INVITATION  AIDS ASIA e FORUM.

Hi,

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

[AIDS ASIA eFORUM] is 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 7,600 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/

Dr. Joe Thomas
Editor
AIDS ASIA e FORUM
http://health.groups.yahoo.com/group/AIDS_ASIA/

CDC seeks those who sat near TB patient

By MIKE STOBBE, AP Medical Writer

Health officials in North America and Europe sought passenger lists Wednesday
for two trans-Atlantic airline flights in their effort to find about 80 people
who sat near a honeymooner infected with a dangerous drug-resistant form of
tuberculosis.

Authorities also disclosed that the man was on several flights between various
European locales over the course of two weeks earlier this month. Passengers
lists for those flights were also being tracked down, they said.

"The investigation is just beginning. It's very challenging," said Dr. Martin
Cetron, director of the Centers for Disease Control and Prevention's division of
global migration and quarantine.

The man, who is under the first U.S. government-ordered quarantine since 1963,
told a newspaper he flew from Atlanta to Greece for a wedding and then traveled
to Italy for a honeymoon. Later he flew back to North America because he feared
he might die without treatment in the United States.

CDC officials are concentrating on the trans-Atlantic flights, when the
likelihood of spreading the disease was greatest because he was in a confined
space with other people for hours. Officials were trying to contact 27 crew
members and about 80 passengers who sat in the five rows surrounding the man for
testing.

Other passengers on the flights are not considered at high risk of infection
because tests indicated the amount of TB bacteria in the man was low, Cetron
said.

"Our big concern is that no one has told us which row he might have sat on,"
passenger Shannon Boccard, whose 10-year-old son was on the same flight, told
WSB-TV in Atlanta.

Health officials in France have asked Air France-KLM for passenger lists, and
the Italian Health Ministry also is tracing the man's movements. A spokeswoman
for Czech airline CSA said medical checks showed no infections among its crew
members who flew with the man, but the airline was contacting passengers.

The man had a supply of masks to wear for the protection of other passengers,
but it is not clear whether he donned them, Cetron said. The man continues to
feel well and shows no symptoms, Cetron said.

The man told The Atlanta Journal-Constitution that doctors did not order him not
to fly and only suggested he put off his long-planned wedding. He knew he had a
form of tuberculosis and that it was resistant to commonly used drugs, but he
did not realize until he was already in Europe that it could be so dangerous, he
said. The man's wife has tested negative.

"We headed off to Greece thinking everything's fine," he told the newspaper. The
newspaper did not identify him at his request, because of the stigma attached to
his diagnosis.

He flew to Paris on May 12 aboard Air France Flight 385, also listed as Delta
Air Lines codeshare Flight 8517.

He and his bride took then took four more flights within Europe, flying from
Paris to Athens on May 14; from Athens to Thira Island on May 16; from Mykonos
Island to Athens on May 21; and from Athens to Rome on May 21.

The passengers on the shorter European hops are not considered to be at the same
level of risk for infection as the passengers on the trans-Atlantic flights,
which each lasted eight hours or more, CDC officials said.

While he was in Rome, health authorities reached him with the news that further
tests had revealed his TB was a rare, "extensively drug-resistant" form, far
more dangerous than he knew. They told him to turn himself over to Italian
health officials and not to fly on any commercial airlines.

Instead, on May 24, the man flew from Rome to Prague on Czech Air Flight 0727.
From Prague, the couple left for Montreal the same day, aboard Czech Air Flight
0104, according to CDC officials.

The man then drove into the United States at Champlain, N.Y. He told the
newspaper he was afraid that if he did not get back to the U.S., he wouldn't get
the treatment he needed to survive.

The man is now at Atlanta's Grady Memorial Hospital under the first federal
quarantine order since the government quarantined a patient with smallpox in
1963. A sheriff's deputy was assigned to guard him.

He is not facing prosecution, health officials said.   A spokesman for Denver's
National Jewish Hospital, which specializes in respiratory disorders, said
Wednesday that the man would be treated there. It was not clear when he would
arrive.

Associated Press writers Daniel Yee in Atlanta and Colleen Slevin in Denver
contributed to this report.
__________________________________________
Dr.Ashok Rau
Executive Trustee/CEO
Freedom Foundation-India, Nigeria, and Botswana
(Centers of Excellence- Substance Abuse & HIV/AIDS)
180, Hennur Cross, Bangalore - 560043, India
Senior Research Fellow, The Terry Sanford Institute of Public Health, Duke
University (USA) Visiting Faculty, Yale University (USA)
Phone (O) +91 80 25440134, 25449766,
Fax (O) +91 80 25440134
e-mail: <ashokrau@...>

The *Vietnam-CDC-Harvard Medical School AIDS Partnership (VCHAP)* is
recruiting an HIV/AIDS Medical Officer for our Hanoi Office.

VCHAP works with the Viet Nam Ministry of  Health and the US PEPFAR program to
provide training and capacity building on HIV/AIDS care and ARV treatment to
healthcare workers throughout Viet Nam. The position is open to Vietnamese and
International applicants.  A medical degree and fluency in written and spoken
English are required.

Vietnam-CDC-Harvard Medical School AIDS Partnership (VCHAP)
Medical Officer (Hanoi) Job Description FY07

Overall Responsibilities

The VCHAP Medical Officer in Hanoi will be responsible for providing training,
technical assistance, and supervision in PEPFAR supported HIV treatment sites in
Hanoi and the northern provinces as determined by the In Country Medical
Director.  Work will be focused at institutions where US Government-supported
antiretroviral therapy (ARV Rx) is being provided.  The Medical Officer will
also participate in training activities for Vietnamese clinicians throughout the
country.

Specific Responsibilities

I. Provision of expert clinical advice on HIV/AIDS to VCHAP’s partners in
Vietnam
1. Clinical advisor to CDC Vietnam Director and staff.
2. Clinical advisor to PEPFAR Vietnam Core Team and USG-funded partner
organizations in HIV care and ARV Rx.
3. Participation in PEPFAR Vietnam Care and Treatment Working Group.
4. Participation in PEPFAR Vietnam Palliative Care Working Group.
5. Serving as the VCHAP liaison for technical assistance and program development
with the Vietnam Administration for HIV/AIDS Control (VAAC) and the Ministry of
Health (MOH).

II. Training Vietnamese physicians in HIV treatment

1. Planning training courses and conferences in collaboration with the CDC
Vietnam Director, Care and Treatment Department of the VAAC, and VCHAP
In-Country Medical Director.
2. Teaching in national and regional training courses with VCHAP and Vietnamese
colleagues.

III. Technical assistance in HIV treatment
1. Assisting in drafting or revising policies, strategies, or guidelines for HIV
treatment as requested by the MOH.
2. Assisting in drafting or revising operational plans and protocols for HIV
care at CDC-funded hospitals and clinics.

IV. Training, technical assistance, and supervision for medical staff at HIV
clinical care sites in Hanoi and the region
1. Leading regular teaching rounds with the HIV Services at OPCs and  hospitals.
2. Serving in active advisory role in formulation of treatment plans for
patients.
3. Clinical mentoring in outpatient care for HIV clinicians at clinics in Hanoi,
Hai Phong, and Quang Ninh.
4. Supervising initiation and scale-up of US Government-supported ARV Rx at
outpatient sites in Hanoi and the region.

V. Palliative care training activities
1. Participating in national and regional palliative care training sessions and
conferences.

Reporting
- In-Country Medical Director
- Director

Applications consisting of a CV and cover letter should be sent by *June 11*to:

Dr. Howard Libman
Director, VCHAP
Email: hlibman@...

Within three months 24 new AIDS patients identified in Sri Lanka

Wednesday, May 23, 2007, 14:16 GMT, ColomboPage News Desk, Sri Lanka.
May 23, Colombo: Sri Lanka Ministry of Health figures identified 24 new
AIDS patients within three months, ringing alarm bells in the third
world country where the control of the disease is internationally
commended.

The latest findings increased the 2006 December total of AIDS patients
in the country from 838 to 862 by the end of March 2007. With the
identification of another AIDS afflicted child, the country's total of
child AIDS patients has risen to 27, Ministry of Health sources said.

http://www.colombopage.com/archive_07/May23141636SL.html

Aussie opens Indonesia's first condom shop

From correspondents in Kuta, Bali

May 28, 2007 12:50pm

AN Australian woman has opened Indonesia's first condom shop in Bali
in a bid to promote safe sex and family planning in the world's
largest Muslim country

The shop, called The Guard, opened last month at an upmarket shopping
mall in Kuta, selling hundreds of condoms of varying colour, texture,
size and flavour.

There's even one that tastes something like Indonesia's durian fruit -
renowned for its flavour but also its pungent aroma not dissimilar
to rotting rubbish.

Sydney woman Sarah Bagus, 27, said she and her Indonesian husband
Endyk wanted to overcome the perception among many Indonesians that
condoms reflected an indecent lifestyle.

"We wanted to make people aware of safe sex practices, healthy
lifestyles and family planning alternatives," she said.

"It's not about freely promoting sexual activity, it's about health
and safety and making people more aware of their options because
there's very little information out there."

Her husband Endyk, a Muslim, said condoms also provided affordable
contraception for poorer families.

"Some husbands make 500,000 rupiah ($70) a month and have to support
five kids," he said.

"How can they ever get ahead like that? Our message is that if they
have fewer kids, they can give them better education and better
opportunities."

This is the first foray into the sex market for the Jakarta-based
couple, who do not yet have any children.

They also run an event management company and wholesaling business.

The Hindu enclave of Bali, undoubtedly Indonesia's most tolerant
society where skimpily-clad foreign tourists party from dusk until
dawn, was an obvious launching pad for The Guard, but Ms Bagus said
she hoped to take the concept around Indonesia as public awareness of
safe sex practices increases.

However, she said these plans were a long way off, with the
Indonesian condom market still very much in its infancy.

Just 90 million condoms are sold each year in a population of 235
million people, according to DKT International, a non-profit US-based
NGO that makes and sells condoms.

Chris Purdey, DKT's Indonesia country director, said many Indonesians
were still embarrassed by the mere mention of condoms and were
reluctant to be seen buying them.

"The atmosphere in Indonesia has changed a lot over the last 10 years
and the condom market has probably tripled, but condoms are still
very much associated with illicit behaviour like pre-marital sex and
commercial sex," Mr Purdey said.

"The Guard is very important in the sense that it is a real step
forward in decreasing the stigma associated with buying condoms and
talking about condoms as we face the spread of HIV/AIDS into the
general population."

The Indonesian Government estimates that up to 200,000 people are
living with HIV, the human immunodeficiency virus that causes AIDS.

By comparison, in Australia, more than 22,000 people had been
diagnosed with HIV by the end of 2005, according to official
statistics.

While the Indonesian figures represent just a fraction of the almost
40 million HIV cases worldwide, the epidemic is gaining momentum
across the archipelago.

"At the moment it's focused on high-risk groups," said Mr Purdey.

"But in some areas, particularly in Papua, it is spreading into the
general population, into mothers and babies, and in a population of
more than 230 million that is pretty scary."

In a bid to curb this trend, Sarah and Endyk Bagus are working with
DKT and other HIV prevention groups to raise public awareness of safe
sex.

They plan to co-host events every three months, and to donate a
portion of the shop's revenue to Bali-based charities.

DKT, whose two brands Sutra and Fiesta together account for about two-
thirds of the Indonesian condom market, is also planning to release
the country's first female condom later this year.

http://www.news.com.au/heraldsun/story/0,21985,21805993-
5005961,00.html

Dear FORUM,

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/896

As a Sri Lakan living with HIV, I appreciate the posting on HIV/AIDS situation
in Sri Lanka.

But, the data is out dated- from 2003. I am wondering what the people
who are responsible for updating this data are doing?

Please do ask whoever is responsible for the National Sentinel Data
Collection and updating, what have they been doing since 2003, other
than warming the chairs in their Ivory Towers? They have no new
sentinel Data or stats or estimates? Or for some unknown reason I
suspect that may be the current REPORTED national sentinel stats ARE
available at STD clinic but due to our usual bureaucratic bungling
may not been shared with UNAIDS.  Or the UNAIDS staff simply forgot
to do their home work?

Governments and national authorities sometimes cover up and hide
cases, or fail to maintain reliable reporting systems. Ignoring the
existence of HIV and AIDS, neglecting to respond to the needs of
those living with HIV infection, and failing to recognize growing
epidemics in the belief that HIV/AIDS 'can never happen to us' are
some of the most common forms of denial. This denial fuels AIDS
stigma and drives the epidemic deeper and deeper underground.

And we believe UNAIDS has an obligation to keep the site up to date
especially since it has a mandate for supporting positive people -
this is really sad. We are three years behind.. no real indicators of
the current situation.

The cumulative AIDS cases reported by 2003 end are 161; the male to
female ratio of reported AIDS cases is 1.4:1. Most of the infections
are acquired by heterosexual route. The cumulative AIDS deaths
reported as of 2003 end are 119. The estimated number of People
Living with HIV/AIDS in Sri Lanka as of 2003 end is 3500.

But we know that at least 5-6 NEW cases each month walk into the
Infectious Disease Hospital (IDH) now for the last 6 months.
Dr.Ananda Wijewickrama and Sister Gamage will verify this if asked.
And these are identified and reported cases. What about all others
who are walking around out there unaware of their status?

So 6 patients a month and new ones, (Only at IDH Colombo)  and based
on information from our own network, makes me think that maybe
there's twice, thrice, four or five times that number out there. I
would not be at all surprised if it is  actually a LOT more.

Don't forget "we" may have our own shadow networks on the ground and
ways and means of obtaining data from all over the island, yes even
from  Jaffana.  Those who really want to know the ground situation
may talk to Dr.Vinya from Sarvodaya and the HIV/AIDS outreach teams
from NEST ( Sanjaya De Paul and Samuel ) and Salvation Army ( Swarna
and Sanjeewa ) as these three have extensive networks across the
island.


Let me go anonymous
Why risk my life and limbs?

HIV/AIDS Situation in Sri Lanka and The National Response

Nearly two decades since reporting its first HIV infection, Sri Lanka
remains one of the few countries in this region with a low-level AIDS
epidemic. There is considerable evidence that Sri Lanka is vulnerable
to the development of concentrated AIDS epidemics. Female sex workers
are found in most of the major towns and cities, and there are
networks of men who have sex with men, who have multiple partners
including paying clients. Sri Lanka has a high number of heroin users
and although few of them currently inject drugs, if there were a
substantial change in drug-use patterns to more injecting drug use,
this would result in the increase in the number of people who are
likely to be exposed to HIV. However, lack of information on all of
these parameters makes it impossible to predict the potential size of
concentrated AIDS epidemics in Sri Lanka.

The national response is coordinated by the National STD/AIDS Control
Programme (Ministry of Health), which is responsible for planning,
monitoring and provision of technical guidance, as well as some
implementation at decentralized levels. Coordination in 2006 included
support to a number of nongovernmental organizations, leaders of
faith-based groups, and government departments and ministries, and
collaboration with major private-sector initiatives.

Donors include the World Bank, eight United Nations (UN) agencies and
the International Organization for Migration, all of which are
represented in the UN Theme Group on HIV/AIDS.  The United States
Agency for International Development has commenced a capacity-
building initiative with selected nongovernmental organizations.

Renewed political violence in the north and east of the country
continues to hinder capacity to work in those areas. The conflict has
also reduced the opportunity for dialogue on issues of a sensitive
nature, which is particularly detrimental to HIV prevention efforts
for people whose behaviour put them most at risk, such as sex
workers, men who have sex with men, and injecting drug users.

Major barriers to HIV prevention, treatment, care and support
include:

• human resources, both in the medical establishment and within civil
society, needed to improve the quality of and expand the response in
clinical settings and in the community;
• stigmatization and discrimination, which discourage demand for
counselling, testing and treatment;
• continuing very low coverage of targeted HIV prevention programmes
for key people likely to be exposed to HIV (female sex workers and
men who have sex with men).

Challenges and emerging issues facing stakeholders in 2007

• Formulation of the 2007–2011 National Strategic Plan should involve
all stakeholders in a broad participatory process guided by the
National STI /AIDS Control Programme.
• Prioritizing targeted interventions for people whose behaviour puts
them most at risk of exposure to HIV, with the highest priority given
to prevention efforts for female sex workers and men who have sex
with men.
• Improving partnerships with engagement and encouragement of civil
society and private-sector participation, with particular emphasis on
capacity-building of nongovernmental organizations and the
revitalization of civil society coordinating mechanisms and
partnerships.
• Improving strategic information (including bridging information
gaps) and establishing a monitoring and evaluation system.
Information on people with high-risk behaviour is acutely needed to
guide the local response.
• Access to HIV prevention, treatment, care and support services in
conflict-affected areas.

UNAIDS SUPPORT TO THE NATIONAL RESPONSE

Activities of UNAIDS (including Cosponsors) at country level in 2006

• The National HIV/AIDS Prevention Project, financed by the World
Bank, supports a multisectoral response in 10 government departments
and encourages this approach down to decentralized levels through
district and provincial health authorities. The National HIV/AIDS
Prevention Project has supported sensitization of political leaders
at all levels, leaders from all faith-based groups and a number of
nongovernmental organizations working with communities most likely to
be exposed to HIV at district level. It has also financed a
comprehensive care and treatment programme offering free
antiretroviral drugs for all who are medically eligible.

• Work continued on a project to develop a behavioural surveillance
system, communications and condom social marketing strategies, and a
management information system.

• All UN agencies were involved in a range of HIV prevention
activities, in partnership with ministries and nongovernmental
organizations. These included provision of support to:
– workplace programmes (International Labour Organization and the
World Bank);
– the agriculture sector (Food and Agriculture Organization of the
United Nations and World Food Programme);
– migrants and tsunami-affected communities (International
Organization for Migration);
– displaced people in the north and east (Office of the United
Nations High Commissioner for     Refugees);
– in-school and out-of-school young people (United Nations Population
Fund and United Nations Children's Fund);
– prison staff and inmates (United Nations Population Fund and World
Bank);
– people living with HIV (UNAIDS Secretariat);
– women leaders in the north and east (United Nations Development
Programme);
– drug users (United Nations Office on Drugs and Crime).
• Technical support on epidemic surveillance and estimation was
provided to the National STD/AIDS Control Programme by the World
Health Organization.
• Through the Asia Pacific Leadership Forum on HIV/AIDS and
Development, the UNAIDS Secretariat is supporting a local advisory
group to work with health-sector leaders, leaders of faith-based
groups, political and civil society leaders in the north and east, a
media initiative featuring popular leaders, and high-level leaders,
including the country's President.

Plans and objectives of UNAIDS (including Cosponsors) at country
level for 2007

• The UN family will help to develop a more focused and truly Joint
Programme of Support for the national response. Particular emphasis
will be placed on supporting the development of a prioritized and
costed National Strategic and Operational Plan on AIDS for Sri Lanka
2007–2011.

• The International Congress on AIDS in Asia and the Pacific, which
will be held in Sri Lanka,        19 – 23 August 2007, also serves as
a major advocacy opportunity to broaden the understanding of the
response required in Sri Lanka.

I. DEMOGRAPHIC, SOCIAL AND ECONOMIC INDICATORS Estimated Population
(thousands) 20 743
Population Growth Rate 0.9%
Life expectancy at birth Men Women
  68 75
Human Poverty Index Rank Value
  42 18.0
Human Development Index 93
Percentage of people living with less than US$2 50.7%
Per Capita Gross National Income US $ 4000
Per Capita Governement Expendaiture on health 55

II. HIV AND AIDS ESTIMATES Number of people living with HIV 5000
[3000 – 8300]
Adults aged 15 to 49 HIV prevalence rate <0.1 [<0.2]%
Adults aged 15 and up living with HIV 5000 [3000 – 8 300]
Women aged 15 and up living with HIV <1000 [<1000]
Deaths due to AIDS <500 [<1000]
GENERALISED EPIDEMICS
Children aged 0 to 14 living with HIV –
Orphans aged 0 to 17 due to AIDS –

III. COUNTRY PROGRESS INDICATORS GENERALISED EPIDEMICS
Expenditures
National funds spent by governements for domestic sources
National Programmes
Percentage of pregnant women receiving treatment to reduce mother-to-
child transmission
Percentage of HIV-infected women and men receiving antiretroviral
therapy
School attendance among orphans N/A non-orphans N/A
Knowledge and Behaviour
Percentage of young people aged 15 to 24 who currently identify ways
to prevent HIV Men Women
  N/A N/A
Percentage of young people aged 15 to 24 who had sex with casual
partner inthe past 12 months Men Women
  N/A N/A
Percentage of young people aged 15 to 24 who had sex before 15 Men
Women
  N/A N/A
Percentage of young people aged 15 to 24 who used a condom last time
they had sex with a casual partner Men Women
  N/A N/A
CONCENTRATED/LOW PREVALENCE EPIDEMICS
Expenditures
National funds spent by governements for domestic sources US $ 2 950
000
Policy Development and Implementation Status
Policy information, education, communication and prevention for most-
at-risk populations Yes
Policy to expand access to essential preventive commodities among
most-at-risk populations Yes
National Programmes
Percentage of HIV-infected women and men receiving antiretroviral
therapy 6%
Percentage of most-at-risk populations reached by prevention
programmes Men who have sex with men Sex workers
  N/A N/A

COUNTRY ASSESSMENTS Sri Lanka is classified as a low-level epidemic
country with HIV prevalence rates among high-risk population
subgroups continuing to remain well below 5%. In the 2003 sentinel
surveillance round, HIV prevalence was 0.3%-1% among STD clinic
attendees, 0.2% among female sex workers and 0.3% among TB patients.
No sample was found positive for HIV among 603 truck drivers tested.
Similarly, among 2,618 military personnel tested, no one was found
positive. Sri Lanka is planning to initiate behavioral surveillance
to track risk behaviors among vulnerable populations. The national
prevalence of HIV is estimated to be below 0.1%. The cumulative AIDS
cases reported by 2003 end are 161; the male to female ratio of
reported AIDS cases is 1.4:1. Most of the infections are acquired by
heterosexual route. The cumulative AIDS deaths reported as of 2003
end are 119. The estimated number of People Living With HIV/AIDS in
Sri Lanka as of 2003 end is 3500.

http://www.unaids.org/en/Regions_Countries/Countries/sri_lanka.asp

More anti-HIV efforts urged for migrant workers

The Associated PressPublished: May 22, 2007
KUALA LUMPUR: The spread of AIDS is threatening millions of migrant
workers in Asia who lack sufficient access to health services,
regional health workers and advocates for migrant laborers said.

"For a comprehensive approach to contain HIV/AIDS, the health of not
only local populations but also migrant communities needs to be
addressed," Caram Asia, a Malaysian-based coalition of groups from 15
countries that focus on migrant health issues, said in an open letter
to Asian governments that was released late Monday.

There are now 53 million migrant workers in Asia who are vulnerable
to HIV, the virus that causes AIDS, because of their relative lack of
access to HIV-prevention programs, health counseling and medical
tests, Caram Asia said.

In many cases, migrants found to be HIV-positive are deported without
any help or immediate treatment, it added. It did not estimate how
many migrant workers in Asia were HIV-positive.

Many migrant workers come from poor parts of Indonesia, the
Philippines, India, Pakistan and Bangladesh. They often find
employment in more affluent Asian countries as maids and laborers.

According to recent UN statistics, about 8.6 million people in Asia
are infected with HIV. About 500,000 people in the region die each
year from AIDS, and financial losses from the disease are estimated
at $10 billion annually.

However, investment in HIV prevention and care in Asia remains
extremely low, officials have said. The number of people in Asia
infected with HIV could more than double to 20 million in the next
five years without a better government response and more funding,
they said.

http://www.iht.com/articles/2007/05/22/africa/migrants.php

WITNESS-Caught in an air raid scare in Sri Lanka

27 May 2007 20:00:17 GMT, Source: Reuters

By John Ruwitch
COLOMBO, May 27 (Reuters) - We boarded on time shortly before 1 a.m.
and a few minutes later the captain came on the PA system. Our four-
hour flight from Colombo to Singapore would be delayed because of
a "security issue", he said.

As soon as the Sri Lankan military cleared us to get under way he
would let us know.

I texted a Colombo-based colleague about the delay, just to be safe,
then switched off my mobile phone and started to doze off.
During my assignment to Sri Lanka, I had mostly written about the
escalating conflict between government forces and Tamil Tiger
separatists.

Almost all of the fighting takes place in the north and east of the
island, hundreds of km (miles) from the capital, so I wasn't too
worried about this vague security issue holding us up.

Then the sound of explosions and the crackle of machine guns
interrupted my sleep.

Orange tracer bullets arced across the sky and the lights inside our
plane were quickly doused.

More gunfire. Now it sounded like it was coming from several
directions, sporadic, not orderly the way I thought anti-aircraft
fire would sound.

The Tigers, who are fighting for an independent state, had mounted
two raids by a newly unveiled air wing in April.

Two nights before my flight on April 29, reports of unidentified
light aircraft heading towards Colombo had tripped air defences.
Power to the city was cut, and anti-aircraft batteries opened up on
the black sky.

That one I'd covered from the newsroom.

This time, I was on a stationary airliner with a fusillade going on
outside.

DE-PLANE NOW

The other passengers looked half-stunned and did not move.

My heart raced. I remembered July 2001 when rebel commandos attacked
the Colombo airport -- this airport – and blew up civilian airliners
on the tarmac during a fierce battle.

"Exit the aircraft as quickly as possible," a flight attendant
announced abruptly. "Take all your bags and de-plane now."

The gunfire continued.

Is the airport under attack, I wondered? We stood in the aisle
waiting. How long can it take for them to open the door and let us
off this sitting duck of a plane full of jet fuel? Does my colleague
back in the city know what's happening?

I tried calling, but the mobile phone network was jammed.

I reached the jet way. "Stay away from the windows. Hurry, hurry!" a
guard said. The popping of gunfire continued.

At the concourse, we joined a stream of people from other flights
scurrying toward the main terminal. Airmen waved their arms, urging
us to go faster. Some people started to run.

The facts of what had happened slowly emerged: The airport was not
attacked but rebel airplanes had bombed oil facilities between the
city and the airport.

Nerves at the airport cooled, and a few hours later passengers were
allowed back on their planes. I stayed to cover the story.

Returning to the bureau from the airport as the sun rose I thought
about the war I had covered but did not know until my last night in
town.

As foreign correspondents, we try to describe events in terms the
proverbial milkman in Kansas City can understand.

Yet if it took being caught in an air raid for me to grasp this
story, how much true understanding could there could be among people
who have never even set foot here, I wondered?

Before I boarded the plane the night of the attack, my colleague and
I joked about the risks.

"Call if the Tigers attack the airport," he'd messaged me in jest.

"I will if I'm alive," I texted back with a dose of gallows humour.

That following night, before I flew out, we didn't joke.

http://www.alertnet.org/thenews/newsdesk/SP249699.htm

'Band positive' spreads AIDS message

A group of nine people in Kolkata, all of them HIV positive, have
decided to live life king size.

They have set up a rock band that is belting out songs that tell
their stories of hope and courage. Now the band plans to travel
across West Bengal to spread awareness about AIDS.

They want their music to serve a higher purpose.

"Music is the best way to express ourselves and make people aware. If
we just talk, no one listens, people listen to our stories if we
speak through music," said Julekha, Band member.

The band Jagriti was formed in 2005. Its initial years were difficult
but then the HIV positive members discovered the magic formula.

Plain entertainment

For plain entertainment, they belt out chartbusters and intersperse
those with songs that tell their own tale. Jagriti is currently
recording songs for its maiden album.

"Initially it was very difficult to get people involved with our
programmes. But, by this time when we are trying to improve the
quality of our songs, music, the total presentation."

"People are responding like anything. We are getting a lot of
appreciation for the kind of work we do," said Indranil Das, Band
Coordinator.

For all nine members of Jagriti, music is not only a passion but also
a medium for spreading awareness about HIV/AIDS.

Through their song, they hope to bring hope to hundreds of others who
share their fate

http://www.ndtvmusic.com/story.asp?id=6477

Family Health International (FHI) is a U.S. based non-profit
international public health organization dedicated to improving the
health of populations in more than 70 countries worldwide through
research, education and prevention services in family health. The Asia/ Pacific
Regional Office (APRO) of FHI is seeking highly qualified and experienced
individuals to join its team. Our work includes public health HIV/AIDS
prevention and care and clinical research on infectious diseases in 12
Asia/Pacific Countries. For more information please visit
our website www.fhi.org <http://www.fhi.org/>

Position : Senior Technical Officer, Monitoring and Evaluation


Position Location: Thailand

Position Description:
In collaboration with FHI/USA, provides leadership and capacity building in
monitoring, evaluation, and quality assurance/quality improvement (QA/QI) to
FHI/s public health programs in the Asia Pacific Region.

Minimum Requirements:
BS/BA in public health or related field, and 7-9 years relevant
experience in HIV/AIDS, infectious disease or family planning with
international development programs; or MS/MA/MPH in public health or
related field, and 5 - 7 years relevant experience; or PhD, MD or
similar degree with 3 - 5 years relevant experience. Overseas field
experience required.

Position : Senior Technical Officer, HIV & Drug User Intervention

Position Location:  Vietnam

Position Description:
To provide and manage technical assistance in and ensure the quality of HIV and
drug-use related HIV/AIDS prevention, care, and treatment
interventions and research in Vietnam and other countries in the Asia
Pacific Region.

Minimum Requirements:
Masters degree or equivalent experience in public health; and at least five
years specialized experience in designing and/or providing
techni cal assistance to HIV prevention, care, and treatment programs for
injection drug using populations in resource-poor setting; at least two years
senior management experience. Experience with U.S. government contractual
requirements and experience working in an international NGO/PVO environment
desirable. Experience must reflect knowledge, skills and abilities listed above.

Please send your letter of intention and updated CV to hr@...


"Pailin Chansiriwong"
e-mail: <pailin@...>

Message from the Co-Chairs, 8th ICAAP Colombo Sri Lanka.

We the congress Co- Chairs feel it is necessary and timely to reassure
participants of the 8th ICAAP on the security situation in Sri Lanka at present
since there have been  concerns expressed regarding the incidents experienced
around Colombo recently.

In order to talk about the present situation it is necessary to provide a little
background. As you may know, Sri Lanka has had to face an intermittent armed
insurgency in the North and East of the country for over 24 years, broken by 4
periods of ceasefire in its history. The conflict is not new to our island, and
is something that our people have learned to accept and live with. Life does
really go on as normal.

The conflict has never targeted foreigners, and currently does not target
civilians. The main conflict zones are around 200 miles away from cities such as
Colombo, the commercial capital.

In response to the security concerns of congress participants, we will be
implementing several specific security measures, providing secured buses from
the airport to the hotels for all participants on arrival, as well as secured
transport from hotels to the congress on a daily basis. The venue of the
congress is also a high security zone, where vehicles are checked and all
participants attending will be registered.

Again we wish to underline the fact that the insurgency is in the North and East
of the country, away from the capital city and that no foreigners have ever been
targeted. We are now in the midst of an active peace process guaranteed by the
international community – including the United States, the European Union and
Japan and an effective cease-fire of all hostilities anywhere in the country is
soon possible.

Sri Lanka is an exquisitely beautiful country and will certainly be eye opening
for visitors who have not traveled to this part of the world before.

And finally, there are cross cutting themes and tracks at this years congress
based on conflict and HIV/AIDS, what better country to host these abstracts 
than a country such as Sri Lanka?

I hope we have been able to reassure you on your safety in attending the 8th
ICAAP in August for which preparations are fully underway, and we look forward
to your participation in making this year's congress the best yet.

Chandi Jayawickrama
Singapore :(0065) 9781 4166
Sri Lanka  :(0094)(0) 777 031 362
www.chandij.com
e-mail: <chandi.jayawickrama@...>

A senior official with Malaysia's health ministry says the country
cannot openly promote condom use to prevent HIV/AIDS.

The ministry's deputy director for disease control, Jalal Halil Khalil,
is quoted in the New Straits Times saying the country fears it will be
perceived as advocating promiscuity in the mainly Muslim nation.

He says the government understands that condom use prevents the
transmission of HIV - cases of which are rising in Malaysia - but could
not openly support it.

The health ministry earlier this year warned Malaysia could face an
HIV/AIDS epidemic, with the number of infected people rising fourfold
to 300,000 by 2015

http://www.radioaustralia.net.au/news/stories/s1928871.htm

Injecting Drug Use  among Australian Indigenous communities

"Something Is Going To Get Us"  A Consultation and Development
Project for a National Campaign Addressing Injecting Drug Use in
Indigenous Communities

This report presents the results of a consultation process with
Indigenous IDUs conducted by the Australian Federation of AIDS
Organisations (AFAO) and the Australian Injecting and Illicit Drug
Users League (AIVL). In response to evidence of an increase in HIV
diagnoses attributed to injecting drug use in Indigenous communities,
the project aimed to explore Indigenous experiences of injecting drug
use and related issues, to inform the development of a national
campaign to address injecting drug use in Indigenous communities.

The report is publicly available (PDF 661 KB, 115 pp) at

  www.afao.org.au/library_docs/indigenous/ATSI_IDU_Consultation.pdf

For further details one may contact

Gary Gahan:
Co-ordinator, Blood Borne Infections Prevention
South East Sydney Illawarra Area Health Service
HIV & Related Programs Unit
Level 2  McNevin Dickson Building
Prince of Wales Hospital
Randwick  NSW 2031
t: +61 2 9382 8124    f: +61 2 9382 8143    m: 0402 241 288
e: gary.gahan@...

Philippines has a hidden but growing AIDS Cases.

by A. Lumaque
Roxas City (19 April) -- A council for the prevention and control of
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
(HIV/AIDS) and other sexually transmitted infections (STI) has been
organized by the Capiz provincial government to carry out various
activities against further spread of the pandemic in the province.
Capiz Gov. Vicente Bermejo, through an executive order, directed the
creation of the AIDS Council in support to the country's pledge to
the principles and targets of the Declaration of Commitment against
the deadly disease.

Dr. Evelyn T. Bolido, STI/HIV/AIDS Program Coordinator for Capiz,
said the trend for HIV transmission in the Philippines, which
was "low and slow" before, has now changed to "hiding but growing"
based on situationer she discussed with members of the council.

"Western Visayas has registered 16 deaths from the 45 cases of People
Living With HIV/AIDS (PLWHAs) as of February this year," said Bolido
as she encouraged those infected by HIV/AIDS to avail of the free
services of the health department.

The province has only recorded two PLWHAs since 2004.

The council is also tasked to conduct various information
dissemination activities, formulate anti-AIDS action plans, and
monitor as well as evaluate the implementation of its plans and
programs, among others.

A candlelight memorial for AIDS victims on May 20 is among the
immediate undertakings of the council to honor the memory of those
lost to AIDS and to demonstrate support for those living with the
incurable disease. (PIA) [top]

http://www.pia.gov.ph/?m=12&fi=p070419.htm&no=17&r=&y=&mo=

Many children of HIV-positive parents are not in their custody Child

Health News, Published: Tuesday, 8-May-2007

A new joint study by UCLA and the Rand Corp. shows that more than
half of children with an HIV-infected parent are not consistently in
that parent's custody.

Researchers found that during the two-year study period, 42 percent
of children were not in the HIV-infected parent's custody at any
time.

The research is the first to use data from a nationally
representative sample of people in care for HIV infection to
investigate the custody status of children. The findings will be
presented at the annual meeting of the Pediatric Academic Societies
in Toronto on May 7.

"Children of HIV-infected parents are at risk for behavioral and
emotional problems. A stable home may help these children and their
parents cope with the effects of HIV on the family," said lead
author Burt Cowgill, M.P.H., a doctoral candidate in the department
of health services at the UCLA School of Public Health and a
researcher at the UCLA/Rand Center for Adolescent Health
Promotion. "By understanding whether children of HIV-infected
parents remain in their parent's custody, pediatricians and other
physicians may be able to help families address custody issues and
offer referrals to social services."

Cowgill added that pediatricians may also want to suggest that HIV-
infected parents include future custodians in their children's
doctor visits so that these individuals are familiar with the
physical and mental health needs of the children.

Using data from the Rand Corp.'s HIV Cost and Services Utilization
Study, the team investigated whether HIV-infected parents had
maintained custody of their children during the two-year period from
1996 to 1998. They found that 47 percent of children remained in the
custody of an HIV-infected parent, while 42 percent were not in the
parent's custody at any time. The remaining 11 percent were out of
their parent's custody at some time during the study period.

HIV-infected fathers, parents with more advanced HIV disease, drug-
using parents and parents with at least one hospital stay were less
likely to have custody of their children.

A child's other biological parent or other family members
(grandparents, aunts/uncles) were most likely to be the alternate
custodian. Parents cited drug use (62 percent) and financial
hardship (27 percent) most often as reasons for losing custody of
their children. Only 10 percent of HIV-infected parents mentioned
the effects of HIV/AIDS as a reason for not maintaining custody of
their children.

"Improved treatments for HIV have enabled many HIV-infected parents
to live longer. Parents continue to face obstacles that can affect
their ability to maintain custody of their children, including
financial hardship, ongoing drug use, and the effects of HIV/AIDS
and medications used during treatment," said the study's primary
investigator, Dr. Mark Schuster, professor of pediatrics and public
health at the David Geffen School of Medicine at UCLA and director
of health promotion and disease prevention at RAND.

http://www.news-medical.net/?id=24861
http://www.ucla.edu

AIDS ASIA forum:

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/884

Thanks for posting the newspaper article on the situation of PLWHA in South
Korea. It's indeed sad news. I'd like to share my abstract that has been
accepted for a oral presentation at the International Association for the Study
of Sexuality, Culture, and Society in Peru. The presentation is based on the
first government funded research on human rights and health disparities among
PLWHA in South Korea. I am currently working on paper and article to submit in a
journal.

_________________________
“Killed Twice”: Sexuality, AIDS, and Nationalism in South Korea

Huso Yi, PhD, Korean Sexual-Minority Culture and Rights Center, Seoul, Korea

Prepared for the VI IASSCS Conference: Dis/organized Pleasures: Changing Bodies,
Rights and Cultures, June 27 – 29, Lima, Peru

Abstract:

South Korea, which used to be a “pure one-blood” ethnic homogenous country, is
now expanding in/out-flows of transnational bodies and culture. Despite the
global trend of Korean popular culture (“Korean wave”) and capitalist
industries, migrant workers, and international marriage (mostly middle aged men
to young women in late teens to early twenties from Southeast Asia), the country
has not loosened its unity by re-confirming the norms of citizenship in
sexuality. In contrast with growing institutional acceptance of sexual and
gender equality, AIDS is yet regarded as “social ill” where fear of discussion
of the communicable disease and being linked to it is wide
prevalent.

The paper presents a preliminary analysis of the first research on human rights
issues for PLWHA. Data were drawn from ethnography with
PLWHA and health service providers, survey of 215 PLWHA, and media analysis of
1,600 AIDS-related newspaper articles from 1982 to 2005. As of June 2006, sexual
contact accounted for 99% of the 4227 reported HIV diagnoses (c.f. <.01% of
total population; 91% male; 3454 PLWHA alive).

Notably, when a myth of “mixing with foreign blood” in the early epidemic was
questioned by constant increase of seroincidence in the localized epidemic, the
discourse of egalitarian human rights emerged. Yet, sexual rights and public
responsibility by the epidemic highly is conflicted. Unlike other countries,
since sexual health and rights movements had rarely connected with AIDS activism
until recently, perhaps for the purpose of achieving sexual citizenship in the
process of democracy, PLWHA did not even receive protective resource from the
sexual minority community. Besides, discrepancy
between the two operates by over-emphasizing individual sexual behavior in
intervention and eliminating social identity in care system. It implies
within-nation boundary between sexuality and disease. Structural barriers were
also identified in terms of absence of understanding of how sexual stigma
affects changing epidemic.


Best,

Huso

Huso Yi, PhD
Senior Research Associate/Co-Investigator
Institute for International Research on Youth at Risk, NDRI
New York, US

Deputy-Director
Korean Sexual-Minority Culture and Rights Center
Seoul, Korea
e-mail: <hy236@...>

Greetings from AIDS Healthcare Foundation!

I am enclosing this brief write up with a questionnaire attached for your kind
attention.  This is a working paper which will be exploring HIV counselling and
testing practiced in the region and the ongoing debate on provider initiated
testing and counselling within the context of expanding access to ARV treatment
strategies.

We are hoping to receive comments and feedback in the form of reply to the
attached questionnaire from each forum members. We shall acknowledge all the
respondents who will send us the completed questionnaire to the below address by
e-mail or by post.

We request you to send us the completed questionnaire before 20th May 2007. We
would be grateful to you all if you could send this questionnaire across to
those who are in the field and face this situation in a regular basis. We shall
also consider questionnaires reaching till the end of May for the final
analysis.

Title: Analysis of Prevailing HIV Testing Policy, Principles and Actual Practice

Background

HIV counselling and testing is an entry point to prevention, treatment and care
services. However, in the region testing for HIV is a big challenge and to make
inroads into how to increase number of people coming for HIV counselling and
testing raises serious questions on the existing HIV testing policy. In many
developing countries, epidemiological data on voluntary HIV testing in general
are very low. Even when anti-retroviral treatment is made available, many do not
access to such treatment. According to the current HIV testing policy in India,
HIV test could be provided only when people volunteer or request for an HIV
test. There is a huge gap in actual policy and what is practiced in reality as
it is evident from the national data on HIV counselling and testing. Therefore,
to understand the ongoing debates and discussions surrounding HIV counselling
and testing strategies in the country, we are preparing a working paper with the
following objectives:

Objectives:

To provide a comprehensive overview of the present HIV testing policy from the
perspectives of key stakeholders
To highlight specific issues on HIV testing policy on VCT/ ICTC and Provider
Initiated Testing and Counselling in selected countries
To understand the importance of HIV counselling and testing to expand access to
ARV treatment and early treatment and support interventions

Methodology
To achieve these objectives, we are compiling the views of different groups of
people living with HIV/AIDS in different regions on HIV testing policy adopted
in principle and what is practiced in reality. The study includes interviews
with programme managers, representatives from the donor agencies, NGOs, medical
community, FBOs, CBOs. On the basis of this analysis we are hoping to come up
with a set of recommendations that will enable to achieve comprehensive HIV
testing policy and expand access to ARV treatment and early treatment.

(We would like to get your valuable inputs through email. We have attached a
questionnaire which will take not more than 2 minutes to answer these questions.
We shall be grateful to you if you would like to share or to be quoted in the
working paper, kindly record your statements in the remark column against any
specific question)

Also, the working paper would be based on extensive literature review from
secondary sources.

Therefore, we request you to provide us with secondary sources in the form of
web links, reports, data from the region etc…which can be extensively quoted for
the working paper. We shall acknowledge every action of yours in the working
paper

Scope

This working paper provides enough scope to explore new strategies on HIV
counselling and testing policy to expand access to ARV treatment and early
treatment needed for the people.
------------------------------
Title: Analysis of Prevailing HIV Testing Policy, Principles and Actual Practice

Respondent’s Name & Organization:

Questionnaire: (Please copy - paste in text format and say ‘Yes’, ‘No’, ‘Don’t
Know’ and 'ADD ANY REMARKS TO SPECIFIC QUESTIONS' send it to us before 20th May
2007)

1   Are you aware of HIV testing policy in your country?

2  Is Voluntary Counseling and Testing [VCT] practiced in your country?

3 According to you, majority of people go for HIV testing by:
a)Voluntary basis OR
b)Referred (Doctors, Nurses, NGOs, Care Homes, etc)

4Who according to you amongst the list of service providers is the key initiator
for HIV Testing at VCT Center:


(a)Government Hospital Doctor

(b)Private Doctor/Hospital

(c)HIVAIDS NGOs

(d)Healthcare Providers

(e)Friend/Peer
                                                                      
(f)Spouse/Partner

(g)PLHA Network

(h)Outreach work

(i)TB Hospital
                                                                       (j)Self

5 Do you agree that service providers (See the previous question’s list) are the
main initiator for HIV Testing?

6 Do you agree that since the concept of HIV counseling and testing that most
HIV tests are mainly due to referrals from providers?


7 Do you agree that ART treatment increase demand for testing?

8 Do you agree that increase HIV Testing would increase demand for ART
treatment?

9  Do you agree that healthcare provider initiating and referring patient for
HIV counseling and testing is ethical?

10 Do you agree that increase HIV treatment services, more testing and easy
access to care and support reduced stigma and discrimination?

11 Do you agree that positive people, groups, networks should be more involve in
HIV counseling and testing issues?

12 Do you think that government should involve NGO in expanding HIV Testing
services?

13 Do you agree that less invasive testing methods such as saliva test for HIV
be introduce as initial screening method?

14  Do you agree that HIV testing and early diagnosis of HIV status leads to
initiation of prophylaxis, medications for OI’s etc. that improve the quality of
life?

15  Do you agree to halt and reverse the HIVAIDS epidemic we need to scale up
HIV Testing?

16  Do you agree that in policy and principle its VOLUNTARY Counseling and
Testing but in practice its Provider Initiated Counseling and testing?


Note: This tool is developed by AIDS Healthcare Foundation-Asia Pacific Region.
It is currently being used for the Working Paper on Analysis of Prevailing HIV
Testing Policy, Principles and Actual Practice”. We request you to acknowledge
‘AHF-Asia Pacific Region’ if the tool is reproduced. Kindly send the completed
questionnaire to
  chinkholal.thangsing@... or mahesh.ganesan@...

Thanks and regards


Dr Chinkholal Thangsing
Asia Pacific Bureau Chief,
AIDS Healthcare Foundation
S 7 Panchsheel Park,
New Delhi 110017, India
Tel: +91 41745541/41745542
Fax:+91 41745543
Cell:+91 98182 70687
chinkholal.thangsing@...
www.aidshealth.org

Dr Mahesh Ganesan
Advocacy Coordinator,
AIDS Healthcare Foundation
S 7 Panchsheel Park,
New Delhi 110017, India
Tel: +91 41745541/41745542
Fax:+91 41745543
Cell: +91 9911331998
mahesh.ganesan@...

30% of AIDS Patients Commit Suicide

By Kang Shin-who, Staff Reporter

Nearly 30 percent of AIDS patients end up committing suicide, Korean
Centers for Diseases Control and Prevention (KCDC) said Thursday.

According to KCDC, at the beginning of the year 4,755 people were
either HIV positive or suffering from the effects of AIDS. As of
March, this year 864 had died. Of this figure 258 people killed
themselves.

Moreover, the number of HIV-positive people who end their lives has
continued to grow over last five years, 18 in 2002, 26 in 2005 and 33
last year.

Experts say that the figure indicates that our society still isolates
and alienates AIDS patients.

``Public prejudice against AIDS has led to discrimination by other
members of society creating a sense of isolation,'' Seong Kyeong-
hoon, education manager of Korea Alliance to Defeat AIDS told The
Korea Times.

``To change it, we should open the AIDS issue to the public. I think
celebrities who are HIV positive should speak out as has U.S.
basketball star Magic Johnson,'' Seong added.

So far, 175 people were reported to KCDC having contracted HIV virus
in the first quarter of the year. However, the disease center says
that many patients have not come forward.

Among the reported patients, 162 or 93 percent were male and about 26
percent of them were in their 40s; 25 percent were in 30s, followed
by 17 percent in 20s.

The health center also sampled 48 among them and found that nearly 67
percent were infected with the disease through heterosexual
relationship while 33 percent got it through homosexual relationship.

kswho@...

http://www.koreatimes.co.kr/www/news/nation/2007/05/113_2269.html

National HIV/AIDS Care Advisor  (open to Chinese Nationals only)

Project: Xinjiang HIV/AIDS Prevention and Care Project (XJHAPAC)
Location:  Urumqi, China

Background

The Xinjiang HIV/AIDS Prevention and Care (XJHAPAC) Project was
designed as a five year program of assistance, with the purpose to
increase the capacity within the region to respond to the HIV and
AIDS epidemic through a multi sector prevention and care approach.  A
two year extension is now in place. The approach of the extension
phase will be a transition to sustainability. The project team will
work with counterparts to increase the depth of interventions, with
the aim of consolidating capacity to continue with the models
developed with support from the project to continue sustainably when
XJHAPAC finishes in 2009.

Project goal is to reduce the rapid transmission of HIV infection and
contribute to the reduction of the impact of the epidemic on the
social and economic development of the region.

Project purpose is to increase the capacity of the Xinjiang Uygur
Autonomous Region to respond to the HIV/AIDS epidemic with effective
multi-sectoral prevention and care programs.

Responsibility and objective of the National HIV and AIDS Care
Adviser position:
Working with the HIV and AIDS Adviser, this position will be
responsible for providing technical advice and support full-time.
This includes the provision of management and technical advice.

The management objective is to co-ordinate, mentor and monitor inputs
from STAs involved in providing technical advice to the project in
the areas of counselling, infection control, palliative and community
based care.

The technical objective is to support the development and
implementation of the continuum of care that reflects the needs of
people living with and affected by HIV and AIDS in the community. The
focus during the extension will be in the context of the "Four Frees
and One Care Policy" in providing a continuum of care, palliative
care, community and home-based care needs.  The interventions will
enhance current formal and informal services and identify and address
gaps to strengthen the continuum of care

Please forward your CV, which details the experiences for this
position, or any enquiries to

Lyn Harper at lynh@...

Dear All,

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/876

Greetings from India. Its sad to read about story on dilutions and changed
thinking on - Red Ribbon to Blue - Red Ribbon.

It's a strange world anyway and every one has their own interpretations and
thinking about self and the world. Let us not bother about all those, which are
not concerned to the larger Communoties and PLWHAs.

Let us express strongly our own commitments and sincerity on HIV/AIDS Awareness
and Prevention. Lets not get confused in our thinking and Good Practices.

We all are on the MDGs, the UNGASS DoC-2001 and other Best Practices to combat
the spread of HIV/AIDS. We are on a campaign: "We the People .....", lets drive
it into the mainstream.

Best Regards.

Dr. Ganesh Rane
e-mail: drrane@...

Clinton arranges cheaper 2nd line  AIDS drugs from India

Clinton arranges cheaper AIDS drugs

By Celia W. Dugger
Published: May 9, 2007

NEW YORK: Former President Bill Clinton announced that his foundation
had negotiated deep price reductions for generic versions of costly,
second-line AIDS drugs needed when the original medicines fail, as
well as for less toxic, easier-to-use first-line medicines combined
in a pill that can be taken once a day.

Clinton also forcefully endorsed recent decisions by Thailand and
Brazil to break patents held by U.S. pharmaceutical companies that
are charging prices Clinton described as exorbitant, but that drug
company executives said were reasonable.

"No company will live or die because of high price premiums for AIDS
drugs in middle-income countries, but patients may," Clinton said
Tuesday.

The new prices would halve the cost of the drugs for better-off
developing countries in Latin America and Asia and cut prices by 25
percent in poor countries, which were already paying lower prices,
the foundation said. The second-line medicines will be bought with
more than $100 million raised by a group of countries led by France.

The improved first-line therapies will largely be financed by the
Global Fund to Fight AIDS, Tuberculosis and Malaria, and other donors.
Second-line drugs have typically cost about 10 times as much as first-
line therapies. Costs have ballooned in Brazil and Thailand, which
began programs to provide universal access to AIDS treatment years
before African countries did, as patients have developed resistance
to generic first-line treatments and move to brand-name second-line
drugs.

The Clinton Foundation's willingness to buy the generic drugs from
the Indian manufacturers Cipla and Matrix will give developing
countries leverage in bargaining with U.S. companies for lower prices
on branded anti-retroviral drugs and may embolden some to follow
Brazil and Thailand in overriding patents, AIDS activists said.

But developing countries still have reason to worry about retaliation
from drug companies and trade sanctions by the United States.
This year, Abbott Laboratories, based in Illinois, withdrew new
drugs, including those for high blood pressure and AIDS, that it had
planned to introduce in Thailand until the override on Abbott's
patent on the second-line drug, Kaletra.

U.S. trade officials last week put Thailand on a watch list for
countries inadequately safeguarding the intellectual property rights
of American companies, noting the overriding of drug patents.

Tido von Shön-Angerer who leads Doctors Without Borders' campaign for
access to medicines, said he was unsure whether the recent
developments would encourage developing countries to exercise their
rights under international trade rules more freely, to make or import
generic drugs. "There's a strong chilling effect from the U.S.
action," he said.

Drug company executives on Tuesday strongly defended their policies
of charging better-off developing countries more for AIDS drugs than
they did for poor countries, as well as the role of patents, which
give inventor companies a monopoly on the sale of a drug, in
stimulating the development of new drugs.

Jennifer Smoter, a spokeswoman for Abbott, said patents were
needed "to ensure innovation in the future" but declined to respond
to Clinton's comment Tuesday that "Abbott has been almost alone in
its hard-line position here over what I consider to be a life and
death matter."

Abbott had been charging $2,200 annually per patient for Kaletra in
middle-income developing countries, which include India, China,
Brazil and Ukraine. Last month, it dropped the price to $1,000. The
foundation's new price for the generic is $695.

Jeffrey Sturchio, a vice president at Merck in New Jersey, said his
company strived to balance providing the broadest possible access to
AIDS drugs while maintaining financial incentives to attract
companies to conduct research and development on new drugs.

http://www.iht.com/articles/2007/05/09/news/aids.php

Dear Forum members,

The Melbourne newspaper, The Age, is today carrying a report that says the
Australian government is considering the public health implications of allowing
HIV-positive people into Australia, and that their movements within Australia
might be monitored.

The following is the public response of Brian Haill, the Founder/president of 
The Australian AIDS Fund Incorporated, a Melbourne-based AIDS-care agency of
some 20 years standing:

"Has Prime Minister Howard indeed reportedly written to his immigration and
health ministers asking if HIV/AIDS poses a public health risk, with a view to
monitoring or forbidding entry to Australia by HIV-positive visitors? If the
Prime Minister himself has to ask such questions some 20 years into the HIV/AIDS
pandemic, Australians have real cause for concern.Perhaps it explains why the
Budget provision for HIV prevention was so dismally low. ("Plan to track
HIV-positive visitors", The Age, 10/5)

"It was bad enough that Mr Howard gave a king hit to Australia's international
HIV response reputation by his recent remarks that he'd consider banning
HIV-positive people entering Australia, remarks aspiring Prime Minister Rudd has
yet to condemn.

"Stigma and discrimination are the twin fuels that have already powered  global
HIV infection to the frightening level that over 40 million men, women and
children are now struggling to live with with the disease, while five million
others are being infected every year.

"But it's far worse if the Prime Minister is actually considering any move to
tag the movements of HIV visitors to Australia. This is just a step away from
what the Nazis did to Jews, homosexuals and gypsies, by having them wear
distinctive patches on their clothing.

"How long before HIV positive Australian residents themselves would be  required
to report to government monitors as they move between Australian States,
especially given increasing and headline reports of deliberate HIV infection in
Victoria, South Australia, Queensland and Western Australia.Such thinking at the
very highest level of Australian government  should trigger alarm bells
throughout the nation.

"We would expect all political parties,civil libertarian groups, States
Attorneys-General, anti-discrimination bodies, and society and church
leaderships in Australia  to quickly condemn any such thinking that could only 
further stigmatise anyone living with HIV."

Brian Haill

President,
The Australian AIDS Fund Incorporated,
Melbourne, Australia.
Email: bhaill@...
Website: www.aids.net.au

Plan to track HIV-positive visitors

Annabel Stafford, Canberra

POSITIVE visitors to the country could have their movements monitored
or be prevented from coming altogether, under policy options being
considered by the Government.

Prime Minister John Howard has written to his immigration and health
ministers asking them for advice on whether HIV/AIDS poses a public
health risk and on the public health implications of letting HIV-
positive people into the country.

When Mr Howard said last month that he would consider stopping HIV-
positive people coming to the country unless there were humanitarian
reasons to let them in, his comments were dismissed by some as
populist.

But this latest move suggests there is a possibility those infected
could find it harder to come to Australia, or, if they can come, to
move about the country without having to report their movements.

A spokeswoman for Immigration Minister Kevin Andrews yesterday
confirmed the Department of Immigration and Citizenship was preparing
advice for the Prime Minister.

The department was "looking at what requirements we have under
different visa classes (for HIV testing)" and whether these need to
be expanded, she said.

People wanting to become permanent residents are currently tested for
HIV, but some on student or business visas are not, she said. When
people do test positive for HIV, their immigration is automatically
reviewed by health authorities who look at whether they will pose a
significant cost to the health system or whether they can support
themselves. But the final decision on whether they can come to
Australia is at the discretion of the Immigration Minister. State
authorities are not necessarily notified if an HIV-positive person is
moving to their jurisdiction.

The Age believes that the departments are also investigating whether
different government agencies should be notified of the movements of
HIV-positive immigrants. But privacy issues will be considered as
well as the rights of people to travel freely without details of
their health status being made broadly available, The Age believes.

A source said the review was not considering a broad ban of all HIV-
positive people, but better screening and monitoring and ways of
monitoring or blocking those that set off "warning bells".

Mr Howard's comments and the subsequent policy review were sparked by
comments from Victorian Health Minister Bronwyn Pike, who last month
attributed part of the increase in HIV infections in Victoria in
recent years to HIV-positive people moving to the state from other
states or overseas.

Ms Pike was under pressure after revelations that her department had
failed to stop Melbourne man Michael John Neal from allegedly trying
to deliberately infect others with HIV, despite being warned several
times about the risk he posed.

Federal Health Minister Tony Abbott has now asked a committee of
state and federal chief health officers to consider national
guidelines for dealing with such cases. But the policy options being
looked at by the immigration, health and possibly other departments,
go much further.

Australian Federation of AIDS Organisations spokesman Don Baxter said
yesterday that "infections arising from short-term visa holders have
had a minuscule impact" and screening of tourists would adversely
affect the industry. But he said the federation was most concerned
about the "false sense of security" screening conveyed that "people
with HIV will be kept out therefore it's OK to have unsafe sex with
people from other countries".

http://www.theage.com.au/news/national/plan-to-track-hivpositive-
visitors/2007/05/10/1178390469695.html

Should patient groups accept money from drug companies? No
Barbara Mintzes, research associate

Therapeutics Initiative and Health Action International (HAI-Europe),
2176 Health Sciences Mall, Vancouver BC, V6T 1Z3 Canada
e-mail: bmintzes@...
BMJ  2007;334:935 (5 May), doi:10.1136/bmj.39185.394005.AD

Patient groups provide valuable support and advocacy for vulnerable
people but funding the work can be difficult. Alastair Kent argues
that not accepting industry money will unnecessarily limit the
groups' effectiveness, but Barbara Mintzes believes that the money
undermines their independence

Patient groups provide information, advice, and support; represent
patients on governmental committees; and speak in the media on behalf
of patients. They can be a voice for someone who faces pain, invasive
procedures, isolation, disability, and at times discrimination and
poor medical care. However, a different view emerges in the
pharmaceutical marketing literature, of "allies to help advance brand
objectives".1

Can patient groups provide impartial information and represent people
who are ill if they are funded by companies that sell products to
treat those illnesses? I believe that the conflict of interest
inherent in such a relationship makes this difficult. For patients
there are three key risks:

Disguised promotion channelled through a seemingly neutral third
party

Confusion between patients' and sponsors' interests in policy of
patient groups

Inadequate representation when those interests diverge.

How big is the problem?

Industry funding of patient groups is common. Ball et al examined
websites of 69 patient groups for 10 chronic conditions; 37 (54%)
disclosed funding sources, with 31 getting some industry funding.2 In
a random sample of US patient groups with annual revenues over $100
000, 20 (80%) received industry funding and two (0.8%) did not accept
it.3 The four groups representing conditions associated with
accusations of disease mongering had over 20% industry funding
compared with 3/25 (12%) of the randomly selected sample.3 A 2003
survey of Finnish patient groups found that 39 out of 55 (71%)
received industry funding.4 Rates of 33-60% have been reported in
Ireland, Sweden, Germany, the UK, and Italy.5 6 7 8 9

Evidence of influence

With such widespread funding from drug companies we need to consider
how this might affect the independence of patient groups. Industry
sponsored research is more likely to report drug benefits than non-
sponsored trials.10 No similar systematic analyses exist of patient
groups, but support for sponsors' drugs and policies in funding
companies' interest is common.

The Canadian Arthritis Society is well respected for its patient
services. However, in 2000, the society's logo was used on newspaper
supplements claiming safety advantages for celecoxib and rofecoxib
without disclosing funding from the manufacturers.11 In 2007, a fact
sheet on the society's website called cox-2 inhibitors "an
advance . . . in terms of safety and stomach protection," without
mentioning cardiovascular risks.12 The society has partnership
guidelines and 6-7% industry funding.

In the United States, a 2001 memo from Merck disclosed in court shows
that the company sought to use the Arthritis Foundation's pain
management programme for promotion. The foundation's president was
unaware of this but unconcerned: "We envision that as an educational
program. Their marketing folks envision it as marketing."13

Cancer United, a patient group funded by Roche, which markets
trastuzumab (Herceptin) and bevacizumab (Avastin) is run by the
public relations company Weber Shandwick.14 The group advocates full
funding of cancer drugs in Europe. Another charity, Cancerbackup
praised trastuzumab as "impressive" in early breast cancer without
mentioning cardiotoxicity or funding from Roche; 9% of its funding is
from industry.15

Emerging concerns about drug safety are highly relevant to patients
but can also be overlooked. For example, the Asthma Society of Canada
fails to mention concerns about higher asthma mortality with long
acting  agonists in its treatment brochures.16 17 The Irish
depression group AWARE sees destigmatisation of antidepressant use as
part of its mandate, but avoids participation in media debates on
antidepressant risks.5

Pressure on reimbursement agencies

When the UK's National Institute for Health and Clinical Excellence
(NICE) recommended restrictions on use of cholinesterase inhibitors,
the Alzheimer's Society, which is partly funded by industry, mounted
an intense lobbying campaign and joined donepezil's manufacturers in
a legal challenge, despite unimpressive evidence of benefit. In
British Columbia, the only Canadian province not to fund these drugs,
the Alzheimer's Society claims that some people get greater than
average benefits but did not support a provincial initiative for
double blind n of 1 crossover trials to determine coverage.18

Industry funded groups often exert strong pressure on governments to
reimburse sponsors' drugs. Michael Rawlins, chair of NICE, warns, "In
the long term it will do the patient organisations an immense amount
of damage and the confidence in their neutrality will dissipate."19

Governments increasingly include public representatives on advisory
committees and European legislation now requires this of the European
Medicines Agency. Despite conflict of interest guidelines, these
representatives are often selected from industry funded patient
groups and networks. The European Patients' Forum represents patients
at the medicines agency and the European Union Pharmaceutical Forum.
The forum was founded solely with industry funding and remains over
90% industry funded.20 On its website, a report funded by Pfizer
supports industry's "strong desire to provide more information than
currently allowed" to consumers and patients.

Does disclosure ensure independence?

The Association of British Pharmaceutical Industry's call for members
to disclose charity funding is a positive step. Better national
regulations governing charities are also needed, to ensure full,
easily accessible, and consistent disclosure.

Are such steps sufficient? From the evidence above, it seems that
even small donations can affect a group's stance. A consumer group
funded by telephone companies would not be trusted to judge the best
mobile phone package, nor to be a public advocate on
telecommunications policy. Is health less important?

----------------------------
Competing interests: BM is a research consultant with Health Action
International, vice-president of DES (diethylstilboestrol) Canada,
and on the Steering Groups of Women and Health Protection and
Pharmawatch. These are consumer and patient groups without industry
funding. She works with the Therapeutics Initiative, funded by the
British Columbia Ministry of Health to carry out systematic drug
reviews that are background reports for drug financing decisions, and
as a clinical reviewer for Canada's Common Drug Review.

References

Durand M. Pharma-s advocacy dance. Pharmaceutical Executive 2006 Oct
1. www.pharmexec.com/pharmexec/article/articleDetail.jsp?
id=377999&searchString=Pharma's%20Advocacy%20Dance

Ball DE, Tisocki K, Herxheimer A. Advertising and disclosure of
funding on patient organisation websites: a cross-sectional survey.
BMC Public Health 2006;6:201.[CrossRef][Medline]

Marshall J, Aldhous P. Patient groups swallowing the best advice? New
Scientist 2006 Oct 28:19-22.

Toiviainen HK, Vuorenkoski L, Hemminki E. Survey on Finnish patient
organizations shows economic and other interactions with drug
industry. First annual meeting of Health Technology Assessment
International, Krakow, Poland, 30 May-2 June, 2004.

O'Donovan O. Corporate colonization of health activism? Irish health
advocacy organizations' modes of engagement with pharmaceutical
corporations. Int J Health Serv (in press).

Media debate in Sweden on industry's relationship with patient
groups. Scrip 2005;3054:6.

UK patient groups accused of being `ground troops' for pharma. Scrip
2004;3009:2.

Tufts A. Sponsorship of patients' groups should be made more
transparent. BMJ 2006;333:1238-d.[Free Full Text]

Mosconi P. Declaration of competing interests is rare in Italian
breast cancer associations. BMJ 2003;327:344.[Free Full Text]

Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry
sponsorship and research outcome and quality: systematic review. BMJ
2003;326:1167-70.[Abstract/Free Full Text]

Batt S. Marching to a different drummer: health advocacy groups in
Canada and funding from the pharmaceutical industry. Women and Health
Protection, 2005. www.whp-apsf.ca/pdf/corpFunding.pdf

Arthritis Society of Canada. Understanding medications: coxibs.
www.arthritis.ca/tips%20for%20living/understanding%
20medications/coxibs/default.asp?s=1

Ginsberg T. Donations tie drug firms and nonprofits. Philadelphia
Inquirer 2006 May 28.

Boseley S. Concern over cancer group's link to drug firm. Guardian
2006 Oct 18.

Slevin M. Funding of patients' groups. Lancet 2006;368:202.[ISI]
[Medline]

Asthma Society of Canada. Medications: asthma basics #3. Use as
prescribed. www.asthma.ca/corp/services/pdf/Medication.pdf

Salpeter SR. Buckley NS, Ormiston TM, Salpeter EE. Meta-analysis:
effect of long-acting beta-agonists on severe asthma exacerbations
and asthma-related deaths. Ann Intern Med 2006;144:904-12.[ISI]
[Medline]

Morgan S, Bassett K, Mintzes B. An outcomes-based approach to
decisions about drug coverage policies in British Columbia.
Psychiatric Serv 2004;55:1230-2.[Free Full Text]

Templeton S-K. Health charities get `covert' aid from drug firms.
Sunday Times 2006 Dec 3.

Health groups want European Patients' Forum to be more transparent.
Scrip 2005;3076:3.

Hello,

After 12 weeks, we now have over 3,300 responses to our survey on
lubricants used for anal sex, coming from 84 countries. BRAVO and THANK YOU to
all of you for filling out the survey and making sure it gets widely
disseminated!

We are waiting for confirmation that UCLA will assist us with the data analysis,
and hope to have preliminary results out in the next few weeks.

In the meantime, your assistance is requested on two fronts:

1) We already have the survey translated into 4 Indic and Dravidian
languages (Hindi, Marathi, Tamil and Telugu), but I have been unable to find
web-based survey sites that support Indic and Dravidian fonts. If anyone knows
of one, please let me know!

2) Once we have preliminary results to share, we will ask your
assitance again in getting those out to relevant web sites, listservs and key
partners and constituents. In the meantime, we certainly could improve the
response rates to the survey in French, German, Spanish and Portuguese, as well
as responses from Africa, Latin America, Asia and Europe. Also, more responses
from women would be great as well. We had set a goal of having 20% female
respondents, and it would be great to reach that goal soon! We have already
raised that proportion from 10% to 15% in just 4 weeks, so we can do it again!

Finally, a special award should be created for the Turks! They have the  second
highest number of responses both in terms of languages (after  English) and
countries (after the US). This is particularly amazing when you consider there
are 70 million people with Turkish as their native language, compared to 1
billion for Spanish, French, German and Portuguese combined!!

Also, for  those of you who are able to take this survey if you haven't already,
please go to www.irmwg.org


Marc-André LeBlanc, Secretary
International Rectal Microbicides Working Group
e-mail: <mleblanc@...>
_________________


Shaleena Theophilus
e-mail: <shaleena@...>

Red Ribbon to Blue-Red Ribbon: Diluting the brand equity, and
confusing the message?

(AAeF) It was the final hours of the Cricket, world cup match.  Sri
Lankan Team was playing against Australians.   A close up of the
sleeves of the  Australian opening batsman Adam Gillchrist was
filled  on the TV screen with what appears as a blue ribbon.

"What is that ribbon on Gillchrist's sleeve?" enquired a fellow
spectator of the game.

"That is a read ribbon, which stands for AIDS awareness" I
volunteered to answer the question.

"I know about Red Ribbon. This is not Red Ribbon" Came the response
from my fellow spectator.

When the TV lenses zoomed again on Gillchrist. I tried to look at the
red ribbon more carefully. It was a half blue – half read ribbon, the
blue arm of the ribbon pinned over the red arm of the ribbon.

Well, this is not the red ribbon many of use are aware of- as the
universal symbol of solidarity to people living with HIV/AIDS and
awareness about HIV/AIDS.

"When did they change the Red Ribbon as the symbol of HIV/AIDS
solidarity and awareness?  And who took the decision to change it?"

Brand equity is the value built-up in a brand. It is measured based
on how much a customer or a consumer is aware of the brand. The
simple red ribbon has been an international symbol of AIDS awareness
since 1991. The Red Ribbon Project was created by the New York based
organisation Visual AIDS, which brought together artists to create a
symbol of support for the growing number of people living with HIV in
the US. Wearing a red ribbon is a simple and powerful way to
challenge the stigma and prejudice surrounding HIV and AIDS that
prevents us from tackling the global epidemic.

The first international celebrity to wear a red ribbon was Jeremy
Irons at the 1991 Tony Awards. The symbol came to Europe on a mass
scale on Easter Monday in 1992, when more than 100,000 red ribbons
were distributed during the Freddie Mercury AIDS Awareness Tribute
Concert at Wembley stadium. More than 1 billion people in more than
70 countries worldwide watched the show on television. Throughout the
nineties many celebrities wore red ribbons, encouraged by Princess
Diana's high profile support for AIDS.

The International Cricket Council (ICC) teamed up with UNAIDS, UNICEF
and the Caribbean Broadcast Media Partnership on HIV/AIDS at the ICC
Cricket World Cup 2007 to "highlight the situation of children and
young people living with and affected by HIV".

It is estimated that more than two billion television viewers are
expected to tune in to the seven week long ICC Cricket World Cup
2007, which began with an Opening Ceremony on 11 March in Jamaica.

However, there was no explanation on the reason for the changes in
the "colour of the red ribbon"  One could assume that the new blue-
red ribbon symbolises "situation of children and young people living
with and affected by HIV". However, at the closing ceremony of the
ICC Cricket World Cup 2007, the volunteers formed a human Red Ribbon.

The Unite for Children, Unite against AIDS campaign promotes four
key  areas: prevention of mother to child transmission of HIV, the
virus  that causes AIDS; increased access to antiretroviral therapy
for  children and young people who need treatment; education
programmes to  help prevent HIV transmission; and increased support
for children who  are orphaned and left vulnerable by AIDS. But,  the
logic, need  behind the promotion of the  new symbol – Blue- Red
ribbon as a symbol  of the campaign  unite for children unite against
AIDS, has net yet been clearly articulated.

In the absence of any compelling reasons for a sub-symbol to
highlight the impact of HIV/AIDS on Children, introduction of this
new symbol is essentially diluting the brand equity of red ribbon; as
a symbol of support for people living with HIV/AIDS, and confusing
the message- a simple and powerful way to challenge the stigma and
prejudice surrounding HIV and AIDS.

The promotion of the new symbol – Blue- Red Ribbon as a symbol of the
campaign to unite for children unite against AIDS, is counter
productive and unwarranted.

The brand equity of red ribbon as a symbol of solidarity to people
affected by HIV/AIDS and awareness about the issues surrounding
HIV/AIDS has built-up through the hard work of many.  The simple red
ribbon has been an international symbol of AIDS awareness  since
1991, if  there is need for a re-branding of the red ribbon, that
require extensive consultation with the key stake holders. The
decision to change the Red Ribbon to Blue-Red Ribbon dilutes the
brand equity of Red Ribbon, and confusing the message.

Should patient groups accept money from drug companies? Yes

Alastair Kent, director. Genetic Interest Group, London N1 3QP
BMJ  2007;334:934 (5 May), doi:10.1136/bmj.39185.461968.AD
e-mail: alastair@...

Patient groups provide valuable support and advocacy for vulnerable
people but funding the work can be difficult. Alastair Kent argues
that not accepting industry money will unnecessarily limit the
groups' effectiveness, but Barbara Mintzes believes that the money
undermines their independence

By accepting donations from drug companies, patient groups lay
themselves open to allegations that they are losing their
independence and becoming part of industry's efforts to "sell more
pills." Not taking such money reduces the opportunity that patient
groups have to advance their case for better services and support the
individuals and families on whose behalf they speak. Damned if they
do, and damned if they don't; is there a way to steer through this
dilemma?

There is nothing inherently wrong with patient groups taking money
from the drug industry provided that it does not put them under
pressure to adopt a position that they would otherwise not choose to
take up. Patient groups and industry share some common objectives, so
collaboration is reasonable when these mutual interests overlap.
Industry can provide core funding, funding for projects or
publications, or both. Providing the source is acknowledged and there
are no hidden strings, industry funding can be an important boost to
the viability of patient groups—particularly as public or charitable
funding often does not cover core costs.


No giving is free
The idea that public money, or grants from charitable trusts, come
without strings attached is a fiction. No person or group will be
overly keen to support a campaigning organisation if they think that
their money will be used to "buy a stick to beat them with."
Government grants often give the grant making department the control
over outcomes. A Charity Commission survey of over 4000 charities
delivering public services showed that only 26 "felt free to make
decisions without pressure to conform to the wishes of the funders"—
that is, the public sector.1

Nor is it the case that public sector bodies display higher standards
of ethical conduct than private sector ones. The World Health
Organization recently seemed to be trying to use a patient
organisation to disguise a grant from industry to help fund a report
on mental health (although it claimed clumsy wording led to a
misunderstanding).2

So why not go to the general public for support? This is an option
for some, but the public is more inclined to give to causes it
understands, and patient organisations (particularly if they
concentrate on policy and strategic issues rather than hands-on
support for affected individuals) may not attract instant public
sympathy. Arguments about animal experimentation or the use of
embryonic stem cells, for example, are difficult to communicate
through sound bites to a mass audience.


Ensuring independence
Patient organisations should not take money from the drug industry if
they feel that it would compromise their ability to achieve their
objectives. Just as many patient groups will not accept tobacco
money, or other ethically unacceptable sources of funding, so they
should avoid becoming over dependent on any one funder, whether
public or private. Fashions in funding change, just as they do in any
other walk of life, and today's funding priority can quickly become
tomorrow's lost cause. Without diversified funding, patient groups
can find themselves dangerously exposed. Diversity also gives
protection from the fear of undue influence being exerted. Although
it may be painful to walk away from a funder, doing so will be much
less of a problem if your portfolio is diversified.

Although clumsy attempts have been made in the past to use money to
manipulate patient groups, the Association of British Pharmaceutical
Industry recently established a framework for industry funding of
patient groups.3 4 A few simple precautions help deter inappropriate
offers of help. Patient groups should ask themselves about the
origins of an idea for a given project—was it their own or did a
third party propose it? Do they retain control over the process and
the outputs? Is there any desire to conceal the payer's identity? If
financial support is out in the open and any attached strings are
clear and appropriate (for example, restricted to a specific project
or publication) then industry money is as good as that from any other
source. Neither patient groups nor the drug industry should be shy
about a relationship that has the potential to benefit not just the
participants but which can also improve effective patient advocacy.
Indeed, it is surprising to many working for patient groups that the
drug industry is not a more vociferous champion of its relationship
with patient groups. Industry funding has been an enabler for many
patient groups—just as it has for clinicians and academics.

Patient groups are not naïve. They value their independence fiercely
and are quite capable of spotting the strings that may be attached to
funding—whatever the source. If those strings are unacceptable then
most will walk away. In the experience of many patient groups,
industry money often comes with fewer strings than that from any
other source.

Although it can feel ideologically fine to take the moral high ground
and turn your back on drug industry money, out in the real world
there is a job to be done. Patient groups need to be principled, but
they need to be pragmatic too. Patients demand effective advocates,
and if drug company money makes this possible then bring it on.
Actions that change things for the better will be welcomed by
patients irrespective of the funding source. Ideological purity at
the cost of preserving the status quo will and should be rejected as
a cop-out.

--------------------------------------
Competing interests: AK has received honoraria from GSK and Novartis
and has travelled to speak at conferences paid for by Roche, EFPIA,
and Genzyme. The Genetic Interest Group has received funding from
various pharmaceutical and biotechnology companies in the past year
(see www.gig.org.uk/gig/docs/annualreport0506/website.pdf for list).

References

Charity Commission. Stand and deliver. Liverpool: Charity Commission,
2007. www.charity-
commission.gov.uk/Library/publications/pdfs/RS15text.pdf

Day M. Who's funding WHO? BMJ 2007;334:338-40.[Free Full Text]
Association of British Pharmaceutical Industry. The pharmaceutical
industry and patient groups.
www.abpi.org.uk/press/media_briefings_06_ntfrs_0c5204e4/patient_groups
06.pdf

Association of British Pharmaceutical Industry. Patient groups,
industry support and medicines.
www.abpi.org.uk/publications/briefings/patientgroups_medicines.pdf

Gita Ramjee: A passion for prevention

The HIV researcher at the centre of a row over clinical trials tells
Linda Nordling why she will never give up

Tuesday May 8, 2007
The Guardian

Months have passed, but Professor Gita Ramjee still recoils at the
memory of events that came close to robbing South Africa of one of
its top scientists. "There came a point when I thought: is it worth
my while? I have dedicated my life to finding an HIV prevention
option for the women of Africa, and these recent attempts to tarnish
my efforts have been very demotivating."

It is fitting that we meet on a day when freak waves and high winds
are causing widespread damage along the Kwa-Zulu Natal coastline. A
storm of a different kind rocked her research unit recently. A storm
less forceful perhaps, but more damaging to those inside.

In January, Ramjee, director of the HIV prevention research unit in
Durban, received the news that a routine inspection by an external
team of experts had discovered anomalies in data from a study of a
potential new microbicide to protect women against HIV/Aids.

Alarmingly, more women receiving the vaginal preparation of cellulose
sulphate appeared to have developed HIV, compared with the group not
receiving the product. Although the numbers were very small, the
external team decided to halt the trial for safety reasons.

A press release was issued explaining that the treatment "might"
increase women's chances of HIV infection. Test products were
recalled from the 1,333 women participating in South Africa, Benin,
Uganda and India, and Conrad, the US-based sponsor of the trial,
ordered a review to shed light on what had happened.

Press field day

Ramjee wished it could have stopped there. But it didn't. The press
had a field day with what was incorrectly christened a "botched"
trial. Some called the women testing the drug "guinea pigs",
encouraged by the scientists to have unprotected sex using the gel as
an aphrodisiac. "I think the whole world was horrified that certain
South African press could stoop so low. That they could misunderstand
an issue so much," says Ramjee

The articles were not just damaging to other HIV prevention efforts
at the unit, but to clinical trials as a whole, she says. "Negative
press such as this can destroy HIV prevention efforts. We need to
have a united front, with civil society and scientists working
together to address the problem and applauding volunteers who come
forward to find solutions." But she admits her unit could have done
more to prevent what happened. "In future, I would like to do it
better, get the press involved, make them understand the science and
interpretation of data."

In the aftermath, Ramjee received strong support from her colleagues,
sponsors and even from participants in the trials. The last tried to
put the record straight with the press. "Don't tell us that we are
guinea pigs, we know exactly what we're doing, and can think for
ourselves," they told the journalists. Did the press print their
stories? "No."

But Ramjee's heart sank. It felt like the very people she had
dedicated her life to help had turned against her. "At the time I was
very, very depressed." But she did not give up. "A lot of people said
to me: if you, one of the best clinical trialists in the world, don't
continue with this fight against HIV/Aids, who will? So you have to
motivate yourself again."

Such dedication to what she values most is a recurring phenomenon in
Ramjee's life. Not for her the latte-sipping existence enjoyed by
some of her contemporaries. "I'm not the type of woman who likes to
spend hours at shopping centres with friends," she says. Instead, her
life has revolved around her family and her career, with the former
taking precedence.

Perhaps it was the many upheavals of her youth that taught her to
hold on to what could always be counted on: close family and her own
faculties. Growing up in Uganda, her first experience of exile came
at the hands of Idi Amin, the dictator who forced all Asians out of
the country in the 1970s. After a couple of years in a high school in
India, the land of her ancestors, she relocated again, this time to
the University of Sunderland in the north-east of England.

It was in here that she met her future husband - a South African of
Indian descent. In 1981, on finishing her degree, she followed him to
South Africa. It was a culture shock. In the early 80s the apartheid
regime was weakening, but still held on to power, particularly in the
Transvaal region, from where her husband's family came. "It was
extremely difficult for somebody used to living in a multicultural,
open society. As a student in England, you didn't look at colour. You
looked at people as individuals."

In search of more liberal surroundings, the young couple moved to
Durban. Here, Ramjee felt more at ease. She felt welcomed by people
from a variety of backgrounds. "I think it was nice for them to meet
somebody who wasn't thinking in the past. I felt very comfortable
living in Durban at that time." She got a job in paediatrics at a
local hospital. This put her in the way of a masters degree and,
ultimately, a PhD on the kidney diseases of children, which she
completed in 1994.

By that time she had two sons whom she tried - sometimes in vain - to
shelter from the idiosyncrasies of South African society. "I was so
determined, coming from a multicultural society, that I would never
put my child in a single-race school." This was easier said than
done, but in the end she succeeded.

The years of her doctorate saw Ramjee make superhuman efforts to stay
on top of family and career. "I used to get up at six in the morning,
prepare food, wake my children, send them off to school, do a half
day of practical work, come back, pick my sons up from school, help
them do their homework and send them to sleep." She would then
herself go to sleep at 8pm only to get up again at two in the morning
to write her thesis. She kept this up for a year. "I never gave up my
responsibility as a parent. Although I wanted to excel in my career,
I never wanted to compromise myself as a mother."

Nascent technology
The sacrifice paid off, but in a roundabout way. After her PhD,
Ramjee wanted a break, but fearful of too much leisure time, she
sought out a small project that would pass the time when her sons
were at school. She found a small research project evaluating the
acceptability of a vaginal microbicide, at that time a nascent
technology in the armoury against HIV/Aids. This work put her in
contact with local sex workers - a "reality check" as she calls it.

"It opened my eyes. These are good women, who are put in a position
that people scorn." In the mid-90s, when Ramjee started working with
sex workers in Kwa-Zulu Natal, 50% were HIV positive. "These women
mostly aren't doing this out of choice. The stories they used to tell
us were horrific. That's when I knew I wanted to be involved in the
prevention of HIV infection in women."

What began as a short project evolved into a strong commitment. In
the years to follow, Ramjee worked her way up through the ranks to
finally head the Durban unit. She inherited a staff of 21, and
quickly built this into a 300-strong organisation with an
international reputation for excellence.

She is matter of fact about her success: "Because I did so well in
clinical trials, I had offers pouring in for me to do clinical
research. I think the key to success is my approach to capacity
building, respecting each and every member of my staff, the
community, and also the fact that I delivered on the contracts. It is
my holistic approach to research, where I'm not just thinking
science."

Today, Ramjee is looking ahead. The final results of a recently
completed trial on a vaginal diaphragm will be out in the next couple
of months and other trials are also nearing completion. There is a
long way to go. "What people don't realise is that none of the
current generation of microbicides or any other prevention technology
is going to be 100% effective. So whether there are microbicides or a
vaccine out there or not, there is nothing that will to allow you to
go have unprotected sex without the risk of infection. Not for a
long, long time."

Still, the recent crisis has taught her the importance of striking a
new work-life balance. "In a way, I feel that while I'm passionate
about my work, it is too consuming a passion. I need to find a more
balanced situation, where I do things that I enjoy as well." But
finding the time to do that will be difficult, she admits. "It's in
my nature to want to excel. My calling is to find a solution. If I
don't succeed in my lifetime, at least I've worked towards it."

Curriculum vitae
Age: 50
Job: Director of the HIV prevention research unit in Durban, South
Africa
Lives: In Durban with her husband, a pharmacist
Likes: spas, exotic travels
Dislikes: insincerity and dishonesty
Married:, with two sons

http://www.guardian.co.uk/science/story/0,,2074720,00.html

Dear all

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/860

I am Violeta Ross from Bolivia, this is in Latin America, but even here, I can
tell you as an anthropologist, we are in terrible situation. All the messages
related to HIV/AIDS awarness and care, are:

   * middle class and upper
   * western
   * condom oriented
   * individual oriented
   * uncomprehensible for people in indigenous cultures in Bolivia

Violeta

Gracia Violeta Ross
Tel 591-2-2777420, Cel (Mobile) 591-70678041
Chasquipampa, Calle 43 Nº 271, a media cuadra de la Av. Hernán Siles Zuazo,
Casilla (PO Box) 498, La Paz- Bolivia
e-mail: graciavioleta@..., graciavioleta@...