Photo: Siegfried/IRIN

Monika Juma, a multi-drug resistant TB and HIV-positive patient waits to be treated at the Blue House Clinic in Mathare slum, Nairobi, Kenya, 5 February 07. Monika has been treated for TB for two months

SIAYA,� – When Dorothy*, a single mother of five, told her neighbours in the Kenyan capital, Nairobi, she had tuberculosis (TB), she expected sympathy and maybe even offers of help. Instead, she found herself so severely ostracized, she felt she had to move out.

“The kind of discrimination I faced from my neighbours made me regret [sharing] my condition with them; I could not even share the [communal] sink,” she told IRIN/PlusNews. “Yes, tuberculosis is very infectious, but those who have it are not death traps.”

According to Joseph Sitienei, head of the National Leprosy and TB Control Programme at the Ministry of Health, stigma associated with TB infection is a major impediment in rallying people to seek early diagnosis and treatment for the airborne disease.

“Many people still believe only those with HIV have tuberculosis and therefore they shy away from seeking diagnostic tests for TB, believing if they are found to have it, then it automatically means they are also HIV-positive,” he told IRIN/PlusNews. “By those infected not seeking treatment due to stigma, everybody is at great risk.”

Dropping out of treatment heightens the risk of multi-drug resistant TB (MDR-TB) developing, “which is very expensive and difficult to treat”, Sitienei added. Kenya has 353 people with MDR-TB, of whom about 70 are on treatment.

According to the Kenya AIDS Indicator Survey, 11.4 percent of Kenyans say they would want a family member’s TB infection kept secret due to stigma.

Kenya ranks 13th on the UN World Health Organization’s list of 22 high-burden TB countries in the world, and is the fifth highest in Africa. In 2008, the country had approximately 132,000 new cases.

Research conducted in Ghana in 2008 found some of the main causes of TB-related stigma were: fear of infection; TB’s association with HIV; health staff’s own fears; self-stigmatization by TB patients; and the blaming and shaming of TB patients by the public.

While Kenya has successfully integrated HIV and TB services at the testing level, TB counselling still trails behind counselling for HIV.

Education is key

“We have done well in offering HIV testing and counselling and diagnosis of TB, but not much has happened in trying to offer counselling services to people with TB,” said Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme. “This is crucial and possible because it can easily be done within the voluntary testing and counselling facilities.”

According to Sitienei, public education about TB is crucial to provide a better understanding of the disease and improve health-seeking behaviour: “With proper counselling, people are better placed to understand their own situation and that of others,” he said.

“The truth is, TB spreads very fast, but it is important to help people relate to those with TB without themselves having to fear putting themselves at risk,” said Charles Mutua, a former TB patient.

“People must also be made to appreciate that TB infection is not necessarily synonymous with HIV infection. I, for example, had TB but I was never HIV infected,” he added.

According to Andrew Suleh, superintendent of Nairobi’s Mbagathi District Hospital, communication messages should include debunking popular myths�- such as the idea that the disease can be transmitted by sharing utensils.

Ending health worker stigma

Sitienei said it was also important for health workers to understand the disease and treat patients with respect. In 2008, the government launched a communication campaign to reduce discrimination and stigma about HIV and TB among health workers.

“At times even the attitude among healthcare workers determines whether people seek services or not, even though our medical personnel are very conscious about issues of stigma,” he said. “Addressing stigma involves fighting it among the public, health workers and those who are infected with TB.”

Suleh noted that ensuring health workers were properly equipped to treat TB would help reduce stigmatization of patients.

“[Health worker stigma and discrimination] can arise when healthcare workers feel they are not given the adequate equipment or facilities to handle such cases,” he said.

ko/kr/oa/mw source.irinnews.org

* Not her real name

UGANDA: AIDS Commission takes new direction in prevention

Photo: Flickr Creative Commons

KAMPALA,� – The Uganda AIDS Commission (UAC) is revamping its national HIV information campaign after HIV prevention messages were less successful than hoped.

“We shall use basic facts in the messages to communicate effectively because we have realized that the level of knowledge about basic facts on HIV information is quite limited,” said Saul Onyango, senior health educationist with the UAC.

The term high-risk sex – previously defined as sex with an irregular partner – is to be redefined as sex with anyone whose HIV status is not known. As such, the term �most at-risk populations� will no longer refer to specific groups such as sex workers, fishing communities and men who have sex with men, but to all members of the population engaging in risky sex.

Campaigns aimed at ending cross-generational sex will be abandoned in favour of generic warnings about engaging in risky sex because of fears that young people may believe that sex within their own generation is risk-free. Officials have also said factors such as alcohol abuse, which predispose people to risky sexual behaviour, must be tackled alongside HIV prevention.

The commission has assembled a team of medical and communication experts to develop the new messages, and will work with English and local language media to disseminate them.

“We have to change the destiny of this country, even if it means putting back the drums of the 1980s that used to frighten people,” said UAC director-general, David Kihumuro Apuuli.

An ominous drumbeat, followed by�a�booming voice warning�that�”AIDS kills”, was the centre of a radio HIV prevention campaign when Uganda first began its fight against HIV in the late 1980s. Several senior officials – including Jesse Kagimba, senior presidential adviser on HIV/AIDS – have called for the return of fear-driven campaigns, which they say were instrumental in Uganda’s initial success in lowering prevalence.

However, detractors of this method say the key to success in prevention is education, not fear. Some studies show that scare tactics alone do not lead to behaviour change, but rather encourage denialism and fatalism. Experts also say that such campaigns promote stigma and discrimination, and that in the age of widely available life-prolonging antiretroviral medication, they could prove ineffective.

We need to change the mentality and behaviour of men; they have multiple sexual partnerships called side-dishes, which is creating a web

After successfully bringing prevalence down from more than 20 percent in the 1980s to about 6 percent by 2000, Uganda’s HIV levels have stagnated, showing a marginal increase in prevalence over the past few years.

Tailored response

The new messages will attempt to bring the HIV response in line with the drivers of the epidemic. According to a recent study, 37 percent of new Ugandan HIV infections are attributable to multiple partnerships, 35 percent occur within discordant monogamous couples, 18 percent are due to mother-to-child transmission, and 9 percent occur through commercial sex networks.

“We need to change the mentality and behaviour of men; they have multiple sexual partnerships�called side-dishes, which is creating a web,” Kihumuro said. “Before we know it the whole of Kampala [the capital] will be entangled into one web.”

According to the UAC, there are 110,000 new HIV infections annually and 63,000 deaths from HIV-related illnesses.

The study found that although Uganda had made good progress in rolling out key HIV prevention services, the campaigns had not reached all sections of the population.

“Over three-quarters of all adults, including many people living with HIV, do not know their HIV sero-status; services for PMTCT currently reach less than half of pregnant women,” it found. “Although condom use has increased, its coverage has not yet reached the critical levels necessary for it to impact on population level HIV transmission.”

Kihumuro noted that there was an urgent need for the government to commit more resources to the fight against HIV/AIDS. At present, the government funds about 6 percent of the national HIV response.

“A lot of the money coming in is from donors; we cannot sustain this,” he added.

en/kr/mw source.irinnews.org

Photo: Jefri Aries/IRIN

A survivor of the 30 September 2009 earthquake waits for aid amid the ruins of her house in Ketaping Village, Padang Pariaman district, West Sumatra (file photo)

BANGKOK, 19 November 2009 (IRIN) – Indonesia�s West Sumatra province, recently hit by a deadly 7.9 magnitude earthquake, is likely to experience an even bigger quake, and buildings need to be constructed to withstand this, experts say.

The 30 September earthquake, which struck off West Sumatra�s coast, hit the provincial capital of Padang, killing more than 1,100 people and leaving numerous collapsed and damaged buildings.

As a result, 45 engineers from Australia, New Zealand and Singapore, funded by the intergovernmental Australia-Indonesia Facility for Disaster Reduction, undertook a three-week survey of 4,000 buildings in the quake zone.

�Essentially we were looking at factors that have basically either contributed to their failure from the ground shaking, or also the factors that have contributed to � some structures not being impacted,� Matthew Hayne from Geoscience Australia and co-leader of the team, told IRIN.

�Some recent studies indicate there is a big [likelihood] of having an 8.5 earthquake in the next decade � Our building codes should consider this potential event,� said Wayan Sengara from the Center for Disaster Mitigation at the Institute of Technology Bandung in Indonesia, and co-leader of the survey team.

The survey has identified the need for technical advice and education for home builders, while there are also several engineering recommendations, including the proper use of reinforcement and concrete.

The results, which are being passed to Indonesia�s National Disaster Management Agency, are intended to help build safer buildings during the reconstruction phase.

�One of the driving factors behind the survey that we�re doing here and the recommendations � relate to the fact that there is a high probability that the future event, when it occurs, will be a tsunamigenic event as well as that earthquake,� said Hayne.

Photo: ReliefWeb A powerful earthquake struck off the city of Padang on Indonesia’s Sumatra island on 30 September (file photo)

Preparing for the next disaster

The Indonesian government has put the number of severely and moderately damaged houses at 181,665, according to the UN Office for the Coordination of Humanitarian Affairs’ (OCHA) latest situation report on 3 November. Ten hospitals, 272 health facilities and 1,078 schools were damaged.

The survey team, assisted by university engineering students, focused on medical facilities and schools.

Sengara said building codes – which needed to be updated; the extent of compliance of building designs to the codes; and, in turn, the compliance of construction to building designs, were all factors that played into the extent of damage.

�Most of the buildings we surveyed [that] experienced some damage were constructed before 2002. So the construction behind the design of the building, and also the construction quality, seems to be one of the contributors to the damage,� he said.

He warned of an �accumulated risk� if the survey�s recommendations were not followed through, but also flagged difficulties with enforcing compliance with building codes, even if they were updated.

�This is an issue in many provinces in Indonesia. What happens is that the compliance of the design to the building code is not well enforced by the government,� said Sengara.

�Before the building can be constructed, there is supposed to be a building permit and before issuing this building permit, there should be some requirements. The compliance of the design to the building code has to be reviewed. And in the current situation, this process is weak,� he said.

Indonesia is part of the Pacific Ring of Fire, which is vulnerable to seismic activity because tectonic plates meet there. West Sumatra�s low-lying coastline faces the Indian Ocean and the province has been called a �supermarket� for disasters, earthquakes and tsunamis by local officials.

ey/mw source.irinnews.org