INVITATION  AIDS_ASIA e FORUM.

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[AIDS ASIA eFORUM] 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 7,200 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/

[Five fee scholarships and stipends are available to
students from developing countries in the Asia/ Pacific region].

Master of International Research Bioethics

Master of International Research Bioethics
3 semesters full-time + 6 semesters part-time
Study mode and course location On-campus (Alfred Hospital, Melbourne)

Course description

This course, offered by the Department of Epidemiology and Preventative
Medicine, is an interdisciplinary program covering comparative moral theory,
research bioethics in an international setting, quantitative and qualitative
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countries in the Asia-Pacific Region.

Students will gain a strong theoretical framework, significant
experience with ethics committees and considerable involvement with
local organisations concerned with the development of bioethical policy and its
implementation. This course is currently funded by the Fogarty Institute of the
US National Institutes of Health.

Course objectives

The overall objectives for the course cover four main themes:

1. Basic moral theory, bioethics and the application of bioethical
principles and law to research in both domestic and international
collaborative contexts
2. Quantitative and qualitative methodology for international health
programme planning and evaluation
3. Special issues in international health
4. Practical application of theory and knowledge

Fees:

In recognition of the fact that people from both NGOs and from
developing countries may wish to undertake this program, we have a
special fee policy for this program. Fees are AUS $19,785 for Australian
students and AUS $22,650 for international students.

In addition, five fee scholarships and stipends are available to
students from developing countries in the Asia/ Pacific region.

WE ARE PARTICULARLY INTERESTED IN SPONSORING STUDENTS WHO ARE
APPROPRIATELY QUALIFIED FROM THAILAND AND VIET NAM
Applicants need to have a TOEFL score of at least 8 to be eligible.

Please contact
Dr Deborah Zion
e-mail: <deborah.zion@...>

Dear Colleagues

The Collaborative Fund for HIV Treatment Preparedness is a partnership of the
International Treatment Preparedness Coalition and the Tides Center to improve
access to HIV treatment for those who need it. The program aims to support civil
society, especially people living with HIV/AIDS, to advocate for improved access
to treatment and to educate people living with HIV about HIV treatment.

In South East Asia, a Community Review Panel (CRP), made up of community experts
from around the region, was established to manage the grants process in
collaboration with the Tides Center. Program funds have been received from many
donor agencies, most notably from the United Kingdom's Department of
International Development Agency (DFID) and the World Health Organisation. The
Collaborative Fund in SEA began its work in 2005 by supporting 18 grantees in 7
countries who reached thousands of HIV positive people and affected communities
in the region.

This letter is to announce the 2nd year of grants in Southeast Asia . We are
seeking submissions of letters of intention (LOI) for community-based HIV
treatments advocacy and education programs. Funding is geographically limited to
Thailand, Cambodia , Laos, Vietnam, Indonesia, the Philippines, Myanmar and
Malaysia. Any nongovernmental organisation from these countries is invited to
apply. Joint projects between organisations will also be considered. Grants are
provided for a program of up to one year with a maximum of USD 10 000 for
individual organisations and up to USD 20 000 for joint applications of two
organisations or more. The total grant program is USD 200 000. Those who submit
successful letters of intention will be invited to submit a further project
proposal.

If you are interested in the Collaborative Fund, you will need to consider the
2006 Guide for Submission of Applications and the Letter of Intention Form . If
these documents are not attached to this letter and you would like to receive
them, e-mail Shiba Phurailatpam at info@...

THE DEADLINE FOR SUBMISSIONS OF LOIs IS 1 DECEMBER 2006.

Please note that it is estimated that projects will start from 26 March 2007.

We are looking forward to hearing from you. Please forward this information to
other organisations who work on treatments access issues. Please contact me if
you need any further information or clarifications.

Shiba Phurailatpam
South East Asia Regional Coordinator
On behalf of the South East Asia Community Review Panel of the Collaborative
Fund
e-mail: <shiba.p@...>

Comments: Governance of AIDS 2006 and beyond:
Joe Thomas, October 30 2006

http://www.thelancet.com/journals/lancet/article/PIIS0140673606696256
/comments?action=view&totalComments=1
________________________________________

A post mortem of AIDS 2006(1) is a welcome change. However, the
response from the International AIDS Society (IAS), (2) did not
address Horton's main concern, the disengagement of the
International AIDS Conference (IAC) from reality, and other concerns
(3). Many describe the IAC as a circus (4, 5).

The authors gloat over the number of delegates attended the
conference. Many delegates would have considered a fully paid trip
to Toronto is part of the perks of their job. How many must have
paid from their own pocket to attend IAC? The conference attendance
is, thanks to some of the donor agencies, governments, NGOs,
bilateral and multilateral agencies. They must take a closer look at
the governance of IAS and it impact on the conference outcome.

Good governance is a prerequisite for an effective HIV response.
Should the governance of IAS, the custodian of the International
AIDS Conference be excused?. The authors (1) refer to the 2005
conference review as a success, but the governance of the conference
had not been addressed in this review as well. The review seemed to
be a public relation exercise. As a result, the claim of Cahn at the
closing of the 2006 conference that"(..) IAS is now a mature
organization", (6) seems debatable as the organization doesn't
measure its maturity of governance and ethical values it promotes.

The values of the IAS administrative staff seem to demonstrate
intolerance to `other' views, unaccountability and even plain
arrogance. For example, they were not willing to trust the laws of
Canada to run the conference smoothly. So they devised a
special "Principles and Values of Conference Participation"

The IAS bylaws (7) testify its ethical poverty. They do not
guarantee that the agency will not be abused by unscrupulous
governing council members or the administrative staff.

The statement "membership may be terminated without indication of
reason..", is an example of high handedness. It appears that they
don't believe in `fair process".

There is also no clause on "conflict of interest' which bounds the
conduct of the IAS leadership. All the IAS leaders and the staff
must declare their conflict of interest. In particular, their
interest in Pharmaceutical industry.

To promote greater accountability is make all beneficiaries of IAS
(in the form of scholarship, travel and consultancy fees) a public
record.

The IAS Governing council election, supervised by IAS office staff
is conducted in an arbitrary and flippant manner. There are no
details of the demarcation of the region or the list of all the
eligible voters. The number of votes received by each candidate is
confidential. IAS elections must me supervised by an Independent
returning officer. A transparent and democratic election procedure
must in be in place.

If Cahn and McClure are genuinely `committed to improving the
conference and strengthening its role…' foremost, they must ensure
better standards of governance of IAS. A fair, transparent and
democratic IAS Governing council election is a precursor of better
governance of IAS

Competing Interests: None

References:

(1) Horton R. A prescription for AIDS 2006–10. Lancet 2006; 368: 716-
718

(2)Pedro Cahn and Craig McClure. AIDS 2006 and beyond.
(Correspondence)
The Lancet 2006; 368:1489-1490. DOI:10.1016/S0140-6736(06)69625-6

(3) Toronto AIDS conference: where were the children? Nigel Rollins
on behalf of 17 other signatories. The Lancet 2006; 368:1236-1237.
DOI:10.1016/S0140-6736(06)69514-7

(4) Karen Birmingham (2002) World AIDS meeting: part science, part
circus. Nature Medicine 8, 767 (2002) doi:10.1038/nm0802-767a

(5) Anindita Ramaswamy, (2006) AIDS circus shuts out HIV patients.
Bangkok Post, 18/08/2006
http://www.bangkokpost.com/breaking_news/breakingnews.php?id=112296

(6) Dr. Pedro Cahn, President, International AIDS Society . Closing
Session Remarks. XVI International AIDS Conference (AIDS 2006)
http://www.iasociety.org/images/upload/1161.pdf

(7)Current IAS Bylaws: http://www.iasociety.org/page_2.asp?
pageId=1220

http://www.thelancet.com/journals/lancet/article/PIIS0140673606696256
/comments?action=view&totalComments=1

Ulaanbaatar 2006 Call for Action

Recognizing that countries with low levels of HIV infection now have
a window of opportunity to contain the spread of the epidemic by
scaling up evidence based interventions, with a strong focus on
prevention;

Noting that in the Asia and the Pacific Region the rates of HIV and
STI infection, despite some successes in containing the epidemic,
continues to accelerate, especially among most at risk populations,
such as sex workers and clients, injecting drug users, men having
sex with men, migrants and mobile populations, majority of whom are
young and given the region's large population could result in the
epicenter of the epidemic shifting to Asia and the Pacific;

Acknowledging the Political Declaration adopted at the High Level
Meeting on AIDS at the General Assembly in June 2006, the 2001
UNGASS Declaration of Commitment on HIV/AIDS and the Millennium
Development Goal 6: Combat HIV/AIDS, Malaria and other diseases;

Mindful that the costs of prevention are considerably lower than the
costs of treatment, care and support and recognizing that given
limited resources, prioritization, particularly most at risk
populations, is the key to effective national strategies in low
prevalence countries.

Recognizing that access to prevention, treatment, care and support
is a basic right for all.

Noting that treatment, care and support for people living with HIV
and AIDS is an important entry point for prevention of further
transmission in low prevalence countries.

Concerned that stigma and discrimination towards people infected or
affected by HIV and AIDS, including those most at risk populations,
particularly in health care settings, impedes universal access to
prevention, treatment care and support services.

Realizing that the label "low prevalence" diverts resources and
attention at all levels of society; and

Recognizing that the demographic, geographic, socio-economic,
cultural and gender issues, ethnic, religious, national and sub-
national service delivery systems and political diversity of
countries in Asia and the Pacific are important factors to consider
when developing appropriate national strategies.

We the participants of the First Asia-Pacific Regional Conference on
Universal Access to HIV Prevention, Treatment, Care and Support in
Low Prevalence Countries recommend that actions be taken by the
following:

Government

1. Establish / upgrade a functional national AIDS coordinating
authority at the highest political level as Chair and the Ministry
of Health as secretariat with all relevant ministries, including
Ministry of Finance and political parties to be involved and ensure
the participation of civil society, NGOs, people living with HIV,
young people, community and religious leaders.

2. Strengthen the national AIDS coordinating authority to
improve programme planning and management, coordination,
surveillance systems, research and M & E, in particular to utilize
disaggregated surveillance data to feed into policy making,
programme design and advocacy to keep ahead of the epidemic.

3. Review, formulate and implement policy that is rights based,
gender and culture sensitive by enacting appropriate legislation,
including decriminalization, to reduce stigma and discrimination and
to create an enabling environment for HIV and AIDS prevention,
treatment, care and support by ensuring the rights of people
infected and affected by HIV/AIDS and the most at risk populations
and the service providers.

4. Develop a costed and comprehensive national strategic plan,
with realistic and measurable targets to be achieved by 2010,
involving civil society, communities and other stakeholders, which
should include young women and men, migrants and people living with
HIV in the design and implementation towards universal access to HIV
prevention, treatment, care and support.

5. Ensure adequate financial resources through national
budgetary and other sustainable financing schemes.

6. Strengthen human resources through improved management and
capacity building for all aspects of HIV and AIDS prevention,
treatment, care and support, at national and sub-national levels.

7. Ensure critical linkages between National Strategic Plans
and other relevant programmes, such as Tuberculosis, Sexual
Transmitted Infection, Sexual and Reproductive Health, Primary
Health Care programmes and education, etc.

8. Maximize the use of flexibilities in the WTO/TRIPS agreement
in national laws, with the aim of putting public health concerns
above trade. Ministry of Health should be involved in the national
implementation of intellectual property rights and participate in
trade negotiations to ensure access to sustainable prevention and
treatment.

Civil Society

1. Initiate and implement innovative HIV and AIDS programmes to
complement government efforts to implement National Strategic Plans
through partnerships, with significant and active representation in
the national AIDS coordinating authority.

2. National civil society and NGOs to continue to actively
participate in the monitoring and reviewing of the national AIDS
response and feed into sub-national/national/international reporting
mechanisms, to ensure that commitments made at the
national/international/regional arena are fulfilled.

3. Establish support groups, networks and capacity building for
communities and people living with HIV and AIDS to increase
meaningful involvement in advocacy, planning, implementation and M &
E.

International Donors and Multilateral institutions

1. Provide financial and/or technical support, recognizing
special requirements of low prevalence countries, to implement the
National Strategic Plans and to achieve the targets set for
Universal Access by 2010.

2. Provide financial and/or technical support for civil society
groups and NGOs to support implementation of National Strategic
Plans.

3. Multilateral and bilateral donors to advocate and mobilize
increased investment for countries currently reporting low level
epidemics.

4. Harmonize indicators and reporting requirements.

Dear FORUM,

It is indeed great news that CIPLA has released its first ever 3 drug
combination. But everything depend on how CIPLA and other agencies like WHO,
unaids and othern national agencies are going to use this opportunity.

The new combination consists of 3 anti-HIV drugs: efavirenz 600 mg, tenofovir
300 mg and emtricitabine 200 mg. The implications of this drug combination are
many fold:

1. We can avoid Nevirapine which can cause side effects like rash and hepatitis,
early resistance and which needs gradual increase in the dose. Moreover this can
also interfere with Anti-TB drugs whereas the new combination can be given along
with TB medicines.
2. We can avoid Zidovudine and Stavudine which can cause side effects on short
term and long term.

3. This drug combination can be given once a day which make the adherence
easier.

4. This drug combination to the best of our knowledge gives better viral
suppression than once day triple NRTI combination. (Hope I am not mistaken here)

5. Also 2 drugs useful against Hepatitis B in this regimen will save Hep B / HIV
co infected individuals from developing drug resistant Hep B Virus.

On a macro scale, this combination will help us to:-

1. Reconsider our first line drug combination: If this combination is considered
as the first line, we can avoid many operational hurdles, side effects and
problems of poor adherence just by switch from current first line to this
combination.

2. Practically avoid the necessity of alternate first line drugs: It may leave
simpler options for second line therapy than PIs.

3. The virtual absence of any known long term and acute toxicity will redefine
the indications for ARV and the never ending confusion between CD4 200 and 350
will be settled in favor of 350.This will in turn reduce the morbidity of large
number of patients in this group .This will greatly change the economics of ART
and will have implications in funding, marketing etc..

I hope CIPLA and other companies will try to reduce the cost of this combination
and make it possible to be available for massive scale-of course after a
feasibility study at all levels.

There is great news this week on the release of heat stable Retonavir by Emcure
tablet which will make the life of those who are on Retonavir Based Second line
better. This is again a great step towards the easy availability of second line
drugs in developing countries. (This means we doctors need not prescribe a
refrigerator along with ritonavir tablet and system need not worry about the
maintenance cold chain!!)

I request the experts in this forum to express your opinion on these ideas in
the forum.


Dr Ajithkumar.K
Medical college Trichur, Kerala
India.
E-mail: <trc_ajisudha@...>

"Low Prevalence' Does Not Mean HIV Prevention Is Low Priority"

ULAANBAATAR, Mongolia, 27 October 2006—Low rates of HIV infection
must not lead to complacency, representatives of 10 Asian and
Pacific "low prevalence" countries agreed today.

Countries where HIV is still relatively rare have a window of
opportunity to avoid more serious epidemics, cost-effectively. But
it is essential that they invest in targeted prevention efforts, and
actively counter the stigma of HIV and the taboos that hinder
addressing risky behaviours.

This was the conclusion of the First Asia-Pacific Regional
Conference on Universal Access to HIV Prevention, Treatment, Care
and Support in Low Prevalence Countries, where experts from
governments, civil society and international organizations shared
experiences and strategies for strengthening national AIDS
programmes.  Delegates adopted the Ulaanbaatar 2006 Call for Action,
highlighting the priorities of an effective response to the
epidemic.

The Government of Mongolia organized the four-day meeting in
partnership with the UN Country Team in Mongolia – UNFPA, the United
Nations Population Fund; the World Health Organization (WHO); the
United Nations Children's Fund (UNICEF); and the United Nations
Development Programme (UNDP) – and UNAIDS, the Joint United Nations
Programme for HIV/AIDS.

Opening the conference, Prime Minister Enkhbold Miyegombo announced
that Mongolia had re-established its national AIDS committee, and
pledged to step up action against HIV. "I believe that the low
prevalence of HIV is not a reason to limit the allocation of
domestic and international financial resources to HIV prevention,"
he stated.

Mongolia's deputy prime minister and minister of health also
addressed the meeting, as did the health minister of Fiji.

Other participating countries, many of which were represented by
high-level health officials, included Bangladesh, Bhutan, Lao
People's Democratic Republic, Democratic People's Republic of Korea,
Malaysia, Maldives, Sri Lanka and the Philippines.

"Whether a country is low prevalence or high prevalence, the risk
factors are the same, and HIV prevention efforts need to be focused
to be most effective," said J.V.R. Prasada Rao, Director of the
UNAIDS Regional Support Team for Asia and the Pacific.

Participants agreed that targeted HIV prevention efforts should
focus on people most at risk of acquiring HIV within the countries,
including sex workers and their clients, injecting drug users, men
who have sex with men and young migrants. Efforts should also be
made to raise general awareness about AIDS to help break down AIDS-
related stigma and discrimination Despite a few notable successes in
containing the epidemic, infections continue to rise throughout Asia
and the Pacific region and have reached concentrated levels in a
number of countries.

They noted that discrimination against people most at risk and
people living with HIV impedes efforts to scale up prevention,
treatment, care and support services.

"Denial, stigma, discrimination and criminalization of people most
at risk of HIV must be addressed by reforming laws and aligning them
with national AIDS policies," said Ts. Purevjav, Executive Director
of the Positive Life Centre, a Mongolian non-governmental
organization.

The Call for Action urges countries to improve surveillance systems,
so they can better understand factors driving the epidemic and
target interventions to those most at risk. National AIDS action
plans, it states, need adequate funding, ambitious but realistic
targets, high-level political commitment, and the full involvement
of civil society. It calls on governments and international donors
to increase support for national HIV prevention programmes.

Under the theme `'Low to zero', the conference involved countries
that have overall HIV prevalence below 0.1 per cent and do not have
significant infection rates among subpopulations. Participants
recommended against using the term "low prevalence", saying it could
lead to a diversion of attention and resources from the HIV epidemic.

In sub-regional working groups, delegations examined the situations
in individual countries, identifying obstacles to and opportunities
for scaling up national HIV prevention, treatment, care and support
efforts, as called for by the UN's 2006 High-Level Meeting on AIDS
in June.

For more information, visit www.lpc2006.mn or contact:

William A. Ryan, ryanw@..., mobile +976 9909 2012

P. Jargalsaikhan, jargalsaikhan@..., mobile +976 9913 5393

Pakistan sitting on a ticking AIDS bomb

Amir Latif,  Friday October 06, 2006 (1626 PST)

She exudes confidence. Confidence of a person who senses that she is
doing a great job for her people and the country. She is one of a
very few people who are paying the price for a crime, which they
never committed, but instead of surrendering to the injustices of
life, they try to save others from those injustices.

Shukria Gul, the first woman with HIV in Pakistan to come out
publicly and campaign on behalf of fellow sufferers, now counsels
those who have nowhere else to turn.

She contracted the disease from her husband who received a
contaminated blood transfusion and later died.

The doctors treated me as if I had an illness you get from just
touching people. In my neighbourhood people started pointing at me,
saying `she's the one with Aids'."

Shukria set up one of Pakistan's few direct support groups and her
experience has made her highly critical of government departments
dealing with HIV.  "They give money to agencies who do nice work on
paper. Maybe they do work but I haven't seen any of it on the
ground.

"Aids will never be contained unless small grassroots groups like
mine are supported, so we can spread the message of prevention by
direct contact."

Though, HIV is not a dominant epidemic in the adult population of
Pakistan, coupled with the extremely low awareness of HIVIAIDS in
Pakistan, as well as growing number of cases, the AIDS epidemic is
poised to take a hold in Pakistan. The presence of additional risk
factors such as unscreened blood, and low condom use rates make the
situation fertile for AIDS to become a major public health issue.

The National AIDS Programme's latest figures show that around 3,000
HIV cases have so far been reported  since 1986, but UN and
government estimates put the number of HIV/AIDS cases between 70,000
and 80,000 with the vast majority going unreported due to social
taboos about sex and victims' fears of discrimination, officials
said.

Pakistan is a good example of a country that is learning fast but
late about the threat of HIV/AIDS.

Unlike India, recorded prevalence in Pakistan is small and the
authorities are working to keep it that way.  However, there are
still plenty of complaints that government departments and NGOs have
done little to help those infected or indeed have any idea of the
full extent of the problem.

Since 1987, the numbers of reported HIV infections and AIDS cases in
Pakistan have risen steadily and affect all geographical regions of
the country. The total number of reported cases by September 2006
was 2,998.  However, the WHO/UNAIDS forecast model estimates a much
higher number: between 70,000 and 80,000 people or 0.1 per cent of
the adult population. Hetrosexual transmission (52.55 percent) and
contaminated blood or blood products (11.73 percent) are the most
commonly reported modes of transmission for HIV/AIDS in Pakistan.

Other modes of transmission include injecting drug use (2.02
percent), male-to-male or bisexual relations (4.55 percent), and
mother-to-child transmission (2.2 percent). Mode of transmission in
26.9 percent of the reported HIV/AIDS could not be established. The
male-to-female ratio is 42:6 and 7:1 (per 100,000) in reported HIV-
positive and AIDS cases, respectively. Limited available research
indicates that HIV prevalence is one percent to two percent in
vulnerable or high-risk populations such as female sex workers and
long-distance truck drivers.

The first case of AIDS in a Pakistani citizen was reported in 1987
in Lahore. During the late 1980s and 1990s, it became evident that
an increasing number of Pakistanis, mostly men, were becoming
infected with HIV while living or traveling abroad. Upon their
return to Pakistan, some of these men subsequently infected their
wives who, in some cases, passed along the infection to their
children. In 1993, the first recognized transmission of HIV
infection through breast-feeding in Pakistan was reported in the
city of Rawalpindi. During the 1990s, cases of HIV and AIDS began to
appear among groups such as sex workers, drug abusers and jail
inmates. The increased rates of infection among these groups are
assumed to have facilitated, at least to some extent, a further
dissemination of HIV into the general population.

Currently classified by WHO/UNAIDS but high-risk country for the
spread of HIV infection, Pakistan has recently witnessed changes in
the epidemiological trends of the disease owing particularly to
rapid rise in infection among injecting drug users.

According to UNAIDS estimates, some 70,000 to 80,000 persons, or 0.1
percent of the adult population in Pakistan are infected with HIV
although cases reported to the National AIDS Control Programme are
less. As in many countries, the numbers may be underreported—mainly
due to the social stigma attached to the infection, limited
surveillance and voluntary counseling and testing systems, as well
as lack of knowledge among the general population and health
practitioners.

Data analysis indicates that most infections occur between ages of
20-44 years, with men outnumbering females by a ratio 5:1. The
trends are closely similar to other countries affected by HIV/AIDS.
By September 2006, sexual transmission accounted for the majority of
reported cases (67.48 percent). Other modes of transmission include
infection through contaminated blood and blood products (6.99
percent); injecting drug abuse (0.82 percent); and mother to child
transmission (three percent).

The mode of transmission remains unknown in 20 percent of the
reported cases most probably due to stigma and lack of awareness.
But given the combination of high levels of risk behaviour and
limited knowledge about AIDS among drug injectors and sex workers in
Pakistan, experts warn that the country could be on the verge of a
serious epidemic.

Situation updates in 2005 by various agencies such as the UNAIDS
report an "outbreak" of HIV among injecting drug users in Larkana,
Sindh, where out of 170 people tested, more than 20 were found HIV
positive.

In Karachi, a 2005-06 survey of Sexually Transmitted Infections
among high risk groups found that more than one in five Injecting
Drug Users (IDUs) was infected with HIV. These represent the first
documented epidemics of HIV in well-defined vulnerable populations
in Pakistan.

The Enhanced HIV / AIDS Programme aims to "prevent HIV from becoming
established in vulnerable populations and spreading to the general
adult population, while avoiding stigmatization of the vulnerable
populations". Following are the factors for vulnerability to AIDS:

High risk behaviour among IDUs

IDUs are at a high risk of acquiring HIV and other blood-borne
infections because they often resort to unsafe practices such as
needle and syringe sharing.  Pakistan is a major transit and
consumer country for opiates from neighbouring Afghanistan, the
world's largest producer of opium.

As far back in 1999 the United Nations Office of Drugs and Crime had
conducted studies in Lahore that revealed that addicts were
switching methods of drug ingestion – moving from smoking
or "sniffing" or inhaling to injecting polydrug cocktails. This, the
UNODC had warned could lead to increase in HIV as needle sharing and
use of non-sterile equipment was common . The number of drug
dependents in Pakistan is currently estimated to be about 500,000,
of whom an estimated 60,000 inject drugs. It is also unlikely that
outbreaks which have been witnessed in 2004 and 2005 are likely to
be contained or limited to one area. Many of these injectors move
from city to city (21 percent of the Karachi users had also injected
in other cities) and a very high proportion of them use non-sterile
injecting equipment (48 percent in Karachi had done so in the week
before the survey was conducted).

Risk behaviour in Lahore is even higher: 82 percent of injectors had
used non-sterile syringes in the previous week, 35 percent did so
all the time, and 51 percent had injected in another city in the
previous year, according to Pakistan's Ministry of Health.

An HIV epidemic among injecting drug users was reported in 2004 in
Sindh, in the town of Larkana where almost 10 percent of drug
injectors tested HIV-positive. Knowledge of HIV among injectors (and
sex workers) is extremely low. In Karachi, Pakistan's main trading
city, more than one quarter had never heard of AIDS and many did not
know that using non-sterile injecting equipment could result in
infecting them with HIV, according to Ministry of Health's findings.

Unsafe Practices among Sex Workers

Female sex workers (FSWs) and female migrant workers are often
exploited and abused, and have little recourse due to their low
social status and limitations in legal protection. Commercial sex is
prevalent in major cities and on truck routes.  Behavioral and
mapping studies in three large cities found a sex workers population
of 100,000 with limited understanding of safe sexual practices.
Furthermore, sex workers often lack the power to negotiate safe sex
or seek treatment for STIs.

Recent findings indicate that although HIV prevalence remains below
one percent, FSWs and their clients report low condom use. Less than
half the FSWs in Lahore and about a quarter in Karachi had used
condom with their last regular client. In Karachi, one in five sex
workers cannot recognize a condom, and three-quarters do not know
that condoms prevent HIV (in fact, one third have never heard of
AIDS), reports UNIADS Update 2005.

It is therefore little wonder that only two percent of female sex
workers said they used condoms with all their clients in the
previous week. In addition to the lack of knowledge and low use of
condoms, there is a high degree of sexual interaction between drug
injectors and sex workers.

Ministry of Health findings reveal that over 20 percent of female
sex workers in Karachi and Lahore had sold sex to injecting drug
users and condom use was very low during those encounters. Among
injecting drug users in Lahore, almost half had had sex with a
regular partner in the previous year, one third had paid for sex
with a woman (11 percent used a condom consistently) and almost one
quarter had paid for sex with a man (five percent used a condom
consistently) . Male sex workers also trade sex with injectors, 20
percent of whom reported buying anal sex in the previous year (and
only three percent of them used a condom consistently).
Men who have Sex with Men (MSM)

While there is little documentation about the extent to which men
engage in sexual activity with other men in Pakistan, the limited
evidence available suggests that such activity does occur throughout
the country.

Anecdotal evidence indicates that sexual activity between men occurs
relatively frequently in boys' hostels and jails; additionally,
research suggests that sex between men is often practiced among long
distance truck drivers. Finally, there is a small but highly mobile
population of transvestites, transsexuals and eunuchs known as the
hijra, who are known to engage in unsafe sexual practices. Lahore
had an estimated 38,000 MSM in 2002. The MSM community is
heterogeneous and includes Hijras (biological males who are usually
fully castrated), Zenanas (transvestities who usually dress as
women) and masseurs. Many sell sex and have multiple sexual
partners.

Inadequate Blood Transfusion Screening and High Level of
Professional Donors

The collection and transfusion of blood and blood products, the use
and re-use of unsterilized medical instruments (especially needles
and syringes) and the generally low level of attention to standard
infection control procedures are important potential avenues for the
spread of HIV in Pakistan's general population.

The indiscriminate use of blood transfusions and of needles in both
formal and informal health sectors is common. In addition, standard
procedures for infection control in health care settings are often
not strictly followed.

A relatively high prevalence of both hepatitis B and C infection in
the general population suggests that unsafe blood transfusion
practices and poor infection control are likely to make a
significant contribution to the further rapid spread of these
infections and of HIV/AIDS among the general population.

It is estimated that 40 percent of the 1.5 million annual blood
transfusions in Pakistan are not screened for HIV. In 1998, the AIDS
Surveillance Centre in Karachi conducted a study of professional
blood donors.

The study found that 20 percent were infected with Hepatitis C, 10
percent with Hepatitis B, and one percent with HIV. About 20 percent
of the blood transfused comes from professional donors.

Migration can create conditions in which people become vulnerable to
infection. It is commonplace in Pakistan for men to travel away from
their homes to find work, either within the country or abroad. This
separation from their spouses, families and communities can result
in loneliness and isolation, and can lead migrants to engage in
social and sexual practices that put them at risk of exposure to
HIV.

In addition, though there is virtually no documentation of the
HIV/AIDS-related risks experienced by the large number of refugees
in Pakistan, global experience suggests that this population may be
highly vulnerable to HIV.

Large numbers of workers leave their villages to seek work in larger
cities, in the armed forces, or at industrial sites. A significant
number (around four million) are employed overseas. Away from their
homes for extended periods of time, they become exposed to
unprotected sex and are at risk for HIV/AIDS.

Studies indicate that 94 percent of injections are administered with
used injection equipment. Use of unsterilized needles at medical
facilities is also widespread. According to WHO estimates, unsafe
injections account for 62 percent of Hepatitis B, 84 percent of
Hepatitis C, and three percent of new HIV cases.

Personal awareness and knowledge of reproductive health issues is
limited, and often erroneous, among men and women of Pakistan due in
part to the generally low levels of education, and also due to their
limited access to effective reproductive health services.

Men and women alike are often unaware of the differences between
reproductive and sexual "health" and reproductive and
sexual "disease". When they do become aware of a possible sexual or
reproductive problem, they often seek care from traditional healers
(hakims) or from one of the many unregulated "sex clinics" in the
informal health sector.

In addition, it is estimated that only 60 percent of the country's
population have access to the formal healthcare system and many
(through personal preference or necessity) resort to the use of
hakims or traditional healers.

It is not uncommon for clinics in villages to be operated by self-
described "doctors" who may actually have little or no formal
medical training.  This reliance upon unqualified practitioners may
compound the risk of further infection due to their lack of
knowledge and the possibility of inadequate infection control during
their therapeutic procedures.

Health care professionals generally believe, however, that the
incidence of STIs in Pakistan may be increasing due to the
relatively widespread presence of risk behaviors. The 2004 STI
survey found that four percent of  MSMs in Karachi were infected
with HIV, as were two percent of the Hijras in the city.

Syphillis rates were also high with 38 percent of MSMs and 60
percent of Hijras in Karachi infected with the disease. As a
consequence, sexually-transmitted infections rates are high: in
Karachi, 18 percent of injectors were found to be infected with
syphilis, as were 36 percent of male sex workers and 60 percent of
Hijras or transgender persons.

Gender inequalities may also play a facilitating role in the further
spread of HIV/AIDS in Pakistan.  Pakistani women in general have
lower socio-economic status, less mobility and less decision-making
power than men, all of which contributes to their HIV vulnerability.
For example, because of gender disparities in educational enrolment,
the female literacy rate in Pakistan is much lower than that of
males (35 percent for women as compared to 59 percent for men).

http://www.paktribune.com/news/index.shtml?156327

Once a day AIDS drug launched in India

New Delhi:A breakthrough combination of three HIV/AIDS drugs,
Viraday has been launched by Cipla which would help the HIV infected
persons in effectively treating the dreaded disease by taking just
one tablet a day.

Viraday is a combination of three anti-HIV drugs including efavirenz
600 mg, tenofovir 300 mg and emtricitabine 200mg.

A single tablet of Viraday could provide all the medicine required
for an HIV infected persons to deal with the viral load so the
person need not take three separate medicines.

This treatment is not only less cumbersome but could be taken even
when the HIV infected person is taking medicine for tuberculosis
which is not the case otherwise.

Cipla on Thursday became the first company to launch the combination
drug in India.

This combination is drug was earlier available only in the United
States and European countries.

However, the cost of this combination therapy in the US and Europe
is Rs 52,800 per month while Cipla has made it available here at
just Rs 5200 per month.

The toxicity of this combination drug has been found to be lower
than the drugs taken individually.

The medical fraternity has long awaited this breakthrough, as it
would give a huge boost to adherence-how faithully patients’ stick
to the course of treatment advised by the doctor.

This is a vital issue in HIV treatment to prevent the infection from
reaching the advanced stage of AIDS, said senior consultant in
Internal Medicine at Indraprastha Apollo Hospital, Dr Nalin Nag.

He said that Viraday is very patient friendly, as it requires just
one pill a day and freedom from the severe side effect of many other
anti HIV drugs.

Cipla has been a forerunner in harnessing its R& D to reduce pill
burden for patients on anti-HIV treatment.

The company was the first to introduce innovative treatment kits and
the three in one pills that have gone a long way to promote
adherence and ease of use.

Viraday with its convenient once a day dosage and accessibility is
Cipla's most significant achievement.

The company, which is providing HIV/AIDS drugs to majority of
African, South Asian, Latin American and many other developing
countries, has provided a major role in reducing the price of
HIV/AIDS drugs in international market.

http://www.moneycontrol.com/india/newsarticle/stocksnews.php?
cid=1&autono=2391&source=ibnlive.com

Malaysia fights looming AIDS epidemic

By Liau Y-Sing, Wed, Oct 25,2006 5:35 AM IST

KUALA LUMPUR (Reuters) - Ex-convict Jonah Chan is a casualty of
Malaysia's losing battle against AIDS.

In 1984, he was jailed for three years for robbery. He came out a
drug addict and is now infected with the AIDS virus.

"I contracted HIV by injecting drugs. I shared needles," said 41-
year-old Chan who has been in and out of a home for reforming drug
addicts and convicts in Kuala Lumpur for the past 15 years.

"Drugs were cheaper in prison because there were a lot of big
pushers," he explained, sitting in the living room of an old double-
storey brick house he shares with 23 other residents.

Malaysia, a conservative, mainly Muslim country, has some of the
world's toughest anti-drugs laws. But the HIV virus is spreading
rapidly due to illegal drug use and a lack of sex education, raising
fears of an epidemic.

Delivering a loud wake-up call to the government, the World Health
Organisation warned last year that Malaysia was on the brink of an
HIV epidemic.

Until recently, Malaysia refused to adopt policies proven successful
elsewhere -- including in fellow Muslim countries Iran and Pakistan -
- such as providing clean syringes to drug addicts.

At the start of 2006, HIV cases in Malaysia totalled 70,559 in a
population of about 26 million, while 10,663 patients had full-blown
AIDS, official data showed.

The numbers are much lower than Thailand which has 560,000 HIV
patients, but Malaysian health officials are worried by the
exponential rise in HIV cases.

In 2005, new AIDS cases in Malaysia totalled 1,221 compared with 233
in 1995.

By contrast, neighbouring Thailand has more than halved the number
of new HIV infections over the past decade, thanks to aggressive
promotion of condom use among sex workers.

"For HIV, the trend has been always upward in Malaysia and we're
getting very worried," Malaysian Health Minister Chua Soi Lek, who
was appointed to the post in 2004, said in an interview.

"People are in a state of denial," he added.

FREE CONDOMS, NEEDLES
Only last year did the government start handing out free condoms and
needles -- a move it had earlier opposed on grounds that it promoted
free sex and rampant drug usage.

It now plans to spend 500 million ringgit ($136 million) on
programmes to combat AIDS, including needle distribution.

HIV is most commonly spread in Malaysia by drug users, with male
AIDS patients outnumbering females by about 10 to 1.

About 60 percent of those believed to have HIV were Malays -- the
largest and most religiously conservative of Malaysia's ethnic
groups. Most of them were unemployed.

AIDS activist groups blame inadequate enforcement of drug laws and a
lack of sex education for the rapid rise in cases.

"The reality is we're losing the war," said Pax Tan, a leader of a
Christian group involved in combating HIV and drug use.

The government is starting to fight back.

HIV education will soon be taught during the national service
programme for youths, Chua said, after surveys showed a rise in
unprotected sex and widespread ignorance about HIV among youth.

Government data showed that about a quarter of AIDS cases from 1986
to 2005 involved those between 13 to 29 years of age.

"With the funding promised by the government, we are very confident
that we'll be able to see a plateau in the rate of increase, maybe
by 2010 or 2009," Chua said.

SEX AND DRUGS

Despite Malaysia's growing affluence and western trappings, the
country remains outwardly conservative on sex.

Kuala Lumpur - which started in the mid-19th century as a tin
settlement with brothels, gambling booths and opium dens - is packed
with clubs brimming with drugs and alcohol but is also a place where
kissing and hugging are forbidden in public parks.

With no sex education at schools, some youths believe that HIV can
be transmitted by mosquitoes, fleas or bedbugs.

Religious leaders are deeply opposed to the distribution of free
needles and condoms.

"(It) will encourage people to have free sex. We must address the
root of the problem," said Ahmad Awang, a spokesman at the Parti
Islam se-Malaysia (PAS), the country's largest Islamic opposition
party.

Instead he suggested tightening government controls on entertainment
outlets and night-time curfews for youths.

Wong Kim Kong, of the National Evangelical Christian Fellowship
Malaysia, believes traditional values may stop the spread of AIDS
rather than free condoms and needles.

"Abstinence is the most important habit that we need to develop," he
said.

http://in.today.reuters.com/news/newsArticle.aspx?
type=worldNews&storyID=2006-10-25T052632Z_01_NOOTR_RTRJONC_0_India-
273578-1.xml

Asian and Pacfic vote for Michel Sidibe for Global Fund leadership

Dear Friends,

Michel is the only Afro-Asian candidate for the Global Fund
leadership and all of us need to read his biography of this eminently
commendable candidate for the leadership of the Global
Fund. I appeal to all community based organizations to read his biography and
root for him as our head so Africa and Asia get their due from  the Global Fund.

Regards
Ashok Row Kavi
e-mail : arowkavi@...
___________________

Michel Sidibe is presently the Director of the Country and Regional
Support Department (CRD) at UNAIDS, where he manages over USD 200
million of UNAIDS financial resources and over 653 staff. Currently
serving at the personal level of Assistant Secretary- General,
Michel brings over 26 years of experience in international public
health and development at various levels to this application for the
Executive Director of the Global Fund.

Heading an International Non-Governmental Organization (NGO) in the
early years of his career, and representing UNICEF in several
African countries, including some of the most difficult and complex
duty stations such as Burundi and the Democratic Republic of Congo,
he has had the opportunity to lead and manage initiatives on a wide
range of issues including immunization, AIDS, malaria and child
soldiers, and also to work with extremely marginalized populations.

Amongst his most significant achievements is his pioneering
collaboration with the Forum for African Women's Education (FAWE) to
initiate the very first girls' education movement in Africa.

In Uganda, he successfully advocated for the end of illegal child
abduction at the national, regional and international level,
resulting in the establishment of a network of 200 organizations --
including civil society, academic institutions, human rights bodies,
donors and other UN organizations--which eventually facilitated the
passing of Resolution L40, condemning child abduction in the Human
Rights Commission. Subsequently,  with the support of the Government
of Uganda he negotiated the release, rehabilitation and family
reunion of 160 Eastern Congolese child soldiers.

Just few months after the Rwandan genocide, he managed the provision of health
and essential services for 500,000 displaced people in Burundi, negotiating
during the embargoes the establishment of a survival corridor with national
leaders and international organizations.

At the global level, as a senior leader within the UN system, he has
been the key architect of important initiatives which address some
of the most critical problems in development: - efforts to
accelerate harmonization and alignment of multilateral spending and
the division of labour among multilateral agencies. This laid a
thorough foundation for his recent leadership to move forward the G8
commitment and to mobilize global, regional and country level
support in over 130 countries for scaling up prevention, treatment
and care for AIDS towards Universal Access. In the course of all of
this work, his efforts have also served to move forward the process
of UN reform and served to expand the collaboration between
multilateral agencies, the private sector and civil society actors.

As the Director of Country and Regional Support for UNAIDS, he has
led major organizational and structural reform of the Secretariat at
the global, regional and country levels. In the spirit of UN reform,
his efforts have also sought to ensure effective delivery of donor
and UN system commitments to scaling up national and regional
responses to the HIV pandemic.

This work has included three key  dimensions:

i) Repositioning UNAIDS in over 100 countries in seven regions by redefining
strategic and operational roles at the field level to support countries' in
scaling up their HIV programmes;
ii) Leading the development and rollout of the Technical Support
Division of Labour, which clarified the roles and levels of
accountability of ten multilateral agencies, including the World
Bank and,
iii) Providing strategic vision and leadership to the "Make the Money Work"
initiative, involving the bilateral community and multilateral organizations.
This resulted in the Global Task Team, which was jointly chaired with the
Government of Sweden.

In his current position, he has advocated among a large number of
African political leaders and Heads of State for sustainable and
strategic actions to accelerate the AIDS response in Africa.  He has
specifically helped to invigorate the role of the African Union and
other intergovernmental and civil society bodies, such as AFRICASO,
and has mobilized regional initiatives such as AIDS Watch Africa
(AWA).

Additionally, he has revitalized political engagement of the
Asia-Pacific region in AIDS, providing strategic leadership to the
UNAIDS-facilitated Asia-Pacific Leadership Forum on HIV/AIDS.  He
has been instrumental to the establishment, as recent as 14th July
2006, of the "Commission on HIV and AIDS for Asia and The Pacific."

Additionally, his efforts have facilitated the establishment of the
International Center for Technical Cooperation in Brazil, through
which the Brazilian government seeks to engage African Lusophone
countries to exchange best practice. Some 13 countries have
benefited form this cooperation.

Outside the UN system and the bilateral community, he has advocated
among a large number of African political leaders and Heads of State
for sustainable and strategic actions to accelerate the AIDS
response in Africa. He has also always been a strong believer in the
private sector and its capacity to strengthen the public health
response in countries.

As UNAIDS Director, he has actively negotiated public-private partnerships
between the UN and major enterprises such as the Coca-Cola Company. Just months
after the release of the Universal Access principles recommending greater
involvement of the private sector, Michel led a public-private partnership
bringing together UNAIDS, Accenture (UK) Ltd, other multilateral partners and
the Global Business Coalition in a project spanning three African countries, to
leverage private sector skills to enhance and accelerate long-term systemic
capacity in countries.

He greatly values collaboration with civil society and the private
sector. His earliest experience with civil society partnership
included establishing the first national coordinating council for
civil society organizations in Mali, building mechanisms for
dialogue and corporate action between state and non-state
organizations. In Burundi, I was instrumental to the development of
the first-ever Burundi Network of People living with HIV, recognized
by the Government.

Michel is a Malian national. Broadly trained in economics,
international development and social planning at the graduate level,
Michel is fluent in English and French and also speaks several
African languages.

Low awareness blamed for 150% surge in HIV cases. 2nd wave of AIDS
feared

By Alex Pal,Inquirer

DUMAGUETE CITY -- An expert on human immunodeficiency virus/acquired
immune deficiency syndrome (HIV/AIDS) said that the steady increase
in HIV cases in the country could usher in a second wave of the
disease in the Philippines and in Asia.

Gladys Rio-Malayang, executive director of the Quezon City-based
Health and Development Institute, said 190 new cases of HIV/AIDS
have been reported in the Philippines this year, representing a 150
percent increase from last year.

Speaking at a forum organized by the Silliman University Church
Sunday, Malayang blamed the low level of awareness among the
population about HIV/AIDS as one of the causes for its spread.

"There is a low level of awareness about the ways of preventing and
the ways of transmission because to many people, AIDS is not an
issue," she said.

Professor Lorna Makil, a retired sociologist, agreed with Malayang's
observation, saying that in the Philippines, the lack of concern
about AIDS is brought about by the attitude that puts blame on the
victim.

HIV is spread when blood, semen, or vaginal fluids from an infected
person enter another person's body, usually through sexual contact
or from sharing needles when injecting drugs.

Department of Health figures indicate that as of December 2005,
there have been 11,168 cases of HIV and AIDS in the Philippines. Of
this number, 86 percent had been transmitted sexually.

The three methods of preventing AIDS are abstinence, being faithful
and condom use.

But Malayang said these methods are not women-friendly. "These are
not the woman's decision," she said.

She said infections are happening within the country and are
starting to affect the general population. "It may be very hard to
stop the spread of the disease," Malayang added.

Studies done by the Health and Development Institute indicate a high
level of needle sharing among IDUs, or injecting drug users.

Judith Alpuerto of the Provincial Planning and Development Office,
meanwhile, underscored the need to establish a data based on
HIV/AIDS in Negros Oriental.

"We don't have any data about AIDS but the absence of data doesn't
mean the problem doesn't exist," she said. There have been at least
two reported AIDS cases in Negros Oriental.

http://newsinfo.inq7.net/breakingnews/metroregions/view_article.php?
article_id=28067

First Asia-Pacific Regional Conference on Universal Access to HIV
Prevention, Treatment, Care and Support in Low Prevalence Countries
Ulaanbaatar, Mongolia, 24-27 October 2006

Averting HIV Epidemics in Asian and Pacific Countries
A number of Asian and the Pacific countries have very low rates of
HIV infection - less than 0.1 per cent - and can still prevent
serious epidemics, at relatively low cost. Representatives from 11
low-prevalence countries will meet at the Chinggis Khaan Hotel in
Ulaanbaatar to discuss how.

In this first meeting of its kind, experts from governments, civil
society and international organizations will share experiences - on
actions  taken to reduce risky behavior, for example. They will
identify obstacles and opportunities, and strategies for scaling up
national responses to AIDS.

The aim is to help countries develop their own "roadmaps" towards
achieving universal access to prevention, treatment, care and
support services by 2010, as called for by the UN's 2006 High-Level
Meeting on AIDS in  June.

Participating countries include Bangladesh, Bhutan, Brunei
Darussalam,  Fiji, Lao People's Democratic Republic, Democratic
People's Republic of Korea, Malaysia, Maldives, Mongolia, the
Philippines and Sri Lanka.

"These countries have a unique opportunity to keep HIV at bay, if
they act now," said J.V.R. Prasada Rao, Director of the UNAIDS
Regional Support Team for Asia and the Pacific. "But they cannot be
complacent. Small socio-economic changes, like a shift in migration
or greater availability of injectable drugs, could trigger larger
epidemics."

The conference organizers are the Government of Mongolia, the UN
Country Team in Mongolia, UNFPA, WHO, UNICEF, UNDP and UNAIDS.

A press conference on 24 October at 3 p.m. will feature: Mr. L.
Gundalai Minister of Health, Mongolia; and Mr. Prasada Rao Director
for UNAIDS Regional Support Team for Asia and Pacific and a civil
society representative.

Also there will be participate  Mr. Sultan Aziz, Director, Asia and
the Pacific Division, UNFPA; all UNCT team group Ms. Pratibha Mehta,
UN  Resident Coordinator in Mongolia, UNDP Representative, Ms. Delia
Barcelona,  UNFPA Representative,  Mr. Robert Hagan, WHO
Representative, Dr. Bertrand Desmoulins,  UNICEF Representative and
conference Steering Committee, Working group members.

For more information, visit www.lpc2006.mn or contact:

William A. Ryan,
e-mail: ryanw@...,
mobile +976 9909 2012 or  +66 9897 6984;

P. Jargalsaikhan,
e-mail: jargalsaikhan@...,
mobile +976 9913 5393

Dear Colleague,

The XVII International AIDS Conference will be held in Mexico City from 3-8
August 2008. The event will bring together diverse stakeholders to share current
knowledge on the full spectrum of issues on the global HIV epidemic.

To plan the overall conference Program, there are three program
committees: Community, Leadership and Scientific. Each committee has 2
co-chairs, one nominated by local partners (from Mexico for AIDS2008) and the
other nominated by the international partners on the Conference Coordinating
Committee (CCC). The three program committees (Community, Leadership and
Science) report to the CCC. The CCC has overall responsibility for conference
policies, priorities and programming.

The role of each of the Program Committee co chairs is to lead a committee of
about 13 members to plan and execute the Community, Leadership, or Scientific
Program for AIDS2008. In addition to their respective committees, co-chairs will
also sit on the CCC. The role of Program Committee co-chair is a voluntary one
that requires substantial time commitments from the individual. All travel and
related costs associated with participation in committee meetings will be
covered by the conference budget.

For full details of specific co-chair functions please go to Co-Chair
Responsibilities [http://www.icaso.org/cch.htm].

As one of the international members of the CCC, ICASO would like to
receive your nominations for us to recommend as the three international
co-chairs for the Community, Leadership, and the Scientific Program Committees.
We will only be able to consider completed applications submitted by individuals
nominating themselves (or proof of agreement).

These will be shared with our community sector colleagues on the
Conference Coordinating Committee; ICW/GNP+, AHRN, and YWCA. The deadline for
receiving nominations is November 8, 2006.

ICASO encourages nominations from People Living with HIV.

Please complete the nomination application form in the format indicated below.

Committee nomination   (Community, Leadership, Science):

First Name
Family Name
Gender:
Present Institution/Organization:
Job Title:
Contact Numbers: Tel (work); Tel (mobile) Email (primary) Email
(alternative) Fax
Postal Address:

In addition, please provide a brief summary of your HIV/AIDS work, your
experience of past International AIDS Conferences, your vision for the
conference's future, and indicate what relevant skills you would bring to the
Committee (Max. 250 words).

Please send your nomination marked “Nomination for Program Committee Co-chair
(AIDS2008)in the subject line to:

Sumita Banerjee
E-MAIL: sumitab@...
Fax: +1 416 921-9979
International Council of AIDS Service Organizations

World AIDS Day 2006: Momentum Building On Calls For Accountability

The World AIDS Campaign has named "accountability" as the global
theme for World AIDS Day 2006. Thousands of campaigns around the
world are preparing local and national events to raise awareness of
HIV and to call on leaders to keep the promises they have made to
tackle the AIDS pandemic.

"Actions taken by governments this year will determine the global
response to AIDS for years to come," states Marcel van Soest,
executive director of the World AIDS Campaign.

The theme of accountability, with the slogan, "Stop AIDS: Keep the
Promise", was chosen in consultation with civil society campaigns to
stress the critical need to meet current commitments to increase the
global response to AIDS and reach universal access to treatment,
care, and prevention by 2010.

Currently, governments are supposed to be engaged in a target
setting process for universal access, called for in a political
declaration unanimously approved by the United Nations General
Assembly on 2 June. However, there have been serious questions about
the lack of clarity in the process, which is due to be completed at
the end of the year.   Civil society groups are maintaining pressure
on governments to actively set national targets through an inclusive
and transparent process.

"This World AIDS Day will show us - either we are on track to
reversing the spread of HIV and AIDS, or through failed promises by
individuals, communities and nations, we will continue to see HIV
spread in every country," states van Soest.

World AIDS Day takes place each year on 1 December.

Selected Campaign Highlights

India - In the city of Pune, where HIV prevalence is twice the
national average, a broad coalition of organisations and groups are
planning an intensive 10-day awareness raising campaign called "Wake
Up Pune!" including a demonstration involving over 50,000 young
people on 26 November.

South Africa - The Treatment Action Campaign of South Africa plans
to mobilise tens of thousands of people to march on the Parliament
in South Africa on 1 December. They demand that the promise of
Universal Access to treatment, prevention, care and support services
by 2010 is kept in South Africa and globally.

Trade unions - The International Federation of Transport Workers is
launching an HIV and AIDS Campaign among its members on 1 December.
As part of their campaign material, a new documentary, "Highway of
Hope", highlights the seriousness of the HIV and AIDS crisis
affecting transport workers on the northern corridor covering
Uganda, Kenya, Tanzania and South Africa.

Faith communities - The Ecumenical Advocacy Alliance is encouraging
faith communities worldwide to hold special worship services to mark
World AIDS Day and is promoting an ecumenical liturgy and action
ideas on "Keep the Promise".

The World AIDS Campaign supports, strengthens and connects campaigns
that hold leaders accountable for their promises on HIV and
AIDS. "Stop AIDS. Keep the Promise" is the World AIDS Campaign from
2005-2010. The campaign secretariat is based in Amsterdam, The
Netherlands.

http://www.worldaidscampaign.org

http://www.medicalnewstoday.com/medicalnews.php?newsid=54486

Analysis and comment

HIV in the Middle East

¹ Department of HIV/AIDS, World Health Organization, Geneva, 1211, Switzerland obermeyerc@...

Prevalence of HIV in the Middle East is low but there is no room for complacency

The problem of HIV in the Middle East has elicited contradictory expectations and responses. Denial ("Not in our region") characterised the early phases of the epidemic. HIV was presented as a disease brought from countries where sexual morals were decadent, and obedience to Islam was thought to offer the best protection.¹ Perhaps as a reaction to this, allegations have been exaggerated that the problem represents a public health crisis concealed "behind the veil."² As in earlier debates on Islam and fertility, preconceived notions seem to stand in the way of assessing the situation in light of evidence.

This review summarises what is known about the HIV epidemic in the Middle East and north Africa region and examines the extent to which lower prevalence can be attributed to cultural factors, particularly those related to the practice of Islam and to gender.

The Middle East and north Africa region is defined here as including Arab countries and Iran.

What is the state of the evidence?

All countries of the Middle East and north Africa compile statistics on reported cases of HIV and AIDS, but case definitions are inconsistent and local capacity for diagnosis and reporting is uneven. Nearly all countries screen blood donors, but epidemiological surveillance is lacking and monitoring of special risk groups is infrequent and at times hampered by local sensitivities. Only a few countries test pregnant women to estimate HIV prevalence in the population. Knowledge, attitude, belief, and practice surveys have been carried out in several countries,^3-5 but they rarely include behaviours because of strong reluctance to discuss sexuality. Thus information about HIV prevalence and trends in the region is insufficient, under-reporting is likely, and it is not possible to obtain exact statistics or to ascertain the specific determinants of levels and trends of HIV.

The evidence has, however, been improving, and recently there has been greater attention to the epidemiology and behavioural dimension of the epidemic. Examples of this expansion include analyses of the epidemiology of HIV in Iran, Lebanon, Morocco, and Saudi Arabia; surveys in Iran among sex workers, prisoners, children, Gypsies, and injecting drug users; and studies on hospital patients and clinic users in Saudi Arabia and on children in Sudan.^6-11 The growing body of evidence in countries of the Middle East and north Africa indicates that the problem of HIV is being increasingly recognised, and it makes it possible to assess the situation of HIV in the region.

HIV rates may increase

Estimates by the World Health Organization and the joint United Nations programme on HIV/AIDS¹² show that HIV prevalence is low in the Middle East and north Africa region (0.2%). This is confirmed by studies of blood donors in Egypt, Jordan, Palestine, Iraq, and Syria, and by screening of patients admitted to hospital in Saudi Arabia.^13-16 Concentrated epidemics (prevalence of 5% or more in some subpopulations), are reported among intravenous drug users in Iran and Libya, whereas generalised epidemics (prevalence among pregnant women of over 1%) have been documented in Djibuti, Sudan, and some areas of Somalia.

The most recent estimate of the number of people living with HIV/AIDS in the Middle East and north Africa region is about half a million¹²; the reliability of the estimate is low because of the paucity of accurate statistics, and depending on which countries are included in the definition of the region it may be higher or lower. Overall, however, it suggests that the region comprises about 5% of the global population, but it accounts for a much lower percentage of people living with HIV/AIDS, about 1%.

Several factors may increase the risk of the epidemic. Firstly, the prevalence of sexually transmitted infections is relatively high and indicative of unprotected extramarital sex.¹⁷ Secondly, war, displacement, and migration, which often bring about risky behaviours, may increase vulnerability to HIV in the region. Thirdly, in some countries, subgroups of intravenous drug users may constitute a "bridge" for transmission of HIV to the general population. The spread of HIV depends on the size of the risk groups and the interaction of these with the general population, neither of which is well understood. Thus there is no reason for complacency. A World Bank review subtitled "Why waiting to intervene can be costly" summarises the need to take action without delay.¹⁸

Links between Islam and HIV prevalence

It has been hypothesised that the low prevalence of HIV in the Middle East and north Africa region is somehow linked to Islam and its influence on the behaviours that affect transmission of HIV. A comparative analysis of data from African countries showed that the prevalence of HIV was negatively associated with the percentage of the population that is Muslim, but that the link between being Muslim and sexual risk factors is ambiguous and variable.¹⁹

HIV testing in a government department, Amman, Jordan Credit: G PIROULX/WORLD BANK

It is possible that some practices among Muslim populations contribute to decreasing the risk of HIV transmission. One is low alcohol use, which reduces disinhibition and hence risky behaviour. Another is male circumcision, which was shown to reduce infection in a recent trial, and whose protective effect may be shown if other ongoing trials find similar results.

At the same time other population trends, beliefs, and practices in the region may have adverse effects. Most countries have young populations with a rapidly increasing age at marriage, but young people may be ill equipped to protect themselves against sexually transmitted infections.²⁰ Traditional Muslim approaches have tended to be conservative, and it is difficult to break the silence around issues of sexual behaviour, especially those that deviate from religious norms. An analysis of religious magazines and doctrinal pronouncements (fatwas) of the past decade found that strong moralising views prevailed; HIV was seen as divine punishment for deviance, whereas religion was a protection.²¹ Hence in many settings fears of stigma and discrimination are great against people living with HIV/AIDS. But more flexible approaches can also be found. A theology of compassion and approaches advocating harm reduction seem to be emerging in several Muslim countries, and greater acceptance of HIV positive people is justified with reference to religion.²²

The gender factor

The Middle East and north Africa region is generally thought to be characterised by gender inequality, and indeed many indicators of women's position are unfavourable. Yet when it comes to HIV some of the practices that stem from sex inequality in the region, in particular the strong prohibitions against extramarital sex, applied more strictly to women, are associated with lower prevalence. Statistical evidence indicates that the percentage of women among people living with HIV/AIDS is lower in the Middle East and north Africa (most under 25%) than in other regions (for example, 57% in sub-Saharan Africa).¹²

The more favourable sex ratio is shifting, suggesting that the disease is spreading and that many women are getting HIV just because they are married to a man who engages in risky behaviours. The age-sex distribution of HIV in the region confirms that women are infected at a much younger age than men, reflecting a pattern whereby younger women are married to older men who are more likely to have been exposed to infection.^{810 17}

Several practices increase women's vulnerability: marriage patterns and age differences between spouses; cultural expectations of women's innocence, making it difficult for them to access information on risks; and the resurgence of early forms of temporary marriages, which may be religously sanctioned in circumstances such as poverty, travel, or tourism.²⁰ There have been calls to recognise that sex norms have changed and cautionary statements that religion is no excuse for inaction regarding women's vulnerability to HIV.²³ Thus, the social construction of gender represents a double edged sword, which may serve to protect or to increase risks.

Some responses to the epidemic are encouraging

In recent years better information systems to track HIV have been put in place in the region.^{6-8 10} About half of the countries have formulated national plans to tackle HIV and have sought support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria for their treatment and prevention activities.

Medicines for HIV are now provided in several countries, with some governments providing antiretrovirals free of charge or at subsidised prices. But global statistics show that the availability of antiretrovirals in the Middle East and north Africa is largely insufficient (about 5% of those needing treatment),¹² underscoring the need for greater mobilisation to scale-up access to treatment.

Although knowledge is still inadequate and stigma and discrimination prevail in many settings, there is greater visibility and more public discussion of HIV/AIDS in the region.²⁴ Throughout the region, governments and non-governmental organisations have initiated promising projects to break the silence around HIV, spread information, promote prevention, and provide care and treatment.(see bmj.com). The challenge now is how to capitalise on the strengths represented by cultural tradition while fostering effective responses to the epidemic.

Contributors and sources: CMO had for more than a decade carried out research on population and health in the Middle East; she has published classic analyses of the demography of the region, the influence of sex on reproductive health, and the links between Islam and population policies. This article is based on a presentation given at the American University of Beirut, April 2004, and another given at the Wilson Institute, Washington DC, September 2005. It has benefited from the comments of colleagues at WHO headquarters in Geneva and WHO office of the Eastern Mediterranean.

Competing interests: None declared.

References

1. Kandela P. Arab nations: attitudes to AIDS. Lancet 1993;341: 884-5.[Medline]
2. Kelley L, Eberstadt N. Behind the veil of a public health crisis: HIV/AIDS in the Muslim world. NBR special report. Seattle, WA: National Bureau of Asian Research, 2005.
3. Tavoosi A, Zaferani A, Enzevaei A, Tajik P, Ahmadinezhad Z. Knowledge and attitude towards HIV/AIDS among Iranian students. BMC Public Health 2004;4: 17.[CrossRef][Medline]
4. Petro-Nustas W, Kulwicki A, Zumout AF. Students' knowledge, attitudes, and beliefs about AIDS: a cross-cultural study. J Transcult Nurs 2002; 13: 118-25.[Abstract/Free Full Text]
5. Jurjus AR. Assessment of AIDS knowledge, attitudes, behaviors and occupational risk of laboratory. J Med Liban 1998;46: 285-90.[Medline]
6. Al-Mazrou Y. HIV/AIDS epidemic features and trends in Saudi Arabia. Ann Saudi Med 2005;25: 100-4.[ISI][Medline]
7. Gheiratmand R, Navipour R, Mohebbi M, Mallik A. Uncertainty on the number of HIV/AIDS patients: our experience in Iran. Sex Transm Infect 2005;81: 279-80.[Free Full Text]
8. Kallajieh W. Epidemiology of human immunodeficiency virus and acquired immunodeficiency syndrome in Lebanon from 1984 through 1998. Int J Infect Dis 2000;4: 209-13.[CrossRef][Medline]
9. Jahani M, Alavian S, Shirzad H, Kabir A, Hajarizadeh B. Distribution and risk factors of hepatitis B, hepatitis C, and HIV infection in a female population with "illegal social behaviour". Sex Transm Infect 2005;81: 185.[Free Full Text]
10. Elmir E, Nadia S, Ouafae B, Rajae M, Amina S, Rajae E. HIV epidemiology in Morocco: a nine-year survey (1991-1999). Int Jf STD AIDS 2002;13: 839-42.
11. Hashim M, Salih M, el Hag A, Karrar Z, Osman E, el Shiekh F, et al. AIDS and HIV infection in Sudanese children: a clinical and epidemiological study. AIDS Patient Care STDS 1997;11: 331-7.[ISI][Medline]
12. Joint United Nations Programme on HIV/AIDS and World Health Organization. AIDS epidemic update 2006. Geneva: UNAIDS, 2006.
13. Lenton C. Will Egypt escape the AIDS epidemic? Lancet 1997;349: 1005.[ISI][Medline]
14. Chemtob D. Epidemiology of HIV infection among Israeli Arabs. Public Health 2005;119: 138-43.[CrossRef][ISI][Medline]
15. Yassin K, Awad R, Tebi A, Queder A, Laaser U. A zero prevalence of anti-HIV in blood donors in Gaza: how can it be sustained? AIDS 2001;15: 936-7.[CrossRef][ISI][Medline]
16. Zawawi T, Abdelaal M, Mohamed A, Rowbottom D, Alyafi W, Marzouki K, et al. Routine preoperative screening for human immunodeficiency virus in a general hospital, Saudi Arabia. Infect Control Hosp Epidemiol 1997;18: 158-9.[ISI][Medline]
17. Heikel J, Sekkat S, Bouqdir F, Rich H, Takourt B, Radouani F, et al. The prevalence of sexually transmitted pathogens in patients presenting to a Casablanca STD clinic. Eur J Epidemiol 1999;15: 711-5.[CrossRef][ISI][Medline]
18. Jenkins C, Robalino D. Overview of the HIV/AIDS situation in the Middle East and North Africa and Eastern Mediterranean region. Why waiting to intervene can be costly. Washington DC: World Bank, 2003.
19. Gray PB. HIV and Islam: is HIV prevalence lower among Muslims? Soc Sci Med 2004;58(9): 1751-6.[CrossRef][ISI][Medline]
20. DeJong J, Jawad R, Mortagy I, Shepard B. The sexual and reproductive health of young people in the Arab countries and Iran. Reprod Health Matters 2005;13: 49-59.[CrossRef][ISI][Medline]
21. Ersilia F. Aids in contemporary Islamic ethical literature. Med Law 2002;21: 381-94.[Medline]
22. Ali S. AIDS and Muslim communities: opening up. AIDS STD Health Promot Exch 1996: 13-6.
23. Khattab H. Socio-cultural and environmental factors and the context of women's vulnerability and risk to HIV infection in the MENA region. Slides presented at the UNAIDS regional meeting on Women, Girls, and HIV/AIDS in the Middle East and North Africa, Amman Jordan, 21-3 Feb 2005.
24. El-Feki S. Middle-Eastern AIDS efforts are starting to tackle taboos. Lancet 2006;367: 975-6.[CrossRef][ISI][Medline]

(Accepted 27 September 2006)

AIDS taskforce explores unit idea for army

Saturday, October 21, 2006
The establishment of a Voluntary Counselling Confidential Testing
(VCCT) unit for HIV/AIDS within the army is being explored.
The idea was mooted by the Fiji AIDS task force at the army's
workshop on HIV/AIDS Policy yesterday and was positively received by
the participants, said VCCT clinical nurse Sereima Vatuvatu.
She said the proposal was important for an institution like the
military despite the mandatory testing of soldiers before
recruitment.

She said this was because of the army's nature of work in which
soldiers were regularly dispatched for overseas missions.
Mrs Vatuvatu was speaking at the workshop at the Tradewinds in Lami
yesterday.

She said it was highly likely they would train military officers in
counselling to handle the unit if it was to become operational.
There is a need to establish such clinics to complement the work
that sexually transmitted clinics do, she said.

"It is important not only because we do confidential testing but the
counselling we provide is as important.

"Counselling involves the process that enables a person to assess
his or her risk of acquiring or transmitting HIV.

"It also helps a person to determine whether to be tested and
provides support when a person receives test results.

"The unit is client centered and promotes trust between counsellors
and clients.

"The information obtained or disclosed by the client is confidential
and even the testing involves analysis of blood or body fluids," she
said.

Meanwhile, acting military commander Esala Teleni said that although
soldiers deployed overseas should go through a HIV/AIDS test before
any overseas mission, this was currently not the case.

http://www.fijitimes.com/story.aspx?id=50245

AIDS class for China sex workers angers police

BEIJING, Oct 16 (Reuters) - An AIDS prevention lecture aimed at
Chinese sex workers who were given free condoms has sparked a strong
rebuke from police, a newspaper said on Monday.

The Centre for Disease Control in northeastern Harbin held the
lecture last week, calling the group of more than 50 sex
workers "sisters" and telling them to call if they need help, the
Beijing News said.

Local police said the lecture was "unacceptable", the newspaper
said.

"The usually underground prostitutes labelled their profession on
their foreheads this time. Being unable to crack down, the police
were really upset," it said. An estimated 650,000 people are living
with HIV-AIDS in China, and health experts say the disease is moving
into the general population with most new infections now spread
sexually, although drug-users follow closely behind.

China has stepped up the fight against HIV-AIDS in recent years
after initially being slow to acknowledge its threat, but public
ignorance and fear remain strong and HIV carriers still live with
stigma and discrimination.

Police have even used the presence of condoms in sex workers'
handbags as a justification for detention.

"Education can be carried out in various forms," the Beijing News
quoted an unnamed Harbin police officer as saying. "But it is hard
for us to accept this kind of public lecture."

Prostitution was wiped out after the Communist revolution in 1949
but has flourished across the country since market reforms started
in the early 1980s.

http://www.alertnet.org/thenews/newsdesk/PEK87605.htm

Dear All:

Below is a note from the Communities Delegation to the Global Fund Board.

Please respond appropriately to Shaun Mellors (Communications Focal Point) at
smellors@...

Responses for the Developing country delegation may be sent to Lucy Nga'nga
(Communications Focal Point) at eannaso@... or to me at bj@....

Please note that the process of interviews will start on the 18th of
October, so quick responses will be appreciated.

Regards,

Dr. Bobby John
Global Health Advocates / Center for Sustainable Health & Development
e-mail: <bj@...>
____________________________

Colleagues:

As a member of the Communities board delegation to the Global Fund against AIDS
TB and Malaria I am requesting your views on who our delegation should vote for
as the new Executive Director on behalf of the Malaria community. Please
circulate this note as widely as possible. The Candidates are listed below

Sincerely

Louis Da Gama

Global Health Advocates


"The communities living with HIV, TB and affected by Malaria delegation is
interested in your opinion as to who you think you should be the next Executive
Director of the Global Fund and your reason for this. We would also like to
know, if you had the opportunity to ask the candidate one question, what would
that be?

The Executive Director will be appointed at the upcoming board meeting in
Guatemala,( 31st October to 3rd November) and all delegations will be asked to
vote for their preferred candidate"


The top 5 candidates are:
(Bio's directly from the Global Fund)

a. Hilde Johnson has a strong background in international development
and public policy. She has a good understanding of the challenges ahead, sound
understanding of the political dimensions of the Global Fund's operations and of
the role and importance of building partnerships. She also addressed the
importance of team building.

b. Michel Kazatchkine has a sound knowledge of the operation of the
Global Fund and a clear vision for the Global Fund. He is strongly committed to
innovative resource mobilization. His strengths are in knowledge of the diseases
and sensitivity to the issues of diversity as well as his background of
diplomacy.

c. James Kolbe has a strong background in public policy and years of
experience in building partnerships with a focus on the needs at country level.
He articulates a vision for resource mobilization and has demonstrated strong
leadership skills and public advocacy.

d. Bill Roedy has a strong background in management and proven
experience in building partnerships and mobilizing vast resources. He
understands the importance of 'branding' a product as well as relationships with
the Board. He is sensitive to the importance of reflecting diversity.

e. Michel Sidibe has a sound understanding of the international
development issues and knowledge of the three diseases. He has demonstrated
management and leadership skills and emphasizes improving Board-Secretariat
relations. He envisages more meaningful engagement of countries from the South
as well as partnerships with the private sector.

Please send your comments and questions to Shaun Mellors (Communications Focal
Point) at smellors@... (please feel free to send  your responses to
the list serve as well, with a cc to Shaun). We kindly request that you send
your comments and questions in by no later than 20 October 2006"

"Bobby John"
E-MAIL: <bj@...>

PLHIV & Access: Basic Health Services”, book launch in Jakarta

Nafsiah Mboi, Secretary of the National AIDS Commision (Komisi AIDS
Nasional) officially launched a book “ PLHIV & Access: Basic Health
Services”, October 12, 2006 at Sari Pan Pacific Hotel, Jakarta. The
book records result a study the experiences of PLHIVs in accessing
those services as well as an attempt to involve and improve PLHIV in
participatory research, done in five provinces in Java.

This book is a result of cooperation between UNAIDS, PLHIVs, and NGOs, and is a
first in documentation in Indonesia.

The study recruited 12 PLHIVs were recruited along with 11 NGO
researchers. After receiving a training in participatory research,
the collected information from their peers and service providers in
Jakarta, West Java (Bandung Sukabumi, Tasikmalaya), Central Java
(Semarang and Salatiga), East Java (Surabaya, Malang) and DI Yogyakarta.

Launching the book with great enthusiasm, in her speech, Ms. Mboi
responded to the recommendations of the book by saying that she would support to
realize the recommendation by doing her part, but members of the civil societies
need to do their part too.

The recommendations of this book included: health services that are
closer and reachable for clients; higher quality of human resources
in the service providers, free from stigma and discrimination; a more 
accessible health subsidy mechanism, especially JPS-BK (jaringan pengaman sosial
bidang kesehatan- health social security network); higher awareness of public
and health personnel about HIV & AIDS. In realization of the recommendations,
many stakeholders including government, the community and PLWHs themselves
should take part.

Although the book itself still needs some fine-tuning in terms of
information presentation and description, the available information
is a great first step to be able to increase the access and quality
of health services for PLWHAs, and can be a model for other provinces as well.
The book is great good result for an incredible process. In general the
completion of this book has received many praises; such process where a
participative approach is an integral part of the work is generally difficult.

Yasmin Kapitan
yasmin@...
Communications Coordinator
CWS Indonesia
Jl Kemang Selatan II no. 4A, Jakarta 12730
www.cwsindonesia.or.id

To International AIDS organizations:

A call for support for PWA's in Taiwan

Dear Sir/Madam:

I am Nicole Yang, founder of the Harmony Home Association, Taiwan, a registered,
non-profit organization established in 2003. We have been devoted to helping
HIV/AIDS patients for the past 20 years. We have 2 halfway houses in Taipei
sheltering a total of 38 people: 29 adults( with 1 comatose; 6 non-ambulatory;
10 mentally-challenged patients) and 9 children (from 1 mo. to 11 yrs old); and
1 halfway house in Kaohsiung province with a total of 17 people: 16 adults (with
3 comatose, 2 non-ambulatory patients), and 1 baby. We are doing our best to
provide shelter, medical assistance, care and support to HIV/AIDS patients and
children affected by AIDS in our care.

At present, we are faced with a difficult situation which we, at Harmony Home
fear may leave our patients and babies homeless. We are earnestly asking for
your support as we fight for our patients' rights. Please allow me to share with
you briefly our situation to give you a clearer background.

In 2005, a friend donated a house located in Taipei Wenshan District to Harmony
Home to be used as a shelter for our patients.  We moved into the house on the
17th of June 2005. Our neighbors, after finding out that we are sheltering
HIV/AIDS patients began their angry protests against our living in the same
community, demanding that we leave the house immediately. They threatened and
harassed us, and eventually brought the case to the Taipei District Court. After
several hearings, it was on the 11th of October 2006 that the court ruled that
we must relocate from our present residence. The following is an article written
by the Taipei Times regarding this matter:
_______________
Court orders HIV/AIDS facility to relocate

DISCRIMINATORY?: The Department of Health expressed regret over the ruling and
said that it would help the facility's organizers to appeal

STAFF WRITER , WITH CNA
Friday, Oct 13, 2006, Page 1

Several groups yesterday came out in support of a care facility for HIV/AIDS
sufferers which the Taipei District Court has said must relocate from its
current site in a Taipei apartment complex.

The court ruled on Wednesday that the facility for those who are infected with
either HIV or full-blown AIDS must relocate from the Chaihsing apartment complex
in Taipei 's Wenshan District because of public health concerns.

Expressing regret over the ruling, the Department of Health said yesterday that
it would offer legal assistance to the care facility so that it could appeal the
ruling.

The court made the ruling on the grounds that residents of the home posed a
threat to the psychological health of other people living in the complex.

Dismissing the court ruling as "outrageous and discriminatory against AIDS
patients," Nicole Yang, founder of the Harmony Home Association which operates
the facility, said the association would appeal the case.

The care facility was set up in June last year in an apartment rented to the
association by Wang Chi-tong, the son of former Judicial Yuan vice president
Wang Tao-yuan.

After learning that the care facility provides shelter and care for more than 10
HIV-infected children and adults, the complex's management committee called two
rounds of meetings in July and August of last year, in which it was agreed that
the care facility be relocated within three months.

However, Yang refused to relocate the facility on the grounds that the
committee's decision lacked any legal basis and that the building's code of
conduct which bans its residents from sheltering any patients with a contagious
disease runs against Article 10 of the Constitution which protects freedom of
residence and the right to move at will.

The committee then filed a lawsuit to seek a court order for the care facility
to be relocated. After four rounds of hearings, the court ruled in the
committee's favor.

In the ruling, the court said the committee's demand that the facility be
relocated did not violate residential apartment block management regulations.

As to the constitutional provision regarding freedom of residence, the verdict
said the Constitution defines relations between the government and private
citizens, rather than regulating relations among private citizens.

Moreover, the verdict said that allowing patients with contagious diseases to
live in a densely populated community could pose a health threat.

Yang expressed deep regret over the court's failure to send its judge to conduct
a field survey before making its ruling. In the course of the hearings, Yang
recalled, a judge even suggested that the facility be relocated to a remote or
sparsely populated area to avoid "scaring" others or causing anxiety in the
neighborhood.

"I disagree with such a suggestion because it would deprive HIV-carriers and
AIDS patients of their freedom of residence," Yang said, adding that the verdict
simply reflects society's ignorance about HIV/AIDS transmission.

Saying that HIV can only be contracted through sexual intercourse, blood
transfusions or breast feeding, Yang said people are not at risk of contracting
HIV by simply having an AIDS patient living next door.

"I hope that the public can show some love to AIDS patients and HIV-positive
people and allow them to rebuild their lives in the community," she added.

(Source:http://www.taipeitimes.com/News/front/archives/ 2006/10/13 /2003331527)

We are doing all we can to find peaceful ways to reach an agreement with the
community. We believe that we may have a stronger chance of appealing to the
court if we have the support of  international AIDS organizations in other
countries through letters of support; documentation; or any information on
existing laws or policies that safeguard the rights of people with HIV/AIDS
against discrimination. We need to show to the court and to those who oppose us
that our shelter is not a threat to the community.

  Your response means a great deal to us. We, at Harmony Home aim to make a
difference in the lives of people with HIV/AIDS and to overcome stigma and
discrimination against them and their families. With your support, we believe we
can have a better chance of giving people with AIDS in Taiwan a more secure
life, and a place they can call home.

If you wish to contact us at Harmony Home, please feel free to call me at 
+886-922 444 536 (mobile) / +886-2-2362 2806 (office) or email us through this
email address: harmonyhome2003@...

Thank you and more power!

Yours Truly,
Nicole Yang
Secretary General
Harmony Home Association, Taiwan

*other news articles:
   http://www.taipeitimes.com/News/taiwan/archives/2006/10/15/2003331826
   http://www.chinapost.com.tw/backissue/taiwan/detail.asp?ID=92806&GRP=B


Harmony Home Association, Taiwan
No.36, Lane 283, Sec.3, Roosevelt Rd.
Taipei 106, Taiwan, R.O.C.
Tel: +886-2-2362 2806
Fax: +886-2-2369 7776
Email: harmonyhome2003@...

Dear forum,

You can watch a new short film on stigma and discrimination and rights of people
living with HIV, created by UNDP Regional HIV and Development Programme in
partnership with key PLWHA networks in the region on Youtube – please click on
this link:

http://www.youtube.com/watch?v=TEDGaSDmS7g

It is titled “Celebration of Life” and a sequel to our earlier short, “Quiet
Storm”.  It follows the same theme of our campaign against stigma and
discrimination launched two years ago, celebrating the indomitable will of
people living with HIV.

Would greatly appreciate your feedback. If anybody wants to obtain a copy of the
film, please write to us. It will be available in 20 languages, through a menu
driven DVD. It is a poetic visual, set to original music and features positive
leaders from the region. Ideal material for your World AIDS Day screening.

We have also posted another film on stigma and discrimination as well. Please
follow this link to watch –

http://www.youtube.com/watch?v=Y5Tnq1X3mOE


With thanks and regards

G. Pramod Kumar
UNDP Regional HIV and Development Programme
UNDP Asia Pacific Regional Centre
Colombo, Sri Lanka
e-mail: <pramod.kumar@...>

General Practice — Viewpoint

Men who have sex with men (MSM): how much to assume and what to ask?

Marian K Pitts, Murray A Couch and Anthony M A Smith

MJA 2006; 185 (8): 450-452

In Australia, about 150 000 men aged 16–59 years identify as gay or bisexual, while a similar number identify as heterosexual but have some history of same-sex sexual contact. Pitts, Couch and Smith advise that the clinical implications for these men include more than sexual health concerns. They suggest several consultation skills that can help doctors to recognise these men and better meet their needs.

Human sexual practice is diverse. In response to the need to better understand that diversity in the face of the HIV epidemic, a fact became widely known that had previously been understood by few: a significant population of men who do not self-identify as "gay" or "bisexual" sometimes have sexual contact with other men. It was recognised that a descriptor for behaviour, rather than an assertion of social identity, was needed, and the term "men who have sex with men", and its acronym MSM, came into being.

We believe there are "definitional" challenges associated with this term, as well as clinical and practical implications when working with men to whom such a descriptor might be applied.

What's in a definition?

It is rare for medical journals to include sexuality and sexual behaviour as important components of men's health and wellbeing. It is even more unusual to acknowledge MSM outside the context of HIV. Use of this acronym in a men's health context both illuminates and challenges. MSM is a behavioural definition; it does not imply an identity, and it does not consider sexual attraction.

We prefer the term "male-to-male sexual practices" (MMSP), as it explicitly acknowledges that the sexual practices, rather than the person, are at issue. The choice of "practices" in the plural also signals that male-to-male sex may incorporate a range of sexual behaviours which may, or may not, include oral and anal sex.

How many men fit the definition?

The Australian Study of Health and Relationships in 2001 surveyed a nationally representative sample of 19 307 Australians aged 16–59 years. These included 10 173 men, of whom 97.4% identified as heterosexual, 1.6% as homosexual or gay, and 0.9% as bisexual, while 0.1% were undecided or "other". A lifetime history of sexual attraction that included other men was reported by 6.8%, and sexual experience with other men by 6.0%. Of the men who identified as heterosexual, 2.7% reported having had sex with at least one other man. By extrapolation to the general Australian population, this suggests that there are about 158 000 men aged 16–59 years who identify as heterosexual but have some history of same-sex sexual contact. This is in addition to the 148 000 men who identify as gay or bisexual.1

What are the clinical implications?

Sex, risk and MSM

What does it matter that the patient, whatever his sense of identity, has anal sex with men, and perhaps also has penetrative sex with women? The international medical literature on MSM builds a picture of a risk-taking and at-risk group. They are particularly, if not exclusively, considered in the context of HIV risk, and to a much lesser extent are known to be at risk of other sexually transmitted infections (STIs).

We recently completed a study of the knowledge and attitudes of gay men towards anal cancer and human papilloma virus (HPV).2 We know that anal sex carries a high risk of HPV transmission, particularly for men who are HIV-positive, but our study showed that very few gay men had even heard of HPV, and most were not aware of its association with sexual practices. In this regard, they differ little from women, who are at similarly high risk — of cervical cancer — through HPV exposure.

MSM are at greater risk of gonorrhoea or syphilis than are other men. However, most consultations with MSM are for issues other than STIs and reflect the profile of health conditions experienced by Australian men.

Substance use

Certainly, if a category or group is defined only in terms of sexual activity, it is unsurprising that STIs feature large. However, there is some evidence of health risks other than sexual health risks in MSM, which nevertheless derives from HIV studies. These indicate a higher than expected rate among some MSM subcultures of alcohol use, and injecting and other illegal drug use. Men in the Australian Study of Health and Relationships who identified as bisexual were eight times more likely to report a history of injecting drug use, and gay men were twice as likely, as those who identified as heterosexual.3 However, they were no more or less likely than other men reporting a history of injecting drug use to report sharing needles or injecting paraphernalia.

In Private lives, our national online survey of health and wellbeing among gay, lesbian, bisexual, transgender and intersex Australians, we found that 38.3% of gay-identifying men reported tobacco use on more than five occasions in the previous month,4 which compares with 26% for Australian men in general.5

Mental health

Findings about MSM are mixed in the area of mental health. Numerous studies have indicated higher rates of depression and anxiety in gay men. A 5-year study in South Australia reported 30% of homosexually active men met the criteria for a major depressive episode, as measured by the Primary Care Evaluation of Mental Disorders screening tool.6 Twenty-seven per cent of the men in the survey were diagnosed with dysthymic disorder on enrolment, while the survey indicated a lifetime prevalence of a depressive disorder of 48%. This is five times the rate for all men reported from primary health care clinics in the United States where the survey instrument was validated.7

In Private lives, which involved 3429 gay men from all Australian states and territories, we found that the prevalence of depressive disorders was high, with 48.7% of men scoring on at least one of the two criteria for a major depressive episode. Nearly a quarter of respondents (23.8%) met the criteria for a major depressive episode, with a similar proportion reporting experiencing depression (24.2%). It is of particular concern that 15.7% of gay men indicated suicidal ideation in the 2 weeks before completing the survey. While the causes are not easily identified, it is probable that living in a society characterised by homophobia is a contributing factor.4

What are the practical implications?

Recognition of MSM

How does one recognise MSM? Would the behavioural question be: "Have you ever had sex with a man?" or "Have you had sex with a man in the past year?" and/or "Have you also had sex with a woman?" And how would the word "sex" be interpreted?

Presumably, the narrowest definition of MSM would be a man who has experienced anal sex (insertive or receptive) on at least one occasion in his life. However, it is not surprising that publications on MSM almost never offer a definition or, if they do, proceed to bundle MSM with gay, bisexual and other homosexually active men into a single analysis.

MSM and their health needs are most likely to evade recognition because of the heteronormative nature of most clinical practice — based on the assumptions that, until proven otherwise, all people have a simple sexual identity, and that it is heterosexual. A gay man who is "out" about his sexuality to his doctor (67.2% of men in the Private lives survey had told their doctors) may find his general health concerns sometimes overshadowed by concerns about sexual health. This may be understandable, given the relatively high rates of HIV and other STIs among these men. However, STIs or any other single issue should not become an overriding focus of any clinician–patient relationship.

When, how, and what to ask a man about sex?

Simply put, when and if you consider it matters, avoiding a default assumption that the man is heterosexual, even if he is married, partnered with a woman or has children. MSM have wives and children too! In most cases, the need to ask is determined by the presenting condition, and it may not matter so much to whom a man is attracted, or what he identifies as his sexual identity, as what his recent sexual practices have been. So, ask questions about the sex he does, rather than about what he is. Of course, if the presenting problem has to do with a complicated life course perhaps including mental health issues, then questions about sexual attraction and identity could well be the important ones. The case scenarios (Box) show the differing process and outcomes when a doctor recognises, or fails to recognise, the possibilities.

For new patients, it may be easy to indicate that a full sexual history is a usual part of an initial consultation, whatever the presentation. For existing patients, sexual history may be best approached indirectly. A statement that hepatitis B vaccination is freely available and recommended for all men who have had sex with another man can be mentioned in the context of reminding all male patients of vaccination schedules. If a clinician (or a practice) takes a "no default assumptions" approach to sex, then the move into questions of sexual attraction, identity and practice will happen when, and if, they matter.

Finally, we are confident that it is rare that health articles define the population in terms of a single behavioural characteristic. To think analogously, would we not shrink from referring to WWR (women who reproduce), PWJ (people who jog), or indeed MSW (men who have sex with women)? Is it so surprising that we would prefer the term "male-to-male sexual practices" or MMSP?

Case scenarios

Scenario 1 — MSM not recognised

Rob is a 36-year-old man who lives in a regional town. He is married with three young children and is feeling guilty and highly anxious following an unsafe sexual episode with another man a while ago. He feels he will be able to relieve his anxiety only by having an HIV test. He goes to a local doctor he does not know, as he does not want to use his family doctor, who also treats his wife and children. On the information form, he states that he is married.

In the consultation, Doctor A invites him to discuss his presenting problem, and Rob leads into it by saying he is very embarrassed because he has been unfaithful to his wife. Doctor A, sensing his embarrassment, tries to help by asking whether the woman is someone he is having an ongoing affair with and whether he feels she might have had an STI. Not knowing how to get round this, Rob says that he is worried about STIs. Doctor A ends the discussion, which is clearly becoming more uncomfortable, by ordering a series of STI checks and suggesting the affair has been a bad idea and should end. The tests do not include an HIV test. Rob has gained nothing from the visit; he does not return for the test results.

Scenario 2 — MSM recognised

Rob, still anxious, goes to another doctor in the town to try to have an HIV test. This time he notices a health promotion poster for same-sex attracted people (Figure*) in the waiting room and so feels more confident. He completes the information form again to say he is married but notes an option for "same sex relationship". These signals lead him to feel safer about discussing his concerns.

Doctor B asks why he has come, and he says he has had unsafe sex with someone other than his wife. "Was that with a male or a female partner?" asks Doctor B. He then asks what Rob actually did with that partner. Rob and Doctor B agree that an HIV test is necessary and discuss other STI tests as well. Hepatitis B vaccine is also discussed, along with the levels of anxiety Rob has been feeling. Doctor B takes the opportunity for a reminder about the importance of practising safe sex in the kind of situation Rob describes, but acknowledges that is not always easy. He will see Rob again for his test results, and makes sure he will return by telling Rob he is pleased to have met him and that he would be happy to see him any time he needs to talk about things.

When his test results come back negative, Rob and Doctor B use the feeling of relief to talk through some of his health risks and to plan strategies to avoid anxiety in the future. After the consultation, Rob feels less guilty and more in control of his life, and less likely to take risks with his own health and the health of his wife in the future.

* This poster and other useful resources are available at http://www.glhv.org.au/
MSM = men who have sex with men. STI = sexually transmitted infection.

Competing interests

None identified.

Author detailsMarian K Pitts, PhD, AFBPS, MAPS, Professor and DirectorMurray A Couch, BA(Hons), Senior Research FellowAnthony M A Smith, PhD, Professor

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC.

Correspondence: m.pittsATlatrobe.edu.au

References

1.      Smith AMA, Rissel CE, Richters J, et al. Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults. Aust N Z J Public Health 2003; 27: 138-145. <PubMed>

2.      Pitts MK, Fox C, Willis J, Anderson J. What do gay men know about HPV? Australian gay men's knowledge and experience of anal cancer screening and human papilloma virus. Sex Transm Dis 2006 Jul 6; [Epub ahead of print].

3.      Grulich AE, de Visser RO, Smith AMA, et al. Sex in Australia: injecting and sexual risk behaviour in a representative sample of adults. Aust N Z J Public Health 2003; 27: 242-250. <PubMed>

4.      Pitts MK, Smith AMA, Mitchell A, Patel S. Private lives: a report on the health and wellbeing of GLBTI Australians. Monograph series No. 57. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University, 2006.

5.      Australian Bureau of Statistics. Social trends 2005. Canberra: ABS, 2005. (Catalogue No. 4102.0.)

6.      Rogers G, Curry M, Oddy J, et al. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med 2003; 4: 271-275. <PubMed>

7.      Linzer M, Spitzer R, Kroenke K, et al. Gender, quality of life and mental disorders in primary care: results from the PRIME-MD 1000 study. Am J Med 1996; 101: 526-533. <PubMed>

(Received 12 May 2006, accepted 16 Aug 2006)

1) Court told of HIV-positive Aussie's sex rampage
2) HIV/AIDS makes a resurgence in Australia
3) New HIV infections in Australia up 41 percent from 2000,


1) Court told of HIV-positive Aussie's sex rampage

A court in Melbourne, Australia, heard testimony Wednesday from
witnesses that an HIV-positive man had unprotected sex with hundreds
of men, with the man's physician citing his patient's report of
unsafe encounters with 200 men in a single year.

The Melbourne magistrates' court heard that Michael Neal, 48, made
the disturbing confession to physician Giles Brewster, who treated
him on two occasions. Brewster said Neal told him the figure of 200
during a consultation to treat gonorrhea on April 14, 2003. "Michael
said he was unable to retain an erection with a condom on.... I
reiterated that his behavior was against the law," Brewster said.

In further testimony, a former sexual partner of Neal's who is HIV-
positive said Neal spoke of "conversion parties," where HIV-positive
men would supposedly have unprotected sex with HIV-negative men
trying to contract the virus, a phenomenon known as "bug chasing."

The man, who cannot be identified for legal reasons, told the court
that his former lover, Neal, had vowed to "seed" him. He said Neal
had told him: "You will be daddy's little poz [HIV-positive] boy."

The man, who told the court he did not have the virus when he began
the relationship with Neal in September 2001, said Neal told him of
his positive status. The man said he became suspicious of Neal's
intent when he became HIV-positive in July 2004.

"Have you said to other persons in the past that Mr. Neal tried to
deliberately infect you with HIV for a period of two years?" the
prosecutor asked the man.

"Yes...there have been times when I have felt that happened," the
man said.

The man told the court he witnessed Neal taking part in group sex
and having sex at gay venues such as Club 80 in Collingwood and at
the Laird Hotel in Abbotsford.

Neal, a father of five, is accused of trying to infect 16 men
between October 2000 and March 2005. Five of the alleged victims
have since tested HIV-positive. He faces 120 charges, including
intentionally causing a very serious disease, rape, and possessing
and producing child pornography. (Cath Pope, U.K./Gay.com)

http://www.advocate.com/news_detail_ektid37529.asp
_________________________________----

2) HIV/AIDS makes a resurgence in Australia

Thursday, 12 October , 2006  08:16:00, Reporter: Michael Edwards

TONY EASTLEY: Just when many people thought the scourge of the 80s and 90s was
under control, a new report indicates HIV/AIDS is again on the rise in
Australia. The Annual HIV Surveillance Report shows a 40 per cent increase in
cases over the past five years, and increasingly it says, unsafe sex is to
blame.

Michael Edwards has this report.

MICHAEL EDWARDS: The possibility of a bird flu pandemic has largely replaced
HIV/AIDS as the disease the Australian public fears the most.

After alarming peaks in the 1980s, aggressive safe-sex education campaigns have
eased infection rates.

But the Annual Surveillance Report from the National Centre in HIV Epidemiology
has found over the past five years the infection rate across Australia has
skyrocketed.

Since 2000, almost 1,000 new cases have been reported - an increase of 40 per
cent from the previous period.

The Centre's Deputy Director, Professor John Kaldor, says people are forgetting
the safe sex lesson.

JOHN KALDOR: The very obvious implication is that there have been increases in
the extent of unprotected or sexual risk behaviour in certain parts of the
Australian population.

HIV/AIDS runs rife in parts of Africa, but here the figures are still alarming.

MICHAEL EDWARDS: An estimated 15,000 Australians are living with HIV. Almost
7,000 people have died from AIDS. It's still the gay community which bears its
full force.

JOHN KALDOR: Most of the transmission still is through male to male sex. That's
been the major mode of transmission in Australia since the beginning of the
epidemic and it continues to be so.

And most of the increase is in cases that are associated with male to male
sexual transmission.

MICHAEL EDWARDS: Don Baxter from the Federation of AIDS Organisations says gay
men are taking more sexual risks because of better treatments available for HIV.

DON BAXTER: I think gay men these days are taking more risks, more occasional
risks about what they do with their sexual partners than what they used to
previously, because they know that there are now treatments available which are
going to keep them alive for much longer than where we were in the 1990s when
everybody died within five to 10 years.

TONY EASTLEY: Don Baxter from the Federation of AIDS Organisations in that
report from Michael Edwards

http://www.abc.net.au/am/content/2006/s1763021.htm
_________________________-----

3) New HIV infections in Australia up 41 percent from 2000, study finds The
Associated Press

Published: October 12, 2006. SYDNEY, Australia New HIV cases in Australia surged
more than 40 percent from 2000 to 2005, according to study results released
Thursday, prompting fears that drug treatment advances are making people lax
about practicing safe sex.

The annual survey report, issued by the National Center in HIV Epidemiology and
Clinical Research, found that new HIV infections reported in Australia rose from
656 in 2000 to 930 in 2005 — a 41 percent leap. HIV is the virus that causes
AIDS.

Gay men accounted for about 70 percent of the new cases. Heterosexuals made up
19 percent, while intravenous drug users and unknown transmission paths
accounted for the rest.

According to the report, new infections hit an all-time high of about 1,700 in
1984, then declined steadily through the late 1990s. But in 2000, the trend
apparently reversed.

It's not just HIV that is on the rise in Australia.

Around 41,300 new cases of the sexually transmitted disease chlamydia were
reported in 2005, a fourfold increase over 1995.

New gonorrhea cases have almost doubled in the past decade, the study said.

"It's very possible that people are just not prioritizing safe sex as they maybe
used to in the very serious HIV/AIDS era" of the late 1980s and early 90s, said
the center's deputy director, John Kaldor.

"It might be here that improvements in HIV treatments have lessened the
motivation for people to protect themselves sexually," Kaldor said.

Australia has about 15,000 people living with HIV, and around 70 percent are
being treated with life-prolonging anti-retroviral drugs, the study found.

Don Baxter, executive director of the Australia Federation of AIDS
Organizations, said widespread use of the drugs — which have been found to slow
the progression of HIV to AIDS — could be a factor behind the recent rise,
especially among gay men.

"The place of HIV in gay men's lives has receded enormously from where it was,
because they and their friends have stopped dying," he said "So the level of
attention to it is much reduced."

He said so-called "treatment optimism" could make some people more likely to
take risks, or "at least rationalize having unprotected sex."

Australia had 22,361 reported cases of HIV as of the end of 2005. A further
9,872 people have been diagnosed with full-blown AIDS, and around 6,700 have
died from AIDS, the report said.

The National Center in HIV Epidemiology and Clinical Research, an independent
medical research institution, collaborates with the government on setting
strategy to combat the spread of AIDS.

http://www.iht.com/articles/ap/2006/10/12/asia/AS_MED_Australia_HIV.php

1) Master of International Health
2) Master of International Research Bioethics


1) Master of International Health


Human Rights and Bioethics Unit
Department of Epidemiology and Preventive Medicine
Monash University

Study mode and course location
On-campus (Alfred Hospital, Melbourne)

Course description

This course is offered by the Department of Epidemiology and Preventive 
Medicine, in collaboration with the Centre for International Health at the
Burnet Institute for Medical Research and Public Health. This degree provides
you with the skills necessary to design implement and evaluate the relevant
programs that address the major public health priorities of communities in
developing countries. In addition students have the opportunity to learn about
human rights, ethics, law and development.

Public health issues are presented in the broader context of economic and social
development, stressing cultural, political, gender and environmental influences,
and the impact of armed conflict and population migration. Course content is
informed by actual field  experiences gained by the Burnet Institute and Monash
University Faculty in their wide range of health development projects in more
than 20 countries in Asia, the Pacific and Africa and in working with
international agencies.

Course objectives

The overall objectives for the course cover four main curricular themes. These
are, moral, political, legal, economic and social influences on health and
development and implementation of primary health care in less developed
countries

Fees:
In recognition of the fact that people from both NGOs and from
developing countries may wish to undertake this program, we have a
special fee policy for this program.

AUS $19,785 for Australian students and AUS $22,650 for international students
______________

2) Master of International Research Bioethics

Master of International Research Bioethics
3 semesters full-time + 6 semesters part-time
Study mode and course location On-campus (Alfred Hospital, Melbourne)

Course description

This course, offered by the Department of Epidemiology and Preventative
Medicine, is an interdisciplinary program covering comparative moral theory,
research bioethics in an international setting, quantitative and qualitative
research methodology, critical appraisal techniques and relevant law. Particular
emphasis is given to ethical issues associated with research in developing
countries in the Asia-Pacific Region.

Students will gain a strong theoretical framework, significant
experience with ethics committees and considerable involvement with
local organisations concerned with the development of bioethical policy and its
implementation. This course is currently funded by the Fogarty Institute of the
US National Institutes of Health.

Course objectives

The overall objectives for the course cover four main themes:

1. Basic moral theory, bioethics and the application of bioethical
principles and law to research in both domestic and international
collaborative contexts
2. Quantitative and qualitative methodology for international health programme
planning and evaluation
3. Special issues in international health
4.  Practical application of theory and knowledge

Fees:

In recognition of the fact that people from both NGOs and from
developing countries may wish to undertake this program, we have a
special fee policy for this program. Fees are AUS $19,785 for Australian
students and AUS $22,650 for international students.

In addition, five fee scholarships and stipends are available to
students from developing countires in the Asia/ Pacific region.


Please contact
Dr Deborah Zion
deborah.zion@...

Dear FORUM,

The registration form to serve as a community coordinator for the 2007
International AIDS Candlelight Memorial is now available. Sign up today to
become an officially-recognized Candlelight coordinator and begin making plans
for this year's Candlelight Memorial taking place on Sunday, May 20, 2007.

As a coordinator, you will receive a coordinator packet including posters, a
manual, and other helpful information. Because of long distances, packets may
take weeks or months to arrive. The earlier you apply, the sooner we can send
your packet and correct any problems with mailing. You must renew your
registration every year. If you plan to coordinator multiple memorials, please
complete one registration form for each memorial.

Register now:
http://ent.groundspring.org/EmailNow/pub.php?module=URLTracker&cmd=track&j=10020\
7937&u=951154

As always, if you have any questions, please e-mail us at
candlelight@....

Thank you,

Todd Lawrence
International AIDS Candlelight Memorial
Global Health Council
e-mail: <tlawrence@...>

http://www.thelancet.com/journals/lancet/article/PIIS0140673606695147/comments?action=view&totalComments=1

A bungalow for AIDS victims

By CHOONG KWEE KIM

A shelter for HIV/AIDS victims has been set up in Penang to provide care and food for those who have been abandoned by their families. 

State Health, Welfare and Caring Society Committee chairman P.K. Subbaiyah said the Penang Municipal Council had offered a bungalow in Bukit Dumbar for the shelter. 

"There are quite a number of HIV/AIDS patients who have been abandoned by their families," he said. 

"Instead of letting them roam around spreading HIV/AIDS, they can come to the centre du-ring the day or stay in. 

"They will be given food and basic medication," he told newsmen after opening the HIV/AIDS Project 2006 themed Anywhere, Anytime, Anyone, HIV/AIDS Does Not Discriminate in Universiti Sains Malaysia (USM) on Tuesday. 

It was jointly organised by AIESEC in USM and the AIDS Action and Research Group (AARG). 

SWEET MELODY:AIESEC and USM members singing a song during the launch of the HIV/AIDS Project 2006.

But it would not be a centre for treatment of patients with HIV/AIDS but a venue to provide them support, he added. 

The centre has taken in three residents since last month. It is managed by Community AIDS Service Penang (CASP), a non-governmental organisation. 

It reaches out to people living with HIV/AIDS and hopes to create awareness and provide education to the public on HIV/AIDS issues. 

Subbaiyah also commended AIESEC and AARG for organising the project to minimise the stigma and discrimination against people living with HIV/AIDS. 

AARG chairman Assoc Prof Dr Ismail Baba said it was the first time the organisation combined efforts with AIESEC, the largest youth organisation in the world, in educating youth on HIV/AIDS. 

"I hope to see the continued involvement and support of the Malaysian youth and the Malaysian society towards ma-king Malaysia a country free of HIV/AIDS," said Dr Ismail, who is also CASP chairman. 

AIESEC USM advisor Junai-mah Jauhar said people living with HIV/AIDS were not any different from people who had a cold. 

"They should be treated with as much care and love as any other person as the best medicine for them is happiness and peace of mind," she said. 

The HIV/AIDS project director Shobana Nair said the pro- ject comprised road shows to school and colleges in the state from Sept 11 to Sept 25 with games and activities targeted at creating awareness on HIV/AIDS. 

An exhibition featuring educational games, power point presentations and movie screenings related to HIV/AIDS will be held from Sept 26 to Sept 29 in USM while a youth conference themed Break Out Day will be held on Sept 30.  

http://thestar.com.my/news/story.asp?file=/2006/9/21/north/15487200&sec=North

Alarming increase in HIV in Victoria

Friday October 6, 02:19 PM

Victoria is heading for a record number of HIV notifications, with a
return to levels not seen since the early 1990s, says state Health
Minister Bronwyn Pike.

In the first six months of 2006 there were 198 HIV notifications to
Victorian health authorities.

Last year there were 286 for the 12-month period and in 1991, at the
height of public concern about HIV/AIDS, there were 317
notifications.

"Twenty years after the Grim Reaper ads, it appears people have
become complacent about the dangers of HIV," Ms Pike said.
"Clearly there is a need for action."

The Grim Reaper HIV/AIDS education campaign was launched in 1987,
with television images of the hooded figure of death mowing down
victims in a bowling alley.

"What happened in the past is that people died of AIDS, now with
improved drugs people live with AIDS," Ms Pike said.

"We need to be much more targeted to specific groups.

"Certainly men who have sex with men, and particularly men in that
older age group who have become very complacent and not heeded the
message of safe sex."

Victoria's chief medical officer Dr Robert Hall said more research
needed to be done to find out why people in particular groups were
taking risks.

Dr Hall said one factor could be that improved medications meant
people were living longer with HIV.

"In the past people in the affected community saw all of their
friends die from this infection," Dr Hall said.

"We're now seeing that people can survive for quite a long time with
treatment."

Paul Kidd, 42, contracted HIV 21 years ago through unprotected sex.
He said advertising campaigns like the Grim Reaper were not the
answer.

"There needs to be proper funding of HIV community organisations who
are at the front line and educating gay men," Mr Kidd said.

"We need to recognise that HIV hasn't gone away."

"The Grim Reaper was extremely effective in demonising gay men and
making people fearful of gay men and increasing the stigma of HIV.

"I don't think scare campaigns work and I don't think that would be
the right thing to do in that situation."

Ms Pike said the state government would provide $2.7 million of
additional funding for new awareness programs on HIV and other
sexually transmitted diseases

http://au.news.yahoo.com/061006/2/10t9c.html