Indonesia: Female Condom Programme Falters

INDONESIA: Female condom programme falters

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.

JAKARTA, 28 August 2007 (PlusNews) - Ningsih [not her real name], 22, was taken aback when she was handed a pack of two female condoms in Jakarta, capital of Indonesia, but was even more surprised when she opened one. Measuring 17cm long and 7cm in diameter with a sponge attached inside, the female condom is indeed large compared to a male condom.

"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.

Indonesia has worked hard to increase condom use but, hampered by a strong patriarchal culture and a sporadic approach to promoting them, the results have been disappointing.

Data from the nonprofit public health organisation, Family Health International, puts Indonesia at the bottom of a list ranking condom usage in Asian countries.

According to official statistics from June 2007, the country's HIV infection rate has reached around one percent, with 5,813 recorded cases of people living with HIV and another 9,689 people living with AIDS, but experts estimate that the real number of HIV-infected Indonesians is between 90,000 and 250,000 out of a population of 223 million.

While HIV infection rates are highest among injecting drug users (IDUs), sex workers and their clients, government officials estimate that 20 percent to 30 percent of infections occur during unprotected sex.

"We've done campaigns to increase [male] condom use and failed. We're facing an alarming situation at the moment, with the general population becoming infected," Sri Kusniyati, deputy secretary of the National AIDS Commission, told IRIN/PlusNews.

HIV infections have already become generalised in the easternmost province of Papua. In this remote mountainous area, where levels of awareness are low and condoms difficult to access, more than two percent of the 2.5 million population are estimated to be HIV-infected.

Some encouragement

The government ran a trial of female condoms in selected areas of Papua in August 2006. According to Kusniyati, women who tried the condoms said they and their husbands enjoyed using them.

Encouraged by the positive feedback from the trial, the government launched a national female condom programme in February 2007. Six months later, however, the programme has been criticised for poor distribution and supply, the high price of the condoms (15,000 rupiahs, or US$1.60 for a pack of two), and even for discriminating against women.

"It has been a year since the female condom was distributed in Papua but, until today, not even one condom can be accessed by our group and we're based in the provincial capital [Jayapura], not in a remote area," said Robert Sihombing of the Jayapura Support Group, a local organisation that provides food packages, financial assistance and emotional support to local people living with HIV/AIDS.

Activists have slammed the programme for, once again, putting the burden on women. "The campaign against HIV/AIDS in this country is often discriminatory," said activist Mukhotib MD from Magelang, a city in Central Java Province.

"In East Nusa Tenggara Province [in the eastern portion of the Lesser Sunda Islands, consisting of 550 islands], for instance, fishermen are called on not to have sex with sex workers without using a condom, but there's no mention in the campaign of not having sex with their wives without using condoms," he said.

"We're afraid that 10 years from now, if HIV infections remain uncontrolled, then women will be blamed, when in fact it's the whole problem of social construction which positions men with the rights to sex and women with the duty to serve them," Mukhotib added.

Kusniyati, of the National AIDS Commission, said the female condom programme was launched to give women more options and to empower them, not to discriminate against them. The Commission was currently training campaigners in six provinces, not only to promote female condoms but also to increase knowledge of HIV/AIDS.

The price of female condoms remained relatively high because they had to be imported, Kusniyati admitted. "We need to push for cooperation with the state Family Planning Coordinating Body, which provides contraceptive products, including condoms, for poor people ... [but it] will only launch a female condom programme some time in 2008."

Somali Woman: "I will never tell my children I am HIV positive"

SOMALIA: Rahma Hirsi, Somaliland, "I will never tell my children I am HIV positive"

Photo: Casey Johnson/IRIN

HIV positive mother of three Rahma Hirsi, 29, holds the ARV drugs she receives at the Hargeisa Group Hospital in Hargeisa, Somaliland

HARGEISA, 22 August 2007 (PlusNews) - Twenty-nine-year-old Rahma Hirsi is trying to raise three children on her own following the death of her husband in 2006. She was diagnosed with HIV the same year and has been on antiretroviral (ARV) medication at Somaliland's Hargeisa Group Hospital since then.

"I first found out I was HIV-positive in January 2006. I think I was infected by my husband, but I will never really be sure how I contracted the disease because my husband was killed in a car accident a few months after I was diagnosed, and he was never tested. What I do know is that my three children are HIV-negative.

"After I was diagnosed, I waited three months before coming to the hospital. I was in denial, I was afraid of being stigmatised, but I was also very sick with diarrhoea, so in the end my family brought me to the clinic.

"After going on the ARV medicine there was an improvement in my health. I had gone down to about 33 kilogrammes and over a three month period had gained about five kilogrammes. Along with my health, the best thing about the ARVs is that they have allowed me to keep working at the tea stall I run in downtown Hargeisa. For me this is the most important thing, because with their father gone, I am the only one supporting my children.

"To this day, my uncle and the staff at the hospital are the only people who know I am HIV-positive; I haven't told my children. Sometimes I talk to them about abstinence, but as long as I live I will never tell my children that I am HIV-positive."

Somalia: Somaliland Begins ARV Treatment; HIV Education Still Lagging

SOMALIA: Somaliland rolls out ARV treatment, but HIV/AIDS education lagging

Photo: Julius Mwelu/IRIN

Somaliland's relative stability contributes to its successful ARV programme

HARGEISA, 22 August 2007 (PlusNews) - Almost two years after appointing a national HIV/AIDS commission, the self-declared republic of Somaliland, in northwestern Somalia, has slowly begun rolling out antiretroviral (ARV) drugs.

The ARV programme, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, started in 2005 with 30 participants; it now provides medicines, supplemental food and counselling services to 300 HIV-positive people in Hargeisa, the Somaliland capital.

"Besides an improvement in my health, the best thing about the ARVs is that they have allowed me to keep working and earning money for my family," said Rahma Hirsi, an ARV recipient and mother of three.

Relief workers attribute the success of the ARV programme to the relative stability of Somaliland compared with south-central Somalia, which continues to be racked by conflict, displacing large numbers of people.

Need for vigilance

Somaliland's position makes it a destination of choice for a constant flow of displaced persons from south-central Somalia, as well as a transit point for migrants from east and central Africa attempting to reach the Gulf States, putting the region at a higher risk of HIV.

According to UNAIDS, Somalia's national HIV prevalence rate is 0.9 percent, significantly lower than its East African neighbours, but in Somaliland the infection level is slightly higher at 1.4 percent.

Regional experts attribute this to a number of factors, including increased border traffic with neighbouring, higher-prevalence Ethiopia, as well as an emerging commercial port at Berbera, on the Red Sea, where UNAIDS estimated the prevalence rate at 2.3 percent.

Activists have criticised the Somaliland government's failure to finalise a national HIV/AIDS policy covering HIV awareness, treatment and care, which has been in draft form for two and a half years.

"The parliament has not seen HIV/AIDS as a priority, and the fact that we have no national policy is proof of this," Mustafe Farah Migane, project coordinator at the Somaliland HIV/AIDS Network (SAHAN), a Hargeisa-based non-governmental organisation (NGO), told IRIN/PlusNews.

According to the executive director of the Somaliland National AIDS Commission, Mohamed Hussein Osman, a comprehensive HIV/AIDS policy was read by the executive cabinet recently and will be tabled in parliament "in a few weeks".

Stigma against HIV-positive people and their families is widespread, and Somali cultural conservatism means discussion about sex is taboo. "There is still this perception that HIV is something that is contracted only through illegal sex," Migane said. "In other words, if you say that you are HIV-positive, you are saying that you had sex outside marriage."

According to UNAIDS, there is "a serious lack of understanding and awareness of basic information on HIV within Somali populations".

SAHAN has led a series of workshops for women, young people and influential religious leaders. UNAIDS, in partnership with the AIDS commissions of Somalia's three regions - Somaliland in the northwest, Puntland in the northeast and south-central Somalia - is also involved in educating people across the country about HIV.

Chechenya Opens First HIV/AIDS Centre

Chechen officials inaugurate HIV and Aids centre - August 6, 2007

Senior Chechen officials on Wednesday at a public ceremony in the capital of Grozny inaugurated a centre for people living with HIV and Aids in the republic, Reuters reports.

"Of course, the mentality of the Chechen people does not allow us to speak about problems such as Aids and drug addiction because Chechens never faced such problems," Kheda Aidamarova, chief doctor of the clinic, said.

"The traditions of the Chechens did not allow people to lead a dissipated lifestyle. But today, as a result of the war, there is chaos in society, which has led to problems like Aids and drugs and people exhibiting low moral standards."

Aidamarova also said that Chechens should not "turn away from people who have problems like Aids. Our aim is that people should not keep their problems to themselves but that they should feel support."

According to Reuters, billboards promoting the Aids centre have been placed around the city. The billboards also encourage a healthy lifestyle and urge people to support those living with the disease.

Chechen President Ramzan Kadyrov was the first official to discuss the republic's HIV and Aids situation publicly, Reuters reports.

Official data indicate that Chechnya has recorded 719 HIV cases, but the actual number of cases might be much higher, Reuters reports (Reuters, 8/1).

Nigeria: Muslim Groups Join the Struggle

NIGERIA: Muslim groups join the struggle

Photo: IRIN

"AIDS doesn't show on a person's face" - a billboard in Hausa in northern Nigeria

LAGOS, 15 August 2007 (PlusNews) - Every weekend groups of Muslim women belonging to Al' Muminat (The Believing Women) meet in Lagos, Nigeria's commercial capital, and along with discussing spiritual matters, tackle the very secular issue of AIDS.

The Social Advocacy Projects (SAP) arm of Al' Muminat introduced the talks a number of years ago, and now organises anti-AIDS campaigns targeted at the Muslim community.

"Women are more vulnerable to the disease, even more so because illiteracy thrives among Muslim women," SAP's National Coordinator, Sherifah Yusuf-Ajibade, told IRIN/Plusnews.

"Some of our Muslim brethren still believe that HIV/AIDS does not exist and those that believe have the wrong notion that local herbs can cure it. We have been showing them real life cases and videos clips so we can make them realise that AIDS is real."

Religious objections

Muslims constitute slightly more than half of Nigeria's population of 140 million, but while Christian groups have long been involved in anti-AIDS efforts, Muslims have been slower to join the fight.

Religious objections to the use of condoms and a reluctance to accept anything perceived as conveying "western values" have dogged efforts to win the support of Muslim communities for anti-AIDS campaigns, according to Dr Ishaq Lakin-Akintola, Coordinator of Muslims Against AIDS (MAIDS).

But following reports that several predominantly Muslim states in the north and south of the country have HIV prevalence rates of between 5 and 6 percent, significantly higher than the national average of 4.4 percent, a growing number of Islamic faith-based organisations are reaching out to Nigeria's Muslims with education about HIV/AIDS.

MAIDS promotes what it calls "Islamic-compliant" HIV prevention methods to improve the chances of acceptance by Muslims. Rather than distributing condoms, for example, they advocate sexual faithfulness among couples and abstinence from sex for unmarried people. The group also promotes the wearing of the hijab (a long scarf covering the hair and outer garments) by Muslim women in the belief it reduces sexual promiscuity.

Meanwhile, the Al Mu'minat women's group has been running AIDS awareness programmes in mosques and schools to combat the high levels of ignorance about the disease. The group also organises rallies to protest against discrimination of people living with HIV.

Another group Muslim Action Guide Against AIDS, Poverty, Illiteracy and Conflicts (MAGA-APIC) trains Muslim youths to become peer educators and has developed a training manual for Islamic scholars with the theme "Its great to wait" that promotes HIV prevention through abstinence.

As a result of its activities and those of other faith-based groups, Mallam Abdusalam Adetokunbo, MAGA's national coordinator, believes that Muslims have become more receptive to HIV/AIDS campaigns. "More people have come for testing and are now living positively with lower levels of stigma and discrimination than before," he noted.

Still battling stigma

Ibrahim Umoru, a Muslim AIDS activist, conceded that the work of Islamic faith-based groups had resulted in some improvements in the levels of stigma against people living with HIV and AIDS but said that much work remained to be done. He advocated a more proactive approach by Muslim leaders. "Some of the Ulamas [Islamic leaders] indulge in a 'holier than thou' attitude and still encourage the belief that people get infected due to promiscuity, which is not the case as we all know," he said.

After the failure of Umoru's first marriage due to his HIV-positive status, he said he struggled to find a second wife who would accept his activism and his openness about being positive. Eventually he married a Christian woman.

"I know of other positive Muslims, but whenever they go back to their communities they are not too open [about their status] because of the high level of stigma that still exists," Umoru said.

Libya Pays Attention to HIV/AIDS Epidemic

Libya pays attention to HIV and Aids epidemic

August 1, 2007

The "drawn-out drama" of the six medical workers released recently from Libyan prison after being sentenced to death for allegedly intentionally infecting hundreds of children with HIV is bringing attention to the country's HIV and Aids epidemic, the New York Times reports.

According to the Times, HIV and Aids in Libya has "never been fully acknowledged" and "continues to spread" (Rosenthal, New York Times, 7/29).

The five Bulgarian nurses and Palestinian doctor in May 2004 were sentenced to death by firing squad for allegedly infecting 426 children with HIV through contaminated blood products at Al Fateh Children's Hospital in Benghazi, Libya.

They also were ordered to pay a total of $1-million (about R7-million) to the families of the HIV-positive children.

The Libyan Supreme Court in December 2005 overturned the medical workers' convictions and ordered a retrial in a lower court.

A court in Tripoli, Libya, in December 2006 convicted the health workers and sentenced them to death.

The medical workers then filed an appeal of the December 2006 conviction with the Libyan Supreme Court.

The Supreme Court upheld the conviction earlier this month.

The six medical workers last week were released and pardoned by Bulgarian President Georgi Parvanov after arriving in the country (Kaiser Daily HIV and Aids Report, 7/26).

Libya by the end of 2006 had recorded 10 450 HIV and Aids cases to the World Health Organisation, but many experts consider the number of people living with the disease in the country to be much higher, the Times reports.

Gabriele Riedner - regional adviser to WHO in Cairo, Egypt - said, "There may be a lot of HIV and Aids cases out there that's not detected or reported, as is true in many countries in the region."

According to a recent WHO report, there is "evidence of increasing HIV infections in Libya, especially among the younger age groups."

The majority of HIV cases in the country occur among injection drug users, according to the Times (New York Times, 7/29).

Related Editorial "To Westerners, the repatriation" of the medical workers means the "end of the an unsettling ordeal," Harriet Washington - author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present" - writes in a Times opinion piece.

However, to "many Africans, the accusations" against the medical workers "seem perfectly plausible," Washington writes, adding that their release "appears to be the latest episode in a health care nightmare in which white and Western-trained doctors and nurses have harmed Africans - and have gone unpunished."

According to Washington, to "dismiss the Libyan accusations of medical malfeasance out of hand means losing an opportunity to understand why a dangerous suspicion of medicine is so widespread in Africa."

She adds that "well-publicised events" -- including the Libyan case and ones involving "Western medical miscreants who have intentionally administered deadly agents" to people in Africa "under the guise of providing health care or conducting research" - have spread a "fear of medicine throughout" the continent.

These fears have had a direct consequence in Africa - such as a rise of polio cases in Nigeria, Chad and Burkina Faso because of beliefs that polio "vaccines are contaminated with HIV or are actually sterilisation agents in disguise" - Washington writes, adding that these "tragedies highlight the challenges facing the most idealistic medical workers" in Africa."

We should approach Africans' suspicion with respect," Washington writes, concluding, "By continuing to dismiss their reasonable fears, we raise the risk of even more needless illness and death" on the continent (Washington, New York Times, 7/31).

Asia Pacific Court of Women and HIV Held at ICAAP

UNDP to organise Asia Pacific Court of Women on HIV in Colombo

First Asia Pacific Court of Women on HIV and inheritance and property rights to be held in Colombo.

Colombo, August 16: Compelling life stories by HIV positive women from Asia and the Pacific on the denial of inheritance and property rights and their dispossessions by families and society because of their HIV status, insightful analyses by activists and academics on the broader context within which this dispossession is taking place and visionary responses from an Eminent Jury will be the highlights of the “Regional Court of Women” to be held in Colombo, Sri Lanka as part of the 8th International Congress on AIDS in Asia and the Pacific (ICAAP).

Organised by UNDP Regional HIV and Development Programme and Asian Women’s Human Rights Council (AWHRC) in partnership with UNIFEM, UNAIDS and several NGOs in the region, this “Asia Pacific Court of Women on HIV, Inheritance and Property Rights: from Disposession to Livelihoods” will be the first regional summit on the issue of inheritance and property rights of women in the context of HIV. It is an attempt to give visibility to the lives and voices of those who are increasingly being pushed to the margins of our societies and polity because they are identified as positive and because they are poor.

Speaking to reporters here today, Ms. Caitlin Wiesen, Regional HIV/AIDS Team Leader, UNDP Regional Centre in Colombo, said, the “Court” will bring to public focus the challenges faced by women in the context of HIV and AIDS. “HIV deepens the prevalent gender inequalities driving the epidemic in the region. When women are denied their rights to inheritance and property, they are robbed of the social and economic empowerment needed to help prevent HIV infection and cope with its impact on families and communities,” she said. “The unequal rights of women to inheritance and property in many parts of the region have been severely aggravated by HIV. Burdened by the care of their spouses, illnesses and the responsibility of the household, women living with or affected by HIV are often denied their rightful access to property when their spouses die. Blamed, abused and expelled from marital homes, HIV positive women are often denied access to their children as well.”

The feminization of the epidemic in the Asia Pacific region and the related challenges are truly daunting, Ms. Wiesen said. About 30 per cent of the new infections in the region are among women. With little or no control over their sexual lives and burdened by abuse, exploitation and violence, women in the region are extremely vulnerable to HIV as borne out by the facts. In PNG, 60 per cent of the new infections are among women while in Thailand, “housewives” accounted for 40 per cent of the new cases.

Inheritance and property rights are tools for empowerment and protection of women in the context of HIV. Studies show that ownership of properties offer some form of protection against violence and HIV vulnerability. However, what we see in the region is that a large number of women are denied inheritance and property rights when they need them the most. A recent socio-economic impact study in India by UNDP and the National Council for Applied Economic Research (NCAER) show that 79 per cent of the AIDS-widows in the country were denied a share of their husband’s property and 90 percent were expelled from their marital home. “Dispossessed of land and property, women are left to inherit HIV, loss of family, shame and poverty,” Ms. Wiesen added. “Women should be empowered to claim their rights to inherit properties and to disinherit their vulnerabilities to HIV”

“The expulsion of HIV widows from marital homes, and the indignities, humiliation and discrimination they face, the deepened deprivation and vulnerability to HIV they endure is well known in other parts of the world such as Eastern and Southern Africa. However, in Asia and the Pacific, the story is yet to be told on a scale that the Regional Court will provide on Saturday.”

Twenty women living with HIV, representing Bangladesh, India, Nepal, Sri Lanka, Pakistan, Malaysia, Cambodia, Vietnam, Thailand, PNG and South Africa will narrate their harrowing tales as testimonials before the “Court”, Ms Wiesen said. With facts and figures we often become numbed to the realities that women live in the context of a burgeoning epidemic. These personal testimonials will bear witness to the socially sanctioned violence women experience at individual and societal levels. It also provides the space to hear and celebrate women who have persisted against all odds and succeeded in reclaiming their rights to housing, safe shelter, livelihoods and their families.

Speaking about the processes and perspectives that inform the Courts of Women, Madhu Bhushan, AWHRC, India, said that the Courts are part of a global movement that seeks to redefine rights and other notions of justice from the lives and life visions of women – particularly from the global South.

Conceived and initiated by Corinne Kumar, the founder of AWHRC and the Secretary General of El Taller International in 1992, more than 30 Courts of Women have been held in different regions of the world – Asia, Arab states, Africa, Central and Latin America. The issues have been diverse and also specific to the regions they have been held in – from the violence of poverty, globalisation and development, the violence of cultures, caste and racism to the violence of nuclearisation and of all wars.

Through exploring the feminist methodology of weaving together the personal with the political, women’s subjective testimonies are woven together with objective realities presented by Expert Witnesses. The Courts also offer us other ways to know through weaving together the logical with the lyrical by interspersing these testimonies and analyses with video testimonies, artistic images and poetry. By urging us to listen to the women as the victims and witnesses to the violence of our times, the Courts seek to create reference points of justice other than that of the rule of law; they seek to return ethics back to politics.

It is in this context that this Court of Women on HIV, Inheritance and Property Rights, seeks to define property and inheritance from the perspective of the dispossessed disinherited women towards finding responses that must not only be legal but also rooted in social transformation.

About 30 testifiers and expert witnesses from different countries in the region including Sri Lanka, Nepal, Bangladesh, Pakistan, India, Cambodia, Vietnam, Papua New Guinea, Thailand, Malaysia and even Ethiopia and South Africa will present testimonies in four sessions i.e.

1.Poverty, Violence and HIV2.Culture, Marginalisation and HIV3.Evaluating State Responses and 4.Voices of Resistance and Hope

The Eminent Jury will include Miloon Kothari, UN Special Rapporteur on Adequate Housing; Marina Mahathir (Malaysia), Justice Shiranee Tilakawardane (Sri Lanka), Justice Kalyan Shrestha (Nepal), Cherie Honkala (United States), Lawrence Liang (India) and Farida Akhter (Bangladesh). In addition, five experts of repute will present their contextual analyses of the diverse aspects of the issue. These “expert witnesses” will be Vicky Corpuz, Tebtebba Foundation, Philippines; Sunila Abeyesekera, INFORM, Sri Lanka; Anand Grover, Lawyers Collective, India; Elizabeth Reid, Sociologist, Australia; and Assefa Yirga Gebregziabher, Ethiopian lawyer.

The issue of HIV and women’s rights to property and inheritance is a major theme of the ICAAP. Starting with first ever Regional Court of Women on the issue, the theme will feature in plenary sessions, symposia, and in the Community Dialogue Space of the Asia Pacific Village.

From the New York Times - November 12, 2006

China’s Muslims Awake to Nexus of Needles and AIDS

Ryan Pyle for The New York Times

Almijan takes methadone at Yuandong Hospital in Kashgar. He says he has tested negative for H.I.V.

By HOWARD W. FRENCH

Published: November 12, 2006

KASHGAR, China, Nov. 6 — The story of Almijan, a gaunt 31-year-old former silk trader with nervous eyes, has all the markings of a public health nightmare.

Ryan Pyle for The New York Times
An AIDS poster in Kashgar in the Xinjiang region, which has one-tenth of China’s AIDS cases and the highest H.I.V. infection rate in the nation.

The New York Times

Kashgar, in a mainly Muslim area, is part of a battle against AIDS.

A longtime heroin addiction caused him to burn through $60,000 in life savings. Today, he says, all of his drug friends have AIDS and yet continue to share needles and to have sex with a range of women — with their wives, with prostitutes, or as he said, “with whoever.”

For now, Mr. Almijan, whose name like many here is a single word, seems to have escaped the nightmare. His father carted him off to a drug treatment center hundreds of miles away in Urumqi, the capital of Xinjiang Uighur Autonomous Region here in China’s far west.

When he relapsed, he was arrested during a drug deal. That landed him in a new methadone clinic, opened last year in this city, where he spent three months cleaning himself up. He says he has repeatedly tested negative for H.I.V.

This day, fresh from a clinic just off of People’s Square here, watched over by a huge statue of Mao, Mr. Almijan slurred thickly after drinking the dose that keeps his cravings at bay. “If I can help other people, I’d be happy to tell you my story,” he said. He explained why he had embraced treatment: “My friends were dying, and I was very afraid.”

The way the authorities handled Mr. Almijan, including his treatment with methadone, is part of a sea change by the Chinese public health establishment, which is struggling to confront an increase in intravenous drug use and an attendant rise in AIDS cases in Xinjiang, an overwhelmingly Muslim region close to the rich poppy fields of Afghanistan and near the border with Kyrgyzstan and Tajikistan.

With a population of about 20 million and an officially estimated 60,000 infections, Xinjiang has one-tenth of China’s AIDS cases and the highest H.I.V. infection rate in the country. Chinese authorities estimate that Kashgar Prefecture, with a population of about three million, has 780 cases, but public health experts here say the real figure is probably four times that and rising fast.

Until recently, addicts were largely left to the police, who regarded them as simple criminals whose drug use was to be combated mercilessly. Resistance to treating drug addiction as a public health concern has been high, mirroring what some international health experts say was a slow response to the virus generally in China as AIDS first gained a foothold.

“Some cadres are not willing to launch a public campaign against AIDS, fearing it would affect their image and investment in their locality,” said Parhat Halik, the deputy commissioner for Kashgar Prefecture, in a speech in June. “Some are still having endless debates about whether to promote the use of condoms, methadone treatment and needle exchange programs, or standing in the way of initiatives to work with high-risk groups. That is our biggest problem in the fight against AIDS.”

But since 2005, the authorities in Xinjiang have been trying everything from needle exchanges and drug substitution programs — approaches that first became popular in the West in the 1960s — to community outreach programs, often giving briefings to imams and mullahs.

The people of Xinjiang are ethnically distinct from China’s Han majority, and have a long history of distrust of the central government.

In the narrow, winding alleys of this city, where most women wear veils and mosques can be found every hundred yards or so, Islamic clerics spoke enthusiastically about antinarcotics efforts.

“These people are killed and arrested, persecuted and punished by the police, and the price of their drugs becomes greater even than gold, and yet they continue to use them,” said Abdu Kayaum, imam at a small brick mosque here. “If I didn’t preach about these ills, I wouldn’t be a Muslim.”

At another mosque, the muezzin, or prayer caller, Abulkasim Hajim, put it slightly differently, saying: “This is not just a problem for the government, it’s a problem for our people. The people who use drugs are going to die, but before they do so, they will waste their family’s money and cause a lot of suffering.”

Mr. Hajim might well have been speaking of Mr. Almijan, whose costly 12-year habit ruined his family’s lucrative silk trading business, left him deep in debt and finally reduced him to a lowly job at a small hotel.

Now, less than a month out of detention in the treatment center, he reports most days to the clinic near Yuandong Hospital where he goes voluntarily to drink a dose of methadone under the watchful eye of a video monitor. Each treatment costs him about $1.20.

“All my money has gone up in smoke,” Mr. Almijan said, explaining that he lacks the capital to get back into the silk trade. “My friends all shared needles when I was using drugs. At least I understood how bad that was and only used my own.”

Another heroin addict, a fruit seller dressed in a tweed jacket who goes by the name Ablimit, said he started injecting heroin in 1999. “I had a bunch of friends invite me to try heroin,” he said. “They either shared a lot of needles or they overdosed. They’re all dead now.”

Mr. Ablimit, who said he had tested negative for H.I.V., has tried to break his heroin addiction many times, including a previous bout with methadone. He recently spent 45 days in a methadone treatment center after his wife caught him shooting up at home and threatened to leave him.

He said that while methadone had given him great relief from cravings for the drug, it was a not a cure. Cravings return when the methadone wears off, and weaning recovering heroin addicts from the replacement drug can be as hard as quitting heroin itself — and some say harder.

Nowadays, Mr. Ablimit works in a neighborhood recreation center, where he helps counsel other addicts and reports less and less frequently to a methadone clinic for a dose of the drug he is trying to wean himself from.

“You can take methadone as long as you want,” he continued, his wife looking on. “But I’ve got children and want to be a regular person. I want to atone for all the bad I have done.”

China's Muslims Awake to Nexus of Needles and AIDS

From the New York Times - November 12, 2006

China’s Muslims Awake to Nexus of Needles and AIDS

Ryan Pyle for The New York Times

Almijan takes methadone at Yuandong Hospital in Kashgar. He says he has tested negative for H.I.V.

By HOWARD W. FRENCH

Published: November 12, 2006

KASHGAR, China, Nov. 6 — The story of Almijan, a gaunt 31-year-old former silk trader with nervous eyes, has all the markings of a public health nightmare.

Ryan Pyle for The New York Times
An AIDS poster in Kashgar in the Xinjiang region, which has one-tenth of China’s AIDS cases and the highest H.I.V. infection rate in the nation.

The New York Times

Kashgar, in a mainly Muslim area, is part of a battle against AIDS.

A longtime heroin addiction caused him to burn through $60,000 in life savings. Today, he says, all of his drug friends have AIDS and yet continue to share needles and to have sex with a range of women — with their wives, with prostitutes, or as he said, “with whoever.”

For now, Mr. Almijan, whose name like many here is a single word, seems to have escaped the nightmare. His father carted him off to a drug treatment center hundreds of miles away in Urumqi, the capital of Xinjiang Uighur Autonomous Region here in China’s far west.

When he relapsed, he was arrested during a drug deal. That landed him in a new methadone clinic, opened last year in this city, where he spent three months cleaning himself up. He says he has repeatedly tested negative for H.I.V.

This day, fresh from a clinic just off of People’s Square here, watched over by a huge statue of Mao, Mr. Almijan slurred thickly after drinking the dose that keeps his cravings at bay. “If I can help other people, I’d be happy to tell you my story,” he said. He explained why he had embraced treatment: “My friends were dying, and I was very afraid.”

The way the authorities handled Mr. Almijan, including his treatment with methadone, is part of a sea change by the Chinese public health establishment, which is struggling to confront an increase in intravenous drug use and an attendant rise in AIDS cases in Xinjiang, an overwhelmingly Muslim region close to the rich poppy fields of Afghanistan and near the border with Kyrgyzstan and Tajikistan.

With a population of about 20 million and an officially estimated 60,000 infections, Xinjiang has one-tenth of China’s AIDS cases and the highest H.I.V. infection rate in the country. Chinese authorities estimate that Kashgar Prefecture, with a population of about three million, has 780 cases, but public health experts here say the real figure is probably four times that and rising fast.

Until recently, addicts were largely left to the police, who regarded them as simple criminals whose drug use was to be combated mercilessly. Resistance to treating drug addiction as a public health concern has been high, mirroring what some international health experts say was a slow response to the virus generally in China as AIDS first gained a foothold.

“Some cadres are not willing to launch a public campaign against AIDS, fearing it would affect their image and investment in their locality,” said Parhat Halik, the deputy commissioner for Kashgar Prefecture, in a speech in June. “Some are still having endless debates about whether to promote the use of condoms, methadone treatment and needle exchange programs, or standing in the way of initiatives to work with high-risk groups. That is our biggest problem in the fight against AIDS.”

But since 2005, the authorities in Xinjiang have been trying everything from needle exchanges and drug substitution programs — approaches that first became popular in the West in the 1960s — to community outreach programs, often giving briefings to imams and mullahs.

The people of Xinjiang are ethnically distinct from China’s Han majority, and have a long history of distrust of the central government.

In the narrow, winding alleys of this city, where most women wear veils and mosques can be found every hundred yards or so, Islamic clerics spoke enthusiastically about antinarcotics efforts.

“These people are killed and arrested, persecuted and punished by the police, and the price of their drugs becomes greater even than gold, and yet they continue to use them,” said Abdu Kayaum, imam at a small brick mosque here. “If I didn’t preach about these ills, I wouldn’t be a Muslim.”

At another mosque, the muezzin, or prayer caller, Abulkasim Hajim, put it slightly differently, saying: “This is not just a problem for the government, it’s a problem for our people. The people who use drugs are going to die, but before they do so, they will waste their family’s money and cause a lot of suffering.”

Mr. Hajim might well have been speaking of Mr. Almijan, whose costly 12-year habit ruined his family’s lucrative silk trading business, left him deep in debt and finally reduced him to a lowly job at a small hotel.

Now, less than a month out of detention in the treatment center, he reports most days to the clinic near Yuandong Hospital where he goes voluntarily to drink a dose of methadone under the watchful eye of a video monitor. Each treatment costs him about $1.20.

“All my money has gone up in smoke,” Mr. Almijan said, explaining that he lacks the capital to get back into the silk trade. “My friends all shared needles when I was using drugs. At least I understood how bad that was and only used my own.”

Another heroin addict, a fruit seller dressed in a tweed jacket who goes by the name Ablimit, said he started injecting heroin in 1999. “I had a bunch of friends invite me to try heroin,” he said. “They either shared a lot of needles or they overdosed. They’re all dead now.”

Mr. Ablimit, who said he had tested negative for H.I.V., has tried to break his heroin addiction many times, including a previous bout with methadone. He recently spent 45 days in a methadone treatment center after his wife caught him shooting up at home and threatened to leave him.

He said that while methadone had given him great relief from cravings for the drug, it was a not a cure. Cravings return when the methadone wears off, and weaning recovering heroin addicts from the replacement drug can be as hard as quitting heroin itself — and some say harder.

Nowadays, Mr. Ablimit works in a neighborhood recreation center, where he helps counsel other addicts and reports less and less frequently to a methadone clinic for a dose of the drug he is trying to wean himself from.

“You can take methadone as long as you want,” he continued, his wife looking on. “But I’ve got children and want to be a regular person. I want to atone for all the bad I have done.”

Niger's Religious Leaders Unite to Fight AIDS

from Reuters, (08.06.2007)

by Abdoulaye Massalatchi

In Niger, where almost half the population is under age 15, and the 2006 birthrate was the highest in the world, religious leaders have formed an alliance to back the government's anti-AIDS efforts.

Muslim, Catholic, and Protestant clerics all have joined in the fight. "Because of their impact on communities and households, and the way they are organized and present on the ground, religious organizations are ideally placed to influence people's values and behavior," said Labo Issaka, religious affairs minister.

Landlocked on the southern edge of the Sahara, the former French colony has one of the region's lowest HIV prevalences: Slightly more than 1 percent of people ages 15 to 49 are infected. Given the nation's booming birthrate, however, authorities have vowed not to be complacent.

Niger hopes to replicate the successful model of Senegal, another predominantly Muslim West African nation. While the Senegalese government's efforts to teach AIDS prevention and condom use were initially met with hostility by Muslim leaders, the clerics eventually relented and agreed to preach abstinence and fidelity while not opposing condom use. Those efforts helped Senegal achieve sub-Saharan Africa's second-lowest HIV prevalence rate in 2003.

"Niger�s Religious Leaders Unite to Fight AIDS"

Reuters, (08.06.2007)

by Abdoulaye Massalatchi

In Niger, where almost half the population is under age 15, and the 2006 birthrate was the highest in the world, religious leaders have formed an alliance to back the government's anti-AIDS efforts.

Muslim, Catholic, and Protestant clerics all have joined in the fight. "Because of their impact on communities and households, and the way they are organized and present on the ground, religious organizations are ideally placed to influence people's values and behavior," said Labo Issaka, religious affairs minister.

Landlocked on the southern edge of the Sahara, the former French colony has one of the region's lowest HIV prevalences: Slightly more than 1 percent of people ages 15 to 49 are infected. Given the nation's booming birthrate, however, authorities have vowed not to be complacent.

Niger hopes to replicate the successful model of Senegal, another predominantly Muslim West African nation. While the Senegalese government's efforts to teach AIDS prevention and condom use were initially met with hostility by Muslim leaders, the clerics eventually relented and agreed to preach abstinence and fidelity while not opposing condom use. Those efforts helped Senegal achieve sub-Saharan Africa's second-lowest HIV prevalence rate in 2003.