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Archive for February 17th, 2012

About 6 percent of Kenyan couples are HIV-discordant

Posted by African Press International on February 17, 2012

KENYA: Discordance strains commitment

Photo: IRIN
About 6 percent of Kenyan couples are HIV-discordant

NAIROBI,  – When they first got married six years ago, Mary and William Simiyu were a typical newly-wed couple – full of love and hope about their future together. Three years into their marriage Mary fell sick and they reluctantly agreed to get tested for HIV. Her result was HIV positive but her husband’s wasn’t. Suddenly, they had become discordant.

“There and then I decided I wasn’t going to stay with her because I wouldn’t risk my life staying with somebody who is HIV positive while I was not. I wanted her to go so that I could look for another woman. The counsellor told us we could just stay together normally, but that wasn’t going to change my mind,” William told IRIN/PlusNews.

Mary said her husband couldn’t share anything with her, including their bed, and when he disclosed her positive status to his mother, pressure mounted on him to send her away.

“He didn’t want to see me and he insisted that all along I knew my HIV status and I wanted to infect him,” she said.

After being counselled by community health workers and the church pastor, the couple agreed to stay together, but both said that at times it is difficult.

“At one time we love each other, but… when it dawns on me that she is positive, I feel like marrying another woman so that I can have a normal marriage, one where I won’t have to use a condom like a youth. I sit back look at our two children and I decide we are in this together… better the devil you know than an angel you do not know,” William said.

His desire to have more children also adds to the tension. “At times I tell myself that two children are not enough and I want more. I don’t want more with her because I fear sex without a condom. This at times pushes me to try and look for another woman,” he admitted.

Experts say the desire to have children could be fuelling the spread of HIV in marriages. “Many people still view children as the epitome of a successful and fulfilling marriage,” noted Lucy Waweru, a psychology lecturer at the University of Nairobi.

''At one time we love each other but … when it dawns on me that she is positive, I feel like marrying another woman so that I can have a normal marriage''

“This phenomenon, while not bad in itself, is pushing many couples, even those that are discordant, to engage in sex without condoms, and it means that the negative partner might sero-convert at some point.”

An estimated 6 percent of Kenyan couples – about 344,000 – are HIV discordant, while a further 22 percent of couples know the HIV status of their sexual partners. Although Kenya has national guidelines for promoting prevention among people living with HIV, implementing them has proved to be a challenge.

Dr Charles Okal, the AIDS and Sexually Transmitted Diseases (STD) Coordinator for Nyanza Province says providing services for discordant couples is made difficult by the fact that testing is the only way to find them, yet couples rarely turn out for testing together.

According to the Kenya AIDS Strategic Plan 2009/13, the higher level of HIV testing amongst women (43 percent) compared to men (25 percent) is mainly due to antenatal testing and the uptake of prevention of mother-to-child transmission programmes.

“We are constantly passing the message forward that couples should be tested together so that those that are discordant can be singled out and ways to stop the infection of the negative partner are put in place,” Okal told IRIN/PlusNews.

“Otherwise, marriages continue to be at high risk because people do not know the status of their partners, and at the same time it is in these unions where condom use is lowest.”

The Kenya AIDS Indicator Survey 2007 notes that 45 percent of all new HIV infections occur in marriages, but the fear of disclosure remains a major problem. “Even those partners who already know their status would rather keep quiet about it because they don’t know how the other partner will react on knowing their sero-positive status,” Okal said.

”If it is a woman, there could be violence or her being sent away by the husband,” he noted. “That could be the moment love ceases to exist for many couples.”


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Deaths due to lack of healthcare worrying

Posted by African Press International on February 17, 2012

MYANMAR-THAILAND: Dying for lack of reproductive healthcare

Disadvantaged at birth

BANGKOK,  – Lack of access to reproductive health services in Myanmar has led to high rates of maternal deaths and unplanned pregnancies among the country’s displaced, migrant and refugee populations, say health experts.

“There are huge unmet reproductive health needs for contraceptives, family planning, and access to skilled birth attendants,” said Priya Marwah, the UN Population Fund’s (UNFPA) humanitarian response coordinator for the Asia Pacific region.

Populations that are on the run or outside their home countries are often unable to gain access to reproductive healthcare, say health workers.

Without skilled birth attendants or contraception, complications from unsafe abortions and post-partum haemorrhage are common along the Thai-Burmese border, where there are more than 150,000 Burmese refugees, according to a new report by the international NGO, Ibis Reproductive Health.

“In Burma, the sad state of reproductive health… [bars] far too many, especially mobile populations, including migrants, refugees, and IDPs, from accessing appropriate, timely, and basic health services,” Vit Suwanvanichkij, a research associate at the US-based Johns Hopkins Bloomberg School of Public Health, told IRIN.

Nationwide, only 37 percent of women gave birth with a trained birth attendant in 2007, according to the most recent government data reported to the World Health Organization (WHO).

Health displaced

Displaced people in Myanmar’s east face “a health disaster”, with a maternal mortality rate (MMR) of 721 deaths per 100,000 live births – three times the national average of 240, according to a 2010 NGO-collaborative report, Diagnosis Critical.

Some 10 percent of Myanmar’s national MMR has been traced to unsafe abortions.

“A lack of safe, legal abortion creates conditions where women in both eastern Burma and Thailand are likely to either self-abort or engage untrained providers who may use methods likely to cause harm or even death,” said Cari Siestra, co-author of Ibis Reproductive Health’s recent report.

The lack of health infrastructure in eastern Myanmar has led to frequent reproductive complications from preventable illnesses, such as malaria, which is “the number-one killer of pregnant women”, said Suwanvanichkij.

“Malnutrition, malaria, and repeat pregnancies without adequate birth spacing all impact [on] women’s ability to carry pregnancies, even wanted ones, to term,” added Sietstra.

Overall health challenges include a shortage of workers, investment and proper infrastructure, San San Myint, a national technical officer and reproductive health specialist at the WHO country office in Myanmar, told IRIN.

“Reproductive health coverage is [available in fewer than] 150 townships out of 325 townships. The main problem is funding and geographical barriers.”


Reproductive health improves for refugees on the Thai side of the border, who have better access to trained providers, according to Sietstra.

But Thailand’s estimated two million Burmese migrant workers, are often reluctant to seek medical assistance.

“Undocumented Burmese migrants are hesitant to access services because of their immigration status,” said Jaime Calderon, the Southeast Asia regional health migration adviser at the International Organization for Migration office in Bangkok.

This is compounded by providers’ discriminatory policies, language constraints and inability to pay, say health workers along the border.

“Put this awful constellation of vulnerabilities together and the result is that far too many women again are sickened, disabled, or die from preventable causes, such as complications of pregnancy and abortions,” said Suwanvanichkij.

While Myanmar’s recent political reforms have the potential to translate into better care if there is long-term investment in the health system, “we still need to address the immediate needs of people urgently”, said Taweesap Sirapapasiri, UNFPA’s programme officer for Thailand.


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Sex workers in Bangladesh

Posted by African Press International on February 17, 2012

ASIA: Breaking down legal barriers to HIV information access

Sex workers in Bangladesh

BANGKOK,  – While a number of Asian and Pacific countries are addressing legal barriers to accessing HIV information and treatment, there is still a gap between policy and implementation, say officials.

“No matter how good our laws are, the effectiveness of them is in the will of those implementing them,” said Fiji’s President Ratu Epeli Nailatikau at a recent UN-convened meeting in Bangkok on addressing legal barriers to HIV care and prevention.

Almost all countries in the region still have at least one “punitive law” – a policy or practice that impedes access to HIV services – according to a recent report from UN Joint Programme on HIV/AIDS (UNAIDS).

Laws that criminalize same-sex relations and sex work or restrict travel for HIV-positive people make it difficult to provide information and care for people most at risk of HIV infection, officials say.

Progress to scrap such laws has been mixed in the region – even within one country.

Fiji, for example, eliminated laws restricting travel of people infected with HIV in 2011 and became the first country in the Pacific region to decriminalize sex between men in 2010.

But at the same time, in February 2010, prostitution was criminalized, giving police the right to arrest and charge people who operate as sex workers.

The government is now reviewing HIV legislation and punitive laws.

Elsewhere in the region, the national AIDS programme manager of Myanmar’s Health Ministry, Khin Ohnmar San, told IRIN Burmese police forces had been informed of a 2007 order that “condoms must not be used as material witness to arrest sex workers”.

But that has done little to assuage sex workers’ fears in Myanmar, said Kay Thi Win, programme manager with a Yangon-based NGO that informs sex workers about HIV prevention and their legal rights.

Many sex workers “are still afraid to carry condoms because of the police”, she added.

Andrew Hunter, president of the Bangkok-based Asia Pacific Network of Sex Workers (APNSW) said regionally, women are still arrested on the suspicion of working in the sex industry, which is outlawed, if they are carrying condoms.

“Everyone pleads guilty because experience shows that fighting cases in court leads to longer jail sentences.”

APNSW provides support to sex workers in 22 countries in the region.

Hunter added: “There is a scale of what sex worker advocates can do across the Asia Pacific, from Myanmar, where advocacy must be done quietly and behind the scenes, to India where sex workers are able to take to the streets to protest.”

In India, which accounts for almost half of those infected with HIV in the region, there are efforts to update police officers about HIV prevention and all policies regarding treatment, said Tejdeep Kaur Menon, a director-general of police forces in the city of Hyderabad in the country’s southeast.

Home to 60 percent of the world’s population, the regional death toll from AIDS in 2010 (some 310,000 people) is second only to that of sub-Saharan Africa.


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