Written By:PPS   , Posted: Wed, Oct 28, 2009

SOUTH AFRICA: HIV-positive inmates speak out

Photo: Eric Kanalstein/UNMIL

DURBAN,  – Just over three years ago, a group of HIV-infected inmates at Westville Correctional Centre, near the South African port city of Durban, won a High Court battle that forced the government to provide them with life-prolonging antiretroviral (ARV) treatment.

Judge Thumba Pillay ordered the national Department of Correctional Services to provide the medicines to the 15 prisoners, as well as to any other inmate in need of them.

He also ordered the department to adopt a comprehensive HIV/AIDS plan for the jail to ensure that inmates would receive not only ARVs, but adequate nutrition, regular and ongoing counselling, and access to health facilities. The government appealed the verdict but it was upheld, allowing thousands of prisoners across South Africa to receive treatment.

Yet many HIV-positive inmates at Westville say that while most of those who qualify for treatment are getting it, the prison authorities take little interest in their health and are not complying fully with the court order.

“Prisoners now have access to ARVs, but the support services are still not there,” said Frank Ntombela, chairman of the Westville HIV/AIDS Support Group, which was instrumental in taking the department to court.

“Good nutrition, which is one of the requirements for people taking these drugs, is unavailable. We get the regular staple food, consisting mainly of rice and soya-bean stew, which is often not good enough,” and the prison authorities did not allow inmates’ families to provide them with healthier food.

Ntombela’s section of the prison houses more than half the total prison population of 7,800, but has only four doctors and four nursing sisters, who only see patients on Tuesdays.

“Sometimes there are more than 50 people who want to see the medical staff, but they force us to choose only seven prisoners who are going to be seen for that week – the others would only get a chance next time, unless they are in an emergency,” said Ntombela.

Another member of the support group who did not wish to be named, told IRIN/PlusNews that the ARVs were helping HIV-infected prisoners. “There was a time between 2005 and 2006 when an average of 140 prisoners died of AIDS a year – we saw corpses leaving the prison hospital every week.”

However, because of overcrowding many HIV-positive prisoners still contracted tuberculosis (TB), including drug-resistant strains of the disease. The support group member estimated that about 60 HIV-positive inmates now died at the prison every year, with very few granted medical parole.

“Many people end up dying lonely deaths here, yet there is a legal provision which allows terminally ill prisoners to be paroled in order to die dignified deaths with their families.”

After their court victory the support group was allocated an office for meetings and treatment and awareness programmes, but prison authorities recently closed down the office after gang violence claimed the lives of two inmates.

“I think they used the gang wars to get to us, because they always resented the fact that we had won the court battle,” said the support group member. “As a result, most of our programmes came to a halt.”

The number of Westville inmates living with HIV is unknown but the prison is located in KwaZulu-Natal, the province with South Africa’s highest HIV prevalence rate. According to the latest government survey, 39 percent of women attending antenatal clinics were infected.

Pastor Leon Assenderpe of the Family Support Group, a faith-based organisation that runs AIDS awareness and care programmes in prisons throughout the country, described the HIV/AIDS situation at Westville as “dire”.

“I know that the government is trying to implement a treatment plan but they are overwhelmed because of the number of prisoners needing treatment,” he said.

Nana Mpungose, the Westville coordinator of Treatment Action Campaign, the national AIDS lobby group that helped the inmates bring their case to court, said her organisation was concerned about the number of complaints from HIV-positive prisoners at Westville and other facilities.

“We are also concerned that the department is not fully compliant with the court order,” she said. “When we ask for permission to meet with prison authorities, or to speak to prisoners, we are denied that opportunity.”

The Department of Correctional Services could not be reached for comment.

cnm/ks/he source.irinnews.org

AFRICA: Electronic records can streamline health care

Photo: Keishamaza Rukikaire/IRIN

Electronic health systems don’t come cheap

NAIROBI,  – Replacing manual data with electronic health records would significantly improve the quality of care and enable African HIV treatment programmes to be scaled up more efficiently, say the authors of a new article on the subject.

“Talkin’ About a Revolution”, published in the latest edition of the Journal of Acquired Immune Deficiency Syndromes, looked at the Academic Model for Providing Access to Healthcare (AMPATH), a programme that uses electronic health records in care and treatment services for around 100,000 HIV-positive patients at sites across western Kenya.

“Scaling up treatment programmes requires timely data on the type, quantity and quality of care being provided,” the authors said. “Health care is an information business; managing patient care requires managing patients’ data at many levels … health care systems the size of AMPATH (or larger) cannot effectively be managed without … [electronic] data.”

More efficient care

The health data system can help programme managers avoid medical errors and stock-outs of key medicines, while enabling clinicians to monitor and care for their patients more effectively.

“Electronic records help us store data efficiently, retrieve it when we need it, and monitor and evaluate the progress of our programmes much more easily than if we were using manual systems,” said Erica Kigothe, AMPATH’s programme manager in charge of data management.

“When a patient comes to a clinic for a visit, instead of poring over large files, the clinician has one summary sheet that contains all the vital patient information and should he or she need more information, they can always go back to the patient’s computerized file,” she told IRIN/PlusNews.

A previous study comparing an AMPATH clinic before and after the adoption of electronic health records found that patient visits were 22 percent shorter, provider time per patient was reduced by 58 percent, and patients spent 38 percent less time waiting.

Kigothe noted that assessing disease trends was also easier with electronic records, as was collating data for the purposes of research and new directions in programme development.

Electronic health systems have been successfully used in the care and treatment of HIV in Lesotho, Malawi, Rwanda, South Africa and Uganda, but few African countries have adopted the systems on a large scale.

“Programme implementers in low-income countries sometimes see clinicians’ recording of patient data and the management of those data as secondary to providing good care, or even a distraction,” the article’s authors commented.

Not all smooth sailing

The programme has not been without its difficulties. “In one of our sites in Busia [town on the Kenya-Uganda border] they have very frequent power outages, so they have had to find ways to work around it, inputting data when power is on, even if that is at night,” Kigothe said.

Finding people with computer skills is not always easy in the developing world, particularly in rural areas, and “like any equipment, computers break down from time to time and require repair or replacement, which can cause some problems” and incur additional expenses, she said. “In addition, the data collectors are human, and therefore prone to the occasional error.”

Electronic systems are not cheap; they require considerable investment in computers, training data collectors and hiring information technology experts. However, according to the study, AMPATH’s total cost of care is under US$100 per patient per year, making the system financially feasible even in resource-poor settings.

“You’re going to have to spend quite a lot of money to set up the system,” Kigothe said. “But looking at the big picture, it saves so much in the long run – for example, each of our data collectors manages 2,000 patients’ information, something that would be impossible using manual data collection.”

kr/kn/he source.irinnews.org

By Martin Mutua

The stern message to Kenya on reform by US President Barack Obama has sharply divided leaders along the predictable fault-line of the Grand Coalition Government.

Whereas Cabinet ministers from the PNU wing threatened to retaliate if Washington made good its threat to slap travel restrictions on Government officials, Cabinet ministers from the ODM wing welcomed the US move.

Justice and Constitutional Minister Mutula Kilonzo, and his Foreign Affairs counterpart Moses Wetangula described the move on Monday by US Assistant Secretary of State for African Affairs Johnnie Carson as aimed at embarrassing President Kibaki.

The two accused the US of practicing ‘rooftop’ diplomacy and meddling in Kenya’s affairs.

On Monday Carson said his country had issued a travel ban on a top government official for frustrating reforms.

Barrack Obama

“Kenya is an independent state and we have options if the US bans our officials because in diplomacy there is the principle of reciprocity. We shall also reciprocate with equal measure,” Wetangula said.

Ban threats

The grand row over the US visa ban threat comes a week ahead of the visit by the Chief Prosecutor of the International Criminal Court Luis Moreno-Ocampo.

The prosecutor has a date with Prime Minister Raila Odinga and President Kibaki on November 6, on trials of suspects in 2007 post-election violence.

Water Minister Charity Ngilu said the pressure by the US was being misconstrued as interference because things seem to be going well for Kenya now.

“How come when things are thick and we invite them for assistance it is not construed as interference?” she posed.

She said for the past 20 years the issue of reforms has been on every Kenyan’s lips. She regretted that some of those who had championed reforms had shifted goalposts after joining Government.

“We need a lot of pressure because if not Kenyans have a way of expressing their displeasure at the opportune time, as was the case in 2007,” she added.

Medical Services Minister Anyang’ Nyong’o said he saw nothing wrong with a country stopping unwelcome visitor to its territory.

“I would like to urge those affected to use the ban to soul- search and act responsibly,” he said.

But at a press conference on Wednesday, Wetangula said the country was on course and did not need meddling from other countries.

“It is unfortunate that an assistant minister (Carson) comes into the country uninvited, then makes some unacceptable remarks and then leaves,” Wetangula argued.

President Kibaki, US Ambassador Michael Ranneberger and Assistant Secretary of State for Africa affairs Johnnie Carson. Pressure continues piling on the Government to deliver reforms. Photo: File/Standard

Wetangula said the country was on course in the reform agenda, adding that within the next 10 days, a Draft Constitution would be ready.

Wetangula added that the Committee on Boundary Review was carrying out its work, and that the Government had shown it was committed to reforms.

UN charter

Wetangula said that according to the UN Charter, Kenya, US, Austria and Switzerland are obligated under Article Eight and 108 not to deny any entry visa to government representatives going to the UN headquarters. He described the visa ban as ‘meaningless’.

He gave the examples of Cuban President Fidel Castro; his Iranian counterpart Mahmoud Ahmedinajad who he said had been given unlimited access to the UN despite their countries having sour relations with the US.

Mutula said by issuing the visa ban to ministers the US wanted to embarrass the President.

Planning Minister Wycliffe Oparanya said the action against senior government official was unfair.

“The problem we have here cannot be solved by an individual. Commitment to reforms and fighting corruption requires political good will. I don’t know why they picked on an individual,” said Oparanya.

When reached on Wednesday, the US Ambassador Michael Ranneberger said: “I’m not going to comment on the minister’s statement”.

Housing Minister Soita Shitanda also hit out at the US, saying it had overstepped its mandate.

“America should respect us. It should not treat us like a colony,” he said, adding that he appreciated the concerns by the Obama Administration, but there were limits.

“We are not an extension of the US because they want us to tackle so many things at the same time, yet the reform agenda was on course,” he added.

Ikolomani MP Bonny Khalwale said Wetangula should know that Kenya was part of a global village and must observe international norms by addressing issues of corruption, impunity, nepotism, and institutional and constitutional reforms.

“If we reform the police, would it benefit us or the Americans?” asked Khalwale. He challenged Wetangula to state since he had expressed interest in running for president, whether he wanted to preside over a corrupt Executive.

Assistant Minister Kabando Wa Kabando said President Obama means well for Kenya, and that with his ancestral roots in Kenya, he should not be expected to sit back and watch the country being destroyed.

Obama roots

“When Obama visited Kenya, he spoke passionately about his roots and what he wanted to see in Kenya. All that he is doing is a follow up of his promise to the people of Kenya, and as a Nobel Peace laureate,” said Kabando.

Assistant Minister Katoo ole Metito called on the US to upscale the pressure on Kenya and get corrupt leaders and those hampering reforms out of Government. Mutito MP Kiema Kilonzo said Kenyan leaders were “behaving inappropriately” and hence the visa ban.

But Kangundo MP Johnston Muthama questioned the visa ban, asking why the US was ‘trying’ Kenyan leaders in its own court.

Muthama, one of the leaders the US had sent a warning letter, said his only engagement with the US was business. He wondered why the US was treating Kenyan leaders as if they were dying to go to the US.

Lands Assistant Minister Gonzi Rai said the ban on certain people by US from stepping on its oil would not resolve the problems facing Kenya.

But Fisheries Development Assistant Minister Abu Chiaba said this was the best way for the US to deal with people undermining reforms.

‘’The suspects are known. The US must come up with better measures of punishing them,” Rai said.

source.standard.ke

SWAZILAND: Thandi Xaba, “If you feel good about life it helps you stay healthy”

Photo: James Hall/IRIN

“People understand about AIDS from our shows”

MBABANE,  – Thandi Xaba, 23, an aspiring actress living with HIV, belongs to an itinerant theatrical group in Swaziland who perform plays dealing with HIV/AIDS, often spiced with humour to engage the rural audience who sit beneath trees to watch the shows.

“In our story [the play] a family farm is on the border [between South Africa and Swaziland], and when they put up a border fence the family is cut in two; the whole community is split this way.

“It gets serious when some community members get HIV and there is a shortage of ARVs [antiretrovirals] on the Swazi side, so they try to go to their neighbours on the South African side.

“Then the flow of people is reversed when there are food packages delivered on the Swazi side that are needed by people who are taking ARVs, because you have to be well-nourished for the drugs to work.

“I know this because I am HIV-positive, so I identify with the people in the story. When I am acting and showing the emotions of fright or anxiety I am just replaying what I experienced myself when I learned from the test that I was HIV, and worried how people would react.

“But I am more fortunate than most. I am educated and I know how to read instructions and understand the literature – I can explain things to others.

“What is really giving me a positive spirit is that I am doing what I want to do. If you feel good about life and you are optimistic, this helps you stay healthy.

“I really like acting – I don’t get paid, we have to provide our own costumes – but it is a way for me to perform in front of people. I am learning, and one day I will go to Jo’burg and audition for real theatrical productions, where they have stage lights and make-up. Now our stage lights are the car and truck headlamps, or candles if the wind isn’t blowing.

“People understand about AIDS from our shows. They see stories about real people and they relate; they laugh and applaud, and that is rewarding.”

jh/kn/he source.irinnews.org