TANZANIA: Low uptake of ARVs hampering universal access

Photo: John Nyaga/IRIN

Pregnant women are not making adequate use of prevention of mother-to-child transmission services

DAR ES SALAAM, 27 October 2009 (PlusNews) – HIV-positive Tanzanians are not taking advantage of the availability of life-prolonging anti-retroviral medication in hospitals around the country, says a senior government official.

“We have an adequate supply of ARVs in our hospitals and other outlets, but there are few people who are turning out for this important service,” David Mwakyusa, Health and Social Welfare Minister, told IRIN/PlusNews.

An estimated 250,000 people are taking ARVs, while another 190,000 who need them are not accessing them. In 2008, the government re-affirmed its commitment to achieving universal access to ARVs by 2010.

“We are working hard to encourage people to check their HIV status and those infected to go for further medical attention and when necessary start taking ARVs, which are in good supply,” the minister said.

Mwakyusa also bemoaned the fact that few pregnant women made use of prevention of mother-to-child transmission (PMTCT) services available at antenatal clinics; just 33 percent of pregnant women who require PMTCT services access them, according to UNAIDS.

Research has found that although HIV-positive Tanzanians welcome anti-retroviral therapy, transportation, supplementary food costs, ill-treatment at hospitals and difficulties in sustaining long-term treatment all act as barriers to accessing treatment. Fear of stigma as well as HIV denial, which often led patients to seek treatment from alternative healers, and inadequate numbers of trained medical personnel, also prevented patients from accessing healthcare.

“Multi-faceted interventions are required to promote regular HIV clinic attendance, including ongoing education, counselling and support in both clinic and community settings,” authors of a recent study by the Centre for Population Studies and the London School of Hygiene and Tropical Medicine recommended.

Mwakyusa noted that Tanzania was planning to cut the cost of ARVs by producing them locally. He said it was important for the country to become more self-sufficient, especially in the face of the global economic downturn.

“We are praying that despite the global financial crisis, donors will continue supporting our efforts,” he said. “The financial crisis is clearly affecting the capacity of donors to fund international programmes on AIDS.”

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Analysis: African IDP convention fills a void in humanitarian law

Photo: Manoocher Deghati/IRIN

What about us? Until now there has been no international convention protecting IDPs (file photo)

KAMPALA,� – The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa is a comprehensive document that will, if ratified, fill a void in international humanitarian law, say experts.

Whereas the rights of people who flee across national boundaries are protected under the 1951 Convention Relating to the Status of Refugees and a similar instrument introduced 18 years later by the Organization of African Unity (now the African Union), there has been no international legislation catering specifically for people displaced within their own country (IDPs).

IDPs vastly outnumber refugees in Africa. In just 10 of the 18 countries in east and central Africa, there are more than 10 million IDPs, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), with Sudan (four million), the Democratic Republic of Congo (2.12 million) and Somalia (1.55 million) heading the list.

In the same region, there are refugees in 16 countries, totalling just less than two million, according to OCHA.

This latest instrument, also known as the Kampala Convention because it was signed in the Ugandan capital, “obliges governments to recognize that IDPs have specific vulnerabilities and must be supported”, said Walter K�lin, Representative of the UN Secretary-General on the Human Rights of Internally Displaced Persons.

“It covers all causes of displacement, is forceful in terms of responsibility and goes beyond addressing the roles of states to those of others like the AU and non-state actors.”

Signed by 17 African states at the end of summit on 23 October, the convention defines IDPs broadly, irrespective of who is displacing them.

According to the International Committee of the Red Cross (ICRC), the convention provides a solid framework for enhancing the protection and assistance of IDPs in Africa. The ICRC is the custodian of international humanitarian law.

“The crucial challenge now is the same one facing international humanitarian law in general � ensuring that once the convention is signed and ratified by as many states as possible, it is actually implemented and respected,” ICRC president Jakob Kellenberger said.

“States must now take concrete steps to implement the convention into their own national legislation and regulation systems, and develop plans of action to address issues of displacement.

“The convention goes further than international humanitarian law treaties in some aspects, for example, in the rules it contains on safe and voluntary return, and on access to compensation or other forms of reparation,” Kellenberger added.

Photo: Manoocher Deghati/IRIN

There are more than 10 million IDPs in East and Central Africa (file photo)

Next steps

To become a binding document, the convention has to be ratified by 15 of the AU’s 53 member states.

“No international treaty is perfect, and the AU IDP Convention does have a few weaknesses. Concerns over the lack of effective enforcement mechanisms and insufficient guarantees for equality and non-discrimination have been raised,” the Brookings-Bern Project on Internal Displacement noted in a statement.

“There is some question regarding the extent to which non-state actors and armed groups called upon by the convention to protect IDPs can be bound by its provisions. Nevertheless, the convention, which has benefited from the input of international experts, is considered to be generally consistent with international standards such as the Guiding Principles on Internal Displacement.”

AU officials in Kampala were cautiously upbeat, urging member states to remain engaged. “It is the responsibility of member states that the convention becomes a binding instrument,” Jean Ping, AU Commission President, said. “At this point, it is an achievement, but not an end in itself.”

Zambian president Rupiah Banda also chose his words carefully. “We have given legal force to the task ahead and Zambia is ready to sign,” he said. “Those who are displaced should not be forgotten.”

An observer who requested anonymity said progress would require member states to demonstrate greater political will to implement the convention and address concerns about sovereignty and enforcement.

“It is a question of a progressive [AU] Commission versus [conservative] member states,” he told IRIN in Kampala. “For example, the inclusion of armed groups in the draft was interpreted by some member states as lending legitimacy to such groups.”

The convention emphasizes the sovereignty of member states but spells out the obligations and responsibilities of armed groups. Among others, it prohibits armed groups from carrying our arbitrary displacement, recruiting children and impeding humanitarian assistance.

“Overall, though, the convention has a good chance of getting the necessary signatures rather quickly,” the observer added. “In April, SADC�s [Southern African Development Community] 11 members committed to speedy signature.”

Political will

Civil society leaders, attending a parallel event, insisted political will and demonstrated commitment were key to progress. The fact that only five presidents came to Kampala, they said, called for an urgent strategy to bring on board more states.

Present were Banda, Ugandan President and host, Yoweri Museveni, Zimbabwe’s Robert Mugabe, Somalia’s Sheikh Sharif Sheikh Ahmed and Mohamed Abdelaziz of Saharawi, along with high-level UN, INGO and AU delegations.

“It is one thing to have a good convention and another to implement it,” Dismas Nkunda of the New York-based International Refugee Rights Initiative told IRIN.

In 2007, the AU adopted the African Charter on democracy, elections and governanc e, but it has so far been ratified by only two member states.

It is one thing to have a good convention and another to implement it

The basic question of impunity also needed to be addressed. Until African countries learn to respect the law, participants said, the continent would “remain at rock bottom” in its attempts to address the problems of the displaced.

AU officials seemed conscious of these sentiments. “We have come a long way, but a plan of action is now envisaged,” Jolly Joiner, AU commissioner for political affairs, told IRIN. “Once member states are on board, we will take this convention forward.”

Antonio Guterres, head of the UN Refugee Agency (UNHCR) and representative of the UN Secretary-General at the summit, said solving the question of displacement in Africa required political solutions.

“There is no humanitarian solution to conflict,” he explained. “The solution is always political.”

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AFRICA: IDP convention – now the hard work begins

Photo: Allan Gichigi/IRIN

IDPs at the Mathare Chief’s camp where they have set up camp in the open field. Kenya, July 2008 (file photo)

KAMPALA,� – Seventeen countries signed the African Union convention on internally displaced persons (IDPs) after years of preparation culminated in a week of meetings in the Ugandan capital but a lot more hard work remains before it becomes effective, according to observers.

“The most important step now is implementation,” Julia Dolly Joiner, AU commissioner for political affairs, said. “We need to move from intentions to actions.”

For the Brookings-Bern Project on Internal Displacement,� it is crucial that implementation is carried out “in a timely fashion and in a manner that makes a real difference to the lives of persons affected by internal displacement in the region, including host communities.

“The first step forward should involve a process of national dialogue and civic education aimed at securing the Convention’s ratification and implementation by the State parties,” according to a statement by the project, which monitors displacement issues worldwide to promote best practice among governments and other actors.

Fifteen countries must ratify the convention before it enters into effect.

Organizers of the 19-23 October meetings insisted that the fact that only 17 signed did not represent a lack of political will and commitment on the part of the African states.

“We debated together and we agreed but when it comes to signing, the person has to have been given the authority by his government to sign,” one AU official told IRIN. “Only 17 had such authorization.”

Ugandan President Yoweri Museveni, who chaired the summit, praised it as “a very important milestone [that] has gone beyond conflicts to address issues of development.

“We have at least agreed in words, we now have to put our words [into] action,” he told a news conference. “The solace for the women in Darfur may not be very immediate, but the fact is that people have come together to discuss the matter.”

The IDP convention obliges states to:
	Prohibit and prevent arbitrary population displacements, respect the principles of humanity and human dignity, as well as aspects of international humanitarian law concerning the protection of IDPs;
	Ensure assistance to IDPs, incorporate obligations under the convention into domestic law and designate a body to coordinate IDP protection and assistance;
	Devise early warning systems on potential displacement and establish disaster risk reduction strategies, protect communities and respect individual rights on protection against arbitrary displacement;
	Respect the mandates of the AU and UN, and the roles of international humanitarian organizations; and
	Take necessary action to effectively organize humanitarian relief and guarantee security; respect, protect and not attack humanitarian personnel or resources, and ensure armed groups conform with their obligations.
It prohibits armed groups from:
	Carrying out arbitrary displacement, hampering the provision of protection and assistance to IDPs and restricting the movement of IDPs;
	Forcibly recruiting, kidnapping or engaging in sexual slavery and trafficking; or
	Attacking humanitarian personnel or resources.
It obliges the AU:
	To intervene in respect of grave circumstances such as war crimes and crimes against humanity;
	To respect the right of members to request such an intervention and support efforts to support IDPs; and
	Strengthen capacity and coordinate the mobilization of resources for protection and assistance to IDPs.

Partnerships urged

Joiner called for international support. “Africa cannot do it alone; that is why we are calling for partnerships,” she told IRIN. “We are optimistic that countries will be faithful to their commitments under the convention.�

The AU will now try to get more signatures, and lobby 15 countries to ratify the convention so it can become a binding document. Observers, however, say much more work needs to be done to generate political will, given that most presidents stayed away from the summit.

The convention addresses the root causes of displacement in Africa, where at least 11 million people are displaced by conflict and climate change-related natural disasters, among other reasons.

According to the Brookings-Bern Project, three of the world’s top five countries with the largest populations of conflict-induced IDPs are in Africa.

These include Sudan, with an estimated 4.9 million IDPs, the Democratic Republic of Congo, with at least one million, and Somalia, where the UN estimates 1.5 million are displaced. Hundreds of thousands more are displaced in Cote d’Ivoire, Ethiopia, Kenya, Uganda, and Zimbabwe.

Overall, citizens in at least 20 African states are experiencing internal displacement.

The convention aims to promote regional and national measures to prevent, mitigate, prohibit and eliminate the root causes of internal displacement as well as provide durable solutions.

“People who flee persecution or conflict and cross into another country are categorized as refugees and, as such, benefit from a long-standing and well-oiled international legal protection system, including the 1951 Refugee Convention,” the UN High Commissioner for Human Rights, Navi Pillay, said.

“Until now [IDPs] have been more or less excluded from the system of international legal protection, even though they are often displaced in exactly the same way, and for exactly the same reasons, as refugees. At least in Africa, that should no longer be the case.”

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ASIA: Human rights body�s shaky beginnings

Photo: Wikimedia Commons

Burmese Pro-democracy leader Aung San Suu Kyi was sentenced to spend another 18 more months under house arrest in August

HUA HIN,� – After only a few days Southeast Asia’s inter-governmental human rights body is already being criticized over its terms of reference as well as its ability to have any impact on human rights in Myanmar.

The Association of Southeast Asian Nations (ASEAN) launched its Intergovernmental Commission on Human Rights (AICHR) on 23 October with the signing of the Cha-am Hua Hin Declaration at� the 15th ASEAN summit held in Hua Hin, Thailand, over the weekend.

Thailand�s Prime Minister and ASEAN chairman Abhisit Vejjajiva said it �showed the commitment of ASEAN member-states to realize the historic quest of the people of Southeast Asia for freedom�.

But critics say its mandate is limited and that its undertaking to �promote human rights within the regional context, bearing in mind national and regional particularities and mutual respect for different historical, cultural and religious backgrounds� does not go far enough, given that Myanmar continues to be cited by human rights watchdogs as one of the world’s worst violators.

Kraisak Choonhavan, chairman of the ASEAN Inter-parliamentary Myanmar Caucus, said the country�s military government had yet to demonstrate a willingness to adhere to principles of democratic governance under the ASEAN charter.

And ASEAN�s long-held assertion that Myanmar�s political and human rights issues were internal affairs was no longer applicable, particularly since such problems had affected other countries in the region, he said.

Engaging with the military

According to Charm Tong of the Shan Women�s Action Network in Myanmar, the military has stepped up operations against ethnic groups in the east ahead of next year�s election, resulting in the displacement of thousands to neighbouring Thailand and China.

Western sanctions are in place, although the US has reversed its previous policy by saying it would talk to the junta.

ASEAN has typically stressed non-interference in the internal affairs of its member states, with a notable exception in August, when a statement issued by the Thai PM in his role as ASEAN chairman expressed “deep disappointment” with the sentencing of Burmese opposition leader Aung San Suu Kyi to an additional 18 months house arrest.

Additional challenges

Other critics cite the composition of the AICHR.

According to Debbie Stothard, speaking on behalf of the ASEAN People’s Forum, a network of NGOs, eight of the 10 commissioners are government appointees, with only Indonesia and Thailand allowing human rights experts and lawyers to select their commissioners.

Of the 10 ASEAN member states, only Indonesia is regarded by US-based watchdog Freedom House as a fully-fledged democracy, with other states ranging from flawed partial democracies to states with little freedom of speech or assembly.

In his closing remarks at the summit, ASEAN Secretary-General Surin Pitsuwan attributed the divergent attitudes towards NGOs among ASEAN member-states to �different rules and regulations, which led to a differing view on how to appoint the civil society representatives�.

Last year, ASEAN launched a charter that pledges to reform the bloc into a European Union-style entity by 2015.The human rights body was created as part of this initiative.

However, according to Bridget Welsh, a professor of Southeast Asian studies at Singapore Management University, the birth pangs of the AICHR do not bode well for ASEAN development in general.

�The handling of the ASEAN human rights body seriously undermines the credibility of the organization and simultaneously raises questions about the transformation of the regional architecture of the organization,� she told IRIN.

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EGYPT: Pig cull hits livelihoods

Photo: Emmanuel Dunseath/IRIN

Unofficial garbage collectors, locally known as ‘Zabalin’, collect trash in Cairo and bring it to the suburbs where they live – in this case, al-Muqattem – to sort through for recycling to sell back to factories

CAIRO,� – �The Egyptian government’s May 2009 decision to cull the country’s entire pig population – ostensibly to stem the spread of H1N1 influenza – has hit the livelihoods of 70,000 former pig farmers and unofficial rubbish collectors and their families in the Cairo area, according to local NGO Association for the Protection of the Environment.

The rubbish collectors, known as `Zabalin’, used to sell much of their organic waste to the pig farmers; there was a symbiotic relationship between the two marginalized groups in greater Cairo.

“I used to collect 1,000 kilos of rubbish every day for the pig farmers, and to recycle and sell to factories,” said Nabil Abu Mazin, a rubbish collector. He lives in Cairo’s al-Muqattem suburb, also known as Garbage City. “Now I collect about 150 kilos a day, because the pig farmers have gone out of business.”

The pig population – most of it in the greater Cairo area – was estimated at 300,000 and it took about a month for the slaughter to be completed, according to the Agriculture Ministry, though rumours abound that many pigs were spirited away.

The World Health Organization (WHO) has long questioned the link between pigs and H1N1, and many health experts have criticized the government’s decision to cull all pigs.

According to WHO, Egypt has 1,053 laboratory-confirmed cases of H1N1, and has had two deaths.

Some of Egypt’s Christian minority saw the cull as an attack on their community, which makes up about 10 percent of the country’s 80 million people, according to CIA World Factbook.

Change of tack

Photo: Emmanuel Dunseath/IRIN

Karim Aweida, a former pig farmer, said he had to get rid of 10 of his 12 staff after all his pigs were culled

The government now says the cull was a general health measure.

Agriculture Minister Amin Abaza told the media the government had been planning to “get rid of the pigs for three years” and that the advent of H1N1 had presented an opportune moment. He also said the cull would ensure that no new strain of avian flu and H1N1 emerged.

According to media reports, and most Egyptians IRIN asked, the public generally supported the cull because they saw pigs, and the manner in which they were kept in Cairo, as unhygienic. However, with heaps of rotting waste in the streets, some are calling for the return of the `Zabalin’, who used to collect roughly half of Cairo’s rubbish, according to various studies, such as a 2004 report by NGO WASTE.

Health experts are concerned that if nothing is done, infectious diseases will spread.

Impact on education

Photo: Emmanuel Dunseath/IRIN

Residents of Cairo suburb al-Muqattem say 50 percent of the children living there have droppped out of school since May

Abu Mazin said that since the cull six months ago, he has only had the means to send two of his five children to school. During school hours, IRIN found hundreds of children running around the rubbish-strewn streets of al-Muqattem, a Coptic Christian stronghold on Cairo’s periphery.

“About 50 percent of our children have dropped out of school over the past few months and around 75 percent of the men are now unemployed,” Karim Aweida, a former pig farmer, told IRIN. He said he had got rid of 10 of his 12 staff as there was much less to do.

He received the equivalent of US$9-45 in government compensation for each pig culled, depending on its size. Prior to the cull he used to sell pigs for $45-146.

Local pig farmers estimated there had been some 3,000 pig farms in and around the city, with some holding up to 2,000 pigs.

No compensation for `Zabalin’

Photo: Emmanuel Dunseath/IRIN

Rubbish being picked up in Cairo by one of thousands of unoffical garbage collectors, known as ‘Zabalin’

Unlike the pig farmers, there has been no compensation for the `Zabalin’.

Abu Mazin said the `Zabalin’ were now leaving organic waste in the streets of Cairo as they had no buyers for it. They only collected items that could be easily sold, or moved rubbish if people paid them directly.

Poorer neighbourhoods, such as Imbaba in Cairo’s Giza governorate, now have piles of rubbish accumulating in the streets, despite residents paying three pounds ($0.5) a month as part of their electricity bill for municipal rubbish collection. Commercial enterprises pay 25 pounds ($4.5) a month.

Compounding the problem has been a feud between the Giza municipal authorities and an Italian company contracted to collect rubbish there.

“The police increasingly harass us when we try to take garbage because we do not have licences to do so. They promised to give us licences before but we are still waiting,” Abu Mazin said.

The ministries of health, agriculture and environment have also promised to build new farms for pigs, sheep, goats and cattle outside the city for those who have lost their livelihoods. However, no deadline has been set for the project, leaving most of the `Zabalin’ sceptical.

“The government… promised to give us new farms. We are still waiting for that but losing hope by the day,” said Tareq, a former pig farmer in the Batni Baqarah area of Coptic Cairo who refused to give his family name for fear that he may never get a farm if he revealed it.

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By Elizabeth Mwai

The Government will spend Sh40 million on a research to establish the number of gay Kenyans.

The survey, set to begin in December till June next year, is the first of its kind.

On Tuesday, National Aids and STD Control Programme (Nascop) director Nicholas Muraguri said the survey would be done in conjunction with the National Population Council.

“We cannot continue excluding this group identified as a key driver to new HIV/Aids infections,” said Dr Muraguri.

In an interview with The Standard, Muraguri said establishing the population of men who have sex with men would facilitate development of interventions.

Apart from knowing their population, Muraguri said the study was aimed at understanding their behavioural practices, condom use and risk factors.

Murgauri said it is believed majority is married for purposes of trying to hide their preferences.

“We want to know how many partners do they usually have, are they married, do they use drugs and what�s their care seeking behaviour,” said Muraguri.

Hot spot

Currently, the gay hotspot is believed to be Coast Province, Nairobi and tourist sites, including game reserves.

Muraguri said gay men had been known to have an almost five times higher the national HIV prevalence than the normal average

He said social exclusion has globally been identified as a major contributor to ill health among gays.

He said the Government finds it challenging to tackle the spread of new infections estimated at 100,000 cases annually because of ignoring key drivers to the scourge.

Studies have shown 15 per cent of the new HIV infections are attributed to gays.

According to the Mode of Transmission Study conducted at Coast Province in 2007 and results released last year, they were responsible for up to 20 per cent of the new HIV infections in the region.

The most at risk have been identified to be commercial sex workers, truckers, injecting drug users and gays.

Muraguri said the Ethical Review Board would appraise tools for the study.

He said most programmes on gays were mostly driven by NGOs, a situation the Government ought to take charge off.

He said by gathering such information, they would reach out to the group in the fight against spread of HIV and Aids.

source.standard.ke