Asia
1.[India] Hope reigns in Manipur
12/09/08 by Tehelka
Wives of intravenous drug users in Manipur, bearing the brunt of the AIDS epidemic, give succor to one another, writes TERESA REHMAN
2.[Indonesia] NGOs in Bali no longer distribute needles
17/09/08 by PlusNews
Needle exchange programmes have reduced the risky practice of needle sharing
3.[Thailand] Thai prison successfully treats 110 tuberculosis patients, challenges remain
26/09/08 by news-medical.net
A prison clinic in Thailand's Nong Khai province successfully has treated 110 inmates with tuberculosis following a six-month treatment course, but the disease remains a serious health challenge in prisons throughout Thailand, the Bangkok Post reports.
4.[Vietnam] HCMC to expand voluntary drug rehab programs
11/08/09 by Minh Nam      
Ho Chi Minh City is considering allowing two additional rehabilitation centers to receive voluntary patients who are willing to pay for treatment, the administration said at a meeting Tuesday.
Outside Asia
5.[Russia] Why Russia Says No To Methadone?
22/09/08 by sarosip
The HCLU video advocacy team attended the Second Eastern Europe and Central Asia AIDS Conference (EECAAC) in Moscow, 3-5 May, 2008.
6.[USA] Puerto Rico's Other Half
18/09/08 by The Body
Harm Reduction Advocates Struggle to Reach Drug Users, Who Account for Half of PR's Yearly HIV Infections
7.[USA] Despite New Law, HIVers Are Still Barred From Visiting, Immigrating to the U.S.
22/09/08 by U.S. News
House Democrats Send Letter to President Bush Urging "Swift Action" on Reversal of Rule Banning HIV-Positive Foreigners From Entering U.S.
8.[AFR] Nigeria arranges 'HIV marriages'
04/09/08 by Map of Nigeria
HIV-positive couples are being paired up for marriage by a northern Nigerian state in an attempt to reduce the spread of the disease.

Asia
1.[India] Hope reigns in Manipur
12/09/08 by Tehelka
Lucy Khumlo, 32, symbolises the brave new face of HIV-AIDS in Manipur. Spouse of an Intravenous Drug User (IDU) and HIV positive herself, Lucy and many of her ilk have decided to go public about their status and create awareness on how married women in monogamous relationships are the new visage of the epidemic.

She still recalls the day when she decided that she had had enough. Attired in her Sunday best, she had gone to the village church with her three kids. It was the first time she had come out after her husband died of AIDS in 2003. It was a revolting experience for her when she heard her neighbours pass snide remarks and was left to sit all alone on the bench in her village church.

Life was difficult for the young HIV-positive widow from Manipur's remote Chandel district. Lucy had acquired the virus from her spouse, who was an IDU. She had already been going through the taunts of her in-laws after her husband died. It only became worse after she disclosed her HIV status. They blamed her for infecting their son. Lucy was a student of class ten and only 18 when she got married. It was a love marriage. Only later did she get to know that her husband was an IDU. Her 11-year-old daughter, HIV-positive and shunned by her friends when she went out to play with them added to her agony.

It was then Lucy came in touch with the women's wing of the Imphal-based Manipur Network of Positive People (MNP+). She started working for MNP+ as a peer educator and is now the Vice-President of Chandel Network of Positive People. "I decided to go public about my status and educate other women like me. I am very happy now as I feel I am doing something meaningful," she says putting up a brave front.

This increasing 'feminisation of the epidemic' was also highlighted at a series of collaborative meetings between representatives of Kenya, Mexico and India organised by International Women's Media Foundation (IWMF), the Centre for Development and Population Activities (CEDPA) and The Center for Women Policy Studies (CWPS) held in Washington DC in June this year.

Lucy is now an active member of MNP+, set up in 1997 by five IDUs and initiated as a self-help group where they can share their problems. The main source of AIDS in Manipur had been the IDUs and their 'needle-sharing' practice. This is due to the easy availability of drugs as Manipur happens to be the transit route for narcotic drugs like heroin and marijuana because of its close proximity to the "Golden Triangle", that is, Thailand, Laos and Myanmar. IDUs kicked off a fashion among the unemployed youths in this insurgency-ravaged state.

In fact, out of the 8 million IDUs in the world, as many as 20,000 are in Manipur and these drug users transmit the virus to their partners through sexual intercourse. The NACO's sentient surveillance data, which is considered more scientific, estimates that HIV infection in antenatal women (placed in Group 1, the highest risk category of HIV prevalence) crossed 3% in Manipur.
According to the latest epidemiological survey by the Manipur State AIDS Control Society (September 1986 to April 2003), 15,166 out of a total of 95,734 blood samples screened were HIV-positive. In a state which has an area of 22,327 sq km and a population of around 2.3 million (2001 census), this is the highest concentration of HIV/AIDS infection in India.

And the new face of HIV/AIDS in Manipur are the spouses of IDUs, most of them widows. And they have taken up advocacy roles to generate awareness about the stigma and discrimination which confronts HIV-AIDS today. Udita Salam, general secretary of MNP+, also an IDU spouse argues, "Women are always at the receiving end. Being an IDU spouse adds to the stigma."

Udita explains that it invariably happens that men, when they are sick get all the attention, care and nutrition. And after the husband dies, the wife is blamed for the husband's HIV status. She is driven out by her in-laws, forfeiting her property rights in the process. And if he happens to fall sick, there's nobody to take care of her.

The spouses of IDUs, HIV positive themselves and left with nothing, have been empowered by MNP+. Most of them are young widows in the age group of 16 to 25 years. Since the first HIV case, which was reported in Manipur in 1992, most husbands have died and later widows have tested positive. Of the 1600 members of MNP+, over 700 are women. Nearly 98 percent of them got it from their husbands.

"Most of the time these women are ignorant of the husband's IDU status. It invariably happens that these spoilt men are married off by their family members so that they become responsible householders. The women later end up being homeless as they do not get property rights. There are no caregivers for women," adds Udita.

Udita, 40, a graduate from Imphal got married to an IDU in 1989. "He was very handsome. I thought I could change his behaviour and his life but post marriage, this seemed a tall order. When my son died in 1997 at three and half months, my positive status was confirmed. It was then that my husband told me that he was HIV positive," she says.

She then got in touch with MNP+. "My husband was already a member. I worked as field worker, counselor and an executive board member. I am good at counseling and negotiating. I do not face discrimination because my husband is still alive," she quips.

But it was not all that easy for Pramo Ningombam, 42, from Thoubal district of Manipur. Also an IDU spouse, her husband died in 1998. She was confirmed HIV positive in 1995 when her six year-old son died after testing positive. "It was then that I tested positive. I was pregnant at that time. There was no counseling. I knew I would die soon. The doctor advised me to go for hospital delivery. The nurses did not want to draw blood or provide nursing care," she remembers. During the delivery of her child, the nurses did not want to touch her. She had to wash herself clean all on her own.

As a widow, she had to face the same stigma and discrimination. She came in contact with MNP+ in 2004, first worked as a peer educator in Thoubal district by setting up a self-help group in 2006, worked as a counselor for a drop-in centre for care and support of PLHA (People Living With HIV /AIDS) and is now working as a project coordinator with MNP+. Her only dream remains to carve out a good life for her school-going 13-year-old daughter, fortunately untouched by the virus.

This group of bold women at MNP+ has set an example of endurance. Sitting quietly in a corner is 32-year-old Roshni Nongmeithem, busy making red ribbon badges. She seems resigned to her fate. Also an IDU spouse, her husband died in 2006. But, fortunately she has an understanding mother-in-law who has accepted her despite being infected with the virus.

Perhaps, the most inspiring of the whole lot of valiant women is Anita Sougaijam, also an IDU spouse but HIV negative herself. She says, "I was associated with MNP+ since the very beginning when my husband was alive. We encourage the women to come out. Though I am negative, I think I am positive as I have a positive outlook."
http://www.tehelka.com/story_main40.asp?filename=Ws200908hope_reigns.asp

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2.[Indonesia] NGOs in Bali no longer distribute needles
17/09/08 by PlusNews
Indonesia's Bali Province is phasing out the role of local HIV/AIDS non-governmental organisations (NGOs) in distributing needles and syringes to injecting drug users (IDUs). The move is mainly in response to a recent revision of the country's narcotics legislation, which designates state health workers as the only people allowed to distribute syringes and needles to drug users.

Previously, NGO outreach workers were responsible for distributing needles directly to IDUs living in communities participating in a government-sponsored Needle Exchange Programme (NEP). The NEP forms part of Indonesia's harm-reduction strategy, which is being implemented with the assistance of various international donors and has played a crucial role in lowering the number of IDUs sharing needles. The primary mode of HIV transmission in Bali, as in the rest of the country, isinjecting drug use: of the roughly 250,000 people estimated to be living with HIV in Indonesia, 46 percent are thought to be IDUs.

But harm reduction strategies - clean needles and methadone substitution programmes - have been a difficult political sell in a Muslim country in which the police have viewed the NEP with suspicion,  preferring to lock-up addicts. Dewa Nyoman Wirawan, an HIV activist with the Kerti Praja Foundation, a community-based organisation in Denpasar, the provincial capital, said state health workers began taking over needle distribution in August 2008.

"The needles that were previously placed in NGO offices are now placed in health centres. NGOs are still going to the field and reaching out to IDUs, but under the instruction of health workers," Wirawan told IRIN/PlusNews. He explained that shifting responsibility to the government would help ensure the programme's sustainability. AusAID, the Australian government's aid organisation and primary donor to the island's HIV/AIDS NGOs, has supported the switch, saying that it may not be able to fund Bali's NEP indefinitely.

IDUs must now make regular visits to their nearest community health centres to get free needles and syringes, but NGOs have agreed to conduct a six-month campaign to introduce the new distribution plan. "The IDUs are still reluctant to go to the health centres," Wirawan said. Drug users have been criminalised by the state, and some NGOs worry that they will shy away from going to state-run institutions, or be put off by the hours that the health centres stay open. "It's a process; hopefully, in the next five years the drug users will be more self-reliant and disciplined."

Bali Island, Indonesia's most popular tourist destination, has the fifth highest prevalence of HIV among the country's 33 provinces, and is where Indonesia's first HIV case was found in 1987. In a population of 3.4 million people there were 1,836 reported cases of HIV at the end of 2007, which had risen to 2,112 by May 2008. The number of new infections among IDUs is still increasing, Wirawan said, but recent research had found the number of cases resulting from sexual intercourse was also "soaring". "It's like we're covering a leak, but there's always another leak."

Wirawan said new strategies were needed to increase voluntary HIV counselling and testing, and condom use. "Instead of arresting the pimps, perhaps we should ask them to cooperate in promoting condom use, but the issues related to prostitution always spark protest from society."
http://www.irinnews.org/report.aspx?ReportID=80440

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3.[Thailand] Thai prison successfully treats 110 tuberculosis patients, challenges remain
26/09/08 by news-medical.net
According to the Post, more than 1,557 inmates in Thailand have TB, one-third of whom also are HIV-positive. In addition, there are between six and 10 cases of multi-drug resistant TB for every 100,000 inmates, compared with 1.6 cases per 100,000 people in the general population, the Post reports. The increased prevalence of MDR-TB in prisons likely is the result of overcrowding and inconsistent treatment, according to the Post.
Surasak Kosupat, a physician responsible for TB control in Nong Khai, said provincial health authorities worked with Thailand's Department of Corrections to control the spread of TB among inmates using an integrated approach that includes biweekly TB screening, assessment of inmates' medical history and DOTS. Surasak added that prisoners with TB also stay in ventilated cells for two months to prevent transmission of the disease. In addition, health workers encourage group discussions between inmates with TB and those without the disease to promote education about TB and how it spreads. "Even though they are prisoners, we have to ensure that they can stay healthy and are able to work like anyone else when they return to society," Surasak said.
According to the Post, Thailand ranks 18th on the World Health Organization's list of countries with the highest TB burdens worldwide. Of the 91,000 new TB cases reported annually in Thailand, 40,000 are active TB cases. In addition, the country diagnoses and treats successfully 72% of TB cases each year, below the WHO target of 80%, the Post reports (Apiradee, Bangkok Post, 8/24).
http://www.news-medical.net/?id=40927

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4.[Vietnam] HCMC to expand voluntary drug rehab programs
11/08/09 by Minh Nam      
Nguyen Thanh Tai, vice chairman of HCMC People’s Committee, told the city’s legislative office at the meeting to set the fees for addicts. Once the authorization is given, these rehab centers under the management of the HCMC Volunteer Youth Force and the Department of Labor, War Invalids and Social Affairs will become the city’s second and third centers to admit voluntary patients and charge fees for services.

The first of its kind, Nhi Xuan Rehabilitation Center managed by the city’s Volunteer Youth Force, is already operating the program. Drug users who voluntarily enter rehab are not penalized and their addictions are not documented in criminal records, said Hoang Thi Diem Trang from the Volunteer Youth Force. “Such regulations will encourage addicts to complete rehab programs and not feel ostracized when reintegrating into the community.”

Trang said the Nhi Xuan Center received 382 voluntary check-ins from January 1 to June 30 this year, most of whom range from 18-30 years of age with 70 percent undergoing detoxification for the first time. According to the city’s Volunteer Youth Force, around 60 percent of the city’s rehabilitants didn’t return to complete their rehab when permitted to go home on special authorized leaves.

Vice Chairman Tai also asked the Volunteer Youth Force to cooperate with district authorities to enhance security at all rehab centers in HCMC to minimize cases of drugs being smuggled into the centers. In the first six months of this year, more than 100 rehab centers nationwide provided treatment to 27,740 drug addicts. The government has set a target to cure 80 percent of drug addicts by 2010.
http://www.thanhniennews.com/healthy/?catid=8&newsid=41911

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Outside Asia
5.[Russia] Why Russia Says No To Methadone?
22/09/08 by sarosip
Our main priority was to interview narcologists (addiction specialist doctors) and create a short advocacy movie on the lack of methadone substitution treatment in Russia. We believe that it is one of the biggest scandal of the world of drug treatment that substituion treatment is banned in a country with 1,5 million people living with HIV – the majority of them infected through the sharing of injecting equipment. Methadone substitution treatment is one of the best available tools of HIV prevention among injecting drug users according to all relevant international organizations (e.g. WHO, UNODC, UNAIDS), the scientific literature proving its positive impacts on public health and security can fill a whole library: it improves the health and social well-being of users, it prevents them from committing crimes, it decreases illicit drug use and needle and syringe sharing among them. Together with the majority of drug treatment specialists from all over the world we are confident that the lack of access to methadone maintenance treatment in Russia is a basic violation of the human rights of people who use drugs.
So, why Russia says no to methadone after all?
http://drogriporter.hu/en/node/1086

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6.[USA] Puerto Rico's Other Half
18/09/08 by The Body
As part of Housing Works Harm Reduction month, the Update is spotlighting harm reduction efforts and advocacy in Puerto Rico. "Harm reduction" is any program or policy that promotes the reduction of harm that individuals may do to themselves or others through substance use and/or unsafe sexual practices.
In Fajardo, Puerto Rico, a small city on the east coast of Puerto Rico, a dozen people hang out in a shooting gallery behind projects. These men and women search for a vein that's not dead so they can shoot up heroin. Then along comes Gloria Gonzalez, with clean needles and lollypops. Gonzalez, a 2008 Keith D. Cylar awardee, is treated warmly by the group, most of whom are chronic drug users. "It's hard to get methadone, but I want to quit," one man explained to the Update. Another searched for a vein in his leg since he was out of veins in his arms. One place he wouldn't go was his groin. "I don't want to kill my penis," he said, chuckling.
Because of Gonzalez, a former drug user herself, these people have access to clean needles, which help prevent the spread of HIV and hepatitis C. Yet Gonzalez receives no government funding for her syringe exchange (or "punto fijo" in Spanish) and does the distribution and outreach on her own time. She is laying the groundwork for harm reduction housing and a community center where syringe access will be provided in Fajardo.
"The mayor of the City of Fajardo believes that all is needed is detox," Gonzalez said. "He thinks he has a done a great job by establishing an agreement with an agency in Philadelphia to which he ships injection drug users who are homeless. Fajardo has an equestrian park, beautiful beaches, ferries which depart for Culebra and Vieques. So, he cleans the streets. He sends them to Philadelphia."
According to estimates, 50 percent of new HIV infections in Puerto Rico are transmitted through injection drug use. Most drug users are chronic drug users, and 17 percent of chronic drug users on the island are women. The statistics are extremely unreliable, but according to the 2008 CDC report, in 2006 there were 2,371 new reported cases of HIV and AIDS.
It's not that the Puerto Rican government is openly hostile to harm reduction -- a 1993 law allows people to openly carry syringes. The main problem is that the government is unlikely to put its money where its mouth is. The federal ban on syringe exchange prohibits U.S. dollars going to this and the state provides little of its own funding for syringe exchange and harm reducation programs. The majority of drug treatment programs are faith-based, abstinence-only programs which don't provide harm reduction to patients.
In addition, groups that provide harm reduction and AIDS care are dealing with a parallel crisis of the ineptitude of Puerto Rican buraucracy. Puerto Rico receives more than $53 million in Ryan White Care Act funds but activists have documented numerous cases of people living with HIV/AIDS who are unable to access medication. In December 2006, the FBI raided four San Juan Health Department offices, seizing 400 boxes of documents in a criminal investigation into possible misuse of Ryan White grants. (Look for an in-depth story in the Update in October about the government's role in the crisis).
http://www.thebody.com/content/art48672.html?mtrk=10444683

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7.[USA] Despite New Law, HIVers Are Still Barred From Visiting, Immigrating to the U.S.
22/09/08 by U.S. News
Lawmakers and HIV advocates are urging the Bush administration to take action on reversing the current ban HIV-positive foreigners from entering the U.S., the AP/Los Angeles Timesreports (Abrams, AP/Los Angeles Times, 9/20). President Bush in July signed into law a measure (HR 5501) that reauthorized the President's Emergency Plan for AIDS Relief through 2013 and included a provision that eases U.S. HIV/AIDS travel restrictions. HHS in 1987 placed HIV on a list of diseases that barred entry into the U.S. for those carrying the diseases. Although that prohibition is separate from the congressionally imposed travel restrictions eased in the PEPFAR bill, federal health officials no longer are bound by law to keep HIV on the list (Kaiser Daily HIV/AIDS Report, 8/6). The agency must write a new rule and submit it for public comment before the ban can be lifted, the AP/Times reports.

Last week, 58 House Democrats -- including Reps. Barbara Lee (Calif.), Henry Waxman (Calif.) and Howard Berman (Calif.) -- sent a letter to President Bush urging him to take "swift action" on a new rule. In addition, Sens. John Kerry (D-Mass.) and Gordon Smith (R-Ore.) last month in a letter to HHS Secretary Mike Leavitt said, "We write to encourage you to act quickly to remove HIV from the list of communicable diseases of public health significance and end the HIV travel and immigration ban."

HHS spokesperson Holly Babin said that the agency is "working hard to revise the regulation" and has a "goal to have it completed during [the Bush] administration." She added that revising the rule is a "time-consuming process" and that agency officials "are giving it the attention it deserves in an effort to anticipate all issues and get it right." Allison Herwitt, legislative director at the Human Rights Campaign, said advocates will "continue to pressure" Leavitt to "finish the job and eliminate regulations that keep that unfair policy in place" (AP/Los Angeles Times, 9/20).
http://www.thebody.com/content/art48686.html?mtrk=10444683

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8.[AFR] Nigeria arranges 'HIV marriages'
04/09/08 by Map of Nigeria
But international Aids experts have voiced concern at the plan.
Warren Naamara from UNAids said the two people could have different strains of the virus, which could interact. He said the couples should use condoms.
Around 70 couples have been matched up in the last few weeks, Bauchi state authorities told the BBC.
Authorities in the state say they are trying to stop HIV spreading and battle the "isolation and stigma" of the disease.
Some 3% of Nigeria's adult population - 2.4 million people - is estimated to be HIV-positive
Bauchi State operates under Sharia, or Islamic laws, and the use of condoms is not encouraged.
Speed-dating
Dr Lirwan Mohammed, the executive secretary of the Bauchi Action Committee on Aids, said the polygamous culture of northern Nigeria had increased the spread of the disease.
File photo of posters advertising HIV tests in Nigeria
Authorities say the move would stop the spread of HIV
"Polygamy, as we have discovered, has become a potent source of spreading the HIV scourge in Nigeria," he said.
The marriages were arranged under strict confidentiality, he said.
"Suitors who have tested positive and are willing to wed each other, can reduce the spread of the virus and also cushion the psychological trauma of isolation."
Couples are introduced to each other during counselling sessions and are free to say yes or no to each potential partner, says the BBC's Shehu Saulawa.
One groom, speaking to the BBC's Hausa service on condition of anonymity, said he was confident the plan would combat the spread of Aids in Nigeria.
"If we should fear God, we should stop spreading the HIV virus through indiscriminate marriage, thereby infecting innocent people," he said.
"Marrying someone with the same HIV status will reduce the spread of the scourge."
Danger
But the head of the United Nations agency in charge of battling the disease in the country said the scheme was dangerous.
"There may be a very big danger in terms of the spread of the disease," said Mr Naamara
He also said it was "not advisable" for such couples to have children.
"The chances are that child would become a double orphan, they would lose both parents."
"Our advice is they should use condoms."
Last month Bauchi state reportedly locked up sex workers who had tested positive for HIV.
http://news.bbc.co.uk/2/hi/africa/7598308.stm

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