Friday, December 21, 2007
At Hajj After Giving Up the Needle
Samir Al-Saadi, Arab News
Former addicts performing Haj under the National Anti-Drug Committee's rehabilitation program rest in their camp in Mina on Thursday.
(AN photo by Marwan Al-Juhani)
MINA, 21 December 2007 — Rehabilitation does not end by giving up the needle. The National Anti-Drug Committee's rehabilitation program, powered by the fifth pillar of Islam, took the extra mile to shed light into the futures of 200 people shattered by a dark past.
From 320 applicants, the committee accepted 200 former addicts and drug dealers to perform Haj this year. The program aims to support them in order to live normal lives without returning to their past addictions, said Abdelilah Al-Sharif, adviser to the committee and head of the Haj mission.
"What better means in opening a clean sheet than by performing Haj?" he said. "This is among a series of programs supervised by the committee to ensure achieving our set goal."
Since the beginning of the program eight years back, 1,250 former addicts have made use of the 12-step program. Of the 1,250 people who performed Haj, only 20 have returned to drugs, said Sharif.
"We have terms to accept applications: first they need to show that they have their mind set on leaving drugs for good, and, secondly, the applicant needs to integrate into the committee's programs."
Sami Al-Matrafi, a former drug addict who currently has devoted his life to helping other addicts in changing their lives, said that he had been an addict for 24 years of his life. "My past experience brings me close to the people on the program, as I have lived their experience," he said.
He described the first and last days of addiction as the hardest on him. "I lived a harsh experience; I feel that I am capable of making up for those years through my current work in helping other addicts," he said. "I have turned from a man with a bad reputation to a person that is currently respected by others."
The self-support program that is provided by the national committee for combating drugs comprises 12 steps with a time frame of between three months and two years depending on the case. The program is available through 13 of the committee's centers scattered across the Kingdom.
Syed Faisal Ali, Arab News
MINA, 21 December 2007 — Wandering barbers were seen — as they are seen every year — roaming around the Jamrat complex with razors in hands, ready to shave pilgrims for a negotiated price. However, the price might turn out to be very high in terms of hygiene, as they usually ignore the Ministry of Health's recommendations.
These inexperienced and nonprofessional seasonal barbers were openly ignoring basic health regulations right under the nose of security officials. And the pilgrims didn't seem to pay too much attention either, flocking to these men to have their heads shaved after performing the stoning-the-devil ritual on the massive, multistory Jamrat overpass.
One of the biggest hygienic risks involved with this practice are barbers — seeking to save a little money — using the same blades on different people. Blades can create nicks, nicks can bleed, blood can contain viruses and viruses can be transferred from one nick to another: from an infected person to a non-infected person.
Though the AIDS virus can be transmitted in this manner, the transmission of AIDS is not the biggest concern here. The biggest concern is hepatitis, a far more prevalent, infectious and equally incurable virus. This is a virus that health officials the world over fear could cause a global pandemic someday. This is an infection that eventually leads to liver failure and death of its victims. And it also happens to be a virus that is found in greater numbers of people from some countries that send pilgrims to Haj, people that may not even be aware that they are carrying the virus because they haven't yet been struck with symptoms.
The Ministry of Health has opened barbershops at many places in Mina through contractors, with sitting space of around 200 each, but they are not sufficient to cater to the well-over two million pilgrims that came for Haj this year. Because of the great demand, the trade of unregulated, seasonal barbers flourishes.
Regulated barbers have been trained to use one razor blade per person, but seasonal barbers (who also often charge half the going rate of SR10) may not even be aware of the risks they are taking with public health.
Doctors are rightfully outraged. Not only are some of these barbers using the same blade on multiple customers, but in the mad rush to shave heads and make as much money as possible, the risk of razor nicks (and therefore transmission of blood-borne infections like hepatitis and HIV) is greater.
"Since they do their job in a hurry they cause bleeding to pilgrims. Then from the same razor they shave another guy and put him at risk of contracting some deadly disease through blood contact," said Dr. Naseem Ahmad.
Some pilgrims are also not happy. "Yes, I know I should not use the services of these guys," said Nafees Ahmad, a Jeddah-based Indian executive. "But I wanted to come out of ihram after stoning the Jamrat. I got my head shaved by these people and left everything at the mercy of the Almighty."
An Indian journalist, Arshad Faridi, suggested that the Health Ministry consider finding a way to educate these men and encourage them to be safe even if what they're doing is illegal.
"Demand for barbers at Mina is very high and it can't be met through government agencies," said Faridi. "And so these people come into the scene. Of course, their main aim is to make quick money, but if they were trained properly and instructed to use standard shaving kits that would help greatly."
Saleh Abdur Rahman, a spokesman for the municipality, initially declined to comment but later said that the task of monitoring these barbers was formidable. "It's not possible to man every inch of space in Mina," he said. "Our patrolling teams are on the ground in Mina, particularly in the Jamrat area, and when officers see them, these 'seasonal barbers' just vanish into the crowd."
So perhaps this serves as a warning to pilgrims. Next year: Consider bringing your own razor blade in your check-in luggage.
Wednesday, December 19, 2007
From Plus News
Photo: Lilian Liang/PlusNews
|Sabrina Salim, a HIV+ Muslim woman, who was infected in a blood transfusion.|
"That was when I finally stopped using drugs," she told IRIN/PlusNews.
After her initial shock she decided to tell her family, friends and her then boyfriend - now her husband - Yulius Adam, also a former intravenous drug user, who was diagnosed HIV positive before Heldina.
Little did she know the prejudice she would encounter as a woman, a Muslim and being HIV positive. The discrimination began in her own family. "Adam's family blamed me for having transmitted the virus to him, even though at the time he was diagnosed my test came back negative." She believes that HIV-positive Muslim women experience more prejudice than men in similar circumstances.
Different weights, different measures
Discrimination was the common denominator of all the stories told by HIV-positive Muslim women who participated in the International Conference on Islam and HIV/AIDS, held in late November in Johannesburg, South Africa.
"Women are still regarded as secondary creatures," said Zahra-Tul Fatima, a director at the Asian Muslim Action Network (AMAN), Pakistan Foundation, which focuses on poverty eradication.
Hany El-Banna, president of Islamic Relief Worldwide, the non-governmental organisation which organised the conference, said the tenuous link between culture and religion was what fed this system of "different weights, different measures".
|Women are still regarded as secondary creatures|
El-Banna cited the example of the honour killings, practiced in a number of Middle Eastern countries, in which a young woman who has had sexual relations prior to marriage was murdered to preserve her family's honour. "But why don't they kill the man too? There needs to be equilibrium and justice," he commented.
Sindile Ngubane, of Al-Ansaar Refugee Service, based in the port city of Durban, South Africa, agreed. "If a teenage girl gets pregnant, she will probably be recriminated and rejected," he said. "But if a boy gets a girl pregnant, no one says anything. They'll probably say that he was the victim of an evil woman."
Sinners and outcasts
Riana Jacobs, the first Muslim woman to go public about her HIV-positive status in South Africa three years ago, said the higher level of prejudice against women was partly because more women than men were open about their condition. "They'd rather keep the issue a secret," said Jacobs, who was diagnosed in 2000.
Another reason is that HIV is commonly associated with illicit sex, but discrimination is a constant, even when infection takes place in other ways.
Sabrina Salim, 37, with three children, was infected by a blood transfusion in Tanzania, her native country. She only discovered she was HIV-positive when she took the test required by the Canadian government for an immigrant visa.
The prejudice followed her all the way to Toronto, where she now lives. She revealed her condition to a friend, who started a wave of rumours that Salim was HIV-positive, giving her dubious reputation in the local African community. "The women would call each other and say, 'Careful with your husband, there's a loose woman among us'," she said.
Women have rights
Photo: Lilian Liang/PlusNews
|Heldina Irayanti and Yulis Adam.|
"The right to education is violated all the time, but education doesn't depend on one's sex," she told a perplexed male audience. "We have to give women the right that Allah gave them to be educated and to express themselves."
She said HIV prevention among Muslim women was directly linked to women's rights, such as being able to choose their own husbands, ask for divorce, ask their partners to be tested, refuse sex with their husbands, demand that their husbands use condoms, and be separated from HIV-positive husbands.
Fatima, of AMAN, suggested practical measures. "There needs to be more places for [HIV] tests, with confidentiality and a support mechanism. And, mainly, more power and autonomy must be given to Muslim women," she said.
Despite the difficulties, some women have chosen to pay the high price of going public. The decision made by Indonesia's Irayanti even had repercussions for her son, Bilal, 3, when the fearful parents of his classmates took them out of school. Bilal, who is HIV negative, was also taken out of school, but returned after his mother explained the situation.
As an HIV-positive Muslim, Irayanti believes she has a responsibility to get people to confront HIV/AIDS. "We have to face up to it," she said. "It's time to talk about HIV and AIDS; if we don't, nothing will change."
Wednesday, December 12, 2007
Photo: Kate Holt/IRIN
|I found it hard to believe I was HIV positive; I had only ever been with one man.|
"I am the last-born and was only three months old when my parents separated. Mum tilled other people's land to provide for nine siblings and me. It was during the war, and it was very hard for her to put food on the table and pay school fees.
"I was still in school when I met him. He worked for an international NGO based in Yambio, my hometown [close to Sudan's border with the Democratic Republic of Congo]. The neighbourhood children fetched water from a borehole in his compound, so everyone knew him. He was a senior officer [in the Sudan People's Liberation Army] and drove around in this big [Toyota] Land Cruiser.
"He must have heard about my situation, so he sent people to me asking that I visit him. When I inquired of his intentions they all said he was a good man, willing to help and to pay my school fees.
"For about a month I resisted his advances - I was 15 and uninterested in men - but one evening he dispatched his driver and security guard, I sneaked out, hopped into the Land Cruiser and in minutes was dropped off at his place.
"He was happy to see me; he excitedly told me many things - that he loved me and wanted to pay my school fees. He took me to his bed saying, 'Do not fear, I will be your father and mother, and will take care of you.' He promised to meet Dad the following day to announce that he is my boyfriend.
"We had sex. It was my first time and very painful. I did not enjoy it but figured that God had found me a caring man to love and see me through school.
"He kept his word and met my family. I moved in with him. He paid my school fees balance in Yambio and also paid for my secondary school in Arua, northwestern Uganda.
"He even bought me a plot in Yambio and built me a two-roomed brick house. I was happy. During one of the school holidays, he brought me a gift - a small Toyota Corolla. We were a happy couple and I felt I had all that I needed.
"The next school holiday I went home [from Arua] to find he had been transferred to Nairobi. He sounded a different man. He said he would continue paying my school fees but would never come back to Yambio. I was devastated.
"2003 was the last time we talked. Later, I tried calling and e-mailing him, but it was in vain. Reality sank in painfully in March this year when I suffered a bout of tuberculosis, fever and malaria. The doctor suggested I take an HIV test. I never felt alarmed - after all, I had only known one man.
"The news that I was HIV-positive was hard to believe. The doctor at Mulago Hospital [in the Ugandan capital, Kampala] admitted me for a month and put me on antiretrovirals (ARVs) - he said my CD-4 count [which measures the strength of the immune system] was very low.
"Recently, in Juba, I met my ex-boyfriend's best friend and former workmate at Yambio. He confirmed that my ex-boyfriend had all along known his status and was on ARV treatment. He was previously married, before we met. In fact, he had lost his wife and two children to HIV-related complications.
"I felt cheated and naïve that I had had sex without protection. I was young and knew nothing about condoms or HIV/AIDS. I feel betrayed by the only boyfriend I ever had. He infected me knowingly, and I will never forgive him.
"My people in South Sudan know very little about HIV/AIDS, its transmission and prevention. Some associate it with witchcraft. That is why I have gone public about my status, telling them 'HIV is real'.
"I visit hot spots like discos and bars, and talk to vulnerable groups: prostitutes, soldiers, long-distance truckers, the 'senke' boys [motorcycle-taxi operators] and the youth. Some do not believe me and tease, 'A beautiful girl like you cannot be HIV-positive'.
"Ignorance and stigma are a bitter reality. A brother-in-law of mine refused to shake my hand or share utensils. My stepmother recently threw me out, telling off my dad for wasting money on a "girl who is dying very soon anyway".
"I have dreams. To go back to school, get into medical college and become a doctor. Most importantly, I want to live long.
Tuesday, December 11, 2007
University Wire (12.03.07):: Dae Woo Son, The Daily Student, Indiana University
The phenomenon of black men on the "down low," men who self-identify as heterosexual but engage in gay sex without telling their female partners, has received much attention from the media but is under-researched. That was the message delivered in a World AIDS Day lecture at Indiana University by Dr. David Malebranche, an assistant professor at Emory University School of Medicine.
"I worked on a review of three databases looking at articles about bisexual black men and HIV risk. Over a span of 24 years, we found 24 articles and two conference abstracts that actually fit the criteria of what we were using, which is a little sad," said Malebranche, whose lecture was entitled "Black Bisexual Men and HIV: Time to Think Deeper."
The degree to which "down low" men transmit HIV to their female partners is unknown, Malebranche said. Yet despite this fact, the men are widely blamed for rising HIV infections among black women. "No one really explains the story of what this man actually went through or what was going on in his world when he contracted HIV. All the black man is, is a vector of disease. He's treated like a mosquito that flies around and infects people," he said.
The available research focusing on "down low" men paints a decidedly mixed picture, according to Malebranche. A Chicago study found that men who hid their bisexuality were more likely to use condoms for anal sex and less likely to be HIV-infected. A Dallas-based study found the opposite. A study based in Atlanta found that sexual identity had no bearing on risky sexual activity.
Malebranche is currently conducting his own two-year study on the topic.
Photo: Lilian Liang/PlusNews
South African Riana Jacobs, 31, has been HIV-positive for the last 10 years
She has been HIV-positive for the last 10 years and is not intimidated by the audience of Muslim religious and academic leaders, mostly men. When she declared her status in 2004, compassion from her religious leaders was hard to come by.
"People accept it when it's not their problem," she said. "But leaders don't want to see that seroprevalence is increasing among Muslims."
This picture of intolerance is slowly changing as more initiatives throughout the world educate imams - Muslim religious leaders - about HIV and AIDS, so that they can teach their congregations.
"The imams are more effective than television or the radio in certain areas because of their authority and influence ... imagine the impact if all imams dedicate time in their sermons to talk about HIV," remarked IRW president Dr Hany El Bana at last week's meeting.
According to UNAIDS, although prevalence in Islamic communities is relatively low, it is growing in countries like Algeria, Iran, Libya and Morocco.
In Mozambique, where a quarter of the population is Muslim, 19.8 percent of the adult population is living with the virus; in Guinea Bissau, where 4 in 10 of the country's 1.4 million inhabitants follow the Islamic religion, the national seroprevalence rate is 3.8 percent.
Data from the National AIDS Commission in Indonesia - the world's most populous Islamic country, with 225 million inhabitants - show that HIV cases have been reported in almost all its 33 provinces, mainly among intravenous drugs users.
Allah Yar Qadri, once an imam and now a consultant on community development, HIV/AIDS and Islamic issues in Malawi, warned that imams could not afford to distance themselves from the issue. "If the imams remain silent, others will take the lead and speak to our communities, but far from Islamic principles."
Do female condoms exist?
In Muslim communities, HIV has been associated with infidelity or promiscuous behaviour, so many people have viewed infection as a well-deserved divine punishment, but this perception is slowly being replaced by a more tolerant attitude.
An effective change in mentality would require not only education about the pandemic, but also more information on sex and risky behaviour, which scholars do not always have. "I'm sorry, but do female condoms exist?" asked Amna Nosseir, a specialist in Islamic philosophy who hosts a television programme in Egypt.
Photo: Lilian Liang/PlusNews
Sheikh Mohamed Bashir Joaque
To a certain extent the lack of knowledge can be traced back to the madrassas (Islamic schools), which are reluctant to deal with more current themes. "The curriculum in the madrassas needs to be revised," Qadri said. "Islam is a religion in progress, so it's necessary to incorporate contemporary aspects into curricula, and sex is an important chapter of the Quran."
Economic factors also matter. In Malawi, for example, many imams are contracted by a committee of community businessmen, so they may not always be able to preach about what they see as most pertinent. "If the imam talks about HIV and AIDS without the committee's approval, the next day he could lose his job," Qadri explained.
Back to school
Some Islamic countries are solving the problem by educating imams about HIV/AIDS. Sheikh Mohamed Bashir Joaque, who was born in Sierra Leone and lives in the United Kingdom, is part of the African Muslim Communities Campaigns Against HIV/AIDS initiative, and the growing success of his courses in London have led to the creation of a manual on HIV/AIDS for religious leaders.
He says the secret is to transmit information gradually, from an Islamic perspective. "We need to adapt. We don't start talking about condoms right from the beginning. We emphasise that the best thing is still abstinence before marriage and faithfulness during marriage," he explained.
"But we also say that we're all human and can all have moral lapses, and if this happens, condoms should be used. If we're too direct, they leave."
Photo: Mercedes Sayagues/PlusNews
|Compassion and action - Muslim response to HIV and AIDS|
JOHANNESBURG, 6 December 2007 (PlusNews) - To most Westerners, a fatwa, or Islamic ruling, evokes the imposition of a death sentence on author Salman Rushdie and the wearing of head-to-toe coverings, or burkas, on women.
Yet fatwas can also be progressive and bring widespread change. Issued by respected Islamic scholars known as ulama, fatwas are guidelines for the ummah, the worldwide Muslim community, which numbers between 1.3 and 1.5 billion people, according to the CIA Factbook.
The draft text of several progressive fatwas were discussed last week by the ulama at the International Consultation on Islam and HIV/AIDS, organised by the charity, Islamic Relief Worldwide (IRW), in Johannesburg, South Africa.
One fatwa would approve the use of funds from the zakat (mandatory alms giving) for HIV-positive people, whether Muslims or non-Muslim, regardless of how they contracted the virus, as long as they are poor.
Another fatwa would approve the use of condoms by married discordant couples, where one is HIV-positive and the other is not, to avoid infection.
The findings are not final. As first-opinions, they will be discussed next year at regional and national consultations.
"These are two [potentially] revolutionary rulings here," said Dr Ashgar Ali Engineer, chairman of the Centre for Study of Society and Secularism, in Mumbai, India.
The use of condoms has long been a divisive issue in the Islamic response to AIDS. Muslim teachings condemn sex before or outside marriage, and reject condoms for both safer sex and family planning.
Yet the views on condoms were not unanimous: "A condom is a necessity sometimes," said Bangladeshi sheik Abul kalam Azad. "The enemy of my enemy is my friend. HIV is an enemy. The condom is the enemy of HIV. If we can save lives with a condom, let discordant couples use it."
Impact on the ground
For charities like IRW, if these opinions become rulings, "we can formulate programmes based on this advice", said Makki Abdelnabi Mohamed Hamid, a Sudanese agriculturalist and head of the Africa region at IRW.
Photo: Mercedes Sayagues/PlusNews
|Sheik Abul Kalam Azad - condoms are an enemy of HIV|
Zakat, mandated at two percent of an individual's accumulated wealth above a certain threshold, mobilises large amounts of money that could go towards HIV and AIDS work. "People and institutions may now feel comfortable giving money for HIV and AIDS," said Hamid.
So far, the Muslim response to the pandemic has been dogged by "the prejudiced association of the disease with moral depravity", said Dr Asghar Ali Engineer, because the virus is transmitted, among other ways, through illicit sex and injecting drug use, which reinforced its link to sinful behaviour.
Muslims accord great importance to the Islamic holy book, the Qu´ran, and its explanatory notes, the hadith. "AIDS and condoms did not exist at that time. We are faced with new challenges and we need new fatwas to deal with new issues," said Hamid.
The unworldliness of many scholars compounds the problem. "Some religious leaders are not exposed to the real world. We, humanitarian workers, we listen to people's stories," Hamid added.
|Muslim NGOs have low visibility yet they are doing extraordinary work. Like Christian groups 20 years ago, they are too busy working to attend international conferences and brag about it|
Dr Ikram Bux, a South African physician and HIV/AIDS specialist working in the east-coast city of Durban, shared his view. "On HIV-related fatwas, the ulama should have advisers who are experts on the epidemic," he told IRIN/PlusNews.
Linking science and religion was the keystone of Senegal's response to AIDS, praised as a model by UNAIDS. As early as 1987, when African governments, with the exception of Uganda, were silent about the disease, Senegalese scientists, epidemiologists and health authorities - all Muslim - met with the traditional Islamic leadership to explain the new disease from a scientific, not moral, perspective.
As a result, imams across the West African nation of 12 million were mobilised to send clear messages on prevention and transmission 20 years ago. Today, many Muslim countries and communities have well-established and creative programmes to deal with the pandemic, ranging from assistance for intravenous drug users in Iran and Indonesia to family planning in Afghanistan and street children in Zambia.
Calle Almedal, a senior consultant to UNAIDS and a specialist on community responses to AIDS, was impressed by the variety and quality of work presented at the consultation.
"Muslim NGOs [non-governmental organisations] have low visibility yet they are doing extraordinary work. Like Christian groups 20 years ago, they are too busy working to attend international conferences and brag about it," he told IRIN/PlusNews.
Tuesday, December 4, 2007
JOHANNESBURG, December 3, 2007 (PlusNews) – Suhail AbualSameed looked calm, yet he was shaking inside. He was seated before a row of ulama,
distinguished Islamic scholars, from Afghanistan to Yemen at the International Consultation on Islam and HIV/AIDS, organised by the charity,
Islamic Relief Worldwide (IRW), in Johannesburg, South Africa, last week.
The previous day, several of them had denounced homosexuality as un-Islamic
Today, AbualSameed had something to tell them.
"As a gay Muslim, I feel unsafe, unloved and unrespected in this space," he
"Were I to become HIV-positive, the first thing I would lose is my Muslim
community. I couldn't come to you guys for support."
You could cut the tension the room with a knife.
AbualSameed continued: "I wish you did not refer to gays with the (Arabic)
words 'shaz' and 'luti' – perverts and rapists – because we are not."
Two men in keffiyas, the gingham headcloth worn by men in many Muslim
countries, waved their arms to silence him but the chairman nodded for him
Spellbound, the audience listened as AbualSameed, a Jordanian living in
Canada, did the unthinkable: outing himself.
The groundbreaking consultation brought together Muslim community leaders,
academics, doctors, relief workers and HIV-positive activists to rethink the
Islamic response to HIV and AIDS. One key issue was HIV prevention among
hard-to-reach vulnerable groups like sex workers, street children, injecting
drug users, and men who have sex with men.
Jaffer Inamdar, the HIV-positive founder and programme manager of the
Positive Lives Foundation in Goa, India, told IRIN/PlusNews: "Lots of sex,
drugs and gay activity take place during the high season from September to
April in this popular tourist destination. Harsh, condemning language make
them [gays] run away, hide and continue to spread HIV."
Homosexuality is forbidden and considered a crime in most Islamic countries.
Six officially Islamic countries (Iran, Mauritania, Saudi Arabia, United
Arab Emirates, Yemen, and the 12 northern states of Nigeria) invoke sharia –
Islamic religious law – and maintain the death penalty for consensual
same-sex sex, according to human rights watchdog Amnesty International.
Other countries punish homosexuality with fines, jail or lashes, coupled
with social stigma and blaming Western culture for introducing gay
Not surprisingly, AbualSameed was fearful.
"I saw their gaze, their body attitude, and my memory told me there could be
a physical reaction," he said.
But he had nothing to fear.
"Afterwards, veiled women, bearded men, the most religious types, came to me
and apologised if they had said something offensive, if they had made me
feel unloved or unsafe."
Each friendly gesture signalled belonging.
"This is us: our culture is intimate, warm, based on relationships. When I
outed to my family, they did not turn on me," a relieved AbualSameed told
The following morning, the ulama had a surprise.
Conference spokesperson and IRW head of policy Willem van Eekelen read their
collective statement, saying that although Islam does not accept
homosexuality, Islamic leaders would try to help create an environment in
which gay people could approach social workers and find help against AIDS
without feeling unsafe.
"This first time ever that a high-level religious forum has talked,
acknowledged and accepted gays," said AbualSameed.
"This will open the door to talks with the Muslim gay community and help
other gay Muslims to come out in a safer space."
To see theologians from Egyptian and Syrian universities, and imams – Muslim
community leaders – from India, Sudan and Pakistan defy official Islamic
homophobia is "definitively a first," said sheikh Abul Kalam Azad, chairman
of the Masjid (mosque) Council for Community Advancement, in Bangladesh.
"Homosexuality is a sin but we should not be cruel. They [gays] suffer a
lot in the Muslim world."
Inamdar welcomed the statement.
"There are many gays in my group [in Goa]. Islam says it is a sin and we
have to follow Islamic rulings, but we are all human and deserve respect."
An unlikely ally for gay rights turned out to be Sudanese sheikh Mohamed
Hashim Alhakim, dressed in a white robe with gold trimmings and a white
turban, and his wife, clad in a black hijab, with their baby just behind
Alkahim runs the S-Smart Training and Consultancy Centre in Khartoum, which
also runs AIDS awareness programmes.
"I used to be very hard against homosexuals and sex workers," he said. "But
I learned to respect their humanity. I advise them to change, but if they
are going to continue they must practice safe sex so they don't harm
themselves and their partners."
During the weeklong consultation, AbualSameed, who is coordinator of the
Newcomer/Immigrant Youth Programme at the Sherbourne Health Centre in
Toronto, had endured homophobic statements.
Just the day before, one scholar had ranked homosexuality with bestiality
and adultery as evils to avoid.
"The harshness of the comments made me passionate; I had to do something for
my own identity and dignity, and of other gay Muslims," said AbualSameed.
His decision to speak out was nurtured in his conference working group, made
up of Muslims from Iran, Kenya, South Africa and Tanzania.
South African psychologist Sabra Desai spoke about care and solidarity, and
recalled the Prophet's words: "'If one part of my body hurts, my whole body
hurts'," she said. "I take this to mean that if one member of my community
hurts, we all hurt."
Then she squeezed AbualSameed's hand under the table and passed him the
Slowly, he started: "As a Gay Muslim …".
And with every word, the doors of tolerance opened wider.
(c) 2007 IRIN/PlusNews, the humanitarian news and analysis service of the UN
Office for the Coordination of Humanitarian Affairs. The opinions expressed
do not necessarily reflect those of the United Nations or its Member States.
Tuesday, October 2, 2007
By Paul Simao
JOHANNESBURG (Reuters) - South Africans queued to learn about sex toys and pole-dancing this weekend, at the first sex fair ever held in a country founded by conservative Christians and still home to many sexual taboos.
The exhibition, modeled on a show running in Australia since 1996, would have been unthinkable 15 years ago when South Africa was still ruled by Afrikaners, the white descendants of the original, largely Puritan Dutch and French settlers.
During the apartheid era, customs officials not only confiscated pornography brought from abroad by travelers, but sometimes detained those trying to import it. Strip clubs did not exist and handcuffs, though abundant, were not fur-lined.
The end of white minority rule in 1994 and the establishment of a new constitution -- generally considered one of the most liberal in the world -- unleashed a torrent of hard-core porn. Sex shops and strip clubs blossomed.
Although authorities tolerate the lifestyle, it remains one that few South Africans openly discuss or admit to supporting.
Meanwhile, South Africa has one of the world's worst AIDS epidemics.
An estimated 12 percent of its 47 million people are infected with HIV, most of them black. Sex is the main channel of transmission in a culture where male dominance is rarely challenged and promiscuity often tolerated.
Each day about 1,000 people die from AIDS and another 1,500 contract the virus.
Amid the racy lingerie, pornographic DVDs and exotic sex toys, the Johannesburg "Sexpo SA" made room for a handful of health advocacy groups to set up stands, including the LoveLife Trust, the national HIV prevention program for young people.
Silas Howarth, the 28-year-old South African who organized the exhibition, said around 40,000 people paid the 89 rand ($13) admission to the fair. He said there were plans to hold similar events in coming months in Durban and Cape Town.
Monday, September 24, 2007
Photo: Hera Diani/IRIN
|Some women are intimidated by the large size of female condoms, but their relatively high cost and problems with distribution and supply have also hampered the government's attempts to promote them.|
"My, it's so huge. Will it be painful using it?" asked the self-professed freelance sex worker, who was hanging out at a sidewalk stall in the Pramuka area of East Jakarta, a well known pick-up spot.
She told IRIN/PlusNews she was not willing to try the female condom; she was fine with a tri-monthly contraceptive injection, which kept her from getting pregnant.
What about sexually transmitted infections (STIs)? "I heard condoms might prevent that, but most of the clients don't want to use them, and I don't dare to insist, although I sometimes provide them," she said. "If a client ejaculates inside me I wash with Betadine," she added, referring to a popular feminine hygiene product.
|Safer sex message needs ears to listen|
"There, do you see those women there, sitting next to the drink vendors?" said Supriyati, project manager for Yayasan Bandung Wangi, a local association that provides HIV/AIDS information and condoms to women working the streets in the eastern suburbs of Jakarta.
"They're sex workers? They look like they're selling drinks."
"No, they're sex workers," said Supriyati, pointing to women dressed in nondescript jeans and t-shirts; waiting, bored, among the night-time pavement traders along the traffic-choked main road.
"Can we get out and talk to them?"
"No," responded Supriyati, 22, who was having second thoughts about the evening's plan. "They'll ask, 'Who are you bringing, what do you want?'." Her concern was that if our voyeurism was spotted and perceived as snooping, it would ruin the relationship she has built with the women.
Selling sex is technically not a crime in the world's most populous Muslim country, but soliciting, pimping and procuring are. Indonesia's sex industry, although smaller that that of other South East Asian nations, still reportedly rakes in the equivalent of somewhere between 0.8 percent and 2.4 percent of the gross domestic product.
The previous authoritarian regime had encouraged designated "brothel complexes" in an attempt to regulate the sex trade. In the last 10 years, the rise of populist Islamic parties under Indonesia's new democratic order has brought the closure of established red-light areas by conservative local councils, wary of being seen as encouraging prostitution.
A booming sex industry
In spite of the new piety, swarms of massage parlours, karaoke bars and nightclubs have opened, cashing in on Indonesia's economic boom. They discreetly offer sex to better-healed punters, but in areas like Cipinang there is no façade. From the kerbside to a nearby alleyway, or shacks by the railway line - the only privacy an industrial rate of intercourse can afford - a streetwalker would be hard-pressed to charge more than US$1.50 for a quick round.
That sad fact undermines the advocacy efforts of activists like Supriyati: in a country where condoms are not popular and sex is cheap, market forces mean men "get sex the way they want it".
"The problem on the streets is that you have to compete [for clients]," said Supriyati. Insisting on condoms would not only be bad for business, but would "suggest the sex worker is HIV-positive". The harsh reality is that 23 percent of sex workers are living with the virus, according to the National AIDS Commission (NAC).
By the standards of the region, Indonesia has a serious HIV problem. In the eastern province of Papua it has become a generalised epidemic, with prevalence at 2.4 percent. In the rest of the country it is yet to break out of the sub-populations of injecting drug users (IDUs), prisoners and sex workers; but these subcultures are expanding as a result of lopsided economic growth.
"Two things force girls into this industry: poverty and lack of opportunity," said Supriyati. Although she must have told the story many times before, she cried when she remembered how her father had sold her, at the age of 12, to settle his debts to an aunty who was running a brothel in east Jakarta. "If he wasn't poor, he wouldn't have done it," she insisted.
Photo: Obinna Anyadike/IRIN
|Recovering heroin addict - drug addiction adds to the risk|
NAC deputy secretary Kemal Siregar told IRIN/PlusNews that regular condom use among sex workers was between 30 percent and 40 percent. Three-year-old surveillance data among brothel-based workers suggested condom use of around 15 percent (compared to almost 98 percent in the Thai capital, Bangkok). Worse still, just under half of all clients buying sex in Indonesia were deemed "high-risk": truck drivers, sailors and port workers.
If safer sex has been a hard sell among female sex workers, male and transgender prostitutes are in a neglected league of their own. "Almost everywhere it has been measured, condom use in commercial sex between men and women is consistently higher than condom use in commercial sex between men, even though sex between men carries a far higher risk of HIV transmission," the MAP study noted.
Sex and drugs
The use of putau - low-grade heroin - has exploded over the last 10 years, adding a further dimension of risk. It is typically injected, often with needles shared by many addicts, speeding the potential rate of HIV transmission. The medical technician in charge at a small government-run methadone programme in east Jakarta told IRIN/PlusNews that 86 percent of the former IDUs who were tested this year were HIV-positive.
Addicts sell and buy sex, and the barrier between those sexual networks and the rest of society is highly permeable. "I've noticed that a lot of parents of young men who are drug users are encouraging them to marry early, to change them. But the fact is that they infect their wives and children," said NAC secretary Nafsiah Mboi.
Islamic leaders are wrestling with the issue of condom use. "We agree condoms should be in red-light areas, but it should be sex workers that buy them; they should not be for everyone, like students for example," was the less than ringing endorsement of Aelhi Laksono, an outreach officer at the Angung Sunda Kelepa mosque in Jakarta.
"The figures show that [HIV prevalence] has nothing to do with good or bad people; a certain percentage of the population will engage in high-risk behaviour, and from them it will enter into the general population," Mboi responded. "The people that don't care about abstinence or being faithful need condoms."
Supriyati acknowledged that even her group, Indonesia's only advocacy organisation made up of former sex workers, has struggled to get its message across. In her depressing assessment, "Until they get infected, Indonesian people will not realise how important safe sex is."
Saturday, September 22, 2007
Saturday, September 22, 2007; A08
TRENTON, N.J., Sept. 21 -- A promising experimental AIDS vaccine failed to work in a large international test, leading the developer to halt the study.
Merck & Co. said Friday that it is ending the enrollment and vaccination of volunteers in the study, which was partly funded by the National Institutes of Health.
It was a high-profile failure in the daunting quest to develop a vaccine against AIDS. Merck's vaccine was the furthest along and was closely watched by experts in the field.
Officials at the company said 24 of 741 volunteers who got the vaccine in one segment of the experiment later became infected with HIV, the virus that causes AIDS. In a comparison group of volunteers who got dummy shots, 21 of 762 participants also became infected.
Michael Zwick, an HIV researcher at Scripps Research Institute, said it is too soon to know whether other vaccines using the same strategy would also fail. "It's par for the course in the HIV field," he said of the Merck result.
The participants were all free of HIV at the start and at high risk for contracting the virus: Most were homosexual men or female sex-workers. Merck said all were repeatedly counseled about how to reduce their risk of HIV infections, including condom use.
In a statement, the NIH said a data safety monitoring board, reviewing interim results, found that the vaccine did not prevent infection or limit the severity of the disease "in those who become infected with HIV as a result of their own behaviors that exposed them to the virus" -- another goal of the study.
Wednesday, September 19, 2007
PAKISTAN: Roadside dentists pose HIV, hepatitis threat
Photo: Kamila Hyat/IRIN
|Roadside dentists heighten the risk of spreading HIV|
Saleem, a car mechanic, has just had a molar removed in Lahore, capital of Pakistan’s eastern Punjab Province. The roadside dentist, Siraj Saeed, who performed the task, has the extracted tooth in a steel bowl next to an array of instruments spread out on a small, stained mat where he receives and treats his patients.
"The problem has gone now. I will be able to sleep properly and eat again in a few hours," Jawad told IRIN/PlusNews.
But while the roadside tooth removal - carried out without anesthetic and with only the most primitive, unsterilised tools - was obviously painful, there could be dire consequences for those who use the services of roadside dentists.
Recent studies in Pakistan have shown that roadside barbers, dentists and doctors are responsible for the rapid spread of diseases such as hepatitis, as well as HIV/AIDS.
"When the same instruments are used on one patient after another, and only dipped in a pail of water to clean them, there is an immense danger of passing on all kinds of disease, including HIV," said Fahd Anwar, a Pakistani dentist based in the USA.
Dr Anwar, who is considering moving back to Pakistan, cited an acute shortage of qualified practitioners - effectively encouraging such practices to thrive.
Shortage of qualified dentists
According to Pakistan government figures for 2006, there were 6,761 dentists in the country for a population of at least 155 million - roughly one dentist for every 23,000 patients.
This ratio had improved somewhat over the past decade, but the number of qualified practitioners remained dismally low.
This also means fees charged by trained dentists at private clinics tend to be high, while government medical facilities are often poor and involve long waiting periods.
"I know people say one can get sick by visiting roadside dentists. I have seen a programme on TV about this, and something about boiling instruments," said Jawad.
|When the same instruments are used on one patient after another, and only dipped in a pail of water to clean them, there is an immense danger of passing on all kinds of disease, including HIV.|
Roadside dentists charge between eight US cents and $3 for their services, while a visit to a private dentist will cost more than $8. Even treatment at public sector facilities often incurs larger costs.
Such costs are beyond the means of many people in Pakistan who earn less than $100 a month.
As a result, thousands of people each year visit roadside practitioners, who usually depend on lessons passed on from elders or simply first-hand experience, for their expertise. Moreover, most have little or no awareness about the need for hygiene, let alone sterilisation or the dangers of HIV/AIDS.
"These things are in Allah's hands; we do what we can," says Saeed. "I wash my tools with soap each evening."
But with the prevalence rates for hepatitis stated by the Pakistan Medical Association to be at least 11 percent and rising, such practices also play an inevitable role in the spread of the disease, which claims hundreds of lives each year, as well as HIV, say specialists.
Pakistan is now ranked in the “concentrated epidemic” stage of HIV/AIDS, according to the World Health Organization (WHO). Pakistan's National AIDS Control Programme (NACP) officially confirms only 3,198 HIV/AIDS cases across the country, but NACP experts concede the "number of sufferers could be higher".
|More on HIV in Pakistan|
|HIV/AIDS will not go away if you ignore it|
|Lonely drivers face HIV/AIDS threat|
|Taboo heightens risk for male sex workers|
|Drug injecting refugees vulnerable to HIV infection|
According to WHO, the number of HIV-positive people in Pakistan could be as high as 85,000.
Epidemics have been reported among IDUs in the town of Larkana in Sindh Province and also in other major cities. The high prevalence of sexually transmitted infections, the large number of female and male sex workers, inadequate checks on blood transfusions and high levels of illiteracy and lack of awareness about AIDS also place Pakistan at high risk.
Following a month-long anti-AIDS campaign, the NACP country director, Asma Bokhari, said that in several Punjab districts, the re-use of syringes was found to be a major cause of the spread of the virus, and that "unsafe medical practices" posed a grave risk.
Yet despite this, across Lahore, and other major cities in Pakistan, dentists - as well as barbers who traditionally also lance boils, ear doctors and other quacks - continue to carry on their unsafe practices.
Their numbers are unknown but it is estimated to be in the tens of thousands. To date, campaigns to tackle such unsafe practices have failed to achieve any results, despite the obvious risks.
Monday, September 17, 2007
|Muslim leaders say promoting condoms is tantamount to promoting adultery|
"I will never sell condoms in my shop; it is like promoting adultery and operating a brothel," Sharrif Mohamed, who owns a shop in Isiolo, Eastern Province, told IRIN/PlusNews.
Most traders in the mainly Muslim northeastern part of the country have refused to stock condoms, which are usually only available at government health centres.
Zamzam, a single mother of three in Garissa, a town North Eastern Province, dismissed condoms as "a thing for the prostitutes", saying, "I use my brain and intelligence when I want to sleep with a man, and can tell who is sick [with HIV/AIDS]; I am not a prostitute to use it." This level of ignorance is common across the region, where literacy levels are the lowest in the country.
"The HIV/AIDS pandemic is a curse and punishment because people have engaged in immoral acts and offended Allah [God]," Maalim Hussein Mohamud, a teacher at a 'madrassa', or Islamic school, in Mandera, near the Somali border, told IRIN/PlusNews. "They have to repent, observe religious teaching and not use condoms."
Mohamud said the only way to prevent the viral infection was to observe religious teachings, abstain from 'illegal' sexual acts and avoid the use of condoms.
"Our position is very clear: we shall never support the use of condoms; Muslims must shun acts that will endanger their lives. To be safe [from HIV], youths must pray five times daily, fast, and refrain from looking at women; extramarital affairs must be avoided and women must dress decently," he insisted.
Noor sheikh, who works at the government's HIV/AIDS and sexually transmitted infection control programme in North Eastern Province, said stiff opposition to the use of condoms was proving to be a hindrance to HIV prevention. "Our region has the lowest use of condoms in the country," he said. "Of course it is a factor responsible for many cases of infections."
Some activists have complained that the government has not done enough to educate the local population about condom use, particularly in rural areas, and it was also often very difficult to obtain condoms.
"Many youths are informed about the use of condoms, but have said they are not available in remote parts of the region," said Margaret Leshore, of the Samburu Women's Empowerment Programme, a non-governmental organisation advocating women's rights.
The condom is one of the main HIV prevention strategies employed by the government, and free condoms are available at most health centres around the country.
Although northern Kenya has some of the country's lowest prevalence rates, concerns have been raised about low awareness of the pandemic and the region's continued resistance to condom use.
Wednesday, September 12, 2007
From the New York Times
By Michael Slackman"
September 9, 2007
THE instructor held up an unfurled green condom as she lectured a dozen brides-to-be on details of family planning. But birth control was only one aspect of the class, provided by the government and mandatory for all couples before marriage. The other was about sex, and the message from the state was that women should enjoy themselves as much as men and that men needed to be patient, because women need more time to become aroused.
Tuesday, September 4, 2007
Photo: Mercedes Sayagues/PlusNews
|Islam is part of the fabric of society in Pemba|
The bustling neighbourhood quiets down on Fridays after 11, when the green-and-white mosque set between the hill and the beach, fills up. Often the sermon is about AIDS. "We teach people how to protect themselves and how to deal with the disease if they have it," Cheba told IRIN/PlusNews.
Seroprevalence in Cabo Delgado, which borders Tanzania, is 8.6 percent, the lowest in the country; the national average is 16.2 percent.
Arab traders brought the Muslim faith to Africa's eastern coast around the eighth century. Around 80 percent of Cabo Delgado's 2.5 million people are Muslim, as are about a quarter of Mozambique's nearly 20 million people.
Cheba knows the power of his words: "In a place of worship people pay more attention," and also in a place of learning. He is the provincial director of 139 registered madrassas (Islamic schools), where pupils start learning about AIDS as early as six years of age, "in an appropriate way, using metaphors, not showing a condom."
Following Islamic teachings, Cheba insists on faithfulness among couples and postponing sex until marriage. Condoms are not recommended.
Many mosques have organised teams who visit the sick and orphans at home, and the Portuguese medical charity, Medicos do Mundo, has trained about a dozen women, including Cheba's wife, to administer home-based care. Orphans are exempt from paying the madrassa school fee of 5 contos (US$0.20) a month, and are given food and clothing.
HIV-positive Muslims are encouraged to join support groups, says Nassurulahe Dula, President of the Islamic Congress of Cabo Delgado, the province's largest Muslim congregation.
All this is helpful, but some AIDS activists in Pemba have often bristled at Cheba's statements: "This disease is a divine punishment; the Prophet said that a disease without cure and sudden death is the punishment for adultery."
He hastens to explain that "like the tsunami in Indonesia, AIDS is a punishment that affects those who do good, and those who do evil. People must repent and return to God."
A good Muslim
Maria de Fatima Bacar, 44, a large, friendly woman who lives in a hamlet 20km inland from Pemba, has one son alive, three dead, and two grandchildren whom she dotes on.
|AIDS does not target Muslims, Christians or pagans; AIDS is like malaria, we are all equal in front of it|
The couple organised a support group, the Association to Help your Neighbour, which now has 22 members and cares for 12 HIV-positive children. They visit the sick, help with burials, make sure that orphans go to school and encourage people to test for HIV at the local health post. "Fifty-seven last month," she says proudly.
Bacar is unhappy about what she hears at mosques. "AIDS is not a divine punishment; whoever says AIDS is a punishment, says it out of ignorance," she says firmly.
"I am a good Muslim woman. I never did anything outside my faith. I was an honest and faithful wife, and I got HIV through my husband. Instead of embracing people, they reject us."
The link between AIDS and sex has long been a thorny issue for faith organisations that promote strict sexual guidelines and behaviour. "We are encouraging AIDS with the way we dress, showing bellies and tempting men," says Awash Ingles, a prominent Muslim woman leader who worships at the Paquitequete mosque.
Islam has "immense problems" in dealing with AIDS in Cabo Delgado, says Diquessone Rodrigues, provincial coordinator of MONASO, the national umbrella for AIDS service organisations.
Photo: Mercedes Sayagues/PlusNews
|Fatima Bacar: "I'm a good Muslim woman"|
MONASO is meeting with groups of mosque-associated women to try to change their perceptions and enlist them to bring about change. "They can speak [about AIDS] at mosques and madrassas," says Rodrigues.
Another potential ally is the Provincial Council against AIDS, which plans to meet with Islamic authorities. "We want to work with Islamic leaders to change this discourse, because it hurts HIV-positive people to hear AIDS is a punishment from God," says Council director Teles Manuel Jemuce.
The idea is to gently nudge Muslim thinking in Cabo Delgado towards common ground with Bacar, who says: "AIDS does not target Muslims, Christians or pagans; AIDS is like malaria, we are all equal in front of it."
Monday, September 3, 2007
From UNAIDS - 24 August 2007
A new national initiative from UNAIDS in Pakistan aims to ensure that communities and the government listen to the experts - people living with HIV - when making decisions about treatment, care, support and prevention.
Twenty-four year old Masood is the newest recruit to one of UNAIDS’ latest initiatives: the“Association of People Living with HIV and AIDS in Pakistan”.
The association was launched on World AIDS Day 2006 with the support of UNAIDS and its UN co-sponsors, and the Pakistan government. The aim is to make sure that people living with HIV are consulted when decisions about prevention, treatment, care and support are taken at federal and provincial level.
In keeping with the principle of greater involvement of people living with HIV, all the executive board members of the association are HIV positive. Now, it is establishing the first network among people living with HIV in Pakistan to provide a platform for them to speak in unison.
“In my experience, most HIV positive people here have difficulty conveying their needs, often because of poverty and because the literacy rate is low and information provided is limited,” says Masood.
“Here in Pakistan HIV is not seen as a priority and people have many issues surrounding their treatment, care and support, stigma and discrimination and society’s attitudes.” Stigma and discrimination is specifically associated with children and women from rural areas of Pakistan. These women have been infected by their husbands; most of them were migrant workers who have been deported by certain countries without being told about their HIV positive status.
The Association has already begun to bring the small number of NGOs and self-help groups together. The objective is to provide training in leadership skills and health information, including adherence to anti-retroviral treatment.
With a Masters in Business Administration from University in Lahore, Masood is working with them to organize themselves strategically, to develop policies and to raise funds.
There has been a three-day workshop on capacity building already, focusing on the issues for people living with HIV in Pakistan and how to operate an effective positive self-help group. Another two-day workshop focused on HIV literacy helped pre-testing and collecting feed back on the newly developed booklets and other information materials produced in Urdu and English for people living with HIV (PLHIV).
UNAIDS will be supporting more workshops across the country and is planning to do this activity in collaboration with Association of PLHIV, provincial and federal Government and civil society organizations working on AIDS issues.
“We aim to contribute to improving people’s lives, give them a sense of belonging, political empowerment and strength of spirit,” says Masood.
At the same time the Association aims to contribute to the national goal – to “prevent a generalized epidemic in Pakistan by containing the spread of HIV and AIDS and elimination of stigma and discrimination against those infected and affected” .
*The country's epidemic is concentrated and intensifying. Pakistan has one of the highest rates of injection drug use in the world (4.5 per capita per annum), and 64% of injecting drug users report use of non-sterile needles. Frequent use and reuse of unsterilized and contaminated needles contributes to a high transmission rate of HIV among injecting drug users (10%). The World Health Organisation and UNAIDS estimate the actual prevalence may be as high as 85,000 (46 000- 210 000).
During the Launching ceremony of Association of PLHIV in 1 st December, 2006 Dr. Aldo Landi, UNAIDS Country Coordinator said:
“This is the first step as a breakthrough in the fight against stigma and discrimination”. He further expressed the need of involvement of PLHIV at both federal and provincial level. Most importantly PLHIV should be treated in full respect of human rights.
Masood is a hemophiliac who contracted HIV through infected blood. In Pakistan, about 50 per cent of blood products are screened for HIV before blood transfusion – and 1.5 million blood bags are transfused every year. About 18 per cent of people living with HIV in Pakistan were infected in this way.
“I have spent many years of my life for humanity,’” says Masood, who has campaigned for better treatment for hemophiliacs and as a volunteer, running a UNICEF funded project for a Lahore based PLHIV NGO, before joining UNAIDS.
“I am very ambitious because I am facing and feeling the pain,”says Masood. “I want to make a real difference by encouraging people living with HIV to realize how important it is for them to be involved at every level.
“They themselves will bring about change. I am happy to be the first drop of rain.”
KARACHI, Aug 18 (IPS) - ''I’ve been running temperature for the past 25 days and lost about five kg in the last one month... just feel so weak every day,'' says Mohammad Sohail, 28, who tested HIV positive a little more than a year ago. His CD4 count is 152.
The strength or weakness of a person’s immune system is calculated on the basis of CD4 count. The normal range is between 600-1,500 cells per cu mm of blood. The count helps health providers decide when to put an HIV positive person on anti-retroviral therapy (ART).
HIV positive people are those found to have, in their blood, the human immunodeficiency virus (HIV) which affects the immune system and causes acquired immune deficiency syndrome (AIDS).
According to World Health Organisation (WHO) guidelines ART must be started when the CD4 count falls below 200.
Despite noting Sohail’s temperature chart and examining a report from his doctor, the government-run referral centre he visits has run no tests on him. But he is being administered antibiotics.
Sohail is among the 175 HIV positive cases currently registered at the Centre of Excellence at Service Hospital, where the Sindh AIDS Control Programme is running the Enhanced HIV/AIDS programme. Of these 60 are on ART.
For the last four months Sohail has been visiting the centre regularly, waiting in line for up to four hours. "The commuting takes another two hours. These visits are taking a toll on me, physically and financially.’’
Each trip to the centre means taking leave from work for a day. He has recently been employed by Dr Saleem Azam for an AIDS prevention project funded by the European Commission on a salary as there were no jobs available for former drug users like him.
But despite his low CD4 count, he is yet to be started on ART that may not cure, but makes the difference between living on the margins and leading a better quality of life. "They (doctors at the referral centre) tell me I look quite fit and don’t need the drug," says Sohail quietly.
He is convinced the indifference is due to his being a former drug user. ''When I complain of discrimination doctors say they fear I may revert to drugs and do not want to waste time and the medication on.’’ Sohail has been drug-free now for over five months.
It is this discriminatory attitude that is making Azam’s work on harm reduction difficult.
Working with intravenous drug users (IDUs) for the last 25 years, he has, at the moment 5,000 IDUs registered with his organisation, the Pakistan Society (PS), which also runs two rehabilitation centres. Almost all of his clients are people from the streets.
"The government is excluding drug users from HIV treatment. This is really dangerous as this population is fuelling the epidemic," says a piqued Azam. In Sindh, 30 percent of all IDUs are HIV positive.
There are over 35,000 to 40,000 IDUs in Sindh and according to the last study conducted in 2000 by the United Nations Office on Drugs and Crime, there are over 60,000 IDUs all over Pakistan. "Careful estimates would now put the figure between 80,000 to 100,000," says Azam.
Officially, the total number of confirmed HIV/AIDS cases in Sindh has gone up to 1,841 and the number of such cases reported from across the country stands at 3,364. Authorities, however, say the unregistered number could well be over 80,000.
Azam’s words echo those of Prasada Rao, Asia Pacific regional director for UNAIDS, the U.N.-joint programme against AIDS. Rao says access to ART is unacceptably low among IDUs because of a "lack of information, exclusion and widespread stigma and discrimination".
For the HIV prevention programmes to be effective, says Azam, these should reach out to IDUs specially.
In the last one year, ten people under his treatment died after they were refused treatment at the state-run hospitals. "About eight months ago, I had to bribe a doctor in Civil Hospital by paying him Rs 4,000 (66 US dollars)) just to operate on one of my clients which should have been done free of charge. Recently, one client died because the Jinnah Post Graduate Medical Centre refused admission on one pretext or the other and, without informing us, shifted him to a shelter run by the Edhi Foundation charity, where his condition deteriorated and he slipped into coma. This is nothing new and happening all the time," Azam said.
The vice-president of the National Association of People Living with AIDS Farid Ahmed Memon faces the same discriminatory attitude. ‘’The Sindh AIDS Control Programme (SACP) told me I don’t need to get the CD4 test done. Imagine if it’s happening to me -- and I know most doctors there -- what the others must be going through."
But Dr Azra Ghias, director of the Centre of Excellence established and run by Enhanced HIV/AIDS Control Programme, says: "No, we don’t discriminate among the various people living with HIV/AIDS nor do we write them off. Everyone who comes to us is our responsibility and our priority. Anyone who needs an ART will get it. But it’s a drug that needs hundred percent compliance and adherence. We do treat IDUs who are drug free for at least four months and who come to us through an NGO. That way we can assure its compliance."
And yet of the 20 HIV positive people registered with PS who have been approved for getting ART by the SACP, only three are getting the drugs "There are almost 100 more who fit the bill," says Azam.
"If this is not discrimination what is? It’s the SACP that runs the tests and register these people, then why the delay? They even have their own standards of gauging who needs the ART and who doesn’t,'' complained Azam.
"CD4 count of less than 200 was the earlier benchmark; it has since been revised by the WHO to 300 and we follow their guidelines," said Ghias.
Azam argues: "Why wait till the person is really sick and on his deathbed to qualify for the drug, why not start earlier? With the formation of the Global Fund to Fight AIDS, TB and Malaria, and ready availability of cheaper generic drugs, why this discrimination against drug users?"
According to the Ghias, one missed dose may cause immense harm. "We spend Rs 30,000 (496 dollars) per month per patient and just one missed dosage would mean his/her resistance to the first line and we’d have to start the person on the second line which is very expensive. That is the reason for our reluctance to giving ART to a drug user who may not know night from day."
But while many await their turn to receive ARV, Azam says there is an urgency to scale up access to other care options. People like Sohail could be diagnosed and treated for opportunistic infections such as tuberculosis, to which people with HIV are especially susceptible.