PNG investigates ‘live burials’ of AIDS victims

By, Daily Times (Pakistan), August 29, 2007

PORT MORESBY: Police and health workers in Papua New Guinea launched an investigation on Tuesday into reports that AIDS victims in the rugged South Pacific nation are being buried alive by their relatives.

Romanus Pakure, deputy director of the government’s National Aids Council, said the allegations were “a wake-up call” and that police were heading to the sites with health officials.

“I am shocked, the chairman of the council was shocked, we really need to investigate this and verify all these things”, he said.

Social worker Margaret Marabe told reporters Monday that she saw three HIV infected men and two women buried alive by their relatives in remote villages when they became too sick to care for.

“They were crying and calling out their relatives’ names and called for help,” Marabe said on her return to the capital Port Moresby after spending five months in the Southern Highlands on an AIDS awareness campaign.

She said one called out “Mama, Mama” as the soil was being shovelled over his head.

Marabe works for a volunteer organisation called Igat Hope, Pidgin English for I’ve Got Hope, which supports people living with HIV/AIDS.

She said relatives of infected family members told her they had buried the victims because they were afraid of catching the disease themselves.

Papua New Guinea’s fight against AIDS is hampered by its rugged terrain and a belief in witchcraft that is widespread in parts of the highlands, which had no contact with the outside world until the 1930s.

The AIDS council’s Pakure said the reported killings might be connected to people’s superstitions and their belief in sorcery.

“The people living in the coastal areas have got the message and they are not discriminating as much as before but it is a fact that (some) people still blame HIV infected people (saying) sorcery has been done on them,” he said.

He admitted that the council’s awareness and education programmes were not reaching everyone who needed them.

Papua New Guinea faces one of the most serious HIV epidemics in the whole Asia-Pacific region. The first case was reported in 1987, and since then HIV prevalence has risen dramatically.

The disease is spread mainly through heterosexual intercourse in a country where polygamy is practised and rape and sexual violence are also common.

The official estimate is that two percent of PNG’s six million people have contracted the AIDS virus, but non-governmental organisations and volunteer workers believe the figure is much higher.

Projected worst case scenarios of the epidemic see PNG suffering a 12.5 percent drop in its workforce and economic costs of 1.25 billion US dollars annually, according to the Australian government agency, AusAID.

The secretary of Igat Hope, Annie McPherson, said that efforts were being made to educate people in rural areas about the disease but the National Aids Council could not cope.

“The provincial offices are really struggling to get the right personnel and to have offices. There are a lot of offices that have been locked up because they cannot afford to meet their rent,” she said.

McPherson backed Marabe’s reports, saying she had heard of live burials happening in the past, attributing some at least to the mistaken belief that victims who have slipped into a coma are dead.

“There’s no proper medical access available to be able to differentiate between some people who are in a coma and some people who are dead so we need to be able to get more services.

“It is a logistical nightmare to get services to people in the Highlands” she said. PNG receives millions of dollars a year from donor countries to fight HIV, and the National AIDS Council was established by its parliament in December 1997 to oversee and coordinate the response. afp

Source: http://www.dailytimes.com.pk/default.asp?page=2007%5C08%5C29%5Cstory_29-8-2007_pg4_11

Madagascar: New law to fight HIV/AIDS stigma

By, IRIN PlusNews, August 20, 2007

The HIV prevalence rate in the island nation of Madagascar may be lower than its neighbouring Southern Africa countries, but the levels of stigma and discrimination are just as high. Activists and government officials are hoping that a recently introduced law will alleviate the problem.

"Finally, we will be able to generalise and apply the law," said Fenosoa Ratsimanetrimanana, executive secretary of the National AIDS Committee (CNLS). The legislation stipulates fines for acts of discrimination of up to 400.000 ariary (US$200), and up to 1,000,000 ariary ($500) for disclosing the status of a patient.

"The spirit of this law is non-discrimination, easing the fight against HIV via prevention and information," said Minister of Health Robinson Jean Louis, who thinks the legislation will limit the "risk of explosion" of the virus.

Yves Bourny, a UNAIDS official, welcomed the move, describing it as a "strong message sent by the Malagasy government, who clearly support and recognise people living with HIV/AIDS".

Madagascar is still relatively unaffected by the virus: the CNLS estimates the national infection rate at 0.95 percent. However, the four percent prevalence rate for sexually transmitted infections (STIs) is much higher and, in the eyes of the Health Minister, this represents a possible "entry way for the HI virus."

No prominent Malagasy figure has publicly acknowledged being HIV positive, but Madagascar's President Marc Ravalomanana was tested in February 2006.

UNAIDS estimates there are about 39,000 HIV-positive people in the island, but only 89 are receiving antiretroviral treatment. The government hopes the legislation will encourage HIV-positive people to come forward and make use of HIV services, and that more people will be tested, avoiding unknowingly transmitting the virus.

Not everyone is convinced, particularly about a clause that allows for up to two years in jail for transmitting HIV through "clumsiness, imprudence, carelessness, negligence, or failure to observe the rules".

"A law was necessary, but it is too unclear and not strong enough. In any case, it will not encourage me to publicly disclose my status," said an infected Malagasy who wished to remain anonymous.

It also remains to be seen how effective the legislation will be in a country where widespread stigma and discrimination persist, and few HI-positive people are willing to be open about their status.

"We have very important sensitisation work to do: some health workers refuse to treat these patients or use the [HIV/AIDS] material," said Hanta Razafiamanana, a welfare officer.

"The most important is not the law; it will be to make it known and make it respected," a person living with the virus pointed out during a support group meeting.

Efforts are underway to educate people about HIV/AIDS: the government hopes to have distributed 400,000 HIV test kits throughout the country by the end of 2007, the CNLS has set up smaller decentralised units in 22 regions, and screening centres in 116 districts.

Local development leaders, nominated by President Ravalomanana, and 17,000 Fokontany chiefs, who each head an administrative district, will be directly involved in efforts to battle the disease. These leaders will hold a two-day meeting, of which two hours will be devoted to discussing HIV/AIDS prevention.

The reformed church of Fiangonana Jesosy Kristy Madagasikara (FJKM), or the Community of Jesus Christ in Madagascar, which has 4,000 places of worship, has agreed to devote five minutes at the end of each Sunday mass to fighting discrimination against those infected with HIV.

"We have been working on this issue for a long time; this is just a new stage," said Pastor William Razafimahatratra, president of the FJKM's committee to combat AIDS.

"We preach abstinence and fidelity, but we are neither for nor against the condom," he said. "We regard it as a drug, and leave the education to the doctors."

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DRC: Stigma hampers fight against HIV/AIDS in South Kivu

By, IRIN PlusNews, August 3, 2007

In the volatile eastern Democratic Republic of Congo (DRC), where people are often more concerned about their safety than HIV/AIDS, widespread stigma and discrimination are driving the epidemic underground, especially in the province of South Kivu.

"When my neighbours learnt that I was positive, they made sure that I was thrown out of the rental house I was living in with my wife and three children," said Borauzima Lukabia, 34, in Bukavu, the provincial capital.

"Because of being stigmatised and discriminated upon, we often lack the means to earn a livelihood," he said. "Take me, for instance: I am 34, yet I have no work; no one will employ me. My biggest problem now is hunger; I am on ARVs and this means I am hungry all the time, yet I have no means of earning a living."

Getrude Muhemeri, the director of Fondation Femme Plus, a national non-governmental organisation (NGO) offering support to HIV/AIDS infected and affected people, told PlusNews that most people living with HIV/AIDS had suffered greatly in the intermittent conflict in the province during the past 10 years.

"War-affected people are mostly very poor; those infected often have to face a lot of stigmatisation, in addition to all the other problems related to violence," she said.

Fear of rejection

Although Bukavu has an estimated population of half a million, a spot-check of NGOs supporting people living with HIV/AIDS showed that only a few thousand were being assisted, which most NGO officials attributed to fear of stigma and discrimination if the HIV-positive status of a person should become known.

"In conjunction with our partners [other NGOs and governmental organisations], we provide psychosocial support to people living with HIV/AIDS; we also sensitise the families of those infected to get them to accept their relatives, but is not enough, said Dr Alex Kabanga wa Kabanga, a medical supervisor at NGO Catholic Relief Services (CRS).

"More efforts need to be made to have whole communities sensitised against discriminating and stigmatising the infected," he said. Although most people in the province knew what AIDS was, many still shunned their relatives who had declared their status.

"When someone is told that their brother has HIV, their response is often one of fear and the desire to give up that person to be cared for by an organisation; they seem to want nothing to do with an infected person," Kabanga said.

"It is because of this fear of stigmatisation that a lot of people would rather not reveal their status."

Kiungi Safi, 34, and her husband, a soldier who is also HIV-positive, said stigma meant that the only house they and their three children could rent was in an area prone to flooding. "Because of this, my husband and I are always suffering from opportunistic diseases that we get whenever our house is flooded during the rainy season," she said.

"My family depends on the little salary my husband gets from the army ... about 10,000 Congolese francs [US$20]. It is not enough to ensure we have food, let alone trying to rent a house in a better neighbourhood and, anyway, we will be thrown out if a new landlord found that we had AIDS."

Kabanga said, "A lot of people who know they are infected do not own up [to their HIV-positive status] because they fear discrimination. They say, 'maybe my wife will leave me, my children will be shunned by the neighbour's children, who will no longer want to play with them, fearing they will get infected, or the landlord will throw me out'."

CRS has been operating in Bukavu since 2005 and works with a network of about 100 volunteers, sensitising those who may be living with the virus and do not know it, as well as the families of people who have declared their status, to promote acceptance and support in the community.

"We use volunteers who visit people's houses, VCTs [Voluntary Counselling and Testing centres], market places and other public areas, and our volunteers often have to make several visits to one area before people begin to open up."

Supporting HIV-positive people in Bukavu

The organisation's biggest project is known as AMITIE, an AIDS mitigation initiative that offers care and support to people living with HIV, as well as orphaned and vulnerable children (OVC).

Kabanga said they had recorded some 1,137 people living with HIV/AIDS in Bukavu, to whom they provided psychosocial support and referred to medical facilities and NGOS where they could get antiretroviral therapy. CRS also assisted 1,843 OVCs, 1,537 of whom were of school-going age, but it could only pay school fees for 770 of them.

"We should pay school fees for all these children but our funds are stretched; all of them need food, others need support to get vocational training, and others need legal aid to benefit from their late parents' properties."

He said an issue of great concern was providing food to people already on ARVs. "AMITIE is a four-year programme, and we hope that our donors [USAID] will increase its aid annually to cover all these needs," Kabange said.

The main donors to NGOs, like CRS and Fondation Femme Plus, who work with several other local and international organisations to support people living with HIV/AIDS in Bukavu, are USAID and the Global Fund on HIV/AIDS, Tuberculosis and Malaria. The government's National Multi-Sectoral Programme for the fight against HIV/AIDS, known by its French acronym PNMLS, is the coordinating agency for all the organisations dealing with HIV/AIDS.

Dieudonne Zirirane, the HIV programme coordinator for Association Sante Familial (ASF), a national NGO affiliated to Population Services International (PSI), said the NGOs working with HIV/AIDS met every month, under the chairmanship of PNMLS.

The major challenges in the fight against HIV/AIDS in South Kivu included the vastness of the province; insecurity, which hampered access to vulnerable communities; funding; an increase in sexual violence in war-affected communities; and a lack of adequate information.

Most of ASF's activities were focused on supporting the health of vulnerable communities, especially those infected and affected by HIV/AIDS, in four main programmes that covered HIV prevention, family planning, preventing malaria, and a safe water project.

PSI, in conjunction with ASF, ran several social mobilisation activities aimed at informing the public about HIV/AIDS. "We undertake these activities to break the barriers, so to speak, in a bid to demystify HIV/AIDS to the largest number of people," Zirirane said.

"We target commercial sex workers, soldiers and the police, demobilised soldiers, truck drivers, the youth as well as people belonging to various religious faiths."

Approaching the targeted groups was achieved mainly by peer education, and a small group in every target group was trained to inform their colleagues about HIV/AIDS.

"In the field, the peer educators give out reference cards to whoever wishes to visit a facility for testing and counselling; the cards have a list of medical facilities and VCTs centres, where potential patients who produce them get served free of charge," Zirirane said.

ASF-PSI also marketed affordable condoms via a network. "Condoms available in health centres and other public places are provided under a ministry of health programme, but we realised that a lot of people did not like the free condoms, so they prefer to instead go through our network where they get to purchase a pack of three condoms for 50 Congolese francs [US 10 cents]."

Zirirane said the prevalence rate among pregnant women had been found to be about three to four percent; two percent among those who donated blood; four percent among documented victims of sexual violence, and 20 percent among commercial sex workers.

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