Photo: Reporters sans fronti�res

Deyda Hydara, editor of the Point (file photo)

DAKAR, – Rights groups have criticized the two-year jail sentences meted out in the Gambia to six journalists for publishing a statement criticizing President Yahya Jammeh.

The journalists, working for The Point and Foroyaa newspapers, were sentenced on charges of sedition and criminal defamation for publishing a 11 June press union statement criticizing the president�s comments on the unsolved murder of Deyda Hydara, editor of The Point.

“Despite President Jammeh’s earlier claims to respect press freedom and freedom of speech, he has now sealed Gambia�s last remaining independent voices,” the Committee to Protect Journalists� Africa programme coordinator, Tom Rhodes, told IRIN.

Reporters Without Borders said in a�6 August statement: �We will soon run out of words to express our outrage at President Yahya Jammeh�s government and its behaviour towards journalists. Is it a crime to express an opinion and ask government officials to explain their actions? Appealing for what is regarded as transparency in other countries is a crime punishable by imprisonment in Gambia.�

The sentences are the most recent in a string of arrests and journalist detentions in the Gambia since President Jammeh came to power.

President Jammeh said in a June statement: �They [journalists] think they can hide behind so-called press freedom and violate the law and get away with it. They got it wrong this time. We are going to prosecute them to the letter.�

The defense will reportedly appeal the verdict.

aj/pt source.www.irinnews.org

Laetitia Bader

US Secretary of State, Hillary Clinton�s visit to Kenya and meeting with the President of the Transitional Federal Government (TFG) of Somalia, Sheikh Sharif Ahmed today, offers the perfect opportunity for the Obama administration to take the lead in efforts to end impunity and establish human rights accountability mechanisms in Somalia.

This will reinforce the vital but threatened work of Somali human rights defenders (HRDs) and grant redress to victims of the acute crisis, primarily the civilian population.

The human rights situation in Somalia has shown little to no improvements in spite of the withdrawal of Ethiopian troops in January and the election of Mr Sharif as president. Human rights violations continue to be committed by all parties involved in a conflict that has brought about severe suffering for civilians.

Somali HRDs, particularly journalists, are among the few voices on the ground speaking out against these violations hoping to get the attention of the international community and ensure accountability.

For this, they continue to pay a high price: face harassment, intimidation, office closures, property vandalism, and continued risk of being victim of targeted killings. The killings of six journalists in Somalia this year alone, three of which were victims of targeted killing, presently makes Somalia the deadliest country in the world to be a journalist.

Ahmed Omar Hashi Tajir�s story is telling of this reality. Working for an independent radio station in Mogadishu, Shabelle Radio, Tajir has escaped two targeted attacks this year, one in which he was shot in the stomach and hand. This same attack cost the life of Mukhtar Mohamed Hirabe, Tajir�s director at Shabelle Radio. Continued death threats and fearing for his life, Tajir has been forced into exile.

International repercussions

In spite of the efforts by defenders such as Tajir the international community has failed to give the human rights situation and the need for HR accountability priority it deserves.

International attention to Somalia has increased in recent months as the crisis is now perceived as fuelled by external forces and as having significant regional and even international repercussions. However, this attention has failed to be translated into concrete steps or measures.

There are no national, regional or international accountability mechanisms in place while diplomatic efforts to ensure accountability are only in their initial phases. And in spite of the increasing support to the TFG by the US government and others, TFG forces have not yet been held to account for their significant abuses.

The international community failure to tackle the country�s deeply entrenched culture of impunity has undermined the work and protection of defenders. It has lead to continued violence, weakened calls for an end to impunity and given free reign to those wanting to silence the scarce voices against ongoing violations: neither the killing of Tahlil Ahmed nor of Hirabe have yet been investigated.

In light of this reality, the Obama administration must show its commitment to lasting peace by placing human rights accountability as a priority in its engagement in Somalia.

Without immediate action, an increasing number of defenders such as Tajir will resort to self-censorship, go into hiding or flee Somalia fearing for their lives. With no regional or international permanent human rights presence and increasingly limited national presence on the ground, their absence will be greatly felt.

Hillary�s visit provides a unique occasion for the US administration to show both the TFG leadership and the broader national, regional and international community it is prepared to take the lead and take concrete steps.

Victims of crisis

Mrs Clinton should publicly support establishment of an international commission of inquiry into past and present violations in Somalia as a key step to ensuring more lasting accountability.

Also, the US should lobby for the setting-up of a more permanent international human rights presence in Somalia under the auspices of the UN High Commission for Human Rights.

These steps are essential to ensuring the voices of Somali activists are heard and their efforts to guarantee redress to victims of the crisis are not in vain. The meeting today will also be a test of whether current efforts by the US to show that Africa will not remain on the margins of its foreign policy are genuine and well directed.

The writer is the Human Rights Officer at the East and Horn of Africa Human Rights Defenders Project, Uganda.

Photo: Antony Kaminju

Some districts are using task-shifting to reach their targets for universal access

JOHANNESBURG,� – Nowhere is the goal of universal access to prevention, treatment and care more daunting than in South Africa, where an estimated 5.5 million people are living with HIV – the largest burden in the world.

While South Africa now has the largest treatment programme in the world, with about 700,000 people receiving the drugs, a further 760,000 are estimated to qualify for treatment under the current national guidelines, and there is limited evidence that the rate of new HIV infections has slowed.

Mark Heywood, director of the AIDS Law Project and deputy chair of South Africa’s National AIDS Council (SANAC), said former President Thabo Mbeki’s dissident views on HIV/AIDS resulted in the national response getting off to a damagingly late start.

“What we’re seeing are the chickens of Mbeki’s AIDS denialism coming home to roost,” he told IRIN/PlusNews. “We wasted from 2000 to 2006 with the president putting it about that maybe there wasn’t a thing called HIV at all. As far as prevention is concerned, that’s the period when the epidemic was moving into its exponential growth phase.”

The legacy of the Mbeki era was not only an inadequate prevention response, but a treatment programme that had to hit the ground running and is still playing catch-up.

The goal of universal access was born in December 2005 when the United Nations General Assembly adopted a resolution to assist governments, civil society and NGOs with “scaling up HIV prevention, treatment, care and support with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it.”

Need for more innovation

The adoption of a five-year National Strategic Plan (NSP) in 2007 that aimed to put South Africa on a path to achieving universal access was welcomed by civil society as the beginning of a new era of greater government commitment. The NSP’s goals included halving new HIV infections by 2011, providing treatment to 80 percent of people in need of it, and reducing mother-to-child transmission of HIV to less than 5 percent.

Opinion is still divided about whether the targets were overly ambitious, but most experts agree that they are now realisable only in the context of major health system reform and a more innovative approach to stretching limited resources.

“If we’re really going to make the big leap, we need to completely change the way we work,” said Dr Mickey Chopra, director of the Health Systems Research Unit at the South African Medical Research Council. “It’s going to take a change in mindset and innovation, both technological and in terms of delivery.”

Some districts have achieved universal access to ARV treatment by decentralizing services from hospitals to primary healthcare clinics, and training nurses to take over some functions from doctors (called task-shifting), but this has not been uniformly applied.

What we’re seeing are the chickens of Mbeki’s AIDS denialism coming home to roost … We wasted from 2000 to 2006 with the president putting it about that maybe there wasn’t a thing called HIV at all

“There are many pools of excellence in prevention, in care, in treatment, but there’s completely insufficient coordination and generalization of best practice … for that reason I believe we’re failing in most areas on the NSP,” said Heywood.

The NSP and SANAC’s Treatment Task Team both recommended task-shifting, allowing nurses to initiate and manage ARV treatment, and lay counsellors to administer HIV rapid tests to alleviate the public health sector’s shortage of professional staff, but the health department has yet to act on these recommendations; currently only doctors can provide ARV treatment and only nurses can do HIV testing.

Frequent changes in the health department have not helped. The removal of Mbeki ally Manto Tshabalala-Msimang as health minister in September 2008 was welcomed by AIDS activists, but her replacement, Barbara Hogan, only had seven months before newly-elected President Jacob Zuma moved her to another portfolio and installed Aaron Motsoaledi as the new health minister in May 2009.

Finding the money

To achieve and maintain universal access to treatment, South Africa would need to start an additional 450,000 people on ARVs every year, but a failure to properly cost the NSP or to manage provincial HIV/AIDS budgets are proving to be major hurdles.

The Treatment Action Campaign (TAC), a prominent lobby group, has pointed out that to start 285,000 people on ARVs in 2009 would require about R1 billion (US$122 million) more than the government has allocated.

Several experts note that universal access to treatment may be achievable by 2010, but it will become unsustainable unless there is significantly more progress on prevention.

Dr Susan Cleary, director of the Health Economics Unit at the University of Cape Town, estimated that by 2021, South Africa would need to spend R25 billion per annum – equivalent to about two-thirds of the current health budget – to keep up with the current demand for treatment.

“There’s been a commitment to a particular course of action … but now it’s a question of facing up to the reality of what it actually implies,” she told IRIN/PlusNews. Tough choices might need to be made between the most effective care and the most cost-effective.

Research demonstrates that patients who start treatment earlier have better outcomes, but already the National Health Council has rejected a recommendation from SANAC’s Treatment Task Team to begin ARV treatment at a CD4 count of 350 rather than at 200. Heywood said the decision was “purely budgetary”.

Leigh Johnson, of the Centre for Actuarial Research at the University of Cape Town, said changing the national treatment guidelines would widen the current treatment gap from about 760,000 to about 1.8 million.

If prevention has been the missing link in South Africa’s efforts to achieve universal access, the 2008 national HIV survey by the Human Sciences Research Council revealed only limited proof of improvement: infection rates decreased among children and teenagers, but rose slightly in adults over the age of 25.

Overall, prevalence has flat-lined at about 11 percent for the last six years, but risky behaviours like having multiple partners and engaging in intergenerational sex are spreading among young people.

“We certainly don’t have evidence we’re succeeding on prevention,” said Heywood. “We’re not reaching any of the high-risk groups, and there’s very little targeted programming for sex workers, refugees, and men who have sex with men.”

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Photo: Jonathan Ball Publishers

JOHANNESBURG,� – Everyone knows the story of how HIV/AIDS treatment finally became available to ordinary South Africans. It is a tale of science and reason pitted against denial and superstition, of a long struggle in which AIDS activists eventually prevailed over politicians.

By now, the life-prolonging effects of antiretroviral (ARV) treatment have become a familiar and comforting antidote to the years of helplessly watching people succumb to the virus. With the right of poor Africans to ARV treatment firmly established, and their ability to adhere to a lifelong drug regimen well demonstrated, the new struggle is to ensure that every HIV-positive African in need of treatment receives it.

If only we had more doctors and nurses, we are told; if only we had better health systems and the necessary political will, we could achieve the goal of universal access to treatment.

In his book, Three-Letter Plague, South African author and journalist Jonny Steinberg examines the implicit premise behind this goal: that if good treatment is available, people will come and get it.

Refusing to be swept along by the missionary-like zeal of treatment lobby groups like South Africa’s Treatment Action Campaign and international medical aid organisation, M�decins Sans Fronti�res (MSF), Steinberg attempts to answer the thorny question of why so many South Africans choose not to test for HIV or to take ARVs, despite the availability of good treatment.

He goes looking for answers in the rural Eastern Cape district of Lusikisiki, where MSF pioneered the use of under-resourced and under-utilised primary health-care clinics to deliver ARV treatment to thousands of local people.In a place where ARVs are available at local clinics instead of distant hospitals, and a well-trained army of lay counsellors support nurses in distributing them, he still finds people with AIDS-related illnesses who choose to stay home and die.

Dr Hermann Reuter, a central character in Steinberg’s narrative who ran MSF’s Lusikisiki programme until it was handed over to local authorities in 2006, offers one explanation: if an individual has travelled a long distance to reach a health facility, and then has to wait hours to see a nurse, who turns him away or gives him inferior care, he is not likely to return.

Without government investment and buy-in, the MSF programme could only achieve so much. Reuter maintains that if local clinics were provided with electricity and running water, stocked with drugs and equipment, and staffed by well-paid health professionals, the patients would come.

Suspecting that Reuter’s explanation tells only part of a much more complex story, Steinberg enlists Sizwe Magadla, 29, a local man, to help him delve deeper.

A successful spaza [informal] shop owner, Magadla is well-educated and affluent by the standards of his remote, impoverished village. He knows about the dangers of HIV; like most South Africans, he has watched people close to him sicken and die from it. He also knows there is a significant chance that he himself may be HIV-positive; yet he refuses to be tested.

“This is not a disease you go and look for,” he tells Steinberg. “You wait until it comes to you, and then you deal with it.”

During the 18 months Steinberg spends regularly visiting Magadla and employing him as a translator, the reasons the young man gives for not testing are as contradictory and complex as the world he lives in.

In Magadla’s eyes, the local people on ARV treatment, who are walking evidence that the “magic pills” work, are at odds with his deep suspicion of white men and their medicine.

He knows that HIV is transmitted through unprotected sex, but also believes in the power of evil spirits. He buys a herbal “cure” for his HIV-positive cousin, yet also takes her and her boyfriend to the clinic.

In Magadla�s world, the shame and fear of HIV are as great a threat as the virus itself: “If I know that I am positive, I will die quicker … Knowing that my blood is dirty, feeling it every time I wake up in the morning, it would not be long before I’m dead,” he says.

In Three-Letter Plague, Steinberg raises more questions about South Africa’s AIDS crisis and what it means for the country than he can answer, but he�suggests it is an enigma that Western science alone cannot solve. People, in all their complexity, lie at the heart of the pandemic, and it is their hopes and fears, beliefs and motivations that must be understood before goals like universal access can be achieved.

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Photo: PEPFAR

The characters in the game speak Sheng, a blend of English and Swahili popular among urban youth

NAIROBI,� – At the community centre in Mukuru, a slum in the Kenyan capital, Nairobi, teenagers spend hours engrossed in a video game, but they are not battling other-worldly forces with super-human weapons; instead, they are finding their way through a familiar-looking city, trying to negotiate real-life situations and learn how to avoid HIV infection.

“Pamoja Mtaani”, Swahili for “Together in the Hood”, is the first multi-player PC video game to try to teach young people how to avoid HIV infection. Players assume the identity of one of five characters who find themselves car-jacked in a matatu (minibus taxi) and attempt to recover their stolen goods and save an injured woman. Through a series of sub-plots, the players are put into positions where the decisions they make can put them at risk of contracting or preventing HIV infection.

“You are able to relate to the behaviour of any one of the characters in the video game and you are able to discard bad behaviour � [such as] using drugs because you can actually see drug abuse leads that particular character into acquiring HIV due to recklessness,” said Perpetua Nduku, one of the young people at the Mukuru community centre, which is visited by about 35 teens a day – 50 a day at the weekend.

The game targets young people aged between 15 and 19 and focuses on five key behaviours that can reduce HIV infections among youth: delaying the onset of sexual activity, abstinence, avoiding multiple sex partners, correct and consistent condom use, and uptake of voluntary counselling and testing services.

Local hip-hop artists provide the authentically local, urban soundtrack, and the characters in the game speak Sheng, a mix of Swahili and English commonly used by urban youth.

“I can now negotiate condom use with my boyfriend and I can tell any other girl who has never been here how to do it because the language used [in the video game] is the same language I would normally use with my boyfriend or with any other person,” said 20-year-old Grace Wangeci.

The game was developed by Warner Bros Entertainment in partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR). The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria recently gave Warner Bros Entertainment a business excellence award for Pamoja Mtaani.

Launched in December 2008, the game is available at four sites in Nairobi; following a review in June 2009, PEPFAR and its local partners now plan to extend the game around the capital and country-wide.

Job Akuno, technical adviser for comprehensive prevention programmes at Hope Worldwide Kenya, which runs the community centre in Mukuru, says young people in the area have embraced the game and learned from it, underlining the need to find more engaging ways to inform the youth about HIV.

“Using the video games provides a platform for reaching out to the youth in a creative way and which is enjoyable to them,” he said, adding that the game’s features had broader messages, such as teaching young women to stand up for their rights and improve their self-esteem.

Kenya’s national HIV/AIDS strategy considers youth aged between 15 and 24 “most-at-risk”; young women have an HIV prevalence of 6.1 percent, four times higher than their male counterparts. Studies have shown that although knowledge of HIV/AIDS among the youth is high, many young people continue to engage in risky behaviour, such as having multiple sexual partners and inconsistent condom use.

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Photo: Family Health International

Few men accompany their wives to the antenatal clinic

MASENO,� – Jennifer Omasa had lost three children when using traditional birth attendants, so when she fell pregnant a fourth time, she opted to visit her local antenatal clinic in the town of Maseno, western Kenya, and now has an eight-month-old baby girl named Zawadi, Swahili for gift.

Her first visit to the clinic revealed that she was HIV-positive. “I did not know what my fate would be … I even considered abortion,” Omasa told IRIN/PlusNews.

“The nurse asked me to bring my husband for the next visit because I told her I could not disclose such a thing to him. I lied to him that the nurse said they do not disclose the sex of the baby without the presence of both parents.”

Her husband, Joab, believed his wife and accompanied her to the clinic, where he was persuaded to take an HIV test that revealed he too was HIV-positive. However, she had received prevention of mother-to-child transmission (PMTCT) services and so far Zawadi has tested negative for HIV.

“I made it my duty to ferry my wife on a bicycle to the clinic every visit day, and I still do it to date,” said Joab. “Even though my HIV result was shocking, I have nothing to regret because this child’s life is a proof it was worth the sacrifice.”

Not enough men visit antenatal clinics

Few men in Kenya accompany their wives on visits to an antenatal clinic, and Joab said he was ridiculed by his peers for doing so. But according to Elizabeth Achola, the PMTCT programme coordinator at Maseno Mission Hospital, women who are supported by their male partners in this way are more likely to consistently visit antenatal as well as postnatal clinics.

“If you look at the trends here [in Maseno], you realize that those mothers who make appearances with their male partners both during initial testing and even after … are very good in clinic attendance,” she said.

“When the male partner is roped in, then both partners get to know their status, and even dangerous practices like forced breastfeeding or forced early weaning are unlikely – the baby’s chances of healthy survival are better than when the woman is left all alone.”

Achola noted that when HIV-positive pregnant women did not disclose their status to their partners, it was difficult to ensure that they would deliver and raise healthy babies.

“When the mother decides not to disclose her status to the father, the baby’s life is in jeopardy,” she said. “The possibility of preventing mother-to-child transmission becomes very difficult, because many women decide to deliver with help of traditional birth attendants or quacks.”

Achola’s experience in Maseno bears out the findings of a study in the Kenyan capital, Nairobi, which noted reduced HIV risk when the male partner of a pregnant woman attended antenatal clinic visits and was also tested for HIV.

The study enrolled 532 HIV-positive pregnant women, 140 of whom were accompanied by their male partners on antenatal visits; the results showed that the one-year-old children of women whose partners had attended the clinics had an HIV-free survival rate 59 percent higher than those whose partners did not attend.

“These findings indicate that promotion of programmes aimed at increasing male attendance in antenatal care … could function to reduce the risk of vertical transmission and infant mortality,” a research scholar at the University of Nairobi and lead author of the study, Adam Aluisio, told the recent 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa.

About 80 percent of antenatal clinics in Kenya offer PMTCT services, but the uptake of counselling and testing is below 50 percent. The government is considering various incentives, such as waiving maternity fees for couples who attend PMTCT sessions together, to boost male participation.

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Photo: UN

The Clinton Foundation has enabled two million people to access ARVs

NAIROBI,� – The Clinton Foundation has announced agreements with two drug companies to bring the cost of second-line antiretrovirals (ARVs) to under US$500 per person annually and reduce the cost of a key tuberculosis (TB) drug to $1 per dose.

“Today’s announcement will help ensure we can sustain treatment over a lifetime, and better treat patients with both HIV and TB, two key steps in turning the tide of the global HIV/AIDS pandemic,” former United States President Bill Clinton said at the Foundation’s headquarters in New York.

Starting in 2010, pharmaceutical company Mylan and its subsidiary, Matrix, will make available four second-line drugs � atazanavir, ritonavir, tenofovir and lamivudine � at a cost of $425 per person per year.

Matrix’s new product will allow patients to take three pills once a day instead of five or more pills twice a day. The product will also include the first ever version of ritonavir that does not require continuous refrigeration, making transport and distribution in developing countries much easier.

Pfizer pharmaceuticals will reduce the price by 60 percent and expand the availability of rifabutin, which is used to treat TB in patients taking second-line ARVs. TB is the leading cause of death among people living with HIV.

“At the moment, second-line ARVs in Kenya cost $1,000 per person per year, while first-line ARVs cost under $100,” said James Kamau, coordinator of the Kenya Treatment Access Movement, who has been on first-line ARVs for the past eight years.

“Even if 10 percent of the 260,000 people on ARVs needed second-line drugs today, it would cost more to put them on second-line drugs than all those on first-line ARVs.”

He said the lower cost of second-line drugs would save countless lives, and “This price reduction is therefore fantastic news.”

In 2008 the UN World Health Organization estimated that only about two percent of patients in low- and middle-income countries were on second-line ARVs, but the number was rising because every year about three percent of ARV patients switched from first- to second-line treatment.

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