, NGOs, patients, doctors, heath-care workers and patients'
families. It has the latest recommendations on HIV management.

Sharmila S. Kurian
E-mail: <shamiru@...>

Aussies prey on tsunami children
Kathryn Shine.April 16, 2005

ABOUT 20 convicted pedophiles tried to travel to Indonesia and
Thailand immediately after the Boxing Day tsunami to prey on
vulnerable, displaced children.

The pedophiles were forced to tell police they planned to travel
overseas, under the rules of the new national child sex offender
register.

Their details were forwarded to Thai and Indonesian authorities, who
are understood to have refused them entry to their countries.
NSW, Queensland, Victoria, Western Australia and the Northern
Territory have established registers that link to the national
database. The other states are due to join the scheme by the end of
the year.

Detective Senior Sergeant Martin Voyez, who heads the West
Australian register, said about 20 registered pedophiles from around
Australian attempted to travel to Thailand and Indonesia earlier
this year.

"After the tsunami, a large number of Indonesian and Thai children
were displaced and became very vulnerable," he said.

"This attracted a higher number of pedophiles to those areas than
usual.

"The details of the pedophiles on the system were communicated to
the Indonesian and Thai authorities.

"We know that countries, including Thailand and Indonesia, do not
allow people on sex offender registers to travel into their
countries.

"They would not give them a visa or they would turn them away at the
airport."

The Australian Federal Police, who are responsible for relaying the
information to overseas authorities, would not release details of
specific cases nor confirm whether they had notified their
Indonesian and Thai counterparts.

An AFP spokesman said the organisation regularly passed information
about pedophilia to police forces within the region. The Weekend
Australian understands that although the AFP relays the information,
it is not always made aware of the outcome of its advice.

Child Wise national director Bernadette McMenamin said she was
delighted Australian authorities were working to prevent child abuse
at home and overseas.

"The register is great," she said. "This is such an improvement but
I would like to see it go further."

"If the offenders are considered to be very high risk they should be
refused the right to leave the country."

Ms McMenamin said Child Wise and other international child
protection agencies held grave fears for children left orphaned and
homeless after the tsunami. "There's no doubt the children are
extremely vulnerable and there has been an increase in trafficking,"
she said.

Under the rules of the national register, convicted pedophiles are
required to tell police where they live and work, what car they
drive, when and where they plan to travel and to what clubs or
associations they belong.

The maximum penalty for failing to register is a two-year jail
sentence and a $12,000 fine.

People must report to police within seven to 28 days of leaving
custody, depending on the state in which they live.

NSW, which was the first state to establish a register, has 1800
pedophiles on its list, while Western Australia has 140, Victoria
138, Queensland 58 and the Northern Territory six.

Police expect 15,000 pedophiles to be registered nationally by the
end of the year.

Only people who were in custody for child sex offences or convicted
of pedophilia when their state legislation was enacted are required
to register. However, the West Australian Government has moved to
expand the state register to include anyone convicted of pedophilia
in the past eight years. Detective Senior Sergeant Voyez said most
pedophiles readily complied with the registering and reporting
obligations.

"Pedophiles are notoriously compliant," he said.

Many recognised the need for a register and some who were not
legally required to provide their details to police had done so
anyway.

"Pedophiles are at high risk of re-offending," he said.
"A vast majority will reoffend. If they are aware they are being
monitored and managed, that's a deterrent. In itself it is not going
to stop people re-offending but it will minimise the risk."

The information on the national register is available only to a
limited number of specialist police. Authorities decided not to make
the information public to avoid vigilantes targeting people with a
history of pedophilia.

http://www.theaustralian.news.com.au/common/story_page/0,5744,1287146
6%255E2702,00.html

[7th ICAAP: Scholarship Announcement]

We,  the Scholarship Committee of the 7th ICAAP to be held in Kobe Japan between
Friday, July 1 and Tuesday, July 5, are pleased to inform you that the results
of  the scholarship selection were sent to applicants by  e-mail, fax, or postal
mail last week.

Scholarships are meant to support and promote participants to join
the opportunities to share ideas and experiences, learn skills and best
practices, and bring what they obtained at the conference
back to their communities and fields.

In the selection process, we tried hard to be very sensitive for applicants'
vulnerability such as HIV status, gender, sex workers, drug users, indigenous
people, and sexual orientation.  And the results reflect them, we believe.

We have been trying hard to secure as many scholarships as possible to  make its
meaning possible. However, we would like you to know that we haven't been able
to award so many scholarships due to the following difficulties:

-Total budget/income of the conference is not so high so far and the
Local Organizing Committe is still in difficulties to raise money.

-Cost of the expenses for scholarship in Japan is very expensive.

So, we tried our best to make the number of awardees biggest by doing
the following action.

*In the beginning, we set 20% percentage of the total budget, which
is likely same as 6th and 5th ICAAP for scholarship budget.  And at
last we hit the target.

*By having negotiations with agencies many times, we discounted
some items of scholarship, and finally we increased 30 awardees more
at last minute.  Also, we prioritize for providing FULL scholarship to
make sure awardess can stay without worries.

We have about three months to have the ICAAP, and we look forward
to welcome all the people and to have honor of your attendance at
this exciting and informative congress in Kobe.

Cordially yours,

Masao Kashiwazaki
Chair, 7th ICAAP Scholarship Committee
E-mail: <icaap7@...>

Vietnam finds HIV carrier infected with bird flu
Thu April 14, 2005 8:20 AM GMT+05:30

HANOI (Reuters - A 21-year-old woman has been infected by both the
deadly HIV/AIDS virus and bird flu, the first such case in Vietnam,
health officials said on Thursday.

The Health Ministry said two other patients have been diagnosed with
the H5N1 virus in the northern provinces of Ha Tay and Hung Yen
between April 2 and 8 but no deaths were reported.

The latest findings brought to 41 the total patients having bird flu
in Vietnam since December 2004, 16 of them had died, the ministry
said in a statement.

Nguyen Van Thich, head of the Centre for Preventive Medicine in the
northern province of Quang Ninh, said the woman, the first to be
diagnosed with both bird flu and HIV in Vietnam, used to work at a
hairdressor's shop. She was hospitalised in late March with fever
and coughing.

"She is still very weak," he told Reuters, adding that the woman has
been treated at a provincial hospital.

Quang Ninh province bordering China has one of the highest number of
HIV carriers in Vietnam, most of them drug addicts and prostitutes.
Vietnam has reported 68 human infections of the H5N1 virus since the
disease first hit Asia in late 2003, killing 36 Vietnamese.

Twelve Thais and three Cambodians have also died of the virus that
the World Health Organisation says has the potential to mutate into
a form that could pass easily between humans and cause a pandemic in
which millions could die.

Doctor Hoang Thuy Long, former head of the National Institute of
Hygiene and Epidemiology, told a government meeting on Wednesday
that most of the infected people in Vietnam, including several
family clusters, had contact with sick birds.

"Even though so far the transmission mechanism of the disease
remains unclear, the avian influenza H5N1 type in Vietnam shows no
sign of being spread directly between human and human," Long was
quoted by state-run Quan Doi Nhan Dan daily as saying

http://www.reuters.co.in/locales/c_newsArticle.jsp?
type=worldNews&localeKey=en_IN&storyID=8175832

Dear colleagues,

Forwarding a peer-reviewed article published in AIDS about an interesting
sociological phenomenon in China

April 8, 2005 (C) 2005 Lippincott Williams & Wilkins, Inc. ISSN:
0269-9370

Authors: Tucker, Joseph D a; Henderson, Gail E a; Wang, Tian F
b; Huang, Ying Y c; Parish, William d; Pan, Sui M c; Chen, Xiang S e; Cohen,
Myron S a

Institution: From the (a)Infectious Disease Center at the
University of North Carolina School of Medicine, Chapel Hill, North Carolina,
USA (b)Department of Sociology, Tsinghua University,
Beijing, China (c)Institute for Sexuality and Gender Research,
People's University, Beijing, China (d)Department of Sociology, University of
Chicago, Chicago, Illinois, USA (e)China National STI Control Center, Nanjing,
China, Chinese Academy of Medical Sciences and Peking Union Medical College,
Nanjing, China.

Title: Surplus men, sex work, and the spread of HIV in
China.[Editorial]

Source: AIDS. 19(6):539-547, April 8, 2005.

Abstract:

While 70% of HIV positive individuals live in sub-Saharan Africa, it is widely
believed that the future of the epidemic depends on the magnitude of HIV spread
in India and China, the world's most populous
countries. China's 1.3 billion people are in the midst of significant social
transformation, which will impact future sexual disease transmission. Soon
approximately 8.5 million 'surplus men', unmarried and disproportionately poor
and migrant, will come of age in China's cities and rural areas. Meanwhile, many
millions of Chinese sex workers appear to represent a broad range of prices,
places, and related HIV risk behaviors.

Using demographic and behavioral data, this paper describes the combined effect
of sexual practices, sex work, and a true male surplus on HIV transmission.
Alongside a rapid increase in sexually
transmitted disease incidence across developed parts of urban China, surplus men
could become a significant new HIV risk group. The anticipated high sexual risk
among many surplus men and injecting drug use use among a subgroup of surplus
men may create bridging
populations from high to low risk individuals.

Prevention strategies that emphasize traditional measures - condom promotion,
sex education, medical training - must be reinforced by strategies which
acknowledge surplus men and sex workers.

Reform within female sex worker mandatory re-education centers and
site specific interventions at construction sites, military areas, or
unemployment centers may hold promise in curbing HIV/sexually transmitted
infections. From a sociological perspective, we believe that surplus men and sex
workers will have a profound effect on the future of HIV spread in China and on
the success or failure of future interventions.

C) 2005 Lippincott Williams & Wilkins, Inc.
______________________
Greetings
Phi Huynhdo <huynhdophi@...>

INVITATION  AIDS_ASIA e FORUM.

Hi,

If you are already a member of this FOURM please forward this message to your
colleagues who may find this FORUM useful.

[AIDS_ASIA e FORUM] is an experimental occasional electronic newsletter. An e-
forum committed to the development of an Asian perspective on AIDS prevention
and care issues. HIV/AIDS does not recognize national boundaries. As Asia-
pacific countries are increasingly interconnected through migration and trade,
it is imperative to generate a regional perspective on HIV/AIDS related issues.

A forum for critical analysis of issues, events and programs, which has
implications on, our ability to address HIV/AIDS prevention and care issues
across the region. More than 4,000 subscribers are using this FORUM.

Strategic HIV information and communication support to promote the capacity of
Asian leaders, activists and people living with HIV/AIDS, to facilitate their
engagement and networking, to highlight their experiences and the solutions they
are offering to address HIV/AIDS issues in this region.

A cross cultural discourse on issues and concerns of Asia- Pacific countries
(regions): Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China,
East Timor, Fiji, India, Indonesia, Japan, Kiribati, Laos, Malaysia, Marshall
Islands, Micronesia, Mongolia, Myanmar, Nepal, New Zealand, North Korea,
Pakistan, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon
Islands, South Korea, Sri Lanka, Taiwan, Thailand, Tonga, Tuvalu, Vanuatu and
Viet Nam will be presented and promoted on this forum.

Please review the archived messages on the following url

http://health.groups.yahoo.com/group/AIDS_ASIA/

The Global Fund to Fight AIDS, Tuberculosis and Malaria
CALL FOR PROPOSALS. Geneva, March 2005

1. Background

HIV/AIDS, tuberculosis and malaria together account for nearly 6 million deaths
per year and cause immeasurable suffering and damage to families, communities
and economies.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was set up in January
2002 as a financial instrument, complementary to existing programs addressing
these three diseases. The purpose of the Global Fund is to attract, manage and
disburse additional resources through a new public-private partnership that will
make a sustainable and significant contribution to the reduction of infections,
illness and death, thereby mitigating the impact of HIV/AIDS, tuberculosis and
malaria in low-income, affected countries, and contributing to poverty reduction
as part of the Millennium Development Goals. As of March 2005, US$ 3.1 billion
have been committed from four previous rounds of Global Fund financing, and over
US$ 920 million have been disbursed since the first grant agreements were
signed.

The Global Fund now calls for proposals for its Fifth Round of financing.

2. Who can apply

For detailed information, please consult the Guidelines for Proposals, Section
II, 'Who may apply'.

3. Developing the proposal and submitting an application

3.1.        Developing the proposal

Proposals must be received by the Global Fund Secretariat no later than 10 June
2005. The Global Fund makes the application form available in MS Word and PDF
format. Applicants are, however, encouraged to submit proposals in PDF format,
as described below. In addition to an electronic version of the proposal, a hard
copy of the proposal, signed by all CCM members, is nonetheless required, and
must be received by 10 June 2005. (If the proposal does not originate from a
CCM, other requirements apply; see the Guidelines for Proposals for more
information.) Applicants are strongly encouraged to review the Guidelines for
Proposals prior to completing the Proposal Form.

Once received, the proposals will be screened and technically reviewed, and
recommendations presented to the Board. The results will be communicated to the
applicants shortly thereafter.


3.2. Application formats

Applications have to be submitted as print-outs (hard-copy) and in electronic
form, using either the MS-Word or a PDF format. For administrative reasons,
applicants are encouraged to use the PDF form. This platform has been designed
to work with Acrobat Reader (version 6 and above) and provides additional
support for the creation of the proposal form. Further information on the
MS-Word and PDF forms is available on the Global Fund website
(www.theglobalfund.org). Applicants may request a CD-ROM (containing the form,
all supporting material and Acrobat Reader installation files for multiple
languages) from the Global Fund Secretariat by sending an e-mail to
proposals@... or online on the Global Fund website
(www.theglobalfund.org).

Forms in both formats can also be downloaded from (www.theglobalfund.org). The
MS-Word application form, Guidelines for Proposals and support documents are
available in Arabic, Chinese, English, French, Russian and Spanish; the PDF
application form is available in English, French, Russian and Spanish.

Submission in English would greatly facilitate the work of the Secretariat and
the Technical Review Panel in reviewing applications. If necessary, proposals
can be submitted in any of the other official UN languages (Arabic, Chinese,
French, Spanish or Russian).

3.3. Address for proposal submission

The Global Fund to Fight AIDS, Tuberculosis and Malaria
Centre Casa?53 Avenue Louis Casa?1216 Cointrin-Geneva
Switzerland

Fax number: +41 22 791 1701
E-mail: proposals@...

Further information

For further information or questions, please contact the Global Fund Secretariat
(phone number: +41 22 791 1700).

All applicants are encouraged to consult the Global Fund home page
(www.theglobalfund.org) to access the complete directory of Global Fund
documents, particularly the Guidelines for Proposals for the Fifth Round.


Forwarded by :
----------------------------
Yours in Global Concern
A. SANKAR
E-mail:<ttn_empower@...>

Subject: Action Alert: Take a Stand Against HIV Stigma & Discrimination in API
Communities
------------------------------------------------------------
While the Asia Pacific Region reports staggering rates of HIV infection, the HIV
epidemic continues to steadily climb in Asian and Pacific Islander communities
across United States and its Pacific Jurisdictions. According to the U.S.

Centers for Disease Control & Prevention (CDC), the rate of AIDS diagnoses among
U.S. Asian and Pacific Islanders increased by 38% from 1998 to 2002. Major
factors contributing to this alarming increase are silence, stigma, and denial.

In response to this, Massachusetts Asian & Pacific Islanders (MAP) for Health
and our national partner, Asian & Pacific Islander Wellness Center , are pleased
to announce The Banyan Tree Project , a national, CDC-funded, multi-year
visibility campaign that aims to eliminate HIV-related discrimination and stigma
in Asian and Pacific Islander communities. We invite you today to join us in
this historic, groundbreaking public health initiative for Asian and Pacific
Islanders, inspired by similar efforts by the African American and Latino
communities.

Mark you calendars—Thursday, May 19th 2005, is the 1st Annual National Asian &
Pacific Islander HIV/AIDS Awareness Day. This occasion will be marked by media
events in six cities across the country: Boston, San Francisco, Washington DC,
Chicago, Los Angeles, and Honolulu. In Boston, MAP for Health will host a media
event that includes: a presentation of awareness raising radio and television
public service announcements to be broadcast nationally through mainstream and
ethnic media; expert speakers, including Asian and Pacific Islanders living with
HIV/AIDS; and, a listing of signatories of the Banyan Tree Pledge.
------------------------------------------------------------
The main URL for the Banyan Tree Pledge is:
http://www.petitiononline.com/tbtp/petition.html
Further information and a hard copy PDF of the
Banyan Tree Pledge may be found at:

http://www.banyantreeproject.org/

UNAIDS  must  reject the US prevention policy restrictions.

Dear all,

Apologies for this mass note - it's a personal plea from me asking
you to send the letter below to UNAIDS and their community
representatives. Adapt it as you see fit. Please circulate it as you
think appropriate. Time is of the essence - comments will only be
accepted for another day.

The US now requires that organizations who receive US government
funding for HIV and anti-trafficking efforts implement policies
against promoting legal acceptance of prostitution. Other forms of
harm reduction, including needle exchange and condom promotion are
also coming under fire.

As part of the process of UNAIDS developing its prevention strategy.
The International HIV/AIDS Alliance hosted a meeting March 7 and 8
to recommend ways for UNAIDS to articulate and promote evidence
based comprehensive HIV prevention programmes.  Key to this was to
discuss  the implications of recent policy developments and  the
obstacles to prevention they have created.

A wide variety of organizations participated, including faith-based
organizations, reproductive rights organizations, and organizations
promoting new technologies such as vaccines and microbicides.

The NSWP was represented by Melissa Ditmore. The presentations from
this meeting and other meeting-related documents are available at
http://www.aidsalliance.org/sw18122.asp.

Individuals and organizations can comment by email to members of the
Programme Coordinating Board who attended this meeting and to UNAIDS
until March 22. Please send a letter to the PCB NGO members and to
UNAIDS! Below is a model letter to adapt or to send as is to:

Kim Nichols kimn@..., africanserve@..., Alena
Peryshkina <alenajhu@...>, <alena@...>, Omololu
Falobi <alutamaster@...>, <omololu@...>,
Anindya Chatterjee UNAIDS <chatterjeea@...>

We are writing to express our strong belief that UNAIDS must reject
the US-required limitations on funding use. It is unthinkable that
the nation with the highest HIV prevalence in the developed world
should be able to dictate policies on HIV prevention.

It is reprehensible that prevention of HIV would be limited to
organizations who take a stance prohibiting prostitution, alienating
some of the strongest groups working with sex workers. Sex workers
are integral to effective prevention efforts with prostitutes, their
clients, and their families. Additionally, US funding is not allowed
to be used for needle exchange, which is proven to prevent HIV.

This US policy is counter to all public health data.

Condoms are the only effective prevention technology available to
sexually active people and must be emphasized in every HIV
prevention effort. The US promotes a model based on abstinence,
fidelity and lastly, condom use. However, in places where HIV
prevalence is extremely high, fidelity is no preventive for HIV.

Safe sex goes far beyond ABC and requires a comprehensive approach
including full information about all ways to prevent HIV. For these
reasons, it is imperative that UNAIDS reject the US funding
restrictions.

Sincerely,

Melissa
e-MAIL: <melissa@...>

What happened in America should not happen in India.

India's main opposition BJP and the Communists to defeat ground-
breaking patent law for pharmaceutical products - what happened in
America should not happen in India

Harish Baliga

Many in India cite the Pharmaceutical industry in America and say
what happened in America should not happen in India. The strict
patent laws allow the Pharmaceutical companies in America to enjoy
some kind of oligopoly and the net result is escalating price level
of drugs. People just cannot afford it. People in America who do not
have access to cost effective health insurance is trying to get the
drugs from Canada. On top of that the Food and Drug Administration
officials have conflict of interest. The Pharmaceutical companies
spend enormous amount of money is influencing legislators and
providing "indirect consulting fees" to FDA officials to make sure
the drugs are approved on time. What happened with Vioxx and some
other drugs are eye openers. President Bush in America is in favor
of generic drugs that help lowering pieces.

Citing these examples, the common people in the main street in India
come out strongly against New Delhi's plans to enact a ground-
breaking patent law for pharmaceutical products. BJP, the main
opposition, understanding the tone among the common people in India
came out strongly against the bill. Manmohan Singh, prime minister,
yesterday expressed disappointment with the tactics of the BJP,
which had drafted the law last year before it was turned out of
office.

The Communists in India popularly known as the Left parties are
against such patent law for a long time. Though the current
Government (Congress led UPA) depends upon the Left parties for its
survival, they were going ahead with the enactment of the bill
hoping that BJP will support them.

According to some released reports, GlaxoSmithKline, India's largest
drug company by sales, expressed frustration at the latest
uncertainty. Russell Greig, president of international
pharmaceuticals at GSK, said: "This is a step backwards for India.
Without quick and full implementation of the patent bill, India's
potential as a base for investment, research and development and
innovation will not be fully realized."

The enactment of the law is required to comply with India's
obligation as a member of the World Trade Organization (WTO).
According to consumer activist group in India and abroad, Mr. Kamal
Nath, Indian Commerce Minister sold out common people of India in
WTO agreement for the sake of the rich and famous. According to
these groups, the agreement will require new Patent law, the price
of medicines will escalate several times and the common people will
suffer. WTO agreement allows Indian industrialists and outsourcing
companies access to Western markets. It is a classical case of
selling the common people to make the rich richer says the activists
in Mumbai, Delhi, Kolkata and Chennai.

Critics argue that the planned law would prevent the export to other
developing countries of vital future drugs, such as the "three-in-
one pill" of anti-retrovirals for people suffering from HIV/Aids.
India supplies drugs to about half the 700,000 HIV-infected people
being treated in the developing world.

Médecins Sans Frontières, the French medical charity, said: "The
availability of affordable fixed-dose therapy manufactured in India
has revolutionised Aids treatment in developing countries. Sources
of new low-cost medicines will dry up globally."

According to the Consumer Unit Trust Society, a pro-free trade
research group based in Jaipur, India, the draft act is designed to
not include safeguards permitted under the WTO's intellectual
property protection regime. They say it is a shame that India has to
have such a law that WTO even does not require.

http://www.indiadaily.com/editorial/1964.asp

Clinton Foundation Provides HIV/AIDS Drugs for Chinese Children
February 28, 2005

The William J. Clinton Foundation in Little Rock, Arkansas, has announced an
agreement with China's Ministry of Health to deliver treatment to two hundred
children with HIV/AIDS.

The foundation will donate a one-year supply of drugs to begin treatment for the
children, while the Chinese government, the pharmaceutical industry, and
international partners work to establish a supply chain for pediatric
formulations of existing treatments. The donation is one component of a
three-year, $10 million initiative to help provide high-quality care and
treatment for all Chinese HIV/AIDS patients who need it.

The foundation also announced the Clinton Foundation HIV/AIDS Service
Fellowships, a program to recognize physicians who commit to treating HIV/AIDS
patients in underserved areas of the country. According to foundation officials,
the fellowships will provide incentives, training, and support to physicians who
visit towns and villages not only to treat patients in need, but to train and
inspire local clinicians.

"Not only are we acting today to put children on equal footing with adults, we
are also working to help China reach its goal of delivering high-quality,
comprehensive, and integrated care and treatment services for patients with
HIV/AIDS on a wide scale," said former President Bill Clinton. "I look forward
to continuing to cooperate on a full range of HIV/AIDS care and treatment
throughout our partnership."

“Chinese Government and Clinton Foundation to Deliver Care and Treatment to
Children with HIV/AIDS.” William J. Clinton Foundation Press Release 2/23/05.
_______________
Greetings: HDP
E-mail: <huynhdophi@...>

Unethical Tenofovir trial: Cambodian sex worker's Concerns

On 4 March, "the ORGANISATION", established by sex workers in Phnom
Penh, sent a letter to Cambodian Prime Minister Hun Sen, reaffirming
support for his decision in August 2004 to prohibit a planned trial
of the drug tenofovir. The drug is produced and marketed under the
name Viread by a US company, Gilead Sciences. It is currently used
to treat patients who are already HIV positive. The company hopes
that it will also prove effective in preventing infection with HIV,
and US and Australian organisations have been enlisted to test this
possibility in countries in Africa and Asia.

The 4 March letter was prompted by reports that would-be sponsors of
the tenofovir test and some NGOs are lobbying the Cambodian
government in the hope of reversing the prime minister's August
decision and allowing a trial go ahead.

This information sheet is produced by the Womyn's Agenda for Change
in support of the Phnom Penh sex workers.

Q1. What is wrong with the proposal to test tenofovir? Don't new
medicines have to be tested on people to find out if they are safe
and effective?

New treatments do eventually have to be tested on human beings;
everyone recognises that. But such tests always involve potential
dangers for the participants, so it is important that the dangers be
minimised as much as possible and that participants who are injured
in any way be guaranteed appropriate treatment for any problem that
is a result of the test.

The Cambodian sex workers are not objecting to drug testing in
general. They call the proposed tenofovir test "unethical" because
it fails to meet these and other necessary conditions.

The risks and benefits of clinical trials should be equitably
distributed. While Cambodian sex workers are to take all the risk,
benefits from the trial are unlikely to reach them.

Participation in clinicals trial must be based on fully informed
consent.  It appears that the researchers have not taken adequate
steps to inform all the potential participants about the exact
nature of the trial. The researchers have not even disclosed the
details of protocol of the proposed trial.

What potential dangers are there for participants if the tenofovir
test goes ahead?

Supporters of the trial have been quoted as saying that it
involves "little risk" for the participants. But they have so far
not bothered to be precise about the risk, nor to explain how they
calculate it. Normally for a scientific study such as this, risks
are calculated, in much the same way that insurance companies
calculate the risk of someone having a serious illness or crashing
their car.

There are a number of different dangers that can be identified. One
is contracting HIV. Tenofovir is not likely to increase this danger
directly (although several years ago tests of an anti-HIV cream
called nonoxynol-9 were stopped when it was discovered that it
significantly increased the chances of HIV infection).

However, the risk of HIV infection could be increased if
participants in the test think that tenofovir gives them protection
that makes condom use unnecessary. And the people conducting the
test would have reason not to stress condom use: if all the
participants in the test always used condoms, there would be no real
test of the effectiveness of tenofovir.


The government of Cameroon suspended a test of tenofovir for several
weeks in February because of concern that participating sex workers
were not properly informed and protected. "There's an obvious
conflict of interest between enforcing prevention measures and
carrying out the clinical trial of a drug that could help prevent
HIV infection", Fabrice Pilorgé, an officer of the AIDS activist
group Act Up-Paris, said about the Cameroon test.

"A friend who agreed to take part [in the test] told me she was
vaccinated now and couldn't catch AIDS", a young sex worker in
Cameroon told a French TV station.

What about side effects from use of tenofovir?

Because tenofovir has been used as a treatment for AIDS for several
years, some possible side effects are already known. Gilead, the
company that manufactures tenofovir, warns users:   "Lactic acidosis
(the build up of lactic acid in the body) and severe liver problems,
including fatal cases, have been reported with the use of reverse
transcriptase inhibitors similar to tenofovir, alone or in
combination. Contact your doctor immediately if you experience
nausea, vomiting, or unusual or unexpected stomach discomfort;
weakness and tiredness; shortness of breath; weakness in the arms
and legs; yellowing of the skin or eyes; or pain in the upper
stomach area. These may be early symptoms of lactic acidosis or
liver problems."

Common side effects of tenofovir are headache, sore muscles, nausea,
vomiting and loss of appetite. There is also evidence that the drug
may cause kidney damage, and may reduce bone mineral density,
leading to osteoporosis.

There are no reliable data on possible side effects in people who
are not infected with HIV.

Would participants in a test of tenofovir in Cambodia receive
treatment for medical problems?

It appears that there is no intention to provide adequate treatment.
One reason that sex workers refused to join the trial last year was
that the sponsors refused to promise them free medical care for
problems that might emerge at any later time. Osteoporosis or damage
to internal organs might not be evident for many years.

It is not even certain that test participants who contract HIV will
receive free treatment for that. In Cameroon, in the consent letter
signed by sex workers participating in the trial, the sponsors
state: "In case of infection ... we will not procure treatment
against AIDS. We will be able to direct you to clinics where you
will have to pay."

There is a need to monitor the long-term side effects of the trial.
The known side effects are based on the experience of people living
with HIV/AIDS. There is not adequate information on the possible
side effects of tenofovir on non- HIV-infected people.

But if participants receive regular medical check-ups as part of the
trial, wouldn't those check-ups find any early signs of side effects?

They might, but they might not. The trial is being conducted by
epidemiologists that is, by doctors who specialise in studying
epidemics. You don't go to an epidemiologist if you have a pain in
your stomach; you go to a clinical doctor, whose training and
experience are in noticing and interpreting symptoms that are often
vague or unclear. And even skilled clinical doctors may not observe
signs of a problem that is not going to appear for several years.

The senior investigators for the trial should be experienced
HIV/AIDS clinicians.

What are the benefits of conducting a tenofovir trial?

There are certainly potential benefits for Gilead, the
manufacturer. "Treatment Insider", an on-line newsletter of the
American Foundation for AIDS Research, reported in October 2002:
"The value of tenofovir to Gilead is inarguable. In the second
quarter of 2001, the firm posted a net loss of $32.4 million. Losses
have been continual for the 15-year-old company.

This spring, with tenofovir accounting for nearly half of Gilead's
sales, it announced a second quarter profit of $19.7 million."

Remember that this profit is based on using tenofovir as a treatment
for people who are HIV positive. If tenofovir were to prove useful
in preventing HIV transmission, Gilead's profits would undoubtedly
soar.

Obviously, there is a benefit to anyone whom tenofovir prevents from
being infected with HIV, if it proves able to do that. But it is not
likely that many ordinary Cambodians would be able to use it. In the
United States, the wholesale price of Viread is $360 per month.
Gilead has said that if tenofovir proves useful in preventing HIV
transmission, it will sell it to poor countries at "cost".

Only Gilead knows for certain what its costs are. However, the
company already has an "access program" to provide tenofovir to poor
countries at a price of $39 a month. (Haiti is the only country in
Latin America or the Caribbean to qualify under Gilead's definition
of "poor"). If that were the price here, the drug would still be
beyond the reach of most Cambodians.

Are there any other problems with the proposed trial?

It seems clear that tenofovir is being tested mainly in poor
countries because that is cheaper than doing it in rich countries.
In effect, this means that Cambodians would be used for the
experiment because they are poor, and this makes it easier to
deprive them of the protections that would be normal for such a test
conducted in a rich country.

For example, the tenofovir trial involves only five counsellors and
one doctor for 400 sex workers. And all of the counselling is
offered in English, a language little used in Cameroon.

It is normal in developed countries that tests involving human
beings are overseen by an ethical review committee that is
independent of the test sponsors. Community-based ethics review
committees are also increasingly a norm in many  situations. There
has been no mention of such a committee for any Cambodian test.
__________________________

Rosanna Barbero WAC Director
Or contact Socheata Sim 012 628602
Or contact Phuong Pry 012 988054

The Womyn's Agenda For Change
Telephone +855 (023) 722 314
Mobile +855 (012) 812 607
http://www.womynsagenda.org/
For our office location, see map at
http://www.womynsagenda.org/images/Map/Big.jpg

I wish I had tested positive: Kenneth Kaunda

SIDDHARTHA D. KASHYAP
TIMES NEWS NETWORK [ SUNDAY, MARCH 13, 2005 03:21:15 PM ]

PUNE/India: "I wish I had tested positive. That would have helped me
immensely fight the stigma and discrimination surrounding the deadly
HIV/Aids infection," says the first president of Zambia, Kenneth
Kaunda, who is better known for his crusade against the growing
epidemic.

On a two-day visit to the (Indian city of Pune), following an
invitation from the Pune-headquartered Emcure Pharmaceuticals,
Kaunda has already interacted with "various stockholders" to spread
a simple yet complicated message, "Let's fight Aids together."

"I got tested myself for HIV/Aids, but the result has been
negative," he admits, admitting that he would have otherwise openly
announced to the whole world.

While he has already held discussions with the Maharashtra governor
SM Krishna at Mumbai, Kaunda, who is also accompanied by his son
Waza Kaunda, who himself is a doctor and an expert on the disease,
is scheduled to meet Congress president Sonia Gandhi, Prime Minister
Manmohan Singh and union health minister Anbumani Ramdoss in New
Delhi.

Chairman of the Kenneth Kaunda Children of Africa Foundation, his
fight against the disease started particularly after losing his
second son to the illness in 1986. "We immediately decided to tell
the whole world that our son, whose left behind six children, has
died of Aids," he says, as a matter of fact.

Himself a testimony to the large number of HIV/Aids related deaths
in Africa, Kaunda says, "The death rate could have been controlled
to a large extent if the affected parents or their relatives were
more open about the disease."

"Our learning in the African continent in general, and Zambia in
particular, has given us various insights that this is not just a
medical problem but it needs to be addressed at the society and
family level too," he says, adding, "The problem has to be tackled
along with the medical side by addressing the stigma, confronting
the wall of silence and pushing for preventive measures."

Calling for a radical change in the Indian laws and the mindset, he
said it is important that people come forward for testing. "But
unfortunately, that hasn't been the case so far. Even those tested
positive go hiding for fear of stigma and discrimination."

Underling the need "to open up," he said political leaders and the
younger generation should take the lead, and act as role models in
getting themselves tested, which would then be emulated by the
general population.

On the Indian laws debarring doctors to maintain confidentiality
about the HIV status of a person, Waza says, "This is an important
factor where we are losing the war against the deadly virus. In my
opinion, doctors should be empowered, and the laws be amended in
order to protect the medical fraternity."

The reason for doing so, according to Waza, is because social
acceptance is the most important issue in fighting the disease. In
Africa, after years of addressing these issues, people have finally
started coming out in the open.

"And the results are evident to all. Children infected with the
virus are still allowed to share the classroom along with others,
widows are not being thrown out from the villages...."

Kaunda's pill:

* Sex only after marriage
* Abstain from illicit sex
* If you can't resist, use a condom
* Create mass awareness

http://timesofindia.indiatimes.com/articleshow/1050142.cms

Ensuring Universal Access: User Fees and Free Care Policies in the
context of HIV Treatment

Meeting sponsored by UNAIDS, WHO and the World Bank

21-22-23 March 2005. Conference Centre of Geneva, Switzerland,

Background and justification

Financing antiretroviral care and treatment from end users was a
major issue at the XV International AIDS conference in Bangkok in
July 2004. During the conference, Thailand announced that it would
provide care--including ARVs--free at points of service delivery. In
doing so, it joined a growing list of countries including Brazil,
Costa Rica, Senegal, and more recently Uganda, Malawi, Botswana, and
Mali.

But the issue is not a new one. The costs and benefits of end-user
cost recovery have been hotly debated in international health
circles since the 1980s, when balance-of-payments crises in the
developing world led to a restructuring of many state health budgets
in order to free up public funds. User fees were widely imposed for
drugs and curative care that had previously been available without
charge; the new pricing structure was implemented throughout Asia
and Latin America, and in nearly every country in sub-Saharan
Africa. However, for many individuals in poor countries,
affordability poses an insurmountable obstacle.

Decisions made by local policy makers on the cost of HIV care and
treatment at the point of service have a profound impact on the
ability of individuals to receive care and treatment for HIV,
affecting program uptake, adherence to treatment, and the emergence
of drug resistance. Meanwhile, the cost of HIV care and treatment is
a significant component of national health budgets.  Moreover, all
governments have some type of health financing policy or strategy
and many are in the process of examining or implementing reforms in
this area, so the question of end user cost for ARVs must be
considered in light of its impact on the health system more broadly
and in the context of overall health financing policy.

These concerns cut to the heart of the global development agenda.
The access to HIV treatment is a cornerstone of poverty alleviation,
as well as economic, social and political security, and will be a
significant determinant of progress toward achievement of Millennium
Development Goals.

Purpose
The purpose of the three-day meeting is to analyse the importance
and impact of policy on free access to HIV care and treatment versus
user fees, with the specific intention of identifying enabling
mechanisms and steps to guide countries and partners in their policy
decision-making process.

Objectives
The objectives of the consultation would be:

1. To understand the range of health financing strategies and
policies across countries and review current experiences of and
obstacles to provision of free HIV care and treatment services at
point of delivery versus fees for services, in resource constrained
settings;
2. To discuss the potential consequences of free HIV care and
treatment on health systems and financing mechanisms capable of
sustaining a free access policy at the national and international
levels;
3. To make recommendations on a basic package of HIV care, funding
mix, and process from situation assessment to decision making, for
policy makers in government, donor agencies, and civil society.

The discussion will range from human rights and ethics, to public
health, economics, and political mobilization. Concerns about
sustainability often confronted by decision makers as a barrier will
be addressed.

Expected outcomes
The expected outcomes will include:

1. Agreement on an agenda for incorporation of free care and
treatment into national and international financing strategies
2. Policy guidance for national decision makers and partners,
3. Launch of a transnational network for monitoring the impact of
user fees and free care policies on access to HIV treatment;
4. Publication of a meeting report with a summary of key issues and
discussions.

National experiences and policy analysis will be used for generating
guidance for government policy decision making.

Organizers
UNAIDS Secretariat, WHO/HIV/AIDS with EIP, EDM, ETH Departments and
the World Bank

Participants
National AIDS Programme managers from low and middle income
countries and Ministries of Finance representatives; national NGOs
providing treatment; International NGOs, People Living with HIV,
ICW, researchers, public health experts, medical ethics specialists,
health economists, human rights practitioners, donor agencies.

Meeting Agenda (Provisional)

Chair: 	 Visweswaran Navaratnam, Malaysia
Monday 21 March 2005

16:00-16:10 Chair's Welcome
16:10-16:45 Opening Remarks
WHO, Jim Kim, Director, HIV Department
World Bank, Debrework Zewdie , Global HIV-AIDS Program
UNAIDS Secretariat, Catherine Hankins, SMI

16:45-17:00 Introduction of Participants
17:00-17:30 Overview of Meeting: Background and Objectives
	 Françoise Renaud-Théry, UNAIDS Secretariat
17:30-18:00 Questions and Clarifications
18:00-20:00 Reception at WHO


Tuesday 22 March  2005
Morning Facilitator:  Paulo Teixeira
I. Report on situation and process for policy decision on free
access to treatment and care at point of delivery versus fee for
services

08:30-09:00 UNAIDS and WHO: review of the evidence and policy
position Julian Fleet, UNAIDS Secretariat
Yves Souteyrand, WHO, HIV Department

09:00-09:20 La gratuité du traitement et ses conséquences sur le
système de santé
Dr Alain Yoda, Minister of Health, Burkina Faso

09:20-09:40 Making HIV treatment free and consequences for
health system Mrs Mutale Nalumango, Minister of Information &
Broadcasting Services,  Zambia

09:40-10:30 Discussion (30 minutes)

10:30-10:45 Refreshment Break

10:45-11:05 Community response to HIV care and treatment:
lessons learnt on free access by Community-based Organizations
Marie-José Mbuzenakamwe, Director, Association Nationale des
Séropositifs et Sidéens, Burundi (TBC)

11:05-11:25 Equity and Social Justice: Sliding fee scales and
subsidization schemes. Do they ensure equity and social justice? Are
they worth the cost?  Alice Desclaux, University of Marseille, France

11:25-12:30 General Discussion
12:30-13:30 Lunch

Afternoon Facilitator: Purnima Mane, Director, SMI

II. Economics and Package of care
13:30-13:50 Estimating the cost: How much would be lost to the
public system by  foregoing all user fees in providing HIV
treatments free to patients at the point of delivery?

William McGreevey or John Stover, Futures Group

13:50-14:10  From ARVs to comprehensive HIV care and treatment:
what services would  be included in the package provided free at
point of delivery? Representative from Partners in Health, Haiti

14:10-15:10 Discussion (60 minutes)

15:10-15:30 Refreshment Break

III. Enabling financing mechanisms
15:30- 15:50 Configuring health system to minimize the impact of
a free HIV care policy on other primary health services
Anupong Chitwarakorn, Ministry of Health, Thailand

15:50-16:10  Macroeconomic Planning and Access to HIV care and
treatment: the ontribution of International Financial Institutions
Peter Heller, IMF, Washington D.C.

16:10-16:30  Sustainable financing:  Mechanisms of risk pooling
to support free treatment at the point of service. David Evans, WHO,
Health System Financing, Expenditure and Resource Allocation (FER)

16:30-17:30  Discussion (60 minutes)

17:30-18:00 Orientation for group work on day 3
	 Aaron Shakow, WHO, HIV Department

1) PACKAGE OF CARE
2) FROM ASSESSMENT TO DECISION
3) FUNDING MIX

Wednesday 23 March 2005

Morning Facilitator:  Jean Paul Moatti, Director, INSERM
08:30-9:00 Review of Principal Points from Prior Day
	 Chair

IV. Panel for discussion:

09:00-11:00 Mobilizing international resources for supporting
free access and issues for donors

Moderator:
Jean-Paul Moatti, Inserm, Université de la Méditerranée (Aix-
Marseille II), France
Participants:
The World Bank, Debrework Zewdie
GFATM, Vinand Nantulya (TBC)
OGAC, USA, Mark Dybul (TBC)
DFID, UK, Robin Gorna (TBC)
French Minister of Foreign Affairs, Serge Tomasi (TBC)

V. Generating guidance for policy decision making on how countries
and treatment programmes can achieve universal and free access to
care and treatment

11:00-13:00 Group work
1) PACKAGE OF CARE
2) FROM ASSESSMENT TO DECISION
3) FUNDING MIX

13:00-14:00 Lunch

Afternoon Facilitator: Debrework Zewdie
14:00-15:00 Reporting on group work in plenary discussion

15:00-15:20 How can UNAIDS, WHO and World Bank maximize the
impact of their  Guidance?
	 Nasr El Sayed, Ministry of Health and Population, Cairo

15:20-15:40 Piloting financing mechanisms – Country follow-up
	 Aaron Shakow, WHO, HIV Department

15:40-16:10 Discussion

16:10-16:30  Refreshment Break

16:30-17:30 What indicators will be useful in monitoring the
impact of free access versus fee for services in scaling up?
Paul de Lay, UNAIDS (TBC)

17:30-18:00 Reactions from co-organisers WHO, WB and UNAIDS
Secretariat

18:00-18:15 Summary and Closing Chair

Singapore government Aids comment outrages gay activists [REUTERS]

11.03.05

SINGAPORE - Gay activists responded with outrage and disbelief on
Thursday to statements by a Singapore official who said a gay and
lesbian festival -- dubbed Asia's largest gay event -- may have caused
a big spike in Aids cases.

The "Nation.04" party -- a festival of international DJs, podium
dancers, pumping music and muscular boys stripping off their tops on
packed dance floors -- had increased in size every year since it was
launched in 2000.

Last August's party could have allowed "gays from high prevalence
societies to fraternise with local gay men, seeding the infection in
the local community," junior health minister Balaji Sadasivan told
parliament on Wednesday.

Sadasivan said this was the view of an unnamed epidemiologist to
explain a 28 percent rise in the number of new HIV/Aids cases in
Singapore in 2004 to an all-time high of 311.

"This is a hypothesis and more research needs to done," he said.

Gay activists such as Eileena Lee of People Like Us accused the
government of promoting homophobia and being irresponsible.

"This is almost like paranoia," she said. "Statements like this can
marginalise and stigmatise what is already a minority group."

Fridae.com, which organised the event and runs Singapore's main gay
and lesbian Internet site, said the government must shoulder more
responsibility for the rise in HIV because of its poor public health
policies and laws which criminalise oral sex.

Under Singapore's Penal Code section 377A, acts of "gross indecency"
between two men are punishable by up to two years in jail. The
government has said it may decriminalise oral sex but only between men
and women.

"In the past 25 years none of the public health campaigns have ever
targeted the gay community. It's really no wonder that the rates of
infection are increasing," said Stuart Koe, chief executive of Fridae.com.

"It's very simplistic and dangerous of them to point the finger at one
single event and say that that is responsible for the spike," he said.

Ninety percent of newly diagnosed patients were male and a third of
them gay men, said Sadasivan, describing the new cases as "the tip of
the iceberg" in Singapore where a total of about 2,000 people are
diagnosed to be suffering from HIV/Aids.

"For every Aids patient we have diagnosed, there are possibly two to
four undiagnosed patients with HIV in Singapore. That means there
could be, anywhere between 4000 to 8000, undiagnosed HIV patients in
Singapore," he said.

The "Nation.04" party -- half of whose 6000 revellers came from other
Asian countries and the United States to make it Asia's largest known
gay festival -- is at odds with Singapore's image as a strait-laced
city-state.

But the government has turned a blind eye to the growth of an
entertainment industry catering for homosexuals, quietly acknowledging
the potential of the "pink dollar. "

Gay activists have urged authorities to decriminalise homosexuality in
the affluent, predominantly ethnic Chinese island of 4.2 million
people to strengthen Aids awareness. - REUTERS

http://www.nzherald.co.nz/index.cfm?c_id=2&ObjectID=10114668
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Related articles:
s'pore health minister's comments on HIV surge and gay parties draw
criticism
http://www.fridae.com/newsfeatures/article.php?articleid=1405&viewarticle=1

press statement on s'pore minister's remarks linking HIV surge to
nation parties
http://www.fridae.com/newsfeatures/article.php?articleid=1406&viewarticle=1

s'pore gay group offers other possible reasons for HIV surge among MSM
http://www.fridae.com/newsfeatures/article.php?articleid=1407&viewarticle=1

Sylvia Tan
E-mail: <sylvia.tan@...>