http://www.Plusnews.org Updated every day en-gb Sun, 22 Nov 2009 01:27:00 GMT United Nations Integrated Regional Information Networks, http://www.Plusnews.org NAIROBI, 20 November 2009 (PLUSNEWS) - HIV-positive women in western Uganda want fewer children than women not living with the virus, but often do not have access to family planning services, a new study reveals. http://www.IRINnews.org/images/2007/200702263t.jpg NAIROBI, 20 November 2009 (PLUSNEWS) - HIV-positive women in western Uganda want fewer children than women not living with the virus, but often do not have access to family planning services, a new study reveals. The study of 421 women in the district of Kabarole found that the probability of HIV-positive women wanting to stop childbearing was 6.25 times greater than it was for HIV-negative individuals. “HIV-positive women tended to want fewer children than their HIV-negative counterparts mainly because they are aware of the risks of mother-to-child transmission and do not want to go through the difficulties associated with having an HIV-positive child,” said Walter Kipp, global health professor at the University of Alberta in Canada, and one of the study’s authors. Statistics from the UN Children’s Fund http://www.scribd.com/doc/20951464/PMTCT show that in 2008, only 55 percent of HIV-positive pregnant women received antiretroviral treatment to prevent mother-to-child transmission; close to 30,000 Ugandan children are infected with HIV at birth every year. Kipp noted that the survey’s results highlight the urgent need to integrate family planning into HIV services. “Family planning in Uganda is not well developed, and if women want to stop having children, often they have no access to contraceptive pills or other family planning methods,” he said. According to the Ministry of Health, 41 percent of Ugandan women who would like to stop having children have no access to family planning services. The country has the third-highest population growth rate in the world; only Yemen and Niger have higher rates. Kipp noted there was a need to harmonize the messages of family planning groups, which tended to recommend the use of hormonal contraception over condoms for contraception, and HIV groups, which emphasized condom use for prevention. “For HIV-positive women, we would usually recommend dual protection, which is the use of both a hormonal contraceptive and condoms,” he added. A recent analysis http://journals.lww.com/aidsonline/Abstract/2009/11001/Benefits_and_costs_of_expanding_access_to_family.14.aspx published in the Journal of the International AIDS Society found that family planning was cost-effective for preventing HIV transmission and unintended pregnancies and would also reduce infant and maternal mortality and result in fewer orphans. The survey noted there was a need for education to inform the population on the benefits of family planning and end misconceptions around the subject. “There is a belief that hormonal contraception can affect future fertility, and that it may lead to malformed children in the future,” Kipp said. “However, the main barrier that needs to be overcome is the lack of availability of these services for women who need them.” kr/oa/mw http://www.plusnews.org/report.aspx?ReportID=87125 http://www.plusnews.org/report.aspx?ReportID=87125 JOHANNESBURG, 19 November 2009 (PLUSNEWS) - In less than seven months South Africa will host the world's biggest single sporting event - the FIFA World Cup. The chance to reach millions of local and visiting football fans presents a golden opportunity, not only for the country's business and tourism sectors, but also for its efforts to combat HIV/AIDS. http://www.IRINnews.org/images/2007/2007082113t.jpg JOHANNESBURG, 19 November 2009 (PLUSNEWS) - In less than seven months South Africa will host the world's biggest single sporting event - the FIFA World Cup. The chance to reach millions of local and visiting football fans presents a golden opportunity, not only for the country's business and tourism sectors, but also for its efforts to combat HIV/AIDS. Health officials, activists and civil society organisations met in Johannesburg on 18 November to plan how to make the most of the event, which will span 30 days and take place in eight of South Africa's nine provinces. Recent international media reports have suggested that the World Cup could aggravate the country's already severe HIV/AIDS epidemic, but several speakers saw the event as a chance to address the health crisis, among them former soccer player Ronny Zondi, who represented the Sport and Entertainment Sector of the South African National Aids Council (SANAC), the body coordinating HIV activities linked to the World Cup. Stadiums, fan parks, hotels and bars are all potential venues where HIV prevention messages could be promoted, condoms and pamphlets distributed, and voluntary counselling and HIV testing made available. The need for all the organizations involved to work with each other and FIFA and its local organizing committee (LOC) to avoid duplication of efforts and confused messaging was emphasized. LOC Chief Medical Officer Dr Victor Ramathesele urged participants to tap into FIFA's marketing expertise to push HIV/AIDS messages before and during the World Cup. Noluntu Ntloko, from FIFA's marketing division, briefed participants on restrictions on the use of registered World Cup trademarks, or branding that could conflict with that of its sponsors and commercial partners, and encouraged organizations to channel any planned HIV activities through the LOC. Through its Football for Hope Movement, FIFA is already partnering with civil society organizations involved in HIV/AIDS initiatives. One such partner, Grassroots Soccer, works with a local NGO, Sonke Gender Justice, to train soccer coaches to teach young people about HIV and AIDS. Rather than limiting their efforts to duration of the event, several organizations are planning campaigns that will last the entire year and reach people all over the continent. Wayne Alexander, of Dance4Life, an international initiative that enlists young people to raise awareness about HIV/AIDS, told the meeting about Fair Play for Africa, a campaign to mobilise communities to advocate for quality healthcare for all Africans, and to hold their governments accountable for health provision. So far 200 NGOs have committed to getting involved and activities in 12 African countries are planned for 2010. "We have come a long way," commented Dr Robin Petersen, chair of the Johannesburg meeting, who recalled that when South Africa started planning its World Cup bid 10 years ago, there was pressure to downplay the HIV/AIDS epidemic. "We're now planning to use this event to address one of the most significant crises our country is facing." ks/he http://www.plusnews.org/report.aspx?ReportID=87109 http://www.plusnews.org/report.aspx?ReportID=87109 SIAYA, 19 November 2009 (PLUSNEWS) - When Dorothy*, a single mother of five, told her neighbours in the Kenyan capital, Nairobi, she had tuberculosis (TB), she expected sympathy and maybe even offers of help. Instead, she found herself so severely ostracized, she felt she had to move out. http://www.IRINnews.org/images/2007/200702151t.jpg SIAYA, 19 November 2009 (PLUSNEWS) - When Dorothy*, a single mother of five, told her neighbours in the Kenyan capital, Nairobi, she had tuberculosis (TB), she expected sympathy and maybe even offers of help. Instead, she found herself so severely ostracized, she felt she had to move out. "The kind of discrimination I faced from my neighbours made me regret [sharing] my condition with them; I could not even share the [communal] sink," she told IRIN/PlusNews. "Yes, tuberculosis is very infectious, but those who have it are not death traps." According to Joseph Sitienei, head of the National Leprosy and TB Control Programme at the Ministry of Health, stigma associated with TB infection is a major impediment in rallying people to seek early diagnosis and treatment for the airborne disease. "Many people still believe only those with HIV have tuberculosis and therefore they shy away from seeking diagnostic tests for TB, believing if they are found to have it, then it automatically means they are also HIV-positive," he told IRIN/PlusNews. "By those infected not seeking treatment due to stigma, everybody is at great risk." Dropping out of treatment heightens the risk of multi-drug resistant TB (MDR-TB) developing, "which is very expensive and difficult to treat", Sitienei added. Kenya has 353 people with MDR-TB, of whom about 70 are on treatment. According to the Kenya AIDS Indicator Survey, 11.4 percent of Kenyans say they would want a family member's TB infection kept secret due to stigma. Kenya ranks 13th on the UN World Health Organization's list of 22 high-burden TB countries in the world, and is the fifth highest in Africa. In 2008, the country had approximately 132,000 new cases. Research conducted in Ghana in 2008 found some of the main causes of TB-related stigma were: fear of infection; TB's association with HIV; health staff's own fears; self-stigmatization by TB patients; and the blaming and shaming of TB patients by the public. While Kenya has successfully integrated HIV and TB services at the testing level, TB counselling still trails behind counselling for HIV. Education is key "We have done well in offering HIV testing and counselling and diagnosis of TB, but not much has happened in trying to offer counselling services to people with TB," said Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme. "This is crucial and possible because it can easily be done within the voluntary testing and counselling facilities." According to Sitienei, public education about TB is crucial to provide a better understanding of the disease and improve health-seeking behaviour: "With proper counselling, people are better placed to understand their own situation and that of others," he said. "The truth is, TB spreads very fast, but it is important to help people relate to those with TB without themselves having to fear putting themselves at risk," said Charles Mutua, a former TB patient. "People must also be made to appreciate that TB infection is not necessarily synonymous with HIV infection. I, for example, had TB but I was never HIV infected," he added. According to Andrew Suleh, superintendent of Nairobi's Mbagathi District Hospital, communication messages should include debunking popular myths – such as the idea that the disease can be transmitted by sharing utensils. Ending health worker stigma Sitienei said it was also important for health workers to understand the disease and treat patients with respect. In 2008, the government launched a communication campaign to reduce discrimination and stigma about HIV and TB among health workers. "At times even the attitude among healthcare workers determines whether people seek services or not, even though our medical personnel are very conscious about issues of stigma," he said. "Addressing stigma involves fighting it among the public, health workers and those who are infected with TB." Suleh noted that ensuring health workers were properly equipped to treat TB would help reduce stigmatization of patients. "[Health worker stigma and discrimination] can arise when healthcare workers feel they are not given the adequate equipment or facilities to handle such cases," he said. ko/kr/oa/mw * Not her real name http://www.plusnews.org/report.aspx?ReportID=87108 http://www.plusnews.org/report.aspx?ReportID=87108 JOHANNESBURG, 17 November 2009 (PLUSNEWS) - A plan by Malawi to offer prostitutes low-interest loans to start small businesses in return for abandoning sex work is generating controversy in a country where women are disproportionately affected by high rates of poverty and HIV. http://www.IRINnews.org/images/2007/200703302t.jpg JOHANNESBURG, 17 November 2009 (PLUSNEWS) - A plan by Malawi to offer prostitutes low-interest loans to start small businesses in return for abandoning sex work is generating controversy in a country where women are disproportionately affected by high rates of poverty and HIV. "Most [sex workers] leave school at an early age, get pregnant, and then have to provide for a child, so they end up on the streets as a way to earn a bit of money," said Ayam Maeresa, special assistant to the Minister of Gender, Children and Community Development, Patricia Kaliati, who proposed the plan after discussions with sex workers, most of whom said they had been driven into prostitution by poverty. The plan aims to economically empower female sex workers and reduce the spread of HIV, but critics question whether it can achieve either of these goals when there are so few opportunities for Malawian women to earn more than they do from prostitution. "If we help them to get out of this trade, we'll also be helping to control the spread of HIV," Maeresa told IRIN/PlusNews. He was vague about what type of businesses the women would be encouraged to set up, saying only that several NGOs had indicated they would provide business management training. Rehabilitation approach flawed Many initiatives in Africa have made attempts to help sex workers find alternative sources of income without much long-term success. None of the sex workers in Botswana, Namibia and South Africa interviewed in a recent study by the Open Society Institute (OSI) had found jobs after completing what the authors called "rehabilitation" programmes. "They offer women an alternative job in another part of the informal economy that is equally if not more unpredictable, and often leads to the women earning much less money," said Vivienne Mentor-Lalu of the Sex Worker Education and Advocacy Taskforce (SWEAT), a Cape Town-based NGO that lobbies for the rights of sex workers. Research by SWEAT found that a South African woman with primary school education could earn up to four times more doing sex work than any other job she would be eligible for, if she could find a job in a country with around 25 percent unemployment. "In South Africa we have this phenomenon where men stand on the side of the road selling their labour, and women stand on the side of the road selling sex," said Mentor-Lalu, who was worried that programmes steering women away from sex work were often less concerned with economic empowerment and reducing HIV risk than promoting a conservative moral agenda. The OSI report suggested that the popularity of such interventions was linked to restrictions on foreign funding that undermined rights-based approaches favoured by the sex workers. Organisations that receive funding from the US President's Emergency Plan for AIDS Relief (PEPFAR), for example, are required to sign an "anti-prostitution pledge" that they will not support or promote sex work. Marlise Richter, a South Africa-based researcher, said the requirement had "a chilling effect" on efforts to support sex workers' rights. "Sex workers don't need to be rehabilitated, they need to be given skills and a safe working environment. I can see there's a place for exit programmes and microloans, but you're not dealing with the underlying system." Rights not rescue In most of Africa, as in the rest of the world, the underlying system is one that criminalises sex work, making it difficult for sex workers to access health services or to report abuse at the hands of clients, pimps and even police. As host of the 2010 FIFA World Cup, South Africa is ahead of much of the rest of continent in starting to debate the merits of decriminalising sex work, a move supported by the National AIDS Council. "Increasingly, there's recognition that you can't begin to look at sex work and HIV if you don't look at sex workers' rights," said Mentor-Lalu. Explaining how the abuse of those rights could contribute to HIV infections, she cited the practice of police confiscating condoms from sex workers; of having to pay fines, when arrested, which made the women more likely to agree to unprotected sex for a higher fee; the marginalisation of prostitutes that prevented them from accessing health services. Rather than addressing any of these issues, the Malawian plan would penalise women who returned to prostitution after accepting a loan from the government. "If it becomes a law, that will be one of the conditions," the gender ministry's Maeresa confirmed. "If you return to the streets, it [sex work] becomes a criminal offence." The Reproductive Health & HIV Research Unit (RHRU) of the University of Witwatersrand, in Johannesburg, South Africa, have adopted a more flexible approach with their "Beauty Shack" project for sex workers from the inner-city neighbourhood of Hillbrow. After completing training in beauty therapy at a local health spa, the women are encouraged to give up sex work and start businesses or seek jobs, but if they choose not to they can still participate in the programme as peer educators, earning a monthly stipend of US$134. Nonhlanhla Motlokoa of RHRU, who coordinates the "Beauty Shack" project, is optimistic that it will be more successful than previous initiatives offering training in cooking and sewing. Although some of the women "are scared to take that leap", two have already secured full-time jobs at the spa where they were trained, while others are enthusiastic about the possibility of starting small businesses. RHRU also operates a mobile clinic that provides condoms, HIV counselling and testing, and treatment of sexually transmitted infections at hotels where the women live and work. Researcher Richter applauded RHRU's public-health approach, but insisted that "The bottom line is the criminalisation of sex work that results in stigma and abuse," and that only legal reform could address the gender-based violence and lack of legal recourse that put sex workers at most risk of HIV. ks/he http://www.plusnews.org/report.aspx?ReportID=87087 http://www.plusnews.org/report.aspx?ReportID=87087 KISUMU, 17 November 2009 (PLUSNEWS) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago. http://www.IRINnews.org/images/200511258t.jpg KISUMU, 17 November 2009 (PLUSNEWS) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago. "We believe the launch of a rapid results initiative to scale up what we are already offering will help meet the demand; our target is an ambitious one to see to it that at least 1.1 million of the uncircumcised men in this country get the cut by the end of five years," said Jackson Kioko, director of medical services in western Nyanza Province. Results of three random trials in South Africa, Kenya and Uganda in 2005 and 2006 demonstrated that medical male circumcision http://www.plusnews.org/InDepthMain.aspx?InDepthId=61&ReportId=73184 reduced the risk of HIV infection among men by up to 60 percent. According to the Kenya AIDS Indicator Survey 2007, 85 percent of Kenyan men are circumcised; HIV prevalence is higher by three-to-five times in uncircumcised men. There are about 1.2 million uncircumcised men between the ages of 15 and 49 in Kenya, most of whom live in Nyanza Province, where fewer than 50 percent of men are circumcised. Since the launch of the national campaign in November 2008, an estimated 40,000 men have been circumcised and 124 sites opened and equipped with facilities and personnel to offer the service. The government has trained 700 health workers in the province to offer the services in various health facilities. "The trained health workers will ensure people who demand these services get them in a safe and timely manner and the training of others is ongoing across the various provinces within the country," Kioko added. The government also plans to roll out mobile medical circumcision. "We do not want people to opt out simply because the services are not near them and we are making arrangements that we go to them rather than them coming to us," Kioko said. "We will, in the near future, offer infant medical circumcision; this has the potential to help people in time before their sexual debut." Experts remain emphatic, however, that male circumcision must not be viewed as a complete prevention tool. "It is refreshing to see that research is being put to use, but we should take precautions to ensure that we constantly give information that male circumcision must work along with other HIV infection prevention strategies to be effective," said Kawango Agot, head of the Nyanza Reproductive Health Society. "We have plans to launch a study to look into the sexual behaviours of men who have been circumcised to find out if they are engaging in risky behaviours due to the fact that they have been circumcised," she added. "We hope this will ascertain if indeed people are engaging in [risky sex]." A 2007 study http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0002443 in Kisumu, provincial capital of Nyanza, found that circumcision did not result in increased HIV risky behaviour. It found that as male circumcision became more widely promoted, there would be a need to monitor “risk compensation” associated with the procedure. ko/kr/mw http://www.plusnews.org/report.aspx?ReportID=87074 http://www.plusnews.org/report.aspx?ReportID=87074 LUANDA, 16 November 2009 (PLUSNEWS) - Esperança Mutamba (not her real name), who has been living with the virus for 10 years and works as HIV/AIDS counsellor in the Angolan capital, Luanda, is still not ready to publicly disclose her HIV status. http://www.IRINnews.org/images/2008/200809021t.jpg LUANDA, 16 November 2009 (PLUSNEWS) - Esperança Mutamba (not her real name), who has been living with the virus for 10 years and works as HIV/AIDS counsellor in the Angolan capital, Luanda, is still not ready to publicly disclose her HIV status. "I consider myself to be good at what I do. I don't want to have my name used, because in my private life only my two sisters know what my job is and that I'm been HIV positive for more than ten years. My children and my boyfriend don't even have any suspicions. "I provide counselling to so many people that I've lost count. Twice a week I carry out visits to HIV patients in the hospital, and I go to patients' homes and fetch them water when they aren't able to. "I also pick up medication at the hospital for those who aren't strong enough to go there. Sometimes I get up at five o'clock in the morning to get there early and find a bed in the hospital for those who live far away. I also find time to work with HIV-positive children and take care of my grandchildren. "When I converted to my church in 1995, I was already HIV positive. I was always sick, I gradually lost a lot of weight, and ended up with malaria and skin tumours, and I had to move into my sisters' home so they could take care of me. "It was only in 2003 that I got up the courage to get tested. The test came back positive for HIV. At the time there was practically no treatment available in Angola. "I managed to begin mine because I confided in a woman from the National Health Council who sent people abroad [to Brazil or Portugal] for treatment. She sent me to the Multiperfil Clinic in Luanda, which was the only one providing this type of treatment in the country. "Soon thereafter, I participated in the creation of an NGO that provides prevention and with care to HIV patients, and I've been working there since. "I've been in a relationship for six years, but my boyfriend doesn't know I'm HIV positive. I take care of him, so I'm not interested in telling him. I stopped having children very early on, when I was 20. "This is not very common in Angola, where we women are encouraged to have lots of children. I had two and didn't want any more. When my boyfriend begins to pressure me to have sex without a condom, I say that I don't want any commitment with children. "In the beginning I hid my HIV status from my children so they wouldn't suffer [from stigma and discrimination], but now, at 46, I live alone, I'm independent and healthy, and I don't see the need to tell them. "I also can't stop working, as it does me a great deal of good, so I'm living this double life. I tell my relatives, my boyfriend and my friends that I work as an activist in NGOs that work in the health sector. "I don't want my picture taken, even from the back: my children are very clever, they're always on the Internet, and they could find out." cmb/kn/he http://www.plusnews.org/report.aspx?ReportID=87064 http://www.plusnews.org/report.aspx?ReportID=87064 LUSAKA, 16 November 2009 (PLUSNEWS) - Abigail Mwanashimba has been looking after her five siblings since the age of eight, when her parents died of AIDS-related illnesses. She is now 19 years old, and without relatives to represent her at her lobola (bride price) negotiations, she was forced to hire traditional counsellors to organise the process of marriage according to the tribal customs. They did a bad job. http://www.IRINnews.org/images/2007/2007032517t.jpg LUSAKA, 16 November 2009 (PLUSNEWS) - Abigail Mwanashimba has been looking after her five siblings since the age of eight, when her parents died of AIDS-related illnesses. She is now 19 years old, and without relatives to represent her at her lobola (bride price) negotiations, she was forced to hire traditional counsellors to organise the process of marriage according to the tribal customs. They did a bad job. "I don't know anything about my tribe or its culture because there has never been anyone to teach or show me," she told IRIN/PlusNews. "I got very little lobola, but the last straw was the humiliation I suffered at my in-laws' home, when I embarrassed them by performing the wrong dance." Losing out on the bride price was one thing, but when she realised that the counsellors she had hired had taught her the wrong traditional dances, she refused to pay them their 500,000 Zambian kwacha (US$100) fee, and is now facing a lawsuit. Agnes Ngubeni, from the central town of Kabwe, also knows this kind of humiliation; she has lived with the embarrassment of not having undergone an initiation ceremony when she came of age, and not being able to speak the language of her tribe. "People called us goats ... they said we were 'cultureless' and were not educated in the ways of our tribe. It never occurred to them that there was no-one to teach us - we lived without elders," she said. Ngubeni and her siblings were orphaned fifteen years ago when her oldest brother was just 10. A Norwegian family living in Zambia committed itself to looking after them, which meant they were clothed and fed, but this presented them with social problems. Their neighbours ridiculed them for eating pasta, bread and rice, instead of the staple, nshima - thick maize-meal porridge - that neither she nor her three sisters can cook. "The neighbours laughed at us for eating the white man's food, which they said was not real food, but what are we supposed to do? We eat what we are given. That's just how it is," Ngubeni said. Ngubeni recommends that people helping child-headed families should consider placing an adult relative or any other person of the same tribe among them to guide and mentor them in the ways of traditional society. Out of touch with culture In its latest report on Orphans and Vulnerable Children (OVC), the UN Children's Fund (UNICEF) found that about 20,000 households in Zambia were led by children, but the number is increasing. The report outlines the severe deprivations of food and shelter these children often face, and concludes that with more youngsters having to take on the responsibilities of running a household at an early age, there is every likelihood that more of them will end up on the street. Joseph Banda heads Tisunge, a local organisation that assists child-headed households to deal with the trauma of loss, and teaches them income-generating and life skills, so that the children are able to fend for themselves and can continue their schooling. Banda said it had never occurred to him that these children would struggle with cultural issues. "I am ashamed to say that I never saw the children's situation in this way," he admitted. "We are so engrossed in keeping the children off drugs and alcohol, and the girls from getting pregnant, and making sure that they become good citizens, that we lose sight of the fact that children need to be socialised in the ways of their tribe." Child psychologist Trina Mayope warned that children growing up without the value of custom and tradition would have problems in future. "It's about growing up with a cultural identity ... The children feel isolation because the communities treat them as aliens, or as something not quite right because of their seeming lack of 'traditional etiquette'." There is also the stigma attached to being orphaned by HIV/AIDS, as is mostly the case. "If these children don't conform to the cultural norms of the society they live in they will suffer a double discrimination," she noted. Mayope acknowledged that urbanisation and the passing of time had caused people to discard many traditions, but the basics of culture were still important and largely defined how someone was perceived. "It's difficult for most people to comprehend how a child can grow up without knowing anything about his or culture. People think they [children] are trying to act like a muzungu [European], but when you have children whose mentor is a fellow child, how are they supposed to learn traditional norms and customs?" zg/kn/he http://www.plusnews.org/report.aspx?ReportID=87056 http://www.plusnews.org/report.aspx?ReportID=87056 KAMPALA, 16 November 2009 (PLUSNEWS) - The Uganda AIDS Commission (UAC) is revamping its national HIV information campaign after HIV prevention messages were less successful than hoped. http://www.IRINnews.org/images/2009/200911161012590796t.jpg KAMPALA, 16 November 2009 (PLUSNEWS) - The Uganda AIDS Commission (UAC) is revamping its national HIV information campaign after HIV prevention messages were less successful than hoped. "We shall use basic facts in the messages to communicate effectively because we have realized that the level of knowledge about basic facts on HIV information is quite limited," said Saul Onyango, senior health educationist with the UAC. The term high-risk sex - previously defined as sex with an irregular partner - is to be redefined as sex with anyone whose HIV status is not known. As such, the term “most at-risk populations” will no longer refer to specific groups such as sex workers, fishing communities and men who have sex with men, but to all members of the population engaging in risky sex. Campaigns aimed at ending cross-generational sex will be abandoned in favour of generic warnings about engaging in risky sex because of fears that young people may believe that sex within their own generation is risk-free. Officials have also said factors such as alcohol abuse, which predispose people to risky sexual behaviour, must be tackled alongside HIV prevention. The commission has assembled a team of medical and communication experts to develop the new messages, and will work with English and local language media to disseminate them. "We have to change the destiny of this country, even if it means putting back the drums of the 1980s that used to frighten people," said UAC director-general, David Kihumuro Apuuli. An ominous drumbeat, followed by a booming voice warning that "AIDS kills", was the centre of a radio HIV prevention campaign when Uganda first began its fight against HIV in the late 1980s. Several senior officials - including Jesse Kagimba, senior presidential adviser on HIV/AIDS - have called for the return of fear-driven campaigns, which they say were instrumental in Uganda's initial success in lowering prevalence. However, detractors of this method say the key to success in prevention is education, not fear. Some studies http://www.popline.org/docs/1323/147687.html show that scare tactics alone do not lead to behaviour change, but rather encourage denialism and fatalism. Experts also say that such campaigns promote stigma and discrimination, and that in the age of widely available life-prolonging antiretroviral medication, they could prove ineffective. After successfully bringing prevalence down from more than 20 percent in the 1980s to about 6 percent by 2000, Uganda's HIV levels have stagnated, showing a marginal increase in prevalence over the past few years. Tailored response The new messages will attempt to bring the HIV response in line with the drivers of the epidemic. According to a recent study [http://www.unaidsrstesa.org/files/u1/Uganda_MoT_Country_Synthesis_Report_7April09_0.pdf], 37 percent of new Ugandan HIV infections are attributable to multiple partnerships, 35 percent occur within discordant monogamous couples, 18 percent are due to mother-to-child transmission, and 9 percent occur through commercial sex networks. "We need to change the mentality and behaviour of men; they have multiple sexual partnerships now called side dishes, which is creating a web," Kihumuro said. "Before we know it the whole of Kampala [the capital] will be entangled into one web." According to the UAC, there are 110,000 new HIV infections annually and 63,000 deaths from HIV-related illnesses. The study found that although Uganda had made good progress in rolling out key HIV prevention services, the campaigns had not reached all sections of the population. "Over three-quarters of all adults, including many people living with HIV, do not know their HIV sero-status; services for PMTCT currently reach less than half of pregnant women," it found. "Although condom use has increased, its coverage has not yet reached the critical levels necessary for it to impact on population level HIV transmission." Kihumuro noted that there was an urgent need for the government to commit more resources to the fight against HIV/AIDS. At present, the government funds about 6 percent of the national HIV response. "A lot of the money coming in is from donors; we cannot sustain this," he added. en/kr/mw http://www.plusnews.org/report.aspx?ReportID=87053 http://www.plusnews.org/report.aspx?ReportID=87053 NAIROBI, 13 November 2009 (PLUSNEWS) - The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved US$2.4 billion in its ninth round of grants, bringing the total amount of approved funding since its inception in 2001 to $18.4 billion. http://www.IRINnews.org/images/20034163t.jpg NAIROBI, 13 November 2009 (PLUSNEWS) - The Global Fund to Fight AIDS, Tuberculosis and Malaria has approved US$2.4 billion in its ninth round of grants, bringing the total amount of approved funding since its inception in 2001 to $18.4 billion. "These grants enable countries around the world to address some of the main problems they are struggling with every day," Dr Tedros Adhanom Ghebreyesus, Ethiopian Health Minister and Chair of the Global Fund Board, said in a press release. The two-year commitment - the second largest ever - was approved by the board of directors during a recent meeting in Addis Ababa, when it also decided to launch the tenth round of grants in May 2010. There had been fears that as a result of a funding shortfall, the board would decide to cancel its 2010 call for funding proposals, curtailing the fight against the AIDS pandemic. Despite the decision to go ahead with a call for proposals in 2010, Michel Kazatchkine, executive director of the Global Fund, noted that the demand for funding was 'enormous', and there was a need for more investment to continue the worldwide momentum of HIV prevention, treatment and care. "We may not be able to continue approving such amounts of financing and see continued progress in health in the coming years unless donor countries scale up their funding even further than what they have done so far," he said. An estimated 2.3 million people around the world are on life-prolonging antiretroviral drugs paid for by the Global Fund, which has also provided anti-tuberculosis treatment to 5.4 million people. kr/he http://www.plusnews.org/report.aspx?ReportID=87031 http://www.plusnews.org/report.aspx?ReportID=87031 SELEBI-PHIKWE, 12 November 2009 (PLUSNEWS) - In most respects, there is nothing remarkable about Selebi-Phikwe, a mining town in northeastern Botswana with a population of about 50,000. The central business district is a sun-baked main street with a few shops and a taxi rank; the copper and nickel mine on its outskirts is the main source of employment. http://www.IRINnews.org/images/2009/200911041537130646t.jpg SELEBI-PHIKWE, 12 November 2009 (PLUSNEWS) - In most respects, there is nothing remarkable about Selebi-Phikwe, a mining town in northeastern Botswana with a population of about 50,000. The central business district is a sun-baked main street with a few shops and a taxi rank; the copper and nickel mine on its outskirts is the main source of employment. No one knows for sure why Selebi-Phikwe has the highest rate of HIV infections in the country, just as they cannot say with any certainty why Botswana - and southern Africa - have been so hard hit by the global AIDS pandemic. Recent figures from a national prevalence survey revealed that 26.5 percent of adults in Selebi-Phikwe were living with HIV, compared to a national rate of 17.6 percent. Half of the town's men and women aged 31 to 49 are infected. More HIV-positive people now access antiretroviral (ARV) treatment and live longer, so prevalence rates can be misleading, but Selebi-Phikwe also led the country with its annual HIV incidence (rate of new infections) of 4.7 percent: 6.9 percent in women, and 2.4 percent in men. Mining towns have often been associated with high rates of HIV infection, but there are many mining towns in Botswana. "We're still not sure why Selebi-Phikwe," said District AIDS Coordinator Lamech Myengwa. There are plans to conduct a study to identify the factors driving the town's epidemic. In the meantime there is no shortage of theories. One is that since a number of textile factories closed in the late 1990s, high unemployment among the town's female residents has made them financially dependant on male mine-workers; truck drivers stopping over on their way north from the border with South Africa also provide a market for sex workers. Could commercial and transactional sex between local women and the miners and truckers be driving the high infection rate? "Most of the women don't have money, especially since the factories closed," said Dikgang Keabetswe, a project leader with Men Sex and AIDS, a local community-based organization. The mine, owned by Bamangwato Concessions Ltd. (BCL), is easily reached from the town rather than being located in a remote compound, as is the case with most other mines in the country. The miners and the local townspeople mix freely, particularly in Botshabelo, an informal settlement where many of the miners that BCL can't accommodate find cheap housing. In bars and shebeens (informal drinking places), alcohol fuels risky behaviours like having multiple and concurrent sexual partners (MCPs) - a practice that recent research indicates may be the biggest driver of HIV infections in southern Africa. "Here is the birthplace of MCPs," remarked Keabetswe, who coordinates a group of volunteers who visit the bars and talk to patrons about their HIV risk. BCL has taken steps to address the HIV/AIDS crisis in Selebi-Phikwe, but most of the initiatives focus on its 4,200 employees rather than the local community. Eighty trained peer educators conduct regular "wellness sessions" that include HIV prevention, and distribute 25,000 condoms a month to their fellow employees. They have succeeded in persuading 90 percent of the workforce to take advantage of voluntary counselling and testing (VCT) for HIV at the mine hospital, which also provides ARV treatment, but community outreach efforts were scaled back after recent budget cuts. Marumo Johane, BCL's Acting HIV/AIDS Superintendent, admitted: "The Phikwe community is the BCL community and I think maybe we need to focus more on community participation." BCL has achieved a 3 percent decrease in HIV prevalence among its workers, but infection rates among the townspeople, particularly young women, have continued to climb: among those aged 20 to 24, 39 percent of women were infected, compared to 5.8 percent of men. In the group between 30 and 35 years of age, a staggering 61 percent of women were infected, compared to 47.7 percent of men. Johane is puzzled - high rates of female unemployment, alcohol consumption and MCPs - "These are social factors that apply to other towns as well as Phikwe," he told IRIN/PlusNews. With its confluence of factors known to drive HIV, Selebi-Phikwe represents a microcosm of southern Africa's multifaceted HIV/AIDS epidemic, and the failure of one-dimensional prevention campaigns to address complex underlying issues such as poverty, gender inequity, and socially acceptable norms of behaviour. ks/he http://www.plusnews.org/report.aspx?ReportID=87011 http://www.plusnews.org/report.aspx?ReportID=87011 NAIROBI, 12 November 2009 (PLUSNEWS) - The United Nations Convention on the Rights of Persons with Disabilities (CRPD) should be used as a tool to improve access to HIV services for disabled people, who are often marginalized in national HIV policies, says a new report. http://www.IRINnews.org/images/2006876t.jpg NAIROBI, 12 November 2009 (PLUSNEWS) - The United Nations Convention on the Rights of Persons with Disabilities (CRPD) should be used as a tool to improve access to HIV services for disabled people, who are often marginalized in national HIV policies, says a new report. "PWDs experience all the risk factors associated with HIV, and are often at increased risk because of poverty, severely limited access to education and health care, lack of information and resources to facilitate 'safer sex', lack of legal protection, increased risk of violence and rape, vulnerability to substance abuse, and stigma," the authors noted in HIV/AIDS and Disability: Final Report of the 4th International Policy Dialogue. HIV/AIDS was implicitly included in the CRPD under article 25a, where "State Parties shall provide PWDs with the same range, quality and standard of free, affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes," the authors noted. "There is usually little national data on the numbers of people with disabilities affected and infected with HIV, and communications campaigns around HIV are not designed with PWDs in mind," said Phitalis Were, of Leonard Cheshire International, a global organisation working with the disabled. "Condoms have expiry dates that blind people cannot read, so how are they to know that a condom is past its sell-by date?" Were also noted that disabled people could not claim their right to health services unless they were educated about these rights. The CRPD came into force in 2008, and has 143 signatories and 71 parties. Were said that if the CRPD was to be effective, governments needed to act on the commitments they made by ratifying it. "Many of our laws are so outmoded and offensive to PWDs, and must be changed urgently; in Kenya, for instance, certain sections of statutory law still refer to people with mental disabilities as imbeciles and idiots." kr/kn/he http://www.plusnews.org/report.aspx?ReportID=87010 http://www.plusnews.org/report.aspx?ReportID=87010 MASERU, 12 November 2009 (PLUSNEWS) - Mokete Tsehlo, 26, a shepherd working in the Berea district in the tiny mountain kingdom of Lesotho, told IRIN/PlusNews how his nomadic lifestyle contributed to his HIV-positive diagnosis. http://www.IRINnews.org/images/2009/200911111358220656t.jpg MASERU, 12 November 2009 (PLUSNEWS) - Mokete Tsehlo, 26, a shepherd working in the Berea district in the tiny mountain kingdom of Lesotho, told IRIN/PlusNews how his nomadic lifestyle contributed to his HIV-positive diagnosis. "My father let me go to a little school and I can write my name, but what I know most is sheep - how to keep them out of danger. Sheep can feed you and give you fleeces that can keep a person warm; you can sell them at the market. The more sheep you own the more prosperous a person is. "Just because I am out here now with the sheep does not mean I am out here all the time. I have friends; we play football. But you have to keep the body out of danger, like I do the sheep. You have to avoid the wild dogs, like HIV, that kill you. "I don't know how I got HIV. They said it was from sex ... Sometimes I go all over with the sheep. We don't just stay here; we must go where the grass is. "I meet girls - I don't sleep with men's wives because that can get you killed - but I guess one girl I slept with slept with someone before me and I got HIV. "I don't take [antiretroviral] drugs. I can take them but it is not easy finding a place to get them. I cannot go to the same place for drugs and get a check-up every week because I am moving around with the sheep. It was easy to get HIV, but in this country there are not that many places we know to get treatment. "My parents know nothing about HIV, so I do not worry them about it. These are my father's sheep, and their descendants will be my sheep one day. I hope to live to have many hundreds of sheep." jh/kn/he http://www.plusnews.org/report.aspx?ReportID=87009 http://www.plusnews.org/report.aspx?ReportID=87009 JOHANNESBURG, 12 November 2009 (PLUSNEWS) - The global economic crisis may have the positive spinoff of forcing countries to allocate increasingly scare HIV/AIDS resources more efficiently. http://www.IRINnews.org/images/2007/2007070910t.jpg JOHANNESBURG, 12 November 2009 (PLUSNEWS) - The global economic crisis may have the positive spinoff of forcing countries to allocate increasingly scare HIV/AIDS resources more efficiently. A recent analysis of national spending on HIV/AIDS found a correlation between prevalence and the amount countries spent on the disease, but a mismatch between how the money was spent and the areas of greatest need. Researchers from the AIDS Financing and Economics Division at UNAIDS and the Centre for Economic Governance and AIDS in Africa (CEGAA) used a tool developed by UNAIDS to track and report how much domestic and international funding was spent in eight different areas of HIV programming by 50 countries in 2006. Their findings are published in a December supplement of the AIDS journal, which focuses on progress in achieving global HIV targets. The data lends weight to recent calls by AIDS experts to concentrate dwindling resources for HIV/AIDS on well-managed interventions that have a strong evidence base. Several countries with the highest HIV prevalence were found to be most dependent on external funding sources - and therefore the most vulnerable to potential cuts by donors in the economic downturn. In the 17 low-income countries included in the analysis, 87 percent of HIV funding came from international donors, with bilateral assistance financing 53 percent of antiretroviral treatment. Middle-income countries that rely mainly on domestic budgets to fund their HIV programmes, such as Botswana and Brazil, may also be forced to do more with less as their national revenues take a hit in the global financial crisis. Botswana, with the second highest HIV prevalence in the world, had by the far the highest per capita spending on HIV in 2006 (US$70.40), followed by Swaziland ($17.30), while the remaining sub-Saharan African countries spent an average of $5.90 per capita. Treatment and care absorbed large shares of overall HIV funding in many countries, leaving prevention initiatives underfunded; stigma and a lack of accurate HIV surveillance data on minority groups meant they were most often overlooked. Countries with generalized epidemics (more than one percent of the population is HIV-positive) spent twice as much on treatment as on prevention, with about 30 percent of overall HIV expenditure going on prevention efforts. Countries with concentrated epidemics (HIV infection is mainly confined to certain groups, such as injecting drug-users or sex workers) often spent most of their prevention budgets on broad programmes that missed the most at-risk populations. In Latin American countries, for example, where an estimated 60 percent of people living with HIV are men who have sex with men, only 0.5 percent of funds for prevention were targeted at this group. The researchers concluded that most governments were not basing the allocation of HIV resources on a thorough understanding of their country's epidemic, nor were they opting for the most effective, evidence-based approaches. "The global economic recession will force countries to rethink national strategies, especially in low-income countries with high aid dependency," they commented. "More than ever, countries need to know their epidemic, and both resource allocations and their HIV programmes need to reflect those data and analyses." ks/he http://www.plusnews.org/report.aspx?ReportID=86996 http://www.plusnews.org/report.aspx?ReportID=86996 HARARE, 11 November 2009 (PLUSNEWS) - Tendai Javangwe (not his real name) is 16 years old but looks half his age; he was born HIV-positive and has been staying at a home run by Mashambanzou Care Trust, a community care and support organisation. http://www.IRINnews.org/images/2009/200901149t.jpg HARARE, 11 November 2009 (PLUSNEWS) - Tendai Javangwe (not his real name) is 16 years old but looks half his age; he was born HIV-positive and has been staying at a home run by Mashambanzou Care Trust, a community care and support organisation. He had been living with his aunt since his parents died, but illness forced him to drop out of school and seek medical treatment at Mashambanzou - meaning "the dawn of a new day/life" in Shona - in Waterfalls, a residential area southwest of the capital, Harare. When Javangwe was admitted the staff were shocked that his relatives had allowed his condition to deteriorate to such an extent. "He was thin and seriously ill. His relatives ... just kept him at home without realizing he needed help," Chipo Munyorovi, the sister in charge of Mashambanzou, told IRIN/PlusNews. Javangwe is now well enough to go home but officials have classified him as a child in need of state protection after the neglect he was subjected to at home, and have said he should be placed in an orphanage or home, which has magnified his problems. Zimbabwe has almost a million orphans, but the country's political and economic meltdown means the extended family is often too poor to cope with additional children. High levels of stigma and discrimination prevent many HIV-positive children from being adopted or being adequately cared for by relatives, so caregivers find it hard to place those who have been abandoned in homes or orphanages. A recent report by a local child rights organization, Streets Ahead, said at least 52 percent of children living and working on the streets of Harare and its satellite towns had lost one or both parents to AIDS-related illnesses. Most did not live on the streets permanently, but came occasionally to supplement meagre family incomes, begging to raise money for school fees and food. "Individuals don't want to adopt them into their families, they want healthy children. Even the established orphanages tell us they have no space for the children ... This is why these children end up stuck with us," said Munyorovi. But Mashambanzou's finances were stretched and the staff struggled to cope with the large numbers of children, who often stayed for a long period of time because they had nowhere else to go. Paurina Mpariwa-Gwanyanya, Zimbabwe's Minister of Labour and Social welfare, attributed these problems to the collapse of social services after years of neglect and underfunding by the previous administration, and told a recent media workshop that the unity government was working hard to restore social services to protect orphans and vulnerable children. New government estimates put the number of HIV-positive children in Zimbabwe at more than 105,000, of which only about 13,000 were on treatment. Javangwe may be one of the few lucky ones on antiretroviral drugs, but without a stable home he may not get the support he needs to make his treatment work. st/kn/he http://www.plusnews.org/report.aspx?ReportID=86986 http://www.plusnews.org/report.aspx?ReportID=86986 NAIROBI, 11 November 2009 (PLUSNEWS) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study. http://www.IRINnews.org/images/2008/200805229t.jpg NAIROBI, 11 November 2009 (PLUSNEWS) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study. "Adult death is associated with increased farm hours ... Older women who suffer the loss of a co-resident member among their baseline household are working five hours more each week," the study found. More than 1,000 men and women older than 50 were surveyed over a 13-year period between 1991 and 2004 in the Kagera region. http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2009/09/02/000158349_20090902155306/Rendered/PDF/WPS5037.pdf. Older adults who had relied on remittances and other in-kind support from their adult children were left with the burden of caring not only for themselves but also their orphaned grandchildren. "Grandparents who should be in retirement are forced to start working and parenting again, often when they are not in the best physical condition," said Wamuyu Manyara, portfolio manager at the Africa Regional Development Centre of HelpAge International http://www.helpage.org. "An older woman with thinning bones should really not be forced to return to the field and farm." The study noted that the shocks caused by the death of adult children were primarily felt by older people living with the children when they died. Women had less secure access to land and assets than men, but shouldered most of the labour after their children died, and also felt the shocks more than men. Owning more assets, such as land and animals, could act as a buffer. "Policies which help ensure complete markets for livestock and other forms of assets, provide asset accumulation, and preserve women's rights to property may help mitigate the long-run negative impact of prime-age [15-50 years] deaths," the report said. Little support The elderly were often marginalised by state welfare programmes. "Older people are not organised enough to advocate for their needs, and they wind up being grouped in government departments with either children or people with disabilities - both these groups have powerful lobbies that drown out the needs of older people," said HelpAge's Manyara. "In Kenya we are currently in the process of identifying community spokespeople to give them a public voice, but because many of them can't speak English or are illiterate, they are not always willing to take on the challenge." Several African governments were doing more to include older people in social welfare programmes, particularly older carers. "There is now an appreciation of the magnitude of the problem, and there are some programmes catering for older people's economic needs," Manyara noted. "Old-age pensions and child-care grants provided to older South Africans, and cash transfer programmes for older Kenyans, are practical examples of the types of programmes that need to be rolled out across the region ... [but the need] is still much higher than the numbers being catered for." Research by the UN Children's Fund, UNICEF, in five African countries found that between 40 percent and 60 percent of all orphans in Kenya, Namibia, Tanzania, Uganda and Zimbabwe were being cared for by grandparents, particularly grandmothers. Need for targeted programming "Some of these older people can still work - they have energy and should be supported in their work with income-generating projects," Manyara suggested. "The conditions for accessing microfinance are usually so rigid that older people do not qualify; something should be done to encourage older people still able to work to access these funds." Kavutha Mutuvi, HelpAge International's regional advocacy coordinator, said older people needed secure incomes. "There should be social pensions ... especially for those who are caring for households in their old age," she said. Yet the bureaucratic hurdles in accessing support were considerable. "When a grandmother wants to claim a foster care grant, she may be asked for death certificates for her children or birth certificates of the grandchildren," Mutuvi pointed out. "She may not have or have access to this documentation, but the fact that she is their grandmother can easily be verified by consulting community leaders - there should be a way to do away with much of the red tape they go through to claim support." Older people also needed psychosocial assistance when their children died and they were left to raise the grandchildren. "We have tried to form support groups, which are more successful among women than men, but when it comes to helping grandparents with parenting skills, there is a definite need ... because they do come to us with questions when kids, for instance, want to know about sexuality," Mutuvi said. The role of older people should be acknowledged when drawing up national home-based care policies and programmes, she said, by providing meaningful support such as physical help from community workers. kr/he http://www.plusnews.org/report.aspx?ReportID=86984 http://www.plusnews.org/report.aspx?ReportID=86984 JOHANNESBURG, 11 November 2009 (PLUSNEWS) - The South African cabinet has approved a new policy prohibiting discrimination against soldiers and would-be recruits on the basis of their HIV status. http://www.IRINnews.org/images/20035161t.jpg JOHANNESBURG, 11 November 2009 (PLUSNEWS) - The South African cabinet has approved a new policy prohibiting discrimination against soldiers and would-be recruits on the basis of their HIV status. Previously, HIV-positive members of the South African National Defence Force (SANDF) could be excluded from recruitment, international deployment, and promotion, but a 2008 high court decision declared such policies unconstitutional and gave the SANDF six months to amend them. The high court case was brought by the AIDS Law Project (ALP) on behalf of the South African Security Forces Union (SASFU) and two HIV-positive men. One man was an SANDF member who had not been allowed to join his unit on foreign deployments; the other had been denied employment in the SANDF, based on his status. The ALP expressed disappointment about the length of time the SANDF took to comply with the court order and the persistence of unfair discrimination against HIV-positive soldiers and recruits, but in October one of the men, Sergeant Sipho Mthethwa, became the first known HIV-positive soldier to be deployed on international service. The SANDF had argued that people living with HIV were unfit to withstand the stress and physical demands of foreign deployments. An estimated 25 percent of SANDF employees are HIV positive, higher than the national adult prevalence of 18 percent. ks/he http://www.plusnews.org/report.aspx?ReportID=86974 http://www.plusnews.org/report.aspx?ReportID=86974 NAIROBI, 11 November 2009 (PLUSNEWS) - Programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria reported 2.3 million people on life-prolonging antiretroviral (ARV) drugs in June 2009. Funding to beneficiary countries is based on performance, and failure to meet targets can lead to delays, suspension, discontinuation or termination of grants. http://www.IRINnews.org/images/20034163t.jpg NAIROBI, 11 November 2009 (PLUSNEWS) - Programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria reported 2.3 million people on life-prolonging antiretroviral (ARV) drugs in June 2009. Funding to beneficiary countries is based on performance, and failure to meet targets can lead to delays, suspension, discontinuation or termination of grants. In November 2008, IRIN/PlusNews brought you a list of some of the countries that have fallen foul of the Fund's strict accounting procedures; here is an updated version. Kenya - In November 2009 the Global fund's technical review panel - an independent team of health and development experts - recommended that the Global Fund Board reject a bid for $270 million in Round 9 of funding. The chair of Kenya's CCM said the main reason given was poor coordination between the country's two health ministries. The government has experienced difficulties with its Global Fund proposals in the past. In 2008 the Global Fund rejected Kenya's application for $300 million in Round 8, and $37 million was delayed in 2003 after claims of corruption in the National AIDS Control Council. Mauritania - In September 2009 the Global Fund suspended support to the Executive Secretariat of the National AIDS Committee after finding evidence of fraudulent and unjustified expenditures. The Fund demanded the reimbursement of US$1.7 million within three months, and immediate removal of the people identified as responsible. The new government, named in September after presidential elections in June, began proceedings against four National AIDS Committee members suspected of embezzlement. The State has promised to return the $1.7 million and account for a further $2 million whose use was questioned, and has committed to re-structuring the Country Coordinating Mechanism (CCM), Mauritania's funding management body; CCM weakness is seen as contributing to the problems. Philippines - In September 2009 the Global Fund suspended all five of its grants to the Tropical Disease Foundation (TDF) - the principal recipient - after an investigation by the Office of the Inspector General found that around $1 million of $85 million in total disbursements were unauthorized expenditure. The Global Fund has demanded repayment and will transfer the TDF's grants to a new principal recipient. Zimbabwe - in 2009 the Global Fund decided to bypass the National AIDS Council as the principal recipient of existing and future grants, choosing to channel money through the United Nations Development Programme and paving the way for the country to receive a grant of $37.9 million in August. Zimbabwe has had a turbulent relationship with the Global Fund; several proposals have been rejected and the government has frequently accused the Geneva-based agency of political bias, which the Fund denies. Chad - In 2006 the Global Fund suspended support after an audit uncovered misuse of funds and a lack of satisfactory capacity in the principal recipient and sub-recipients to manage the Fund's resources. The suspension was lifted in 2007 after a series of investigations and commitments from stakeholders to put better systems in place. Nigeria - In 2006 the Fund decided to discontinue its Round 1 support for HIV/AIDS programmes, but awarded other HIV/AIDS grants in Round 5. Myanmar - In 2005 the global Fund terminated grants worth $98.4 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_050819] after the government imposed temporary restrictions on travel and new procedures for reviewing the procurement of medical and other supplies. The Fund said at the time that the restrictions "prevented implementation of performance-based and time-bound programs in the country". Senegal - In 2005 the Fund cut malaria grants worth $7.1 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_050301] over systemic issues that resulted in poor performance. A grant proposal for malaria projects submitted in Round 4 was later approved. South Africa - In 2005 the Global Fund Board stopped funding for an HIV prevention programme [http://www.plusnews.org/Report.aspx?ReportId=39240]. The Board decided that the grant, received by an NGO named loveLife, had failed to "sufficiently address weaknesses in its implementation". Uganda - In 2005 the Global Fund temporarily suspended all five of its grants after a review by accounting firm PricewaterhouseCoopers found "serious mismanagement" of one of the grants by the Project Management Unit in the Ministry of Health. The grants were worth $201 million over two years, of which $45.4 million had been disbursed. The health minister and his two deputies lost their positions and are standing trial with several other government officials for the misuse of Global Fund money. Ukraine - In 2004 the Global Fund temporarily withdrew grants worth $92 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_040130] citing "management issues". The grants were reinstated six weeks later, when a new principal recipient, the International HIV/AIDS Alliance, was put in place. Pakistan - In 2002 the Fund discontinued support for Pakistan's malaria projects because of weak project implementation, slow procurement of health products, poor data quality, and slow spending of project funds; according to reports, only 15 percent of insecticide treated bed nets were distributed during the grant period. Several other countries, including Bolivia, East Timor, Namibia, Sierra Leone, Tanzania and Togo, have also had funding proposals rejected, or have had funding withdrawn. Countries can appeal a grant decision when a proposal has been rejected in two consecutive rounds. kr/kn/he http://www.plusnews.org/report.aspx?ReportID=86972 http://www.plusnews.org/report.aspx?ReportID=86972 NAIROBI, 10 November 2009 (PLUSNEWS) - Kenyan officials are protesting as 'unfair' a recommendation by the technical review panel of the Global Fund to reject the country's bid for Round Nine funding. http://www.IRINnews.org/images/2009/200909291210050641t.jpg NAIROBI, 10 November 2009 (PLUSNEWS) - Kenyan officials are protesting as 'unfair' a recommendation by the technical review panel (TRP) of the Global Fund http://www.theglobalfund.org to reject the country's bid for Round Nine funding. James Ole Kiyapi, permanent secretary in the Ministry of Medical Services and chair of Kenya's country coordinating mechanism http://www.theglobalfund.org/en/ccm/?lang=en, who is responsible for submitting grant proposals to the Fund, said the main reason for the TRP's recommendation was that Kenya's two ministries of health had failed to properly coordinate the management of resources. In 2008 Kenya split its health ministry into the Ministry of Public Health and Sanitation, and the Ministry of Medical Services. Local media have reported wrangling over roles and access to financing - at one point both ministries appointed someone as head of the National AIDS and Sexually Transmitted Infections Control Programme, a major HIV/AIDS body. The final decision on the recommendations of the TRP lies with the Global Fund Board http://www.theglobalfund.org/en/board/?lang=en, which is meeting in Addis Ababa, Ethiopia. A high-powered delegation has been sent to appeal the decision. "We hope our side of the story will be heard," said Ole Kiyapi. The country is requesting US$270 million from the Fund. Kenya's 2008 proposals http://www.theglobalfund.org/en/fundingdecisions/notapproved for funding for HIV, TB and malaria were also rejected; in 2003 the Global Fund delayed the disbursement of funds over concerns about corruption in the National AIDS Control Council. Analysts say a recent row http://www.plusnews.org/Report.aspx?ReportId=86496 among HIV/AIDS NGOs over funding could also have played a part in the TRP's decision. "We as a country have done a shoddy job of managing previous funds. Let this be a wake-up call, and let us learn from our mistakes and tackle the problems that have put us here in the first place," said James Kamau, head of the Kenya Treatment Access Movement, a national advocacy group. Aidspan, an independent watchdog of the Global Fund, http://www.aidspan.org/index.php?page=gfgrants&menu=globalfundgrants&country=96, gives Kenya a 'D' in terms of grant performance, noting that on average Kenya grants are almost nine months behind schedule. "If the bid is rejected outright people will die, because the government itself contributes nothing to HIV treatment in this country," Kamau said, adding that the government should start funding its own HIV programmes rather than relying so heavily on donors in order to avoid such uncertainty in the future. The Global Fund, Kenya's biggest HIV/AIDS donor, has contributed over US$87 million to prevention, treatment and care programmes; more than 200,000 Kenyans are receiving antiretroviral medication. ko/kr/oa/he http://www.plusnews.org/report.aspx?ReportID=86969 http://www.plusnews.org/report.aspx?ReportID=86969 JOHANNESBURG, 10 November 2009 (PLUSNEWS) - A television advertisement that will air in South Africa in November aims to reach deaf people with vital information about how to protect themselves from HIV, while giving hearing South Africans a brief experience of a world without sound. http://www.IRINnews.org/images/2009/200911101417530937t.jpg JOHANNESBURG, 10 November 2009 (PLUSNEWS) - A television advertisement that will air in South Africa in November aims to reach deaf people with vital information about how to protect themselves from HIV, while giving hearing South Africans a brief experience of a world without sound. A recent survey by the Human Sciences Research Council (HSRC) found that 14 percent of disabled respondents were living with HIV, but levels of knowledge about HIV were much lower than among other groups: only 21 percent had an accurate understanding of how the virus was transmitted, and just 20 percent knew their HIV status. The silent one-minute ad features Eric Mahamba, a member of the Deaf Federation of South Africa, who uses sign language to communicate the dangers of having unprotected sex with multiple and overlapping partners. Subtitles ensure that the message is not lost on other viewers. "There is a new man in South Africa; a man who chooses a single partner over multiple chances with HIV," Mahamba signs. "A man whose self-worth is not determined by the number of women he can have." According to the HSRC survey, 14 percent of disabled people reported having multiple and concurrent partners, a practice identified in recent research as one of the most risky behaviours for contracting HIV. The commercial was created by Brothers for Life, a national campaign aimed at encouraging men to positively influence each other on issues relating to HIV, gender-based violence and male sexual and reproductive health. "We saw from the survey that they are a vulnerable group, but not many campaigns have targeted them in the past," said Richard Delate, country programme director of Johns Hopkins Health and Education in South Africa, which is leading the Brothers for Life campaign funded by USAID and a number of local partners. Brothers for Life is also issuing a brochure in Braille to reach South Africa's blind population with information about HIV prevention. ks/he http://www.plusnews.org/report.aspx?ReportID=86966 http://www.plusnews.org/report.aspx?ReportID=86966 NAIROBI, 10 November 2009 (PLUSNEWS) - Three years after the Kenyan government began to promote emergency contraception as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV. http://www.IRINnews.org/images/2009/200907271222000139t.jpg NAIROBI, 10 November 2009 (PLUSNEWS) - Three years after the Kenyan government began to promote emergency contraception [http://www.who.int/mediacentre/factsheets/fs244/en] as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV. "When you speak to young girls and the youth, they confide that unwanted pregnancy rings more in their minds than the possibility of contracting venereal diseases or HIV," said Anne Muisyo, coordinator of the Abstinence and Worth the Wait programme at Crisis Pregnancy Ministries. "It is the very reason I have qualms about a campaign telling people to relax because there is a pill they can run to after engaging in unprotected sex." Muisyo's fears seemed borne out by students IRIN/PlusNews spoke to in the Kenyan capital, Nairobi. Jack*, a student at the Kenya Polytechnic University, says even though he fears HIV, he finds some reassurance in the existence of the pill. "You know for us young people, we engage in quick and unplanned sex, for example at a party... You get a girl and you do not have a condom, what do you do? Let the opportunity pass by? No," he said. "Do it and give her some small money for a pill tomorrow." Molly*, a student at the same university, said: "It's not that I do not use condoms at all with my partner, but the comfort you get when you realize there is a pill which is available cheaply is very tempting." "You give yourself the belief that just once will not bring damage," she added. The government is keen to stress that emergency contraception must not replace the condom. Not a replacement for condoms "I think it is important to note that we have been very consistent in our condom use promotion campaigns and we are not ready to change course because it prevents both pregnancies and HIV," said Shahnaaz Sharif, the director of public health at the Ministry of Public Health. "We have also been very consistent in saying that these pills do not in any way prevent one from contracting HIV." Experts warn that unless the messages about emergency contraception are accompanied by further education on family planning and warnings about the dangers of unprotected sex, the government's campaign could backfire. A study published in a recent edition of the East African Medical Journal found that just 15.8 percent of sexually active students said they used condoms every time they had sex, compared to 22.5 percent who reported never having used a condom. Need for more education "Various studies have shown that the sexual debut amongst the youth is happening very early," said Marsden Solomon, regional medical adviser for reproductive health NGO Family Health International. "Because a pregnancy has an immediate effect on them both psychosocially and economically, they would jump into anything that presents an opportunity to prevent it, and an emergency pill provides that opportunity for them." "What they forget is that while they might have prevented an unwanted pregnancy, they have not done anything to protect themselves from HIV and any other sexually transmitted disease," he added. "I think the message to the youth should be abstinence, and for those who cannot, then dual protection methods like other long-term contraceptives together with a condom should be the most appropriate." Solomon noted, however, that the emergency pill should not be dismissed altogether, noting that with proper education, it could form a useful tool in a much-needed national family planning push. According to the 2003 Kenya Demographic and Health Survey (KDHS), nearly 20 percent of births in Kenya are unwanted and a further 25 percent happen at an unwanted time. A study by social marketing group Population Services International - the government's partner in the national emergency contraception campaign - reported that the average age of women who use emergency pills regularly is 24. (* not their real names) ko/kr/oa/cb http://www.plusnews.org/report.aspx?ReportID=86953 http://www.plusnews.org/report.aspx?ReportID=86953 LUSAKA, 9 November 2009 (PLUSNEWS) - An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council. http://www.IRINnews.org/images/2008/2008021212t.jpg LUSAKA, 9 November 2009 (PLUSNEWS) - An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council. The 2009 Zambia HIV Prevention Response and Modes of Transmission Analysis noted that the percentage of new HIV infections had stabilized, but the absolute number of new infections increased due to population growth. As many as 71 out of every 100 new infections occur as a result of sex with a non-regular partner, while people who reported having only one sexual partner accounted for around 21 percent of new infections. "This shows significant HIV risk even for those who are faithful. The country is facing new and tough challenges to reduce the infection rate because the disease is threatening the foundation of families and marriages," the report commented. Other drivers of Zambia's epidemic are low levels of male circumcision in most parts of the country and inadequate condom use, particularly among discordant couples (in which one partner is HIV-positive and the other negative). Although Zambia has recorded successes in its prevention of mother-to-child transmission (PMTCT) programme, ensuring a safe blood supply, and behaviour-change communication campaigns, the authors recommended urgently focusing future prevention efforts on curbing common practices such as having multiple concurrent partners, transactional sex and inter-generational sex. "Multiple concurrent partnerships are the leading cause of HIV infection in Zambia. Within these relationships, correct and consistent use of condoms remains dismally low despite condoms being readily available, in most cases free of charge," President Rupiah Banda said at the opening of the National HIV Prevention Convention in Lusaka, the capital, last week, and called for more concerted efforts to curb new infections. However, the report revealed that the annual estimated requirement was 200 million male condoms and 2 million female condoms, yet only 96 million male and 500,000 female condoms were available. Vice President George Kunda blamed the high number of new infections on the poor uptake of HIV/AIDS services and reluctance to change risky behaviours. pc/ks/he http://www.plusnews.org/report.aspx?ReportID=86946 http://www.plusnews.org/report.aspx?ReportID=86946 NAIROBI, 9 November 2009 (PLUSNEWS) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said. http://www.IRINnews.org/images/20051198t.jpg NAIROBI, 9 November 2009 (PLUSNEWS) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said. "We have continued to ignore this group of people yet they are responsible for a big chunk of new HIV infections; we have resolved as a government that we cannot sit back and wait for things to get out of hand," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme (NASCOP). There have been few studies on HIV among MSM in Kenya; a survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43 percent among men who had sex with men exclusively, compared with 12.3 percent among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4 percent. HIV programming for MSM is extremely limited despite the country's national strategic plan for HIV/AIDS classing them as a “most at-risk population”. "We cannot do this [provide HIV programmes for MSM] without knowing roughly how many they are and what special needs they require; I hope the survey that we will embark on will help us answer some of these questions," Muraguri said. He noted that the survey - due to start in December and last six months - will attempt to discover information such as the specific sexual health risks and needs of MSM, MSM “hot spots” around the country, and the number of MSM-friendly health facilities available. It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research. High hopes for better services Joshua* is a male commercial sex worker in Nairobi who recently received training from NASCOP on reaching out to his peers with HIV/AIDS messages. "Today I talked to 75 male commercial sex workers - 40 of them are HIV-positive but they do not know what to do," he told IRIN/PlusNews. "Many are homeless after being kicked out of their homes due to stigma." Joshua hopes the survey will enable the government and NGOs to provide more services to MSM. "Currently at a clinic in Nairobi, we are given one bottle of [water-based] lubricant to last three months but you know as a commercial sex worker, you finish it in a week," he added. "So it means for the remaining time, you engage in sex without the lubricant, putting yourself at great risk." He noted that there was also a lack of sufficient knowledge about the risks associated with HIV and anal sex in the general population. "Many women [clients] approach us for anal sex wrongly believing that it lowers their chances of getting infected," he said. "Everybody should be educated on the dangers of this kind of sex because it seems people have the wrong perception." However, not all MSM are as enthusiastic about the prospect of being counted and questioned by a government that has thus far shown little support for the rights of MSM. Not everyone on board "People in this country are still very homophobic and we are stigmatized a lot; who will want to come out to agree that he is a homosexual? Let them address issues of stigma first," said Donald*, who has not come out of the closet. "How do you convince me to come out and say I am a homosexual yet the same government that is asking me to do this criminalizes what I am engaged in?" "I would rather they offered the services without going into the business of knowing who we are and trying to count us," he added. Proof that homosexuality remains taboo in Kenya was not hard to come by on the streets of Nairobi: "To say they want to offer services to people who are engaged in acts that do not conform to the law is taking this issue of human rights too far," said Lynette Moseti. "That money can be used to help children who are living with HIV." Homosexuality remains illegal in Kenya, punishable by up to 14 years in prison. According to Muraguri, however, the urgency of the problem necessitated ignoring the law. "Rigidity will only make our situation worse," he said. Muraguri stressed that the government's survey did not intend to stigmatize MSM. "We appreciate the stigma these people face and that would be [the] last thing we would want to do; even in other mainstream HIV services that the government offers we use data to offer services, so I do not think there is anything unusual about the survey," he said. Lorna Dias, MSM coordinator at Liverpool VCT (voluntary counselling and testing), Care and Treatment, one of the only organizations in the country that provides services to MSM, says the planned survey shows that the government is serious about tackling the epidemic among most at-risk populations. "It is a positive step and a clear indication that the government is ready to open up to the reality that men who have sex with men pose a great risk to the war against HIV unless they are integrated within mainstream HIV and AIDS programmes," she said. "The next step should be to de-stigmatize them and see them as normal people who need services like everybody else." *(not their real names) ko/kr/cb http://www.plusnews.org/report.aspx?ReportID=86932 http://www.plusnews.org/report.aspx?ReportID=86932 JOHANNESBURG, 5 November 2009 (PLUSNEWS) - Wavering international support for HIV/AIDS efforts is resulting in funding shortfalls that could wipe out a decade of progress in rolling out AIDS treatment, the international medical and humanitarian organization, Médecins Sans Frontières (MSF), has warned. http://www.IRINnews.org/images/2007/2007080115t.jpg JOHANNESBURG, 5 November 2009 (PLUSNEWS) - Wavering international support for HIV/AIDS efforts is resulting in funding shortfalls that could wipe out a decade of progress in rolling out AIDS treatment, the international medical and humanitarian organization, Médecins Sans Frontières (MSF), has warned. In a report called "Punishing Success? Early signs of a retreat from commitment to HIV/AIDS care and treatment", released on 5 November, MSF highlights worrying indications that the two biggest international funders helping developing countries expand their AIDS programmes are starting to scale back or flatline their contributions. The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which largely relies on money from developed countries to award grants in 140 poor countries, will soon decide whether to cancel its 2010 call for funding proposals. If so, it will be the organization's first year since 2002 without a funding round; the total amount of HIV grants recommended for funding in 2009 was 35 percent lower than in 2008. Countries like Malawi are heavily dependant on Global Fund grants to finance their antiretroviral (ARV) treatment programmes. The MSF report notes that with the Fund in crisis, Malawi's chances of achieving universal access to treatment are sinking. The US President's Emergency Plan for AIDS Relief (PEPFAR), under the leadership of former President George Bush committed to scaling up treatment from the more than two million people it supports to at least three million by 2013. Now, faced with an economic crisis, President Barack Obama's administration has flatlined US funding for HIV/AIDS in 2009. In Uganda, a principal beneficiary, some PEPFAR-supported organizations have stopped putting new patients on ARVs. "We're launching this report because we think we're at a very dangerous turning point," said Dr Tido von Shoen-Angerer, director of MSF's Access to Essential Medicines campaign. "Critical decisions are being made by governments and we're starting to see the early effects on the ground." After leading the charge for universal access, the UK Department for International Development (DfID) has started redirecting funds to other health issues, while Netherlands is considering a reduction of 30 percent in its HIV/AIDS spending. "The message five years ago was 'Go for it and we'll support you'," said Dr Eric Goemaere, MSF medical coordinator for South Africa and Lesotho. "Now that we're midway across the river, they seem less sure." Von Shoen-Angerer was critical of the recent trend in global health policy of pitting AIDS against other health priorities, such as maternal and child health. He pointed out that AIDS was "a continuing emergency" and accounted for more than half of all deaths in five of the countries with the highest HIV prevalence. "Clearly, there are other global health needs, but it can't be an either-or game," he said. "The dirty secret here, I think, is that donors are getting cold feet about funding a long-term chronic disease." The decision by some donors to shift funding out of HIV/AIDS treatment and into prevention also created what Goemaere called "a false dichotomy" - for instance, areas like South Africa's Western Cape Province, which had achieved high levels of treatment coverage, were seeing the greatest drop in HIV infection. Von Shoen-Angerer warned that the cost of treatment was set to rise in coming years. The World Health Organization is considering revising guidelines to reflect research findings that starting ARV treatment earlier improves survival rates and reduces the incidence of opportunistic infections. This could effectively double the number of patients who qualify for treatment. A growing number of patients will also need second-line ARV drugs, which are currently much more expensive than first-line medications. ks/he http://www.plusnews.org/report.aspx?ReportID=86902 http://www.plusnews.org/report.aspx?ReportID=86902 SELEBI-PHIKWE, 5 November 2009 (PLUSNEWS) - On a recent Wednesday evening, Gillian Otsile, a volunteer at a local NGO, Men Sex and AIDS, approached a group of young men drinking cartons of traditional sorghum beer at a tavern in Selebi-Phikwe, a mining town in northeastern Botswana. http://www.IRINnews.org/images/2009/200911041532540002t.jpg SELEBI-PHIKWE, 5 November 2009 (PLUSNEWS) - On a recent Wednesday evening, Gillian Otsile, a volunteer at a local NGO, Men Sex and AIDS, approached a group of young men drinking cartons of traditional sorghum beer at a tavern in Selebi-Phikwe, a mining town in northeastern Botswana. In a country where nearly one in four adults is infected with HIV, Otsile's focus is talking to the patrons of local drinking establishments about the risks of combining alcohol with sex. Most of the group in the bar in Selebi-Phikwe are unemployed and rely on occasional piece-work to buy beers for themselves and any girls they meet. Tato, who is slightly older than the others and works as an electrician, confirmed that after buying a girl beers all night, he expected to go home with her. Using a condom depended on how drunk he was. "If you're drunk, you lose half the sensation, so the only way you can do it is flesh-to-flesh. You forget about HIV." Tato's comments echo the findings of several studies: heavy drinking is associated with an increased likelihood of engaging in sexual behaviours that put individuals at risk of HIV infection. A 2006 study in Botswana found that both male and female heavy drinkers were above three times more likely to have unprotected sex than non-drinkers; their odds of having multiple partners and paying for or selling sex were also much higher.  Need for policies Alcohol use as a driver of HIV infections is evident throughout southern Africa, the region worst hit by the global HIV/AIDS pandemic, but few governments have implemented policies to address the problem. However, in 2008 Botswana President Ian Khama's government acknowledged the link by legislating shortened hours for bars and slapping a 30 percent levy on alcohol. It is too soon to say whether these measures have changed drinking habits enough to have an impact on HIV infection rates. Some commentators say people have simply switched to drinking traditional beer called Chibuku, which still sells for less than US$1 for a one-litre carton that can be shared between friends. One of Tato's friends pointed out that bars are also popular places to buy condoms, so "if the bars are closed, they're not going to find a condom." The tavern adjacent to the office of District AIDS Coordinator Lamech Myengwa is still doing brisk business, especially at month-end. "In Botswana, drinking has become a pastime," he told IRIN/PlusNews. Few small towns have a cinema or much else by way of recreational facilities. "Every evening people will go to the bars to socialise - that's where everybody mixes, young and elderly - no wonder there is this intergenerational sex going on." Government figures from 2008 show that HIV infections in Selebi-Phikwe, as in most of Botswana and across southern Africa, are highest among young women and older men, demographics that tend to be replicated in the bars. "The women are young girls, from 16 [years old]," said Dikgang Keabetswe, a project leader at Men Sex and AIDS, one of several community-based organizations receiving funding from Population Services International (PSI), a global health organization, to raise awareness about alcohol and HIV in local bars. "Some [young women] go [to the bars] without a cent; they look for males to buy them something to drink, and even for transport money. Men mostly expect sex in return. The BCL guys [workers at the local copper and nickel mine] - those who have more money - are mostly over 25." Employment opportunities for women in Selebi-Phikwe have shrunk since several textile factories closed in the late 1990s, and some have turned to commercial sex work, while others occasionally exchange sex for drinks or small amounts of cash. On her way home from buying a bag of maize, Elizabeth, 27, has stopped at the tavern where Tato and his friends are drinking. "I want a drink but I don't have money, so I'm hoping someone will buy me one," she said, admitting that some men expected sexual favours in return. "If I want, I go with him. Sometimes I use a condom, but if he says, 'I don't have a condom', and I see he has a lot of money, I'll agree ... In life, we need money." She recently tested negative for HIV, but believes it is only a matter of time before she contracts the virus. "I think everyone nowadays has HIV," she said. Tato and his friends have similarly fatalistic attitudes and a reluctance to change risky sexual behaviours; several said they slept with sex workers whenever they had money. "I'm not afraid of HIV because there are ARVs [antiretrovirals] for free," said one, referring to the government ARV programme which reaches nearly 100 percent of those in need of the medication. "I'm afraid of it ... when I'm sober," laughed Tato. Changing behaviours no easy task Persuading people to reduce their alcohol consumption will have little effect on Botswana's HIV infection rates unless it is accompanied by fundamental changes in attitudes and behaviours. The young volunteers doing the PSI-funded interventions at bars are trained to strike up conversations with people not only about drinking responsibly, but also about the common practice of having multiple concurrent partners (MCPs) - perhaps the biggest and most neglected driver of HIV infections in southern Africa, according to recent research. PSI is providing technical assistance to Botswana's National AIDS Coordinating Agency (NACA) in an initiative launched earlier this year to raise awareness and eventually change behaviour. The first phase is a mass media campaign featuring the slogan "o icheke" (check yourself), to get people to recognize the risks of having MCPs. Starting in December, a second phase will target demographic groups most likely to have MCPs with tailored messages, said Richard Matlhare, head of behaviour change at NACA. "We looked at alcohol as one of the predisposing factors, and that's why the President has taken a stance on responsible drinking," Matlhare said. "We know people can't make informed judgements when they're drunk." ks/he http://www.plusnews.org/report.aspx?ReportID=86899 http://www.plusnews.org/report.aspx?ReportID=86899 GABORONE, 4 November 2009 (PLUSNEWS) - Katlego Lally*, 17, belongs to a club for HIV-positive teenagers run by the Baylor Children's Clinic Centre of Excellence in Gaborone, Botswana's capital. She talked to IRIN/PlusNews about how the club has helped her overcome feelings of isolation and depression. http://www.IRINnews.org/images/2009/200911041529190979t.jpg GABORONE, 4 November 2009 (PLUSNEWS) - Katlego Lally*, 17, belongs to a club for HIV-positive teenagers run by the Baylor Children's Clinic Centre of Excellence in Gaborone, Botswana's capital. She talked to IRIN/PlusNews about how the club has helped her overcome feelings of isolation and depression. "I was born in 1992. Back then, there was no PMTCT [prevention of mother-to-child transmission] so I got the [HI-]virus from my mother, but I wasn't diagnosed then. I just grew up falling sick every time, and we didn't know why. "In 2003 we did some tests and then they found out that I had the virus, and my mother also. I don't think I understood at that time ... But as time went by I came to understand the disease, and that's when I told my brain: 'Okay, this is a death sentence', and that's when I became depressed. "I remember in 2007, I was falling sick often and my exams were about to come, so I was a bit down, always just kicking myself – 'Why? Why me? What have I done?' - I was just living in a dark tunnel, waiting for the day I would die. "Then last year I was referred to Baylor [Children's Clinic] and that's when I think my life changed. The doctor told me about Teen Club; then I came and I saw a whole new world that I never knew. "I didn't realize - I thought it was just me - but I saw a whole lot of excited and happy teenagers, and I also got that energy, that positive thinking, from them. "This year I was elected to be a [Teen Club] leader. I have to be a role model to the younger teen members, I help with serving lunch, lead ice-breakers and train other teen leaders from satellite clubs. "I've made a lot of friends - they're like my family. Everyone is open with each other, because when you're in the same situation you understand each other. We don't normally talk about HIV or medications here in Teen Club; we sometimes go on trips, listen to music, or sometimes we get life skills. "Being a teenager is very hard - you have to keep up with the changing life, do what the others do. My school friends don't know [about being HIV-positive], but just like most people here generally in Botswana, especially teachers when they talk about HIV, they bring it up in a whole negative way. "I have friends who drink, who have sex, and sometimes you try to tell them: 'this is not good'. But how are you going to make them understand? You'd maybe have to start by saying, 'I'm HIV positive and you don't want to be HIV-positive', and that would be like, ugh, so I just leave it. "Teen Club helps me. I know I don't have to go to the bar and drink alcohol, I don't need drugs to get me high, because I have a happy life and I have a lot of goals for myself. First of all I want to be a lawyer, but if not law, then radio journalism, and if not, then accounting ... or I want to be a movie star. "I go on dates, but sometimes I can just be out of the dating mode. I want a person I can spend the rest of my life with, but when the time comes for us to maybe have sex, how am I going to disclose my status? "You never know what they'll think. What if that person is not that trustworthy? Once you tell him he'll get really angry and start to spread rumours about you, so I just have to leave it. "Right now I'm writing my final exams so after then, that's when I'll start seeing what to do. If I fall in love with someone who's negative, I'll see if I disclose my status to that person, how they will react." *Not her real name ks/he http://www.plusnews.org/report.aspx?ReportID=86881 http://www.plusnews.org/report.aspx?ReportID=86881