By Terence Sesay, API-Liberia

Monrovia (Liberia)-Liberian President Ellen Johnson Sirleaf Friday disclosed that the Ghanaian government has offered seven scholarships to the Armed Forces of Liberia (AFL) to help train its personnel.

She also recognized the efforts of African countries like Nigeria, Benin and Rwanda for the assistance they have rendered the Liberian military since she assumed leadership of the country.

Addressing the 54^th anniversary celebration of the Armed Forces of Liberia, President Johnson Sirleaf said this level of assistance to the AFL “coupled with the mentorship provided by active United States military personnel, will enable the AFL to be proficient and positively contribute to the socio-economic development of the country.”

She said as the country enters its transition period with the United Nations Mission in Liberia , the “goal of the government is to strengthen the capability of the AFL, moving into a manageable force with the resource constraints, to effectively carry its mission.”

She spoke of the need to increase the size of the engineering company to battalion level and the size of the reactivated coast guard to half a company.

The Liberian leader then expressed the hope that the AFL will be capable to carry out various missions by 2014 at which time a Liberian could be appointed Chief of staff of the national army. The current Chief of Staff of the AFL is a Nigerian who was appointed about four years ago upon the reactivation of the AFL.

The AFL was dissolved following the conflict because it took sides during the conflict and needed to be restructured.

KENYA: HIV-positive forest evictees struggle to access ARVs

Photo: Manoocher Deghati/IRIN

MAU FOREST, 17 February 2011 (PlusNews) – Wesley Kipkoech*, 21, may be illiterate and speak only his native Ndorobo tongue, but he understands all too well that if he does not have regular access to his HIV medication, he is likely to die.

Kipkoech is one of hundreds of internally displaced people living on the edges of the Mau Forest Complex in Kenya’s Rift Valley Province after the government began evicting them in 2009, in a bid to rehabilitate the forest after decades of farming, charcoal burning and other harmful activities.

An estimated 30,000 people have been affected, according to the UN Office for the Coordination of Humanitarian Affairs.

“I got infected while working at a hotel in Bomet [in the western Rift Valley]. When I discovered my status, I stopped working for fear that my employer and colleagues would find out and shun me as it is common,” he told IRIN/PlusNews.

For the first year following his diagnosis, accessing treatment was easy – all he had to do was visit a nearby public health centre.

“I worked hard on my father’s land in the forest, keeping livestock and growing millet for sale,” he said.

When the evictions began, however, he lost his livestock and his ready-for-harvest millet crop. “I have to struggle very hard every month to raise money for the ARVs [life-prolonging antiretroviral drugs],” he said.

High price for ARVs

It costs Kipkoech KSh300 (US$3.75) to pay for transportation from his home in Tarta Camp to Oloengurone Health Centre and another $0.60 to pay for services at the government-run health facility.

Sometimes I am lucky and get casual jobs… that way I can raise money for transport [to the nearest health centre, 50km away], but when I do not get the jobs, I have to walk

When he cannot raise the money for transport, he has to walk 50km to and from the health centre for treatment.

“Sometimes I am lucky to get casual jobs, either grazing people’s livestock or cultivating farms nearby; that way I can raise money for transport, but when I do not get the jobs, I have to walk,” he said. “Most of the time I have to ask a Good Samaritan for a place to spend a night, so that I can return to the camp the following day.”

Herbal option

Lucy Ngeno* and her husband, both HIV-positive and raising six children aged between one and 14, say they rely on herbal medicines when money is too tight to pay for the 40km ride from their Kapkembu Camp home to the nearest health centre.

The herbs, a concoction of boiled leaves and roots, cost about US$6.50 for a month’s supply. While the cost is similar to what she would spend travelling to the hospital, Ngeno says the herbalist’s medicine has other advantages.

“I can take the concoction on credit, and pay when I get the money,” she said.

Ngeno says another major problem her family faces is the lack of sufficient food. Hunger can be a side-effect of ARV medication, and without food, taking the drugs becomes difficult.

Stigma

“It is like a taboo to talk about one’s status; most HIV-positive people fear victimization,” said Pastor Joseph Maritim, who had to persuade Kipkoech and Ngeno to speak to IRIN/PlusNews, and even then on condition of anonymity.

This secrecy, he says, would make it very difficult for them to access help even if it became available.

Photo: Mercedes Sayagues/PlusNews

Even if help was available, people living with HIV around the Mau Forest would rather suffer in silence than be stigmatised by their community

“I have been trying to convince those who are HIV-positive in my church to form a support group, but some of them have even left church after listening to my proposal,” he added.

According to Kuresoi District medical officer Joan Chepkorir, the health ministry has been trying to eliminate stigma in the Mau Forest Complex.

“Every time we visit there, I try convincing [people] that HIV is a condition like many others, and those who were positive had a right to live just like other people, but they are too conservative,” she said.

Because of stigma and the fact that the evictees came from disparate parts of the forest, it is difficult to estimate the number of HIV-positive evictees. Prevalence in Rift Valley Province is 7 percent, according to government statistics, while the national rate is 7.4 percent.

Transactional sex

“Livestock dealers buy sex for as little as KSh50 [$0.60] due to high poverty levels – they take advantage of even young, desperate female evictees,” said Kapkembu Camp chairman Joel Koech.

What is more, says Koech, condoms are a rare commodity in the area. “Condoms are not available in local kiosks; it is almost a sin to sell them as it is taken as odd by local people. Besides, there is no supply by wholesalers or the government,” he said.

rk/kr/mw

source http://www.irinnews.org

SOUTH AFRICA: HIV patients go missing before treatment

Photo: Mujahid Safodien/PlusNews

JOHANNESBURG, 18 February 2011 (PlusNews) – A study has found that about 55 percent of HIV patients in South Africa who are not eligible for treatment at the time of diagnosis will disappear from clinics within a year of initial monitoring, leaving a serious gap in HIV care and prevention, say researchers.

Most patients in South Africa must have a CD4 count – a measure of the immune system’s strength – of 200 or less to be eligible for antiretrovirals (ARVs), but previous research has shown that about two-thirds of people will not meet ARV treatment criteria at diagnosis.

Published in the 1 March edition of the journal AIDS, the study examined about a year’s worth of CD4 laboratory records for 4,223 HIV patients in South Africa’s KwaZulu-Natal province who were not eligible for ARVs. Conducted by the Africa Centre for Health and Population Studies at South Africa’s University of KwaZulu-Natal, the research found high loss-to-follow-up rates and that patients diagnosed HIV-positive at higher CD4 counts, and who were younger and male, were more likely not to return for CD4 count tests at the recommended six month intervals.

The study also noted that among patients who remained in clinic’s outpatient care, the majority returned only once for CD4 monitoring and that their CD4 counts dropped much more quickly than previous South African research has suggested. CD4 level counts dropped by an average of about nine cells per month. However, patients with higher CD4 counts, who were also less likely to adhere to CD4 monitoring, saw drops as much as twice that.

While the study did not include qualitative data on patients’ reasons for discontinuing care, lead author Richard Lessells said the limited medical services available to pre-ARV patients may be partly to blame.

While patients like these can access drugs such as bactrim and co-trimoxazole for opportunistic infections, Lessells said that if patients are sick enough for these drugs, they are usually sick enough to qualify for ARVs.

“As a doctor the most frustrating thing is seeing a patient return with opportunistic infections and finding out that they were diagnosed two years previously with a CD4 count of 300 but had been lost to the system. Now they are presenting sick and require hospital care,” he told IRIN/PlusNews. “It’s frustrating to know that, in theory, this is preventable.”

For Lessells, the study highlights a patient population that has been sidelined in the rush to get those who are eligible on ARVs.

“These patients certainly aren’t the priority,” he told IRIN/PlusNews. “The clinics are already overcapacity just dealing with patients ARVs so there’s very little scope or time even for people who are not in that category.”

Neglected but important

With priorities elsewhere, he added that most programmes and the South African Department of Health do not collect data on pre-ARV patients or their access to care, but that these patients represent a key entry point for initiatives looking to reduce AIDS-related mortality and new HIV infections.

With an estimated HIV prevalence of about 18 percent, South Africa currently runs the world’s largest ARV programme with more than one million patients on treatment. In an effort to get more patients on treatment earlier and bolster behavior change, the government is in the midst of a national campaign to voluntarily test 15 million South Africans for HIV by April 2011.

But Lessells cautioned that the high loss-to-follow up of pre-ARV patients jeopardizes these goals.

“The whole point of this testing campaign is to try and get as many people to know their status as possible, based on the assumption that people will change their behaviour, but we need to make sure that there are programmes supporting people, and giving them appropriate care and education about prevention,” he said. “There’s a lot of literature out there about the integration of HIV care and prevention, but at a practical level, this isn’t happening.”

Research needed to inform programme design

While a smaller, Johannesburg-based study published last year in the journal of Tropical Medicine and International Health confirmed high pre-ARV loss-to-follow-up, Lessells said more research was needed into this group, including what programmes could provide in terms of incentives.

And figuring out what keeps pre-ARV patients away, may mean rethinking programmes.

“[Researchers, programme managers] are always looking at what it is about the patients that makes them not come back; there’s always this sense that the patient is to blame,” he told IRIN/PlusNews. “We need to get over that and start thinking what it is about our programmes that are not encouraging people to stay.”

While many studies have shown that the farther patients must travel to a clinic, the less likely they are to return, Lessells’ study found that retention was low despite the fact that about 90 percent of the study population lived within 5km of the nearest clinic.

As government continues to push for the roll-out of isoniazid preventative (IPT) tuberculosis therapy among all HIV patients, Lessells said he hoped research was being undertaken to ascertain whether the addition of this service would provide the kind of incentive needed to retain patients or whether the added stress on clinics and pharmacies would become yet another disincentive to staying in care.

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source http://www.irinnews.org

RWANDA: Bloodless male circumcision to boost HIV prevention

Photo: Charles Akena/IRIN

NAIROBI, 15 February 2011 (PlusNews) – The Rwandan government plans to expand its national voluntary male circumcision programme using a new device, the PrePex system, which officials say saves both time and money.

The PrePex system works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a week. A study conducted by the Rwandan Ministries of Defence and Health in 2010 found the device to be safe and effective.

“You don’t need a sterile environment, you don’t need anaesthetic, you don’t need to use an operating theatre,” Agnes Binagwaho, permanent secretary in Rwanda’s Ministry of Health, told IRIN/PlusNews. “It does not need highly trained medical personnel, and can be conducted in a clean consultation room with a bed.

“In Africa, where we lack medical infrastructure, we feel it is the best way to go,” she added.

Although cost-effectiveness studies are still under way, Binagwaho said the elimination of factors such as anaesthetic and highly trained staff as well as the gains made by the shorter healing time meant it was likely that the PrePex system would be cheaper than traditional clinical male circumcision.

“Three or four hours after circumcision, a man can be back at work,” she said. “This means that the economy does not suffer because men have taken several days off work to heal.”

She noted that while the UN World Health Organization (WHO) had not approved any device for adult male circumcision, the PrePex system is approved by the European Union.

“We are still waiting to see the data showing the efficacy, safety and acceptability of the device,” Tim Farley, a scientist with the WHO’s Department of Reproductive Health and Research, told IRIN/PlusNews. “If the promise of the device is borne out by the data, we would be very keen to approve it.”

Rwanda’s HIV prevention strategy includes a plan to circumcise an estimated two million adult men within two years; only 15 percent of Rwandan men are circumcised, according to the government.

The PrePex device is a game-changing innovation… a non-surgical technique with no local anaesthesia will make this technology accessible and scalable

“The PrePex device is a game-changing innovation… the evidence from the study is very compelling – a non-surgical technique with no local anaesthesia will make this technology accessible and scalable,” Steven Kaplan, a urologist New York’s Cornell University and co-investigator of a current PrePex study in Rwanda, said in a press release.

WHO and UNAIDS recommend the inclusion of voluntary medical male circumcision in HIV prevention programmes, alongside counselling and testing, promotion of safer sex, treatment of sexually transmitted infections and condom use.

While surgical male circumcision remains the preferred method of most national male circumcision programmes in sub-Saharan Africa, a few countries – including Kenya and South Africa – have piloted the use of different clamps for adult male circumcision.

According to WHO’s Farley, the body has approved the use of three different devices – the Mogen clamp, the Gomco clamp and the Plastibell – but only for infant circumcision.

kr/mw

source http://www.irinnews.org