http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbTue, 17 Nov 2009 09:14:07 GMTKISUMU Tuesday, November 17, 2009 (IRIN) - 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.KISUMU Tuesday, November 17, 2009 (IRIN) - 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.irinnews.org/report.aspx?ReportId=87074KAMPALA Monday, November 16, 2009 (IRIN) - The Uganda AIDS Commission (UAC) is revamping its national HIV information campaign after HIV prevention messages were less successful than hoped. KAMPALA Monday, November 16, 2009 (IRIN) - 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.

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http://www.irinnews.org/report.aspx?ReportId=87053MUZZAFARABAD Sunday, November 15, 2009 (IRIN) - Rameesha Butt, 12, remembers being trapped in her classroom as the horror of the October 2005 earthquake that killed at least 73,000 people in the North West Frontier Province (NWFP) and Pakistan-administered Kashmir unfolded around her.MUZZAFARABAD Sunday, November 15, 2009 (IRIN) - Rameesha Butt, 12, remembers being trapped in her classroom as the horror of the October 2005 earthquake that killed at least 73,000 people in the North West Frontier Province (NWFP) and Pakistan-administered Kashmir unfolded around her.

“Our school was very old, and many of the walls collapsed. I was not hurt badly, but it was terrifying to see bricks and mortar fall all around us. Some pupils were trapped under the rubble,” Rameesha told IRIN.

According to government estimates, the quake damaged or destroyed 6,000 schools – making up around 52 percent of schools in the quake-affected area. Some 17,000 students and 900 teachers were killed in classrooms.

For years after the quake, children have studied in makeshift classrooms. Now, under an initiative by the UN Children’s Fund (UNICEF) and the Earthquake Relief and Rehabilitation Authority (ERRA) in conjunction with the Ministry of Education, 100 new schools have been built and handed over to provincial authorities.

The new schools are more spacious than the ones they replace, with at least one square metre of classroom space per child. Hand-washing stations have also been set up to promote good hygiene. Under the ‘build back better’ motto adopted after the quake, the new schools are also designed to be earthquake resistant and to offer a more child-friendly learning environment.

“Our aim is to ensure children receive the best possible education,” Syed Fawad Ali Shah, emergency education officer for UNICEF Pakistan, said. He said teachers at the schools had been trained in child-friendly teaching methods and corporal punishment had been banned.

“Not scared anymore”

Pupils of Government Girls Primary School Mohajir Colony in Muzaffarabad, capital of Pakistan-administered Kashmir, are among those who now have a brand new school. The girls, who for months after the quake had huddled in a freezing tent-school, were visibly excited about their new earthquake-resistant building.

“We are not scared anymore because this is a new building, not like our old school,” Shahzia Ali Lone, a fourth grade student, said.

Parents across the area hit by the quake are also relieved that their children can go to school in safety. “For over a year after 2005, I was scared of sending our three children to school. So many children had died in classroom collapses, but now there are better schools for them and we are confident they will receive a good education,” Aziz Ahmed, 40, said.

“There is no greater investment in the future of a country than an investment in the education of the children” Luc Chauvin, deputy representative for UNICEF Pakistan, said. “In partnership with ERRA, the Ministry of Education and provincial authorities, we have not just constructed schools, but have taken an important step toward ensuring that children in the areas affected by the 2005 earthquake have access to a higher quality education than ever before.”

kh/edhttp://www.irinnews.org/report.aspx?ReportId=87042NIAMEY Thursday, November 12, 2009 (IRIN) - High school students in the Niger capital, Niamey, learned to put HIV/AIDS and reproductive health in a broader context during a recent essay contest.NIAMEY Thursday, November 12, 2009 (IRIN) - High school students in the Niger capital, Niamey, learned to put HIV/AIDS and reproductive health in a broader context during a recent essay contest.

"In preparing my essay I learned that AIDS is not a death sentence," said one female student who requested anonymity. "This kind of exercise should be encouraged because it allows students to increase their knowledge of AIDS and its consequences."

Nearly 500 students in Niamey participated in the recent contest, an initiative of the Réseau National des adolescents et jeunes en population et développement (RENAJEN/POPDEV).

Students were asked to cover one of two themes: what kind of moral support to offer to a friend who learns he/she is HIV-positive, or what advice to give to someone who does not practice birth spacing, said Hinsa Garba of RENAJEN.

The contest aimed to bring home the concept of responsible sex to students, Ousseini Boubacar, the head of RENAJEN, told IRIN. "At the same time, by participating in this contest the young people give us the opportunity to gauge their knowledge of reproductive health and HIV/AIDS."

Niger authorities welcomed the exercise. "It's a good strategy, not only for educating youths about sexually transmitted diseases, but also to call parents' attention to the necessity to facilitate openness and debate about these subjects," Mallam Issa Mallam Souley, national population director, told IRIN.

Abdoul-Kader Moussa, one of the contest winners, told IRIN: "I said in my paper that I would tell a friend not to be discouraged, and to follow the treatment as prescribed by a doctor." He said this was based on things he had learned in radio and television education programmes about HIV.

Cultural factors sometimes trump education – about 40 percent of adolescents in Niger have sexual relations before age 15, according to the Joint UN Programme on HIV/AIDS (UNAIDS); 97 percent of women have never had an HIV test. UNAIDS said the determining factors included low education, economic dependence, and early sexual relations and marriage.

Niger has an HIV infection rate of 0.7 percent. In its 2008-2012 poverty reduction strategy the country aims to keep the rate below that.

bb/np/hehttp://www.irinnews.org/report.aspx?ReportId=87013RUDAKI Wednesday, November 11, 2009 (IRIN) - Six months after floods hit parts of southern-central Tajikistan, damaging or destroying dozens of schools and other buildings, hundreds of students are still attending school in overcrowded and sometimes unsafe buildings, according to local teachers and officials.RUDAKI Wednesday, November 11, 2009 (IRIN) - Six months after floods hit parts of southern-central Tajikistan, damaging or destroying dozens of schools and other buildings, hundreds of students are still attending school in overcrowded and sometimes unsafe buildings, according to local teachers and officials.

One of the affected schools is in Rudaki District: “We have two classrooms in a damaged building. It is not safe; it is dangerous, but we don’t have any other option,” Huseyn Toshev, headmaster of School No. 12 in Rudaki, told IRIN.

In some of the classrooms two pupils share a chair, or three are squeezed onto two chairs - unheard of in normal circumstances. “We now operate three shifts. We have 828 pupils being taught in two buildings, while the planned capacity is for only 300,” Toshev said.

The shift system meant teachers and pupils had no time for lunch breaks, he added.

“The old part of the school [where there are two classrooms for younger pupils] was built in 1927. It is not fit for purpose and unsafe. It should be demolished and a new one built,” he said. “We pray there is no quake and hope nothing happens.”

Shamigul Murodova, a teacher at School No. 38 in Sangtuda village, Rudaki District, said the school was built in the 1930s and parts of the walls collapsed during the floods. “We used to have 11 classes, with two shifts of pupils. After the floods we have three classes with 595 pupils studying in three shifts,” she said.

Mavjuda Boboeva, deputy head of the Rudaki District administration, told IRIN the floods affected 10 schools in the district, four of which were badly damaged.

“Those four schools are in a dangerous condition. If there is a four degree earthquake they will collapse,” Boboyeva said.

“In one school, the beams are rotten and if there is snow, the roof will collapse. There are other schools in very poor condition, but no funds for rebuilding. We ask donors and international organizations to help,” she said.

According to the local met office, over 50 floods and mudflows affected more than 12,000 people in April-May 2009, with the districts of Khuroson, Pyanj and Qumsangir in Khatlon Province and Nurobod, Rudaki and Rasht districts (administered directly by central government), the worst affected.

More than 2,000 buildings, including 13 hospitals and 70 schools were partially or totally damaged, according to the 12 August Early Recovery Appeal - Tajikistan Floods and Mudflows http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUnidFilename/MYAI-7VA9UY-full_report.pdf/$File/full_report.pdf by the Rapid Emergency Assessment and Coordination Team (a local team comprising government bodies, UN agencies and NGOs).

Stalled aid

Italian NGO CESVI has drafted a US$950,000 project (as part of the Early Recovery Appeal) to rebuild three education facilities destroyed by floods in Zaynabobod, Guliston and Lohur local councils in Rudaki District, but there has been no response from donors so far.

Asked about why donors have not been generous, UN Resident Coordination Michael Jones said donors were more eager to fund humanitarian emergency projects.

“Each donor has its own policies, its own criteria that it has to apply. Some projects fit the criteria some don’t. The whole aid world over the years has become compartmentalized [such] that you have your emergency assistance, your humanitarian assistance, then you have your recovery envelope where funding facilities are very limited,” Jones said.

at/cbhttp://www.irinnews.org/report.aspx?ReportId=86976LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.

"I just joined a new school a few weeks ago [20 October]," 14-year-old Kelly Lanyasunya said at Lesidai primary school in Samburu Central District (central-northwestern Kenya). "I got a new uniform and I am making friends but if this area gets insecure, I will have to move to another school."

Like her classmate, Nabik Kekichorumongi, is forced to change schools whenever bandits attack the surrounding villages.

Stephen Leparachwo, head teacher at Lolkunono primary school in Samburu Central, said Lesidai primary school often receives parents bringing their children from Pura, a neighbouring area affected by banditry.

"When they come, some are even without food… The bandits follow the fleeing residents [and their cattle], not giving the children a chance to read," he said.

Cattle-rustling

Much of the insecurity is due to cattle-rustling between the Samburu, Pokot, Turkana and Borana communities, according to local residents. In September, for example, Pokot cattle raiders killed 32 people in Samburu Central.

Rustling has also affected food production, especially in fertile areas like Ngano on the Kirisia ranges, where bandits lurk in the beautiful landscape.

In 2008, insecurity worsened in Ngano, according to the headmaster of a local school, Simon Lenolkulal. "We could hear gunshots, so we were seeking cover on the ground with the children," he said, recalling a recent incident.

"There is a high rate of transition even of school teachers here… Teachers are reluctant to work here because of the insecurity. One week there is peace, the next week we are moving... Every week we enrol new children, then when there is tension they leave."

The school relies on food aid from agencies like the UN World Food Programme (WFP). According to Lenolkulal, however, people could farm the land and eliminate food aid, if there were more security.

At neighbouring Lgoss primary school, deputy head teacher Bernadeta Lesuruan told IRIN: "When there is conflict and the parents flee, we have more children coming to the classes."

Hunger

Food scarcity tends to drive up school attendance, local residents said.

When there is a general food distribution, enrolment in school goes down, while in more difficult times the number of children increases, Lesuruan said.

"During such times you see young children carrying toddlers to school for the food… During the drought, the children were entirely relying on food in school. Some were fainting after coming from home hungry. When there is no food [at all], school attendance is very low."

In August, WFP was feeding at least 900,000 children in schools to help drought-affected families in Kenya's arid and semi-arid regions.

"Food is an issue," said Peter Emanman, the school feeding programme officer in Samburu Central.

Recent rain has brought hope of an improved food situation. "People are starting to plant but the food crops will not be ready by December [the next school holiday month]. What will happen then?" Emanman asked.

Few girls at school

There are few school teachers and hardly any female teachers. At Lgoss, Lesuruan was the only female member of staff.

"Since I came here [in 2008] more girls are staying in school especially those who would run away for the period of their menstruation," said Lesuruan. "I bring pads to the school for the girls."

Apart from the location of the school, 12km from the nearest shopping centre, the high cost of sanitary pads also feeds absenteeism.

Early marriages also affect girls’ attendance at school: Most drop out in the middle primary school classes. In 2008, some Samburu schools had no girl candidate sitting the national primary school leaving exam.

"There is a mentality that if girls are educated and get jobs, the earnings will not return home but go to the husband," said another teacher.

Most of the boys in school are late entrants; some of the girls stay at home to work. "In this community people are not fond of keeping children in schools," the teacher added.

Night school

However, some communities are trying to educate residents about the value of education: Currently under way in Baragoi District, the pastoralist night school initiative targets cattle herder children who are unable to attend day school.

"The children leave the fields at 4pm and then attend class," said Emanman. "The students get `uji’ (maize meal porridge) in the evening and are taught until 10pm."

Some children from these schools have progressed to the formal education system, but the night school initiative is largely designed to teach basic literacy to herders and others, he added.

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http://www.irinnews.org/report.aspx?ReportId=86968NAIROBI Tuesday, November 10, 2009 (IRIN) - 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.NAIROBI Tuesday, November 10, 2009 (IRIN) - 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)

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http://www.irinnews.org/report.aspx?ReportId=86953NAIROBI Monday, November 09, 2009 (IRIN) - 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.NAIROBI Monday, November 09, 2009 (IRIN) - 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/cbhttp://www.irinnews.org/report.aspx?ReportId=86932KABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).KABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).

NRVA 2007/08 was produced by the government with European Union funding and in collaboration with aid agencies.

A bleak picture is painted:

26 percent literacy rate (12 percent female and 39 male)
24 percent of all child deliveries are attended by a skilled birth attendant
Less than 30 percent of people have access to safe drinking water
Over 90 percent do not have access to proper sanitation
About 20 percent have electricity in their homes.
Half of the estimated population of 25 million is under 15

“NRVA is an effective tool for… poverty alleviation and development programmes,” Naseer Ahmad Popal, an official from the Ministry of Rural Rehabilitation and Development, told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86889NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.

“Malaria kills many people in Africa, both children and adults, despite the availability of free treatment in certain African countries. While it is true many governments in Africa, with development partners, give free pediatric treatment for malaria, many still cannot access this facilities and resort to home treatment,” says Merlin Wilcox of the Research Initiative on Traditional Antimalarial Methods and the University of Oxford.

Some specialists at the ongoing 5th MIM Pan African Malaria Conference in Nairobi said medicines drawn from plants that abound in the continent could be utilized to save many people, especially those in poor settings, from malaria.

BN Prakash, a researcher with the Foundation for the Revitalization of Local Health Traditions, based in Bangalore, said Africa could draw on experiences in India where medicinal plants have been used with great success in the control of malaria-related deaths.

“Research in India has shown a 5-10 times reduction in malaria-related deaths among communities who use traditional medicinal plants like Guduchi [tinospore coeditdia], a local medicinal plant found in India,” said Prakash.

Preserving traditional knowledge

Another speaker, Gemma Burford of the Global Initiative for Traditional Systems of Health, said while there had been increased cases of loss of knowledge about traditional medicinal plants, student-led research could be used to preserve knowledge and create a database on these plants.

“When we carried out research involving school children in rural Tanzania about traditional Maasai medicines, we found out that 48 percent of these children already had knowledge about these plants. We used [this knowledge] to create a database for the purposes of preserving the knowledge and these plants too,” said Burford.

“It is important to note that many malarial drugs are still bought from commercial pharmaceutical shops and not many of them are that cheap. Costs also involve how easy or not it is to access these government facilities, especially in Africa where medical facilities are far-flung,” Burford said.

Educating the youth

Speakers at the conference called on African governments to introduce educational programmes that would teach the younger generations about the traditional methods of treating malaria and other diseases plaguing the continent.

“The biggest obstacle to use of traditional medicines is lack of interest from the youth and teaching them about these medicines would be the best way to let them appreciate their values. Evangelical churches and development agencies must also be persuaded to stop fighting traditional African medicine because modernity and tradition can be married to provide a formidable force against malaria,” added Burford.

Effectiveness and dangers

Doumbo Ogobara, director of the Mali Malaria Research and Training Centre, and a lecturer at the University of Bamako, said there should be more research to ensure the effectiveness of traditional medicinal plants in the treatment and management of malaria.

“More research must be directed towards finding out the effectiveness of these traditional medicinal plants and their safety and efficacy because initiatives on using them could be counter-productive if this is not done. More emphasis therefore must be laid on research for plant-based prophylactics for malaria,” said Ogobara.

Mahamadou Sissoko of the Centre called for caution in taking the traditional medicinal route, arguing that many malaria-related deaths have occurred even among communities that have relied heavily on traditional plants for treatment.

“People are dying even in places where there is still widespread use of traditional medicinal plants and unless the efficacy of a traditional plant on malarial treatment can be ascertained through vigorous research, we could have our backs against the wall. Many traditional healers will abuse this and give anything as medicine so long as it is a plant - we must urge caution,” said Sissoko.

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http://www.irinnews.org/report.aspx?ReportId=86866NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.

"I was experiencing a bad smell from my private parts and I wondered whether it was because I was HIV-positive; I could not keep quiet any more and I shared with one of the nurses and she referred me to the doctor," Mworia told IRIN/PlusNews. "I did not even know there was anything called cervical cancer, which I was informed can kill very easily."

According to the UN World Health Organization (WHO) [http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/KEN.pdf], some 2,635 Kenyan women are diagnosed with cervical cancer every year, with 2,111 dying from the disease, making it the most prevalent cancer among women in the country. About 38.8 percent of women in the general population are estimated to harbour cervical human papillomavirus (HPV) infection [http://www.cancer.gov/cancertopics/factsheet/Risk/HPV] - a leading cause of cervical cancer - at any given time.

High risk, low knowledge

For cervical HPV infection to progress to cancer, certain co-factors must be in place, including smoking, long-term hormonal contraceptive use and co-infection with HIV.

"Women who are HIV-positive have weak immune systems and this makes them very susceptible to persistent human papillomavirus that develops into cancer of cervix," said Lucy Muchiri, a senior lecturer in human pathology at the University of Nairobi's College of Health Sciences and a member of the sub-Saharan Africa Cervical Cancer Working Group.

"It takes a relatively shorter time for the HPV virus to develop into full-blown cancer of the cervix for women who have the HIV infection … It would take relatively longer in women who are not infected with HIV."

Pap smear tests - which check for changes in the cells of the cervix - are available at most district health facilities in Kenya, but according to WHO, fewer than 6 percent of women access them.

"I think many women die from the disease for a number of reasons - one is ignorance because knowledge about the disease among women and in the general population is very low and it is mistaken for other diseases," she said. "It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women."

According to Francis Kimani, director of medical services at the Ministry of Health, Kenya is planning a screening programme for early detection and treatment of cervical cancer as well as a widespread education campaign.

Education gap

"I think our best bet is to carry out education to let people know about the disease and that early detection of it can be very helpful," Kimani told IRIN/PlusNews. "It is true that not many people - especially in rural areas - know about the disease."

Studies [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631263] have shown that HPV is higher among women who have multiple sexual partners and unprotected sex.

"Maybe to prevent it in the first place, the same methods used in combating HIV, like condom use, abstinence and keeping to one faithful partner, should be encouraged in this case too," Muchiri suggested.

She noted that the government also needed to invest in making the HPV vaccine - which protects against four major types of HPV, including two types that are responsible for 70 percent of cervical cancers - widely available in public hospitals.

Vaccine availability

The Kenya Pharmacy and Poisons Board approved the sale of an HPV vaccine in the country in 2007, but its availability is extremely limited and it is still prohibitively expensive for most Kenyans.

"HPV is a sexually transmitted virus and with the vaccine in place, it is important to encourage parents to take their young girls between the ages of nine and 15 to be vaccinated before they debut into sex," she said.

A recent study by the local NGO, Centre for the Study of Adolescence, found that four in 10 Kenyan girls had sex before the age of 19, many of them as early as 12.

"Once they [women] become sexually active, it is important to encourage [them] to go for Pap smear tests or visual detection of the pre-cancerous lesions but even vaccination at this stage is still feasible so long as one has not contracted the virus," Muchiri added.

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http://www.irinnews.org/report.aspx?ReportId=86853DHAKA Tuesday, November 03, 2009 (IRIN) - A new report by the UN Children’s Fund (UNICEF) says most children in Bangladesh are regularly exposed to physical abuse at school, at home or where they work. DHAKA Tuesday, November 03, 2009 (IRIN) - A new report by the UN Children’s Fund (UNICEF) says most children in Bangladesh are regularly exposed to physical abuse at school, at home or where they work.

The study [http://www.unicef.org/bangladesh/media_5661.htm] entitled Opinions of Children of Bangladesh on Corporal Punishment involved nearly 4,000 families and was published on 8 October 2009.

“In all regards, the children of Bangladesh are in a very vulnerable position,” Mohammad Kafil Uddin, director of Bangladesh Children’s Rights Forum, an organization of 235 NGOs working in the children’s rights sector, told IRIN in Dhaka.

According to the report, 91 percent of the children surveyed faced various levels of physical abuse at school, while 74 percent were abused at home.

The report found that 87.6 percent of schools still used switches and sticks to discipline students, and that the most common forms of punishment were: hitting with a switch or stick, pinching or pulling an ear, hair or skin, and slapping.

Some 23 percent of students said they had to face different forms of corporal punishment every day. Seven percent reported injuries and bleeding resulting from the punishments administered by teachers.

The threat of corporal punishment was a major reason why children played truant or had lost interest in their studies, the report said, adding that only 75 percent of enrolled students regularly attended school.

“They [teachers] beat us with wooden and steel rulers and sticks,” Ishrat Jahan Ima, a seven-year-old second year student at the Sher-E-Bangla Nagar Government Girls’ School in Dhaka, claimed, recalling how one teacher proudly showed off a broken switch bragging that he had broken it by beating a fifth-year student.

In the workplace

Although child labour is illegal in Bangladesh, the practice is prevalent, say child rights activists, and the report indicated that about 10 percent of the children had jobs.

Of these - apart from having to put up with a heavy workload, poor wages and dangerous working conditions - a quarter of them were regularly beaten; 65 percent said they were punished in one form or another in their workplaces.

In the home

At home the survey found that 99.3 percent of the children reported being verbally abused and threatened regularly by their parents. Slapping was a common form of discipline for 70 percent of the children, while 40 percent were regularly beaten or kicked.

“Physical abuse of children is a daily occurrence and this is a problem which needs a complete mindset change… The level of awareness among the people of Bangladesh regarding the rights of children is very low,” Bangladesh Children’s Rights Forum director Mohammad Kafil Uddin said.

The report also correlated the household income and education of the parents with physical punishment: Parents from poorer and less educated households were more likely to resort to corporal punishment.

Bangladesh was one of the first countries to ratify the UN International Bill of Rights for Children in the 1989 UN Convention on the Rights of the Child (UNCRC). [http://www.unicef.org/crc/] The UNCRC states that all forms of physical and mental abuse against children must be prohibited, and a 2006 UN report recommended a target date of 2009 for the universal prohibition of corporal punishment.

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http://www.irinnews.org/report.aspx?ReportId=86850KABUL Tuesday, November 03, 2009 (IRIN) - A UN World Health Organization (WHO) official has backed the Afghan government’s health emergency declaration which involves a three-week closure of all schools and universities in Afghanistan as a means of preventing the spread of H1N1 influenza. He called it an “appropriate and timely measure” to curb its spread.KABUL Tuesday, November 03, 2009 (IRIN) - A UN World Health Organization (WHO) official has backed the Afghan government’s health emergency declaration which involves a three-week closure of all schools and universities in Afghanistan as a means of preventing the spread of H1N1 influenza. He called it an “appropriate and timely measure” to curb its spread.

“It was the right decision by the minister of health as we see the number of H1N1 cases rising,” Ahmed Abdul Rahman, WHO’s officer-in-charge in Afghanistan, told IRIN on 3 November. The government made the announcement on 1 November.

According to the Ministry of Education there are over nine million children and students at schools, colleges and universities in the country. All of them will be required to stay at home from 2-23 November.

Afghanistan had reported over 320 H1N1 cases with two deaths as of 3 November.

Some observers have suggested that the closure declaration was designed to prevent protests against President Karzai’s controversial re-election announcement, made the following day.

“In a country where two mothers die every hour from pregnancy-related complications, why is the suspected death of only two patients from flu declared an emergency?” asked an international aid worker in Kabul who did not want to named.

“The disease was not widespread and cannot justify a state of emergency in which the entire education system is closed,” Kabir Ranjbar, a member of parliament, told IRIN.

However, the Ministry of Public Health (MoPH) defended its decision and said the state of emergency was in no way politically motivated.

“Countries like Ukraine, the USA and Mexico, which are not in [the midst of] elections, have also declared H1N1 emergencies and so has Afghanistan,” Farid Raaid, MoPH’s spokesman, told IRIN.

“We are in the midst of at least three emergencies namely security, political and now health,” said Ajmal Samadi, director of the Kabul-based rights watchdog Afghanistan Rights Monitor.

Six million at risk?

Health officials told IRIN over six million of the country’s estimated 28 million people risked catching H1N1. Pregnant women and children were particularly vulnerable, they said.

“Through the health emergency we want to mitigate the risks and prevent a major outbreak of H1N1 in the country,” said Amir Ansari, an adviser to Health Minister Mohammad Amin Fatimie.

The government has prepared a snap appeal for over US$60 million to procure medication, such as Tamiflu and seasonal flu vaccines, and undertake other necessary measures to combat the disease, Ansari said.

The MoPH has also asked the World Health Organization (WHO) for support and the provision of over one million doses of Tamiflu, officials said.

Afghanistan only has one virology laboratory capable of diagnosing the H1N1 virus but about 200 surveillance units have been established across the country to quickly report suspicious flu cases. No H1N1 vaccine is available yet but the health authorities have received over 30,000 doses of tamiflu tablets from WHO, according to the MOPH.

The H1N1 type of influenza was first reported in Mexico in April 2009 and quickly spread to dozens of countries around the world. Globally, over 440,000 cases of H1N1 and over 5,700 deaths were reported by WHO as of 25 October [http://www.who.int/csr/don/2009_10_30/en/index.html].

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http://www.irinnews.org/report.aspx?ReportId=86858ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.

"It's a chance to experience life; there is no family, there are no restraints," said Biniam Mohammed, project coordinator of the Modelling and Reinforcement to Combat HIV/AIDS (MARCH) [http://www.aau.edu.et/march] project in the Siddist Kilo Campus of Addis Ababa University (AAU). "Some use it in a good way but some do risky things, such as chewing khat [a mild stimulant] … having [unprotected sex] and using commercial sex workers.

"Some of these students will have limited awareness of the risks of HIV/AIDS, and then there is peer pressure as well," he added.

Ethiopia's overall HIV prevalence is a relatively low 2 percent, but prevalence in the capital, Addis Ababa, is 7.5 percent. According to the Federal HIV/AIDS Prevention and Control Office (FHAPCO), anecdotal evidence of widespread unsafe sexual practices suggests students may be among the more high-risk groups in terms of HIV vulnerability.

MARCH statistics show that 50 percent of AAU students are sexually active, but only half of them use condoms, said Biniam.

High-risk behaviour

"Often they do not use condoms… they are doing it emotionally, without any thought," said Selam, a 19-year-old AAU student.

Selam added that students coming to the city from the countryside usually had less information about HIV and were not as street-smart as Addis youth, leaving them unprepared to resist unwanted sexual advances or insist on protected sex.

Former student Girma Tesfaye, now Addis Ababa project coordinator for HIV-focused NGO Mekdim, says female students often fall prey to “sugar daddies”.

"There are lots of beautiful girls at university and older people with beautiful automobiles stop around the university and look for them," he said. "It is common to take students this way. They have lots of money; they will provide the girls with money and different [presents].

"The older 'daddy' may have three or four partners in such a way, which facilitates the spread of HIV," he added.

Selam agrees that this is a significant problem, noting that in the early evening, heavily made-up and scantily clad female students make their way to the area outside the main gates known as the Debab to try to find a rich boyfriend, usually one who already has a wife, and quite possibly a string of other girlfriends.

"If you have sex because of a threat, or you have a 'sugar daddy', it is one-sided and that makes them more at risk," said MARCH's Biniam. "Influenced or coerced sex is high risk."

Evidence also suggests that male students use local sex workers; a survey [http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/EthiopiaSynthesisFinal.pdf] of Addis-based sex workers found that 5.8 percent of their clients were students. Sex workers in the nearby Arat Kilo area confirmed that many of their clients were AAU students.

MARCH, with funding from the US President's Emergency Plan for AIDS Relief, produces Life 101, a quarterly photo graphic novel that follows the story of three students and one couple at AAU as they experience daily university and city life and deal with issues such as transactional sex, condom use, relationships, testing for HIV, and gender equity. MARCH also facilitates student-led entertainment events to stimulate discussion of the issues.

Recently, more than 20 Ethiopian university presidents initiated a request [http://hapco.gov.et/index.php?option=com_content&task=view&id=103&Itemid=2] to the Ministry of Education and FHAPCO for more HIV activities, including a national HIV/AIDS policy and strategy for universities, an HIV/AIDS research and information centre, gender and HIV/AIDS advocacy efforts and sustainable training and discussion forums.

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http://www.irinnews.org/report.aspx?ReportId=86837LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.

Bushra and her husband have never considered the possibility that their daughter’s sight problem could merely be a refractive error, easily corrected with a pair of glasses. The couple, who have little formal education, have two other children.

“We have no money to take Kaneez to a doctor or buy glasses,” said Bushra. The family’s income is Rs 8,000 (US$100) a month.

According to Niazullah Khan, country director in Pakistan of the UK-based charity Sight Savers International, there are 1.4 million blind people in Pakistan. Of these, 45,000-48,000 are children under 15.

“Three times that number of children has low vision,” he told IRIN.

The World Health Organization (WHO) defines low vision "as visual acuity less than 6/18 and equal to or better than 3/60 in the better eye with best correction". It also notes there is, globally, a “high burden” of refractive error - which can be rectified with appropriate optical correction.

“We often see children with eye problems and though we refer them to free eye clinics not all parents take [their] children there. They are not aware poor sight can affect learning and quality of life,” said Dr. Nishat Kausar, a general practitioner. “Often people just try to buy cheap glasses from roadside sellers,” she said.

There are at present only 64 schools for blind and visually impaired children in Pakistan (population 165 million).

“We are trying, under new government policies, to facilitate education in mainstream schools for children with low to moderate vision, because the environment in schools for the disabled is not right for them. They need to live with normal people and learn how to manage,” Khan said.

Cataracts

Aroosa Haroon, 12, was diagnosed with cataracts in both eyes a year ago. Her parents, both librarians, were able to pay for surgery, performed on an outpatient basis at a private hospital, and Aroosa says “I can see perfectly again.”

She is fortunate. There are 9,000-10,000 cataract blind children in Pakistan. Cataracts account for 53 percent of all blindness in the country.

According to Sight Savers, 3000-4,500 paediatric cataract surgeries take place annually.

However, there are also other threats to sight, some of them linked to poverty. This is one reason why Kaneez, from a low income family, struggles with an uncorrected vision error, while Aroosa, from a more privileged background, was treated before poor sight could affect her education.

The link between poverty and blindness has been established by some scientific studies.

Vitamin A deficiency

One of the reasons for this is a widespread Vitamin A deficiency, experts believe. Globally, WHO notes, this is the leading cause of childhood blindness.

“Clinical deficiency of Vitamin A causes night blindness that may ultimately end up with loss of vision,” Azhar Abid Raza, health officer for the UN Children’s Fund (UNICEF) Pakistan, told IRIN. “According to the National Nutrition Survey 2001-2002, 12.5 percent of children showed evidence of being vitamin A deficient,” he said.

Pakistan has, with UNICEF support, run a Vitamin A supplementation programme, linked to National Polio Immunization Days, since 1999.

The battle against blindness is being waged in both the public and private sectors, with organizations such as the charitable Layton Rahmatullah Benevolent Trust running 56 eye clinics and hospitals across the country.

“We treat one in every three eye patients [in the country] and our mission is to offer quality eye-care to anyone who needs it,” said Najmus Saquib Hameed, a trustee of the organization.

But despite these efforts, children like Kaneez Fatima remain out of school. “I wish I could see enough to read, like my sisters can,” she said.

kh/at/cbhttp://www.irinnews.org/report.aspx?ReportId=86829AKKAR Thursday, October 29, 2009 (IRIN) - In Lebanon’s remote northeastern district of Akkar, teachers and pupils at the Rajam Issa public school are hoping this winter will be the first when the lights stay on. “Electricity is the lifeline of the school,” said head teacher Ibrahim Salame, complaining of frequent and prolonged power cuts.AKKAR Thursday, October 29, 2009 (IRIN) -  In Lebanon’s remote northeastern district of Akkar, teachers and pupils at the Rajam Issa public school are hoping this winter will be the first when the lights stay on. “Electricity is the lifeline of the school,” said head teacher Ibrahim Salame, complaining of frequent and prolonged power cuts.

Upstairs, the new computer room remains unused and unfinished, lacking both trained staff and power. “During the winter if the power goes out and it’s dark we just teach in the dark,” said Salame. “What usually takes one session to explain using a projector takes two hours on the blackboard.”

It is hoped that by the end of November their classroom lights, projectors and photocopying machines will stay on during power cuts thanks to a set of rooftop photovoltaic panels producing renewable electricity from one of Lebanon’s most abundant natural resources, the sun.

“Lebanon has an average of 300 days of sunshine per year, yet we are not making sufficient use of it,” said Jihan Seoud from the Energy and Environment Programme at the UN Development Programme (UNDP) in Beirut.

“The government is looking to reform the electricity sector, but mostly on the supply side. We are working with government entities to reduce load on the demand side. Reducing demand means the government can spend less on electricity generation,” Seoud said.

Burden of oil imports

Lacking oil and gas resources, Lebanon imports some 97 percent of its energy needs as fossil fuel. Government efforts to modernize electricity infrastructure since the end of the Civil War in 1990 have been unable to keep pace with growing demand.

The solution, say many Lebanese environmentalists, is a combination of solar thermal power to heat water, and photovoltaic panels for back-up electricity. These can have a direct humanitarian impact.

“Renewable energy can have huge positive effects both directly and indirectly for humanitarian use. Solar water heaters (SWH) can substantially reduce the energy bills of healthcare and education facilities,” said Pierre Khoury, acting manager of the Lebanese Centre for Energy Conservation (LCEC) in the Ministry of Energy and Water (MEW). “It can also reduce poverty by reducing energy bills of poor people and creating ‘green jobs’.”

After the July War of 2006 further damaged Lebanon’s power infrastructure [http://www.irinnews.org/Report.aspx?ReportId=70043], including destroying 190 of the nearly 500 SWH units installed in south Lebanon and donated by China, UNDP and LCEC teamed up with the Spanish government to install solar water heaters in south Lebanon.

This was followed by the creation of the CEDRO project through the Lebanon Recovery Fund to promote energy efficient reconstruction of homes and public buildings.

With earlier donations from Sweden and Greece, UNDP and MEW/LCEC have successfully installed or repaired over 500 SWH units and identified 180 public sector buildings in which to demonstrate renewable energy applications.

In a study [http://www.lcecp.org.lb/Files/LCEC%20SWH%20analysis%20paper%20Lebanon.pdf] of one SWH system installed in a typical family home in Marjayoun in South Lebanon, the LCEC found that over a year the system offset some 98.6 percent of the electricity previously needed to heat water.

Total annual savings were calculated to be US$195, though the real saving to the state power company, Électricité du Liban, totalled some $415 per system, providing a payback period of two years. The report concluded that around 290,000 SWH systems are needed to offset the need for a 100 MW power plant in Lebanon.

Reduced bills

Lebanese law does not allow citizens to generate their own electricity and connect to the grid, meaning solar photovoltaic electricity remains too costly for all but the largest private businesses, or for small schools like that in Rajam Issa which was given the system.

Heating water from the sun, however, has proved cost effective, and sales of SWH units tripled between 2005 and 2008, according to a survey by LCEC.

As well as is installing an initial 25 photovoltaic systems on the roofs of small schools in North Lebanon, the Bekaa valley and South Lebanon, CEDRO has constructed large-scale solar water heaters on an initial four public hospitals.

One of these is the Abdallah Rassi Hospital, the first public hospital in Akkar, serving half a million people of whom, in the words of Ali Saada, its general manager, “400,000 are poor”.

With the hospital running at an annual deficit of around half a million dollars, said Saada, a third of which is spent on heating water via a diesel generator, the 48 SWH panels now on its roof will soon start making big savings, with a tangible benefit to patients.

“If we can save most of a third of our total running cost then the hospital could break even in three years, perhaps two if we get more patients,” said Saada. “Without the solar panels it would take us five. That means the intensive care department could open earlier and we could afford to buy a new scanner and other equipment.”

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http://www.irinnews.org/report.aspx?ReportId=86796BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.

In Guinea-Bissau 98 of 114 health centres now offer family planning services and 10 percent of women use contraception which while low is an improvement, said Antonieta Martins, a UN Population Fund (UNFPA) adviser to the Ministry of Health.

UNFPA estimates that giving women access to modern contraception could prevent 40 percent of maternal deaths worldwide.

In Guinea-Bissau one in 13 women dies in pregnancy or childbirth, according to the UN – one of the highest rates in the world.

The service

At San Domingos government hospital 90km north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.

UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.

Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too young and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.

They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages.

“Women want family planning here – we meet with very little resistance to our messages,” he told IRIN.

But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said.

Dada Saar, 36, mother of five children, spoke to IRIN while waiting to receive her next contraceptive implant at Simao Mendes hospital in Bissau.

“Five [children] is enough,” she told IRIN. “We don’t have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn’t want more.”

Next to Saar sat Florence de Silva, 28, who has one daughter and wants another child, but plans to stop at two. “Otherwise I will not be able to educate them…even if I have just two and they are both educated, they will be able to look after me when I am older.”

Economic security or better health?

Economics increasingly sways urban families’ decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.

“In towns people are more conscious that they want fewer children. They understand life is expensive.”

But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. “People have more faith in medicine working, so are starting to think their babies won’t necessarily die [when ill],” Alves said.

Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed – a countrywide survey is due out in 2010 – health workers told IRIN maternal and under-five mortality is declining across the country.

While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates, Martins said.

Choices

Concerned about the slow progress of international efforts to reduce maternal mortality to meet 2015 Millennium Development Goals, health ministers, government officials, UN and NGO representatives from around the world gathered in Addis Ababa on 27 October to urge governments to make family planning a priority.

Reducing the rate of unintended pregnancies and stopping women from dying in childbirth worldwide would cost US$23 billion per year, they said in a communiqué.

However in Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 percent dependent on donor funding, deciding priorities is difficult, said Alves.

Martins said: “The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems.”

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http://www.irinnews.org/report.aspx?ReportId=86788DAR ES SALAAM Tuesday, October 27, 2009 (IRIN) - HIV-positive Tanzanians are not taking advantage of the availability of life-prolonging anti-retroviral medication in hospitals around the country, says a senior government official.DAR ES SALAAM Tuesday, October 27, 2009 (IRIN) - HIV-positive Tanzanians are not taking advantage of the availability of life-prolonging anti-retroviral medication in hospitals around the country, says a senior government official.

"We have an adequate supply of ARVs in our hospitals and other outlets, but there are few people who are turning out for this important service," David Mwakyusa, Health and Social Welfare Minister, told IRIN/PlusNews.

An estimated 250,000 people are taking ARVs, while another 190,000 who need them are not accessing them. In 2008, the government re-affirmed its commitment to achieving universal access to ARVs by 2010.

"We are working hard to encourage people to check their HIV status and those infected to go for further medical attention and when necessary start taking ARVs, which are in good supply," the minister said.

Mwakyusa also bemoaned the fact that few pregnant women made use of prevention of mother-to-child transmission (PMTCT) services available at antenatal clinics; just 33 percent of pregnant women who require PMTCT services access them, according to UNAIDS.

Research [http://www.ncbi.nlm.nih.gov/pubmed/16987051] has found that although HIV-positive Tanzanians welcome anti-retroviral therapy, they fear that transportation and supplementary food costs, ill-treatment at hospitals and difficulties in sustaining long-term treatment all act as barriers to accessing treatment. Fear of stigma as well as HIV denial, which often led patients to seek treatment from alternative healers, and inadequate numbers of trained medical personnel, also prevented patients from accessing healthcare.

"Multi-faceted interventions are required to promote regular HIV clinic attendance, including ongoing education, counselling and support in both clinic and community settings," authors of a recent study [http://www.ncbi.nlm.nih.gov/pubmed/19444672?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed] by the Centre for Population Studies and the London School of Hygiene and Tropical Medicine recommended.

Mwakyusa noted that Tanzania was planning to cut the cost of ARVs by producing them locally. He said it was important for the country to become more self-sufficient, especially in the face of the global economic downturn.

"We are praying that despite the global financial crisis, donors will continue supporting our efforts," he said. "The financial crisis is clearly affecting the capacity of donors to fund international programmes on AIDS."

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http://www.irinnews.org/report.aspx?ReportId=86756HARARE Tuesday, October 27, 2009 (IRIN) - Violence and intimidation against members of the Movement for Democratic Change (MDC) increased sharply within days of the party "disengaging" from Zimbabwe's unity government, MDC spokesman Luke Tamborinyoka told IRIN. HARARE Tuesday, October 27, 2009 (IRIN) - Violence and intimidation against members of the Movement for Democratic Change (MDC) increased sharply within days of the party "disengaging" from Zimbabwe's unity government, MDC spokesman Luke Tamborinyoka told IRIN.

In one incident three armed men accosted MDC security official Edith Mashaire, 32, and tried to force her into a waiting vehicle as she walked towards her office in the capital, Harare, during working hours.

"Two other men, one brandishing an AK-47 rifle and another holding a pistol, approached me and threatened to shoot me. They started assaulting me with their weapons while telling me to get into the truck," Mashaire told IRIN. She screamed to other pedestrians that she was an MDC official and frightened the men off.

"We have received reports of our supporters being beaten up and having their homes set on fire, allegedly by ZANU-PF supporters led by war veterans and members of the army," Tamborinyoka said. President Robert Mugabe is the leader of ZANU-PF, the other wing of the unity government formed in February 2009.

Teachers targeted

Morgan Tsvangirai, MDC leader and Prime Minister, "disengaged" from the unity government on 16 October in protest over the re-arrest of the party's treasurer and deputy agricultural minister designate, Roy Bennett, which had "brought home the fiction of the credibility and integrity of the transitional government".

Violence has erupted in Mashonaland Central Province, once a ZANU-PF stronghold in the north of the country. "The violence has intensified in rural areas ... Also affected are close to 100 teachers who have fled from the province," Tamborinyoka said.

"Some of the biggest victims in this ongoing cycle of violence are children, because they have nobody to teach them," he told IRIN. ZANU-PF supporters have accused the teaching profession of being allied to the MDC, and teachers have been told that since their party, the MDC, had pulled out of the government, they were now considered enemies of ZANU-PF.

"The violence is spreading to many parts of the country like Mashonaland West and East [provinces], Manicaland [province in the east] and Masvingo [province in the south] - all former ZANU-PF strongholds - and even in central Harare. We believe that ZANU-PF is retaliating after our party disengaged from the government two weeks ago," Tamborinyoka said.

At the weekend, heavily armed police and soldiers raided a house used by MDC officials and accused the group of stealing weapons from army barracks in Harare. Tamborinyoka said recent events showed all the hallmarks of a crackdown on the MDC and its supporters. "Recently, a brigadier-general pointed a gun at one of our members of parliament and threatened to shoot him."

ZANU-PF youth militia deployed in rural areas

A special audit report on ministerial accounts has also revealed that the youth development ministry employed 10,277 ZANU-PF youth militia since May 2008, who were subsequently deployed to rural areas.

The period of recruitment, which began after ZANU-PF lost its majority in parliament for the first time since independence from Britain in 1980, coincided with escalating violence against MDC supporters, including incidents of murder, rape, torture and displacement, during the second round of the presidential ballot in 2008.

Tsvangirai got the majority of votes in the first round of the presidential poll but narrowly missed securing the 50-plus-one votes required for an outright win. He withdrew from the run-off presidential vote in protest against alleged state-sponsored violence. Mugabe thus won unopposed, but international observers dismissed the poll as invalid.

"The appointees [youth militia] were not subjected to a medical examination, as required by the public service regulations, declarations of official secrets were not completed, and there were no staff files opened at either the ministry headquarters or provincial centres," Tamborinyoka said.

Raymond Majongwe, secretary-general of the Progressive Teachers Union of Zimbabwe, said ZANU-PF youth militia, working as "youth or ward officers", were harassing teachers in schools.

"Sometimes they talk about the need to 'teach children the correct history of the country', and are going as far as appointing school prefects," Majongwe told IRIN.

In the past two months "war collaborators" - people who assisted guerrilla fighters during the war of independence in the 1970s and remain staunch ZANU-PF supporters - have been holding meetings across the country, raising fears of an increase in violence. Zimbabwe's defence minister, Emmerson Mnangagwa, recently addressed one of the meetings.

dd/go/he http://www.irinnews.org/report.aspx?ReportId=86773CAIRO Monday, October 26, 2009 (IRIN) - The Egyptian government's May 2009 decision to cull the country's entire pig population - ostensibly to stem the spread of H1N1 influenza - has hit the livelihoods of 70,000 former pig farmers and unofficial rubbish collectors and their families in the Cairo area, according to local NGO Association for the Protection of the Environment.CAIRO Monday, October 26, 2009 (IRIN) -  The Egyptian government's May 2009 decision to cull the country's entire pig population - ostensibly to stem the spread of H1N1 influenza - has hit the livelihoods of 70,000 former pig farmers and unofficial rubbish collectors and their families in the Cairo area, according to local NGO Association for the Protection of the Environment.

The rubbish collectors, known as `Zabalin', used to sell much of their organic waste to the pig farmers; there was a symbiotic relationship between the two marginalized groups in greater Cairo.

"I used to collect 1,000 kilos of rubbish every day for the pig farmers, and to recycle and sell to factories," said Nabil Abu Mazin, a rubbish collector. He lives in Cairo's al-Muqattem suburb, also known as Garbage City. "Now I collect about 150 kilos a day, because the pig farmers have gone out of business."

The pig population - most of it in the greater Cairo area - was estimated at 300,000 and it took about a month for the slaughter to be completed, according to the Agriculture Ministry, though rumours abound that many pigs were spirited away.

The World Health Organization (WHO) has long questioned the link between pigs and H1N1, and many health experts have criticized the government's decision to cull all pigs.

According to WHO, [http://www.emro.who.int/csr/h1n1/] Egypt has 1,053 laboratory-confirmed cases of H1N1, and has had two deaths.

Some of Egypt's Christian minority saw the cull as an attack on their community, which makes up about 10 percent of the country's 80 million people, according to CIA World Factbook.

Change of tack

The government now says the cull was a general health measure.

Agriculture Minister Amin Abaza told the media the government had been planning to "get rid of the pigs for three years" and that the advent of H1N1 had presented an opportune moment. He also said the cull would ensure that no new strain of avian flu and H1N1 emerged.

According to media reports, and most Egyptians IRIN asked, the public generally supported the cull because they saw pigs, and the manner in which they were kept in Cairo, as unhygienic. However, with heaps of rotting waste in the streets, some are calling for the return of the `Zabalin', who used to collect roughly half of Cairo's rubbish, according to various studies, such as a 2004 report [http://www.waste.nl/content/download/788/5692/file/Field%20study%20report%20Egypt%20ebook.pdf] by NGO WASTE.

Health experts are concerned that if nothing is done, infectious diseases will spread.

Impact on education

Abu Mazin said that since the cull six months ago, he has only had the means to send two of his five children to school. During school hours, IRIN found hundreds of children running around the rubbish-strewn streets of al-Muqattem, a Coptic Christian stronghold on Cairo's periphery.

"About 50 percent of our children have dropped out of school over the past few months and around 75 percent of the men are now unemployed," Karim Aweida, a former pig farmer, told IRIN. He said he had got rid of 10 of his 12 staff as there was much less to do.

He received the equivalent of US$9-45 in government compensation for each pig culled, depending on its size. Prior to the cull he used to sell pigs for $45-146.

Local pig farmers estimated there had been some 3,000 pig farms in and around the city, with some holding up to 2,000 pigs.

No compensation for `Zabalin'

Unlike the pig farmers, there has been no compensation for the `Zabalin'.

Abu Mazin said the `Zabalin' were now leaving organic waste in the streets of Cairo as they had no buyers for it. They only collected items that could be easily sold, or moved rubbish if people paid them directly.

Poorer neighbourhoods, such as Imbaba in Cairo's Giza governorate, now have piles of rubbish accumulating in the streets, despite residents paying three pounds ($0.5) a month as part of their electricity bill for municipal rubbish collection. Commercial enterprises pay 25 pounds ($4.5) a month.

Compounding the problem has been a feud between the Giza municipal authorities and an Italian company contracted to collect rubbish there.

"The police increasingly harass us when we try to take garbage because we do not have licences to do so. They promised to give us licences before but we are still waiting," Abu Mazin said.

The ministries of health, agriculture and environment have also promised to build new farms for pigs, sheep, goats and cattle outside the city for those who have lost their livelihoods. However, no deadline has been set for the project, leaving most of the `Zabalin' sceptical.

"The government... promised to give us new farms. We are still waiting for that but losing hope by the day," said Tareq, a former pig farmer in the Batni Baqarah area of Coptic Cairo who refused to give his family name for fear that he may never get a farm if he revealed it.

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http://www.irinnews.org/report.aspx?ReportId=86742ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.

Many of the women entering into sex work in Addis are rural migrants who have failed to secure formal employment, or are escaping poor-paying jobs in the city or unwanted marriages in the country, according to a 2008 article [http://download.interscience.wiley.com/cgi-bin/fulltext?ID=119387830&PLACEBO=IE.pdf&mode=pdf] published by the UK's Royal Geographical Society.

Teguest, a 16-year-old girl from Gonder, a town 700km northwest of Addis Ababa, fled to the capital four months ago after the death of her parents and a dispute with her brothers.

The relative she contacted in the capital was already engaged in sex work, so the decision to enter the trade was an easy one. Teguest charges 10 Ethiopian Birr or $0.80 per client and has sex with as many as 20 men a day in her tiny room; she is adamant that under no circumstances would she have unprotected sex.

"No, I would not do that for any money. I need my life," she said. "They sometimes offer 200 Birr [$16] and beg me, but life is more important than money."

Teguest says in the past four months, at least 10 men have asked her for unprotected sex at a higher fee.

The good news, according to research by Wise-UP - a condom-promotion project implemented by local NGO Timret Le Hiwot [http://timretlehiwotet.org] and funded by social marketers DKT-Ethiopia [http://www.dktethiopia.org] - is that 99 percent of sex workers in 42 Ethiopian cities said they used a condom with their last paying partner, compared with 91 percent in 2002.

Shame factor

But according to health workers, not all sex workers are as fastidious about condom use as they claim. When Abeje Israel, monitoring and evaluation officer at Wise-Up, posed as a paying customer for random surveys, some women did agree to have sex without a condom for a higher fee.

A 2006 study [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576726] published in the British Medical Journal found that results of sex worker studies obtained using surveys and questionnaires may be biased as they will not always reveal the truth because of "pride, fear, or shame".

"They may say that they do not have sex without a condom, but the reality may be different; they may pretend and not show the real circumstances," Abeje said.

"All these [sex] workers are very vulnerable," he added. "They are not very powerful and they receive a very small sum of money; if you offer them more money, they may be willing to have sex without a condom."

Education vital

Further investigation makes it clear that the city's sex workers still need education on protecting themselves from sexually transmitted infections.

Meron, 25, also says she would never have sex without a condom, but added that she took the “precaution” of insisting her clients used two condoms - a practice roundly advised against as it increases the chances of a condom tearing.

Low levels of education and alcohol use also affect the likelihood of female sex workers using condoms, according to a study [http://ejhd.uib.no/ejhd-v20-n2/93_98_EJHD_20%20no%202%20final.pdf] by Addis Ababa University.

Wise-UP aims to achieve 100 percent condom use among sex workers in the capital, which has an HIV prevalence rate of 7.5 percent, almost four times the national average of 2.1 percent.

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http://www.irinnews.org/report.aspx?ReportId=86718CAIRO Thursday, October 22, 2009 (IRIN) - The Egyptian ministries of health and education have ordered all schools in Cairo to halve the number of children in each class to mitigate the possible spread of H1N1 influenza - no small challenge in this overcrowded city of 20 million.CAIRO Thursday, October 22, 2009 (IRIN) - The Egyptian ministries of health and education have ordered all schools in Cairo to halve the number of children in each class to mitigate the possible spread of H1N1 influenza - no small challenge in this overcrowded city of 20 million.

The resulting uncertainty has led schoolchildren to attend classes on three alternate days a week instead of six under a long-running double-shift system designed to ease overcrowding.

“I go to school on the second shift on Sunday, Tuesday and Thursday now,” Toqa Ali, 13, a student at Abdullah Ibn Rawaha School in the Imbaba area of Cairo, told IRIN. She said she used to have up to 80 children in her class but there were now around 25 as children were attending on alternate days and some were staying at home for fear of catching H1N1.

Toqa said she and many other children wore surgical masks in play time but tended to take them off in classrooms, which now have the windows open and fans on most of the time.

The UN Children’s Fund (UNICEF), in conjunction with the Health Ministry, has run an extensive awareness campaign with TV advertisements, public service announcements and awareness kits.

“We are distributing awareness kits in all schools in Egypt on avian flu and H1N1. In fact, we already had a distribution network set up for avian flu so now we are just adding H1N1,”said Hala Abu Khatwa, chief of communications for UNICEF in Egypt.

WHO school guidelines

A World Health Organization (WHO) briefing note in September for schools said schools could serve as a vector for spreading the virus.

It recommends hand hygiene, respiratory etiquette, proper cleaning, good ventilation, isolation of staff or students who fall ill and measures to reduce overcrowding.

“Decisions about if and when schools should be closed during the pandemic are complex and highly context-specific. WHO cannot provide specific recommendations for or against school closure that are applicable to all settings.”

However, it said that the timing of school closures was critically important and that “modelling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1 percent of the population fall ill.”

To close or not to close?

“While slowing the speed of spread of H1N1 by schools’ closure can buy some time as countries intensify preparedness measures, there are a lot of discrepancies about it, as school closure is associated with social and economic impacts,”said Rana Zaqout, head of the Pandemic Influenza Contigency (PIC) unit for the Middle East and North Africa, which is part of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“As a parent, while I am concerned about the academic year, I believe that school closure should reduce the transmission of the disease if accompanied by policies that include measures that limit congregation of students outside schools,” she added.

On 14 October, Education Minister Youssri el-Gamal told the Middle East News Agency: “There is no intention of closing schools at the beginning of the winter season.” He said only 10 children out of 20 million primary and secondary students in the country had been infected.

Two days later, La Mère de Dieu girls’ school in Cairo became the first school in Egypt to be closed after three H1N1 cases were discovered. The 1,200 pupils were ordered to stay at home for two weeks.

On 22 October, four private schools in the greater Cairo area were closed for two weeks.

“The main issue is that people do not trust the government or the Health Ministry. They don’t feel they are transparent,” Abu Khatwa of UNICEF told IRIN.

A number of classrooms in schools in Cairo and Alexandria have also been closed for two weeks on orders from their respective city governors.

Exams

Ahmed Ali, a teacher at Youssri al-Gamal School in Imbaba (Cairo), felt that overcrowding was the enduring problem. While he was happy to see his 70-children classes more than halved this term, he still had concerns:

“I can’t teach them the same curriculum in half the time. The Education Ministry will have to delay exams this semester so the students will have a chance to pass,” Ali said.

Meanwhile, the Egyptian Health Ministry said it would be receiving its first batch of H1N1 vaccinations - some 80,000 doses - on 23 October.

“Priority will be given to pilgrims going on Hajj, doctors treating H1N1 cases, people who work in public transport and public services, journalists, and school and university students with chronic illnesses, health complications or a weak immune system,” Health Minister Hatem el-Gabali said in a statement.

As of 17 October, WHO reported 14,739 laboratory-confirmed cases of H1N1 in its 22-country Eastern Mediterranean Region. Egypt had the fourth highest number of cases - 1,053 - and two deaths.

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http://www.irinnews.org/report.aspx?ReportId=86695BAGHDAD Thursday, October 22, 2009 (IRIN) - Panic over the possible spread of H1N1 influenza has prompted the closure of more than 2,000 schools in Iraq, according to officials. BAGHDAD Thursday, October 22, 2009 (IRIN) - Panic over the possible spread of H1N1 influenza has prompted the closure of more than 2,000 schools in Iraq, according to officials.
 
Education Minister Khudhair Al-Khuzaie said the unauthorized closure of schools was “illegal and unprofessional” and blamed “exaggerated media reports that have created such a panic”.

“Over the past week, we diagnosed four cases of H1N1 influenza among school students in the southern province of Kut, then the number increased to 25 cases and that prompted us to quarantine and shut down the school [where the cases were detected],” said Ihsan Jaafar, a senior Health Ministry official.
 
A few days later, other cases were confirmed in six Baghdad schools. “We’ve also closed them and that brings the total number of schools closed based on decisions issued by the Health Ministry to seven,” Jaafar told IRIN.
 
“Unjustified panic” had prompted some officials in southern Iraq to close schools where no H1N1 cases had been detected, a measure “unacceptable to the Health Ministry,” Jaafar said.
 
On 20 October, two local officials in the southern provinces of Thi Qar and Kut said that nearly 2,500 schools and kindergartens would be closed to prevent the disease from spreading.

Muthana Hassan Mahdi of Kut education directorate said a five-day precautionary shutdown had been in force since 21 October in 950 schools and kindergartens.

Meanwhile, Hadi Al-Riyahi, a local health official, said 1,477 schools would be closed in Thi Qar for 10 days from 22 October.

Kut is 160km and Thi Qar is 320km south of Baghdad.
 
Precautionary measures

Schools should only be closed for a week if a teacher and 2-3 students have the disease, Jaafar said. Those infected would be quarantined and the school sterilized. Students and infected students' families would be closely monitored, he added.
 
Tamiflu stocks were sufficient for 300,000 cases; another batch of 150,000 doses was expected in the next few days, he said.

According to the Health Ministry, the total number of confirmed H1N1 cases in Iraq is 523, of whom 113 are Iraqis and the rest foreigners, including members of the US forces. The death toll stands at three.
 
Education Minister Al-Khuzaie said overcrowding due to a shortage of school buildings represented an increased risk factor. He said US$4 billion was needed to build more than 4,500 new schools to ease overcrowding in Iraq’s roughly 19,000 schools.
 
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http://www.irinnews.org/report.aspx?ReportId=86693TEL AVIV Thursday, October 22, 2009 (IRIN) - Some 838 students formally offered places and/or enrolled at foreign universities are unable to leave Gaza, according to the Palestinian interior ministry and Gisha, an NGO campaigning for freedom of movement.TEL AVIV Thursday, October 22, 2009 (IRIN) - Some 838 students formally offered places and/or enrolled at foreign universities are unable to leave Gaza, according to the Palestinian interior ministry and Gisha, [http://www.gisha.org/] an NGO campaigning for freedom of movement.

Of the 1,983 Gazan students in this position, only 1,145 have been able to leave Gaza since the beginning of 2009 due to a combination of travel restrictions and bureaucratic hurdles.

Many studying in the USA, for example, cannot get a US visa as they have been prevented by the Israeli authorities from travelling to the US consulate in Jerusalem.

According to Gisha, the criteria for departure set by Israel include obtaining a recognized scholarship and studying only in a country with diplomatic representation in Israel. Students who wish to leave through Israel must also be accompanied by a diplomatic representative.

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http://www.irinnews.org/report.aspx?ReportId=86686MAUNGDAW Wednesday, October 21, 2009 (IRIN) - Hla Moe, 25, has a university degree but it is worthless in the eyes of Myanmar's military government. Thus, he and other Rohingya youth have no choice but to till the land just as their ancestors have done for generations in Northern Rakhine State.MAUNGDAW Wednesday, October 21, 2009 (IRIN) - Hla Moe, 25, has a university degree but it is worthless in the eyes of Myanmar's military government. Thus, he and other Rohingya youth have no choice but to till the land just as their ancestors have done for generations in Northern Rakhine State.

"There is no difference between the educated and uneducated young men here," Hla Moe said, outside his parents' farm near the town of Maungdaw, not far from the Bangladeshi border.

"We [Rohingya youth] have two options: live a suffocating life or flee the country."

There are some 800,000 Rohingya in Rakhine today, most of whom live in abject poverty. Barred from civil service jobs, as well as from travelling freely to secure work elsewhere, most are casual labourers, farmers and fishermen.

Although the Rohingya comprise about 85 percent of Rakhine's population - this ethnic, linguistic and religious minority is de jure stateless, according to the laws of Myanmar.

A report by Human Rights Watch (HRW) says forced labour and expropriation of property are a daily reality.

"The state orchestrates violence either directly, to force the Rohingya to leave, or foments discriminatory attitudes and practices whose ultimate aim is to push the Rohingya out," the report states.

Restrictions

While many young people do try to leave - often via smugglers to Bangladesh, Thailand or elsewhere in the region - those who remain struggle to eke out a living under very challenging conditions.

In addition to arbitrary taxation, the Rohingya require permission for everything from travelling from one town to the next to carrying out simple home repairs and marriage.

Many couples attempt to flee the country, while others marry in secret, running the risk of prosecution and even imprisonment.

"We applied for permission three years ago, but we still haven't heard," one 24-year-old Rohingya in Maungdaw said.

Their children - they are only allowed two - may have even fewer opportunities in Myanmar.

"Young people don't see a future for themselves or for their children in this country," Chris Lewa, coordinator of the Arakan Project, an NGO involved in research-based advocacy in the country, said.

Education is possibly the greatest obstacle, as it is often poor or sub-standard, even though it is available at primary and secondary level, she said, and attendance is low due as additional school costs are often too high for many Rohingya families.

Many families spend between 80 and 100 percent of their income on food and other basic essentials. Others routinely keep their children at home to help with household chores, or to contribute to farm work or other activities to supplement the family's income.

As the Rohingya speak a dialect of Bengali with no written form, some 80 percent of the population is estimated to be illiterate - leaving them no choice but to learn the Burmese or Rakhine languages.

Travel restrictions

The ongoing travel restrictions imposed by the government have a particularly onerous impact on young people seeking education and employment opportunities outside the state.

One 19-year-old Rohingya girl was repeatedly denied permission by the authorities to register for university entrance exams - so she works in her parents' shop in Maungdaw instead.

Even if they gained admission as well as the necessary travel permits to attend classes, under Burmese law they are effectively barred from studying certain subjects, including engineering and medicine.

In 2008 alone, more than 400 Rohingya students were prevented from attending colleges and universities, according to the Arakan Rohingya National Organization (ARNO).

"Lives have become unbearable and suffocating for the Rohingya," Nurul Islam, ARNO president told IRIN, citing instances of young people being arbitrarily detained or arrested, often on trumped-up charges for extortion purposes.

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