Kaisernetwork.org (Washington, DC)
13 November 2008
Global Challenges
Increasing Number of Countries Criminalizing HIV Transmission
[Nov 13, 2008]
Some health officials are concerned that a growing trend to criminalize the transmission of HIV will undercut gains made in the fight against the virus worldwide, the AP/Yahoo! News reports. According to a recently released report from the International Planned Parenthood Federation, 33 countries are considering legislation that would prosecute people who transmit the virus, and 58 countries already have similar laws or use existing laws to prosecute HIV transmission. Paul de Lay of UNAIDS said he is concerned that such laws, if "applied badly," could lead to policies that force people to undergo HIV testing or cause people to hide their HIV status. He added that this could move the epidemic underground, allow the virus to spread undetected and "set us back and do incredible damage."
According to the AP/Yahoo! News, seven West African countries have passed such laws since 2005. The West African laws vary in extremity -- just exposing a person to HIV, regardless of if the virus is transmitted, is a crime in Benin, and Tanzanian law carries a possible sentence of life in prison for intentional transmission -- according to the AP/Yahoo! News.
Although some critics argue that laws criminalizing the spread of HIV are necessary for individuals who are "maliciously" spreading the virus, the AP/Yahoo! News reports that many experts argue those are extreme cases. Osborne said, "The criminal law is a blunt instrument. If you put everyone in prison with HIV, then you think you've controlled it. But you haven't dealt with the issues around the intimate behaviors that spread HIV."
According to the AP/Yahoo! News, 32 states in the U.S. have laws that make HIV transmission a crime, and experts approximate that thousands of people throughout the country have been charged with spreading the virus. In addition, 16 people in the United Kingdom since 2001 have been prosecuted for HIV transmission, and a Canadian woman in 2005 was charged with criminal negligence and aggravated assault for transmitting HIV to her infant while pregnant. Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, said criminalizing HIV transmission in wealthy nations like Canada, the United Kingdom and the U.S. "sets a poor example," allowing other countries to "think this is an appropriate or desirable way to deal with HIV" (Cheng, AP/Yahoo! News, 11/13).
The IPPF report is available online (.pdf).
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Global Funding 'Vital' For Preventing Millions of AIDS-Related Deaths, Piot Says
[Nov 13, 2008]
Millions of HIV-positive people in the world's poorest countries, particularly in Africa and Asia, will die if donors worldwide downsize funding because of the global financial crisis, UNAIDS Executive Director Peter Piot said on Wednesday, Reuters reports. "If we interrupt (funding) even for six months or a year, it will result in millions of deaths," Piot said, adding, "If we interrupt these activities, we will have to pay later as more people will become infected." Experts and major donors supporting global HIV/AIDS initiatives have warned that amid the current global financial difficulty, rich countries might cut back on their aid to developing countries. According to Piot, this funding is "absolutely vital for the survival of millions of people in the poorest countries" (Majumdar, Reuters, 11/12).
In related news, Piot on Thursday said that India must address the recent increase in injection drug users in the country to help prevent the spread of HIV, Reuters reports. "If we don't prevent new infections in new emerging populations like [IDUs], it can go up as bushfires," Piot said, adding, "We may see a major surge in infections." He also said he is concerned about the spread of drugs in the country. "Drug use is moving a bit everywhere, we can see it in Bihar (Uttar Pradesh) and in Kashmir, it is kind of moving across the northern part of the country," Piot said. He added, "I was really shocked to hear what was going on."
About 200,000 IDUs are reported in India, with many IDUs living in remote areas of the northeast region. According to Reuters, official figures show that more than 10% of India's IDUs are HIV-positive (Majumdar, Reuters, 11/13).
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Britons in 30s, 40s Use Condoms Less Frequently Than Teenagers, Study Finds
[Nov 13, 2008]
People in their 30s and 40s living in the United Kingdom are half as likely as teenagers to use a condom when having sex with a new partner, according to a study published recently in the International Journal of Epidemiology, London's Daily Telegraph reports. The study found that nearly 70% of those between ages 16 and 19 used a condom with a new partner, compared with 38% of men and 29% of women between ages 35 and 44 (Gammell, Daily Telegraph, 11/12). The new information follows an announcement from the United Kingdom's Health Protection Agency that rates of sexually transmitted infections such as HIV are on the rise in the country, with a 6% increase in the total number of new STIs diagnosed in 2007 compared with 2006 (BBC News, 11/12).
The study, led by Catherine Mercer of the Centre for Sexual Health and HIV Research at University College London, looked at the heterosexual relationships of 11,161 people (O'Brien, PA/The London Paper, 11/12). The data showed that although the overall number of heterosexual people using condoms during a first sexual encounter stood at 55%, that figure declines with age (Daily Telegraph, 11/12). Mercer said that because interventions promoting consistent condom use with new partners traditionally are targeted at younger people, such efforts are "urgently required" for those in their 30s and older. She said, "I definitely think older people need to be encouraged to use condoms a lot more when they start new partnerships," adding, "We didn't ask people why they didn't use condoms, but maybe it's complacency or denial something will happen to them." Mercer said that while other forms of contraception may have been used among the age group, they were unlikely to protect against STIs at the start of a relationship.
According to Mercer, a significant concern stemming from the research is the effect of the growing number of divorces on the sexual health of older people. She said, "Although a disproportionate amount of partnerships are formed among people in their teens and 20s, the fact is that about 45% of marriages are now expected to end in divorce, which means that the 'population attributable risk' of partnership formation by those in their 30s and 40s will increase" (PA/The London Paper, 11/12).
Julie Bentley, chief executive of the Family Planning Association, said, "This research shows that no matter what age you are, or what type of relationship you are in, sexual health messages still apply." Lisa Power of the Terrence Higgins Trust said, "STIs are no respecter of age and although most media portrayals of sexual relationships involve young people, these figures show that it's important to support people to have a healthy sex life at every age" (BBC News, 11/12).
The study is available online (.pdf).
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Malawi Expands National HIV Testing Campaign to Prison System
[Nov 13, 2008]
Malawi plans to expand its national HIV testing campaign to include the country's prison system following several reports that more HIV-positive inmates are dying compared with HIV-negative inmates, the Nyasa Times reports. The announcement was made by Mary Shawa, principal secretary for nutrition and HIV/AIDS in the Office of the President and Cabinet, who also said that district health centers and prisons have been linked so that HIV/AIDS treatment can be accessed by inmates who test positive for the virus.
According to the Times, human rights reports also have indicated that inmates living with HIV/AIDS are vulnerable because there is no special diet available for those on antiretroviral drugs. Charles Kasambara, executive director of the Centre for Legal Assistance, said the conditions of Malawi prisons are "extremely bad" and in need of "government's intervention." Prison inmates often receive one meal daily, according to Kasambara.
Malawi's HIV/AIDS prevalence is about 12%, with approximately 85,000 people dying from AIDS-related illnesses annually, according to the Times. The national HIV testing campaign this year is targeting 250,000 people, and the country recently received a $20 million grant from the Global Fund To Fight AIDS, Tuberculosis and Malaria to increase its HIV/AIDS treatment efforts by purchasing more antiretroviral drugs and HIV testing kits (Moyo, Nyasa Times, 11/12).
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High Rate of IDUs in Pakistan Living With HIV/AIDS, Official Says
[Nov 13, 2008]
Approximately 30% of Pakistan's injection drug users are living with HIV/AIDS, Arshad Altaf -- senior provincial surveillance support officer with an HIV/AIDS surveillance program called the Sindh AIDS Control Program that is managed jointly by Canada and Pakistan -- said on Wednesday at the International Symposium on Tropical Medicine and Hygiene, Pakistan's Daily Times reports. According to the Times, 7.5% of IDUs living with HIV/AIDS in Pakistan are male commercial sex workers and 3% are transgender sex workers.
Altaf also said the rapid increase in Pakistan's population is a major factor in the spread of HIV in the country, adding, "Unless reasonable efforts are made to contain the disease, it may infect the general population in the near future." Arif Hassan, a consultant at the Urban Resource Center, said the "lack of resources and education, coupled with the utter disregard for social and environmental conditions in poor settlements, has led to congestion in the city." He also said that this is "aggravating" the spread of HIV/AIDS and "harming the mental and physical health of the citizens." The symposium is scheduled to continue through Thursday and also will focus on tuberculosis and hepatitis C in Pakistan (Daily Times, 11/12).
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Burundi's Food Shortages Create Challenges for People Living With HIV/AIDS
[Nov 13, 2008]
People living with HIV/AIDS in Burundi often face the additional challenge of fighting the disease without proper nutrition because of a widespread food shortage in the country, IRIN/PlusNews reports.
Jean Rirangira, interim executive secretary of the national AIDS Control Council, said, "When assessing the needs of people living with HIV in the country, we find that food is an enormous problem." The United Nations World Food Programme reports that 19% of Burundi's population has food security, and rising food prices in addition to low levels of food production leave as many as 46% of residents malnourished, IRIN/Plus News reports.
Although WFP in 2008 reversed a 2006 decision to cut special HIV/AIDS food programs, non-governmental organizations are calling for increased funding for HIV-positive people and their families. Jeanne Gapiya -- founder of the Association Nationale de Soutien Aux Seropositifs et Sideens, which provides support to 3,200 Burundi families -- said, "At our center, we try to provide support to the entire family, because the person with HIV is not the only one facing food shortages. If it is an HIV-positive woman, she will usually feed her children first and remain with nothing herself." According to Gapiya, her organization, WFP and the government are in talks to develop methods of providing more food to families affected by HIV.
The Global Fund To Fight AIDS, Tuberculosis and Malaria recently approved Burundi's proposal for $150 million in funding. According to Rirangira, people living with HIV/AIDS and others affected by the disease -- including orphans and vulnerable children -- will be a priority for the country (IRIN/Plus News, 11/11).
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