Nigeria: New Study Reveals Discrimination by Health Professionals Against People Living with HIV/AIDS is Fueled by Fear of Infection, Lack of Protecti

(Toronto) While the majority of Nigerian health care professionals comply with ethical obligations and do not deny care or treatment to People Living With AIDS (PLWA), a disturbing number of health care professionals engage in discriminatory behavior toward treatment and care of PLWA, according to a new study released today by Physicians for Human Rights (PHR). Health care professionals also reported engaging in practices that are against international and Nigerian codes of professional ethics including testing without consent and disclosure of confidential medical information without permission.

"The health sector is not immune to the kind of virulent discrimination that has hurt people with HIV/AIDS for many years. It is a very serious impediment to adequate AIDS treatment and affects the willingness of people with HIV to come forward," said Leonard Rubenstein, JD, PHR's Executive Director. "The study suggests that for some health providers at least, the lack of knowledge and lack of protective gear contributes to discrimination. Their fear affects their treatment of patients," said Rubenstein. "The situation underscores the need for a plan to build African health systems so that medical workers have information, gloves and other supplies to protect themselves while caring for patients."

The PHR report, Nigeria: Access to Health Care for People Living With AIDS, contains data from two surveys. The first is a survey of a representative sample of 1,021 health professionals in four sites in Nigeria, and the second, a convenience sample of people living with HIV/AIDS in those four states and in Lagos and Abuja. These findings were supplemented by a survey of directors within the facilities where the health professional surveys were conducted and individual interviews with key informants including national and state policymakers, NGO representatives, and officers of international agencies.

Ten percent of respondents themselves reported refusing to care for or admit people living with AIDS to a hospital. Sixty-six percent of respondents reported observing their colleagues' refusal to care for HIV/AIDS patients and 43% observed their colleagues' refusal to admit people living with AIDS to a hospital. Forty-eight percent of professionals expressed their belief that a person with HIV/AIDS cannot be treated effectively in their facility. Twelve percent of professionals said that treatment of opportunistic infections in HIV/AIDS patients wastes resources. Seven percent agreed that treating someone with HIV/AIDS is a waste of precious resources.
Among health care professionals, the three most important concerns about treating HIV/AIDS patients were fear of becoming infected (a full 81% of respondents expressed this), contamination of facility, materials and instruments (17%), and not having materials needed to treat (10%) the disease.

The study, which also included a survey of 227 people living with HIV/AIDS (PLWA), concludes that discrimination undermines efforts to provide effectiv e prevention, diagnosis and treatment programs.

"Discrimination can threaten the survival of people with HIV/AIDS by denying them medical care. It robs them of the fundamental respect for their dignity and their right to health," commented Rubenstein.

Seventy-two percent of health care professionals surveyed said they practice universal precautions in all cases. Of those who did not do so in all cases, 65% indicated that this was due to lack of materials. One policymaker quoted in the study stated, "Most hospitals don't have protective supplies. There is no incentive for health care professionals to risk infection."
A majority of health care providers surveyed have not received sufficient training on HIV and AIDS prevention and treatment and have limited access to current information about HIV and AIDS.

A large majority of professionals voiced support for protection of the rights of women and people with HIV/AIDS. Yet over half of the professionals reported that they obtained informed consent of patients for 50% or less of HIV tests they ordered, including 14% who indicated that they never obtained informed consent for HIV tests. Seventy-five percent of health care professionals agreed that there are circumstances where it is appropriate to test a patient for HIV without his or her knowledge or consent.

Most respondents to the PLWA survey reported being informed of their HIV status in the past three years. Approximately half of them (49%) stated that they did not know they were being tested for HIV. Eighteen percent of PLWA reported that it was their idea to be tested while 45% stated that the test was the idea of the health worker. About a quarter (24%) of respondents to the PLWA survey indicated that their current sexual partners were not aware of their HIV status. Five percent stated that their doctor revealed their HIV status to someone without their permission. Four percent said a nurse revealed their status without their permission and 3% reported that a laboratory technician did this. Seven percent reported being shunned by their family and 7% by their community.

The health care professional study was conducted in four Nigerian states: Abia, Gombe, Kano and Oyo. Survey respondents from each state, who were proportionally sampled, included doctors, nurses and midwives. Similarly, the people living with AIDS were interviewed in the four states and in Abuja and Lagos. This study represents the attitudes and experiences of nearly 4,500 health care professionals in the four states who serve a combined population of approximately 17.8 million people.

"Stigma associated with HIV/AIDS and the discriminatory behavior practiced by health providers has had an enormous impact on those people living with AIDS. Such practices are corrosive to the health sector in general, eroding trust in health practitioners and dissuading people infected with HIV/AIDS from seeking care and ultimately contributing to the spread of AIDS," said Rubenstein. An estimated 3.5 million Nigerians are living with HIV/AIDS.
Discrimination that occurs within the health sector may have devastating social and personal consequences and legitimize other forms of discrimination toward PLWA such as in the work place and by families and communities. PLWA may be evicted from their homes, be denied inheritance rights, lose their jobs or be passed over for promotion, or shunned by their families and communities. Anti-discrimination policies must be instituted and enforced by the government of Nigeria usch that those experiencing such behavior can seek redress, PHR said.
Respondents from both surveys - health professionals and people living with AIDS -- identified a lack of financial resources as being the greatest barrier that HIV positive people face when trying to access health care.

Recommendations

President Olusegun Obasanjo's signature of the Government's new HIV/AIDS policy and stated government commitment to pass legislation protecting PLWA from discrimination are promising steps. In moving forward to implement the new National HIV/AIDS Policy, the relevant stakeholders should include the following steps:

Government of Nigeria:

• Provide sufficient supplies of protective materials for practice of universal precautions including the provision of gloves and disposable syringes to all health facilities under Federal Ministry of Health control.
  
• Provide sufficient supplies of drugs including antiretrovirals (ARVs) (for post-exposure prophylaxis and treatment), antibiotics and other drugs needed for treatment and prevention of HIV/AIDS and related conditions to all health facilities; make these drugs available to patients at a reasonable cost.
  
• Develop and implement programs to educate health care professionals and all staff in health facilities about HIV/AIDS including modes of transmission and universal precautions, ethics, and treatment and care. Involve PLWA in preparation of these programs.
  
• Engage in a thorough review of laws and the constitution and enact reform to ensure legal protection of PLWA in all sectors.
  

Nigeria Health Professional Associations:

• Uphold standards of medical practice that are consistent with Nigerian codes of medical ethics. Engage in continuing education of physicians, nurses and midwives on HIV/AIDS and on matters of professional ethics.
  

People Living with AIDS (PLWA):

• Work with the Nigerian Federal and State Ministries of Health, Local Government Authorities and health care professionals to develop, promulgate and enforce HIV/AIDS testing and treatment policies within health institutions that conform to the Nigerian code medical ethics and that guarantee non-discrimination against PLWA.
  

Nigeria Health Professional Associations:

• Uphold standards of medical practice that are consistent with Nigerian codes of medical ethics. Engage in continuing education of physicians, nurses and midwives on HIV/AIDS and on matters of professional ethics.
  

International Donors:

• Provide material and technical assistance, in particular to professional associations for efforts to educate health professionals and the public about HIV/AIDS and ethics of the medical profession.
  
• Provide material and logistical support to ensure that all health facilities have sufficient and consistent supplies of materials for HIV/AIDS treatment and prevention, including for implementation of universal precautions.
  
• Support the Global Fund to Fight AIDS, Tuberculosis and Malaria.
  

For 20 years, Physicians for Human Rights (PHR), based in Cambridge, MA, advances health and dignity by protecting human rights. Health Action AIDS, a project of PHR, mobilizes health professionals to support a comprehensive AIDS strategy and advocates for funds to combat the disease. It develops ways for US health professionals to support colleagues and activists around the world and researches the connection between human rights and HIV/AIDS. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.

Source://http://www.phrusa.org/campaigns/aids/news_2006-08-17.html

Stigma stops HIV disclosure

A group of researchers from South Africa's Human Sciences Research Council is part of an ambitious, international study to develop or adapt theory-based behavioural risk reduction interventions to reduce the risk of HIV transmission by people living with HIV and Aids who know their status.

"Sub-Saharan Africa is home to an estimated 25 – 28 million people living with HIV/Aids (PLWHA),” said Dr Leickness Simbayi, project director and coordinator for four of the eight African countries covered by the study. “But most behavioural studies have focussed on the general population and research into interventions to reduce risk behaviour, have been neglected. This study is one of the first to focus on the PLWHA themselves.”

The results of the first phase of the study was presented at a satellite session of the XVI International Aids Conference in Toronto, hosted by the Social Aspects of HIV/Aids Research Alliance (SAHARA). The session, which was held on August 17, looked at ways of managing the complexity of the HIV/Aids challenge in sub-Saharan Africa. The study is being undertaken by researchers from Botswana, Lesotho, South Africa, Swaziland, Kenya, Rwanda, Burkina Faso, and Senegal.

“We know that a substantial (but unknown) number of stable sexual relationships are between partners where one is HIV positive, but does not tell the other partner,” Dr Simbayi said. “Stigma is a very real part of these people's lives. Disclosing one's HIV status can be risky.”
“For example, our study in South Africa showed that 40% of people living with HIV/Aids had experienced discrimination and one in five had lost their homes or their jobs because of their HIV status.”

“Add into the mix the fact that many PLWHA consider their HIV status as secondary to the other problems they face in their daily lives - such as poverty, unemployment and gender-based violence – and you begin to understand why some people are not disclosing their HIV status,” he said.

The study also highlighted the need for HIV prevention interventions for people who have tested HIV positive.

Non-disclosure

Anonymous surveys were completed by 413 HIV positive men and 641 HIV positive women, most of whom (73%) were younger than 35 years old, African (70%), unemployed (70%), and unmarried (75%), whilst nearly half (49%) had been hospitalized for HIV-related conditions (49%) and exactly half (50%) were taking antiretrovirals (ARVs). Among the 903 (85%) participants who were currently sexually active, 378 (42%) indicated that they had sex with a person that they had not disclosed their HIV status to in the previous three months. Participants who had not disclosed to all of their sex partners were significantly more likely to have multiple sex partners, HIV negative partners, partners of unknown HIV status, and unprotected intercourse with non-concordant sex partners.

Having not disclosed HIV status to partners was also independently associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners.
The gay community was even more marginalised, with 45% of the HIV positive gay men interviewed reporting that they had lost their homes or their jobs because of their HIV status. Internalised stigma was found to be most prevalent among this group, with 58% hiding their HIV status from others and over 45% feeling guilt or a sense of shame because of their HIV status.

Interventions neededDr Simbayi's team concluded that interventions are needed in South Africa to reduce Aids stigma and discrimination and to assist PLWHA to make effective decisions whether to disclose their HIV status and to practice safer sex regardless of disclosure decisions.
There is also an urgent need for social reform and interventions to reduce Aids-related stigma and discrimination at societal level.

It is critical that interventions also address some of the concomitant social conditions co-existing with Aids such as gender discrimination, homophobia, racism, xenophobia, unemployment, hunger and poverty.

Two interventions have been selected as possible candidates for adaptation in sub-Saharan Africa. These are Healthy Relationships (which is based on social support groups and was developed by Professor Seth C. Kalichman and associates of the Centre for Health, Intervention and Prevention (CHIP) in the Department of Psychology, University of Connecticut), and the clinically-based Options for Health (developed by Professor Jeffrey Fisher and associates from the same centre).

In Phases 2 and 3 of this study which are about to commence, these interventions will be adapted and their effectiveness tested.

Source: http://www.health24.com/news/HIV_AIDS/1-920,37099.asp

Frontline: Realities of stigma in health care settings

by HDN Key Correspondent, Uganda
August 2006

While the majority of health care professionals comply with ethical guidelines and do not deny care or treatment to people living with HIV (PLHIV), a disturbing number of health care professionals engage in stigmatising and discriminatory behaviour, according to studies presented at the recent XVI International AIDS Conference in Toronto.

Health care workers are also reported to engage in practices that contravene codes of professional ethics, including HIV testing without consent and disclosure of confidential medical information without prior permission. This was revealed by Takawira Moses, who works with Medicin Sans Frontiers (MSF) in rural Zambia.

It is clear that the health sector is not immune to HIV-related stigma or discrimination, which is reported to be ‘rampant’ in many communities where HIV is still seen as taboo. This is a serious impediment for many PLHIVs coming forward to receive much needed treatment, care and support services, and to disclosing their status and fully facing the virus.

According to research findings presented by JS Oruko, conducted in four districts hospitals and eight rural health units in Kenya, the lack of adequate knowledge and lack of universal precautions to protect health workers, such as gloves, adequate sharps disposal and post-exposure prophylaxis, contributes to the formation of stigmatising attitudes among health workers, who themselves fear infection.

“The fear they face affects the kind of treatment given to the PLHIV”, said Oruko.

This underscores the need for a comprehensive plan to develop the health systems of resource limited counties so that health workers have enough knowledge and basic equipment to protect themselves while caring for their patients.

The uneven distribution of knowledge, care competence and basic resources between urban and rural settings also means that stigmatising attitudes tend to be highest in rural health care. This surely suggests that poverty is also one of the underlying factors in creating HIV-related stigma.

According to Dr Katende from Uganda, who has provided technical expertise in developing tools to measure stigma, a considerable number of health workers admit to having refused to care for or admit people with HIV. There are cases where health workers express sentiments like: “Treatment of opportunistic infections in PLHIV is wastage of valuable resources.”

It is appalling that among the health workers, the three most important concerns about treating HIV-positive patients are fear of becoming infected, contamination of the health facility and lack of availability of materials and instruments needed for treatment, as is revealed through a report from Nigeria by Physicians for Human Rights.

One way to reassure health workers working with PLHIVs is provision of post-exposure prophylaxis (PEP) to treat possible cases of nosocomial infection through, for example, needlestick injuries. To some health workers PEP is still a mystery, particularly those working in rural settings. But where PEP is available it provides health care workers with the reassurance that in case of accidental exposure – which is very rare – something can nevertheless be done.

If we are to reduce and eventually eradicate HIV-related stigma and discrimination in health care settings, we must look very honestly at the realities that health workers face. Their fears are in some ways justified. Provision of support and information is essential to fight the fear that breeds stigma.

HDN Key Correspondent, Uganda
Email: correspondents@hdnet.org
Website: www.healthdev.org/kc

(First distributed: August 2006)

Spotlight: Reducing stigma and discrimination: Successful examples from the health care sector in Asia

By HDN Key Correspondent, August 2006

There is no shortage of studies demonstrating that stigma and discrimination is common in health care settings in Asia. Ask anyone living with HIV where they experience the most discrimination based on their serostatus, their occupation as a sex worker, or their injecting drug use: They will often reply that health workers are the ones that make them feel the worst. Stories of segregation in wards, refusal of care, and disclosure of status are common in the region.

What really works to reduce stigma and discrimination? There is in fact a very small evidence base for what has been proven to work. During the session: ‘Stigma and discrimination: The undoing of universal access’ [at the International AIDS Conference, Toronto] we heard that there is no longer any reason for inaction. The tools to measure stigma and discrimination are available and ready to be adapted to local situations.

One of the most successful illustrations of action has taken place in India. The capital Delhi is in a relatively low HIV prevalence area but is in a good position to try out methods that may be applicable to other parts of the country where there are more people living with HIV (PLHIV).

The Population Council undertook formative research to measure the level of stigma and discrimination in three public sector and one private hospital. They then worked with a local nongovernmental organisation and PLHIVs to undertake a series of activities with all levels of health workers to successfully reduce stigma and the resulting discrimination.

The hospitals developed a set of guidelines that they could apply as ‘gold standards’ of non-discriminatory care and support for PLHIV. They created a checklist that could be used to see if they improved the quality of the care they delivered and they developed pride as they discovered that they could disseminate their ‘PLHIV-Friendly Achievement Checklist’ for others to assess their work.

The methods then used in Delhi were simple. Training was provided for all health workers in the hospitals, not just the doctors. Infection control was improved. And voluntary counselling and testing services were enhanced. Stigma and discrimination reportedly decreased in all four hospitals. The only weakness of this approach was that self observation was used to determine whether anything changed. Patients and PLHIV were not asked directly whether the behaviour of hospital staff had changed. But that is no detractor of the success – just a suggestion to improve it.

The brilliant example of Delhi has not yet been taken up by other health care institutions in India. But nothing is stopping UNICEF from promoting the use of these guidelines in the hospital based prevention-of-mother-to-child-transmission (PMTCT) programmes they are promoting in India and Myanmar. In addition, the World Bank, in a new publication released at the conference – ‘AIDS in South Asia: Understanding and Responding to a Heterogeneous Epidemic”, has recommended that all countries in South Asia develop programmes to reduce stigma.

These tools are also being tested in several sites in Vietnam. With two successful examples in both South Asia and East Asia, there are no reasons that the activities cannot be replicated to reach the majority of health care institutions in the most populous continent. They are inexpensive to implement and it is simple to set targets for their use. By the end of this year many Asian countries will have national universal access plans. How many of them will include achievable targets for reduction of stigma and discrimination?


HDN Key Correspondent, Thailand
Email: correspondents@hdnet.org
Website: www.healthdev.org/kc


Links:

For Population Council PLHIV-Friendly Achievement Checklist:
http://www.popcouncil.org/horizons/pfechklst.html).

For new World Bank publication:
http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/Publications/448813-1155152122224/southasia_aids.pdf

(first distributed: August 2006)

Burmese male sex workers in Thailand face stigma and AIDS risks

Chai Sor, 29, is a male sex worker in one of Chiang Mai's many gay bars. He earns between 7,000 and 20,000 baht a month, depending on how many clients he gets.

Chai Sor is one of many Burmese who make up a significant number of male sex workers in Thailand.

There are no statistics on the exact number of Burmese migrants in the industry but Phongthorn Chanlearn, a project manager with Mplus+, said about 80 percent of gay-bar workers were from Burma's Shan, Kachin and Karen states.

Mplus+ runs sexual-health clinics for male sex workers in Thailand and aims to reduce the stigma surrounding the industry. Phongthorn said many men were forced into the industry due to their lack of legal status and work rights. "A lack of nationality and no identity cards pushes them automatic to engage in several gay bars and become male sex workers," Phongthorn said.

According to Phongthorn, some clients paid male prostitutes big money for unprotected sex, making it easier for them to contract sexually transmitted infections (STIs) including HIV/AIDS.

But Chai Sor said he refused clients who asked for sex without a condom and had a medical checkup every three months at the MSM clinic run by Mplus+.

"I am always aware of how to have safe sex."

Tin, 23, also a sex worker, said he used condoms when with his clients.

". . . I understand to have safe sex with any clients."

But Phongthorn said many male sex workers, some under the age of 18, were already infected with HIV/AIDS or STIs.

She said bar owners were scared to employ men under 18 and many were forced to work independently, searching for clients around Chiang Mai's night bazaar and Tha Phae gate late at night. While Thai HIV/AIDS prevention and education programs have met with considerable success, NGO workers said there were still many young men at risk of infection. Dr Kreang Sak of the Chiang Mai-provincial public Health Office, who works part time at the Mplus+ MSM clinic, said young male sex workers in Thailand faced a high risk of contracting STIs.

"There is another high risk groups including male sex workers and drugs addicts youngsters in Thailand," said Dr Kreang Sak. "Due to the high frequency of sex every day more than other normal people, they become high risk groups for HIV/AIDS," he said. According to a report by the Center Disease Control in Bangkok, many adolescents in Thailand have Gonorrhea and Chlamydia. "The country can face as the same situation of HIV/AIDS epidemic crisis as previous last 10-years, if there is less attention to such high risk groups," Dr Kreang Sak said. "Because of the social stigma on male sex workers by the society, it is still difficult to get in touch (through) Campaigners in our society," he said.

Dr Kreang Sak said there was a need for more clinics like the MSM clinic. Mplus+ has only two clinics – one in Chiang Mai and one in Phuket – and there is only one government-run clinic in Bangkok targeting male sex workers. Chiang Mai's MSM clinic was set up at the end of 2004 and treats an average of 10 patients a day. But Dr Kreang Sak said it was impossible for staff at the clinic to record data on the nationalities and ages of their patients as it was their policy not to ask patients for identification. "Every thing is free of charge and we avoid the social stigma by checking their nationalities," he said adding staff suspected many patients lied about their ages and were actually under 18.

He also said while more programs were needed to target young male sex workers, it was up to them to take responsibility for their health. "Every male sex workers has full responsibility and need to aware of their safer sex and so that they can stay away from infected of HIV/AIDS and STIs."


Source: UNDP, August 14, 2006

HIV Is Treatable, It's the Stigma That's Fatal

The murder in June of Vivian Kavuma in Uganda by her lover after she disclosed that she was infected with HIV.

The brutal stabbing with a pitchfork of 15-year-old Isaiah Gakuyo last April in Kenya by his uncle simply because the orphan was HIV-positive. There were numerous witnesses to the attack, but none intervened.

The murder of in June 2005 human rights activist Octavio Acuña Rubio in a condom shop he owned in Mexico.

The arrests in December of five Zimbabwean AIDS activists commemorating World AIDS Day at a public square in Harare.

The house arrests in March this year of at least 23 people living with HIV in China's Henan Province to keep them from bringing petitions to the Chinese congress.

And the list goes on.

"We have the knowledge to defeat HIV now, we know what is effective, and that is recognising that the epidemic is caused by human rights abuses, which fuel the epidemic," Joseph Amon, director of the HIV/AIDS Programme at Human Rights Watch (HRW), told IPS.

Since the virus was first identified in the early 1980s, HIV/AIDS has claimed 22 million lives and infected over 60 million people. Last year, five million people were newly infected and three million died of AIDS.

Between 2003 and 2005, the number of people living with HIV in East Asia rose by more than 25 percent and the number of people living with HIV in Eastern Europe and Central Asia rose more than one-third.

But according to HRW and others, in the 25 years since AIDS was first discovered, few countries have succeeded in controlling the epidemic. Those that have done so have provided comprehensive information on HIV transmission to their populations, addressed the vulnerability of women and girls to violence and abuses, ensured access to condoms, clean needles and methadone, and expanded access to anti-retroviral drugs.

Experts stress that vulnerability to HIV/AIDS is closely tied to the social marginalisation of people most affected by the virus. They include young girls, injecting drug-users, sex workers, men who have sex with men, migrants and prisoners, categories which are frequently victims of discrimination and other human rights abuses.

The connection between abuses of women's rights and their vulnerability to the disease is particularly evident in sub-Saharan Africa, where 58 percent of those infected with AIDS are women. According to HRW, in 2003, half of all governments in sub-Saharan Africa had yet to adopt laws specifically banning discrimination against people living with HIV/AIDS, while only one-third of countries worldwide had adopted legal measures specifically outlawing discrimination against populations vulnerable to the disease.

"If we attack the epidemic by attacking human rights abuses we can turn the epidemic around. The way we can do that is to have comprehensive prevention and information provided to people. We need to empower communities to take the step that they need to recognise the epidemic and respond to it," Amon told IPS.

Documenting and punishing human rights abuses related to HIV/AIDS is essential in raising public awareness and fighting the epidemic. Unless countries adopt approaches to HIV that are rooted in human rights principles and informed by scientific evidence, the epidemic will keep growing, HRW says.

The need for global HIV prevention based on sound scientific evidence is supported by groups like the Caucus for Evidence-Based Prevention, a coalition of U.S.-based non-governmental organisations and their international partners whose aim is to implement strategies with proven success in lowering HIV transmission rates.

In fact, according to the multidisciplinary group of more than 30 organisations, for different reasons, too often strategies with no proven efficacy have been promoted instead of those that are known to work.

For example, in Uganda, once one of the continent's greatest success stories in reducing HIV rates, infections are now on the rise again since the government and evangelical groups have pushed abstinence-only messages and attacked the effectiveness of condoms.

In Thailand, another initial bright spot in the fight against AIDS, condom use is down and infections of sexually transmitted diseases are up. HRW says the government has done little to reduce HIV infection among drug users or migrant workers, and leading AIDS experts say that Thailand's success is "history".

In Zimbabwe, some 350,000 people urgently need anti-retroviral drugs but only about 25,000 have access to them. The life expectancy for women is 34 years -- the lowest in the world.

In the United States, African American women are 19 times more likely to be infected with HIV than white women. The number of new infections has remained static for a decade, and HRW says that "programmes that once vigorously and creatively challenged communities to confront AIDS and learn how to protect themselves from HIV are being replaced by proposals to eliminate individual pre-test counseling and written consent, and simply have doctors routinely test everyone they treat for HIV."

"One of the ways to combat the epidemic is by having greater accountability by governments, having better cooperation between civil society and governments in terms of monitoring the epidemic, having specific concrete goals and having periodic reports that include civil society in terms of tracking progress," Amon said.

"In Southern Africa, for instance, there are many policies which maintain the vulnerability of women and there is also a lack of protection and enforcement of property rights abuses. The traditional systems often do very little to respond to those abuses," he noted.

At the just-concluded Group of Eight summit in St. Petersburg, Russia, leaders of the world's richest nations adopted a document pledging to achieve "tangible progress" in the fight against HIV/AIDS by 2010. However, activists said donors must also increase funding or they would miss their own target, set last year at the summit in Gleneagles, Scotland, of providing treatment to four million Africans by that same deadline.

In order to achieve universal treatment for HIV/AIDS, at least an additional 10 billion dollars would be needed, they note.

Many hopes are now pinned on the Aug. 13-18 conference in Toronto, where HRW has called on government representatives, United Nations officials and delegates to recognise that "only by protecting the rights of those most vulnerable, and by empowering those most marginalised, can the few success stories to date in the fight against AIDS be expanded and sustained."


Source: Alberto Cremonesi, Inter Press Service News Agency

AIDS Retains Stigma in Eastern Europe

AIDS retains stigma in Eastern Europe, as fears rise of impending catastrophe

Adrian Calea found out he was HIV positive when he accidentally saw a doctor's note in his mother's purse when he was 10.

Two years later, he learned on the Internet exactly what that meant."

I thought about slitting my wrist," he said. "But then, I thought if I am going to die of this disease, at least I am going to go down fighting."

Calea is now 18, a student and hip-hop artist, healthy because of a cocktail of antiretroviral drugs. He is one of more than 7,000 Romanian children who were infected between 1987 and 1990 because the communist regime made it a practice to reuse syringes and give transfusions of untested blood.

Romania ended up with half the HIV-positive children in Europe.

The dirty needles are long gone. But a quarter century after AIDS was discovered, many HIV-infected people in Romania and the rest of Eastern Europe continue to struggle with discrimination and poverty.

Calea was forced to drop out of school in the southern Romanian city of Alexandria when he was diagnosed with HIV in 1998. The principal told his family that other parents would protest.

He now plans to play his music and visit schools to raise awareness about AIDS. He is probably the first HIV-infected person in Romania to publicize his condition to fight the stigma.

But AIDS remains controversial.

After officially denying the existence of AIDS during the communist years, Romania now requires AIDS tests for people getting married or applying for jobs _ a rule activists say perpetuates discrimination.

Health experts warn that infection rates in Eastern Europe will skyrocket if countries fail to adopt more pragmatic policies.

Ukraine has a national AIDS law that is recognized as a model in the region because it incorporates human rights protections for people living with HIV/AIDS. But the law is often disregarded, with patients often turned away by doctors when they seek help.

Ukrainian officials say more than 80,000 people have been registered HIV-positive since the first reported case in 1987. But other experts say as many as 500,000 people _ 1 percent of Ukraine's population _ could be infected.

Human Rights Watch accused the government this year of police abuse and medical discrimination against HIV/AIDS victims. The official stigma means HIV-infected people are marginalized _ forced into isolation in hospitals or their homes.

In Russia, there are 334,000 registered HIV-infected people. But the U.N. AIDS agency puts the figure at nearly 900,000 and others say the total could be above 1 million _ around 1 percent of Russia's population.

The disease is rapidly spreading beyond traditional risk groups _ drug users, gay men and prostitutes _ into the wider Russian population through unprotected heterosexual sex, with young people particularly vulnerable.

In Romania, about 11,000 people have HIV or AIDS, with about 350-500 new infections per year. However, infections could increase as the country's HIV children grow up into adulthood.

Parents in Romania are not required to inform the children they are infected until they are 18. Experts say the age should be lowered to 14.

Adrian Streinu-Cercel, who coordinates Romania's AIDS program, said about 20 percent of HIV-positive children are still unaware they are infected because parents are afraid to tell them.

"They already ask their parents 'why do we take so many pills?'" said Streinu-Cercel.

Calea hopes to spearhead a new rights movement and wants to encourage others to come out about their condition, saying that he felt liberated after he stopped denying that he was HIV-positive.

"Instead of waiting around, hoping for the elusive vaccine, we should try to improve our situation," he said. "I want to fight against discrimination ... It's about my future."


Source: Associated Press: writers Mara Bellaby in Kiev and Henry Meyer in Moscow.