Complete Wellness

Anil Netto

PENANG, Malaysia, Feb 1 2007 (IPS) – Eyeing the expanding market for clinical research in the region, Malaysia is trying to position itself as an ideal place for pharmaceutical majors to conduct clinical trials. But critics worry about weak safeguards and poor enforceability of existing regulations.
Indeed, the local population s lack of sophistication about clinical trials appears to be one of the selling points.

In a brochure that encourages foreign biotechnology players to conduct clinical trials here, investPenang , the Penang state government s marketing arm, not only touts Malaysia s ethnically heterogeneous population, but actually brags that Malaysians are still drug naïve .

Since 2000, the number of Phase III clinical trials in Malaysia has more than doubled to reach around 50 in 2005. This is based on the number of applications received by the National Pharmaceutical Control Bureau for clinical trial import licences of unregistered products and excludes bio-equivalence studies.

This number could soar further if Malaysia signs a Free Trade Agreement with the United States for which negotiations are ongoing. A senior official from the U.S. Patent and Trademark Office reportedly pointed out last month that Jordan has conducted or is in the process of carrying out 35 clinical trials after it signed an FTA with the U.S.in 2000, compared to only one before that year.

Contract research organisations (CROs)in Singapore, Malaysia and Thailand are already eyeing market opportunities estimated to be worth 140 million US dollars in 2007.
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Meanwhile, the Science University of Malaysia (USM) in Penang is planning a 30 million ringgit (8.5 million dollar) building, which will also house incubation companies , especially those involved in biotechnology, at its proposed biotechnology park. Among the anchor tenants for the new building is a firm called Info Kinetics Sdn Bhd.

Info Kinetics bills itself as a one-stop CRO that handles clinical trials and bio-availability and bio-equivalence studies. Through a strategic alliance with Gleneagles Clinical Research Centre, which belongs to the largest network of private hospitals in the region, it has access to 100 hospital sites for conducting clinical trials in South-east Asia and beyond.

Info Kinetics carries out a range of clinical trials, including providing Viagra to children aged 1 16 suffering from pulmonary arterial hypertension (high pressure in the blood vessels to the lungs), a life-threatening condition. Viagra is said to lower blood pressure throughout the body including that in the lungs.

About a dozen children are believed to be involved in the ongoing trials, which are randomised and double-blind placebo controlled, according to the firm s website. A source familiar with the trials revealed that the side effects of Viagra on the subjects include bluish vision similar to the effect of (seeing through) a blue filter , depending on the dosage given.

When IPS contacted Gleneagles paediatrician Dr Sim Joo Seng, who is involved in the clinical trials, he declined to comment, saying he needed written authorisation from the ethics committee and permission from the sponsor before he could speak to the media about the trials.

The ethics committee he was referring to is probably the Joint Penang Independent Ethics Committee , a 14-member committee under the joint authority of the Penang Medical College and Gleneagles. This committee carries out ethical reviews of clinical trials conducted at the privately owned Gleneagles Medical Centre, Penang and the Penang Medical College, which is partly owned by the state-run Penang Development Corporation.

Whether it is really independent is debatable. Among the sponsors listed on the Info Kinetics website are big pharmaceutical firms such as Pfizer, Bristol-Myers Squibb, GlaxoSmithKline and Malaysia s Pharmaniaga.

When contacted, Associate Corporate Affairs Manager for Pfizer Malaysia Chin Yoon Ann was unable to confirm if such clinical trials on children were being carried out, saying that she had to check first . Another Pfizer spokeswoman, when contacted over the telephone, wanted e-mailed verification of identity before she would respond to questions about the firm s involvement in clinical trials.

It is not just the private sector that is involved in clinical trials. The Clinical Research Centre of the health ministry, based in Kuala Lumpur, serves clients from pharmaceutical, biotechnology and medical device industries, both public and private health care providers and medical research organisations . The Centre makes use of the health ministry s network of hospitals ( those with experienced and GCP certified investigators ) as investigative sites for clinical trials.

The Centre s head, in a presentation at the BioMalaysia 2006 conference in Kuala Lumpur in December, noted that in Malaysia there are no specific legal provisions addressing the conduct of Clinical Trial(s); only administrative provisions through Malaysia GCP (Good Clinical Practice) Guidelines .

These guidelines, among other things, state that in obtaining informed consent from subjects, investigators should adhere to the GCP and in the ethical principles that have their origin in the Declaration of Helsinki . All serious adverse events should be reported within two working days to the sponsor.

The guidelines add that those conducting the trials must also comply with the applicable regulatory requirements on the reporting of such reactions to the authorities and to the independent review board/independent ethics committee.

On the other hand, the National Pharmaceutical Control Bureau s website, provides the regulatory guidelines for the reporting of adverse drug reactions during clinical trials. All fatal and life-threatening, unexpected adverse drug reactions should be reported within seven days while other serious, unexpected reactions that are not fatal or life-threatening must be reported within 15 days.

The problem is that all these official guidelines are not binding and enforcement is lax, observed Dr T. Jayabalan, an advisor on health care issues for the Consumers Association of Penang, who has written on the ethics of large pharmaceutical firms conducting clinical trials in developing countries. They are merely good practices to follow, he told IPS. There is tremendous under-reporting of adverse drug reactions in the private sector. That is well known.

He said the procedures are cumbersome and bureaucratic, and very few would want to go through the hassle of reporting . In an article for Resurgence, a magazine published by the Penang-based Third World Network, Jayabalan noted that pharmaceutical firms can save 30 percent on the cost of conducting clinical trials in Asia compared to in the West. Relaxed or non-existent regulatory mechanisms also play a significant part in the choice of drug trial destinations.

Jayabalan added that the trend of outsourcing clinical trials to developing countries has raised concerns about large biotechnology and drug companies exploiting the healthy who are strapped for cash and the sick who seek cheap or free remedies.

Xianzhou Luofu เป็นหนึ่งในสถานที่ภายในเกม Honkai: Star Rail’ ที่เราจะได้มีโอกาสเข้าไปผจญภัย โดยสถานที่แห่งนี้ดูปราดเดียวก็รู้เลยว่าได้รับแรงบันดาลใจมาจากประเทศจีน ไม่ว่าจะเป็นสิ่งปลูกสร้าง รวมไปถึงชุดต่าง ๆ โดยล่าสุดมีผู้ใช้งานทวิตเตอร์ที่ชื่อว่า @k3tchup4 ได้ออกมาโชว์แฟนอาร์ตสุดบรรเจิดด้วยการนำตัวละคร 2B และ 9S มาสวมใส่ชุดสไตล์ Xianzhou Luofu มาให้เราได้ชมกัน

จากภาพด้านบนนี้เราจะได้เห็น 2B ที่มาในชุดสไตล์คล้ายกับ Jingliu และ 9S ที่มาในชุดคล้ายกับ Yanqing ซึ่งผลออกมาเรียกได้ว่าลงตัวมาก ๆ โดยเฉพาะ 2B ที่มีความคล้ายกับ Jingliu สุด ๆ เพราะทั้งคู่ใส่ผ้าปิดตาเหมือนกัน ทำให้ผู้เล่นที่เข้ามารับชมภาพนี้ก็ชื่นชมกันเป็นจำนวนมาก เช่น

“ลงตัวแบบคิดไม่ถึงเลยแหะ”

“2B คือเป๊ะมากอ่ะ อยากเห็นตอนเธอปลดผ้าปิดตาออกเลย” คำพูดจาก สล็อตเว็บตรง

“สุดยอดเลยแหะ”

“อยากเห็นตัวละครอื่น ๆ บ้างจังเลย”

Honkai: Star Railเป็นเกมมือถือ Turn Based RPG ซึ่งภายในเกมนี้ผู้เล่นจะได้พบกับเรื่องราวที่น่าติดตาม แถมผู้เล่นจะได้ควบคุมตัวละครสำรวจฉากภายในเกมอีกด้วย โดยเกมดังกล่าวจะพาผู้เล่นไปผจญภัยในจักรวาลข้ามดวงดาว ถึงเวลากระโดดขึ้นรถไฟ Astral Express และสัมผัสกับความมหัศจรรย์ที่ไม่มีที่สิ้นสุดของกาแลคซีในการเดินทางครั้งนี้ที่เต็มไปด้วยการผจญภัยและความตื่นเต้น

fanart Honkai: Star Rail

เมื่อวันที่ 26 มีการเปิดเผยว่าเกม ‘Ragnarok: Monster World’ แนว RPG Web3 ที่บริษัทเกมโกลบอล Gravity พัฒนาร่วมกับบริษัทผู้เชี่ยวชาญด้านบล็อกเชนอย่าง Zero X And (0x&) ได้เข้าร่วมRonin Network เตรียมเปิดให้บริการในประเทศไทยครึ่งปีหลัง 2024 นี้

Ragnarok: Monster World เป็นเกมที่นำมอนสเตอร์จาก Ragnarok มาพัฒนาเป็นเกมแนว RPG ซึ่งผู้เล่นสามารถสร้างเด็คตามสไตล์ตัวเองได้และนอกจากนี้ยังสามารถสนุกเพลิดเพลินไปกับคอนเทนต์ภายในเกมที่หลากหลายได้อีกด้วย

Ragnarok เป็นเจ้าแรกซึ่งพัฒนาเกมบล็อกเชน Web3 โดยนำ IP จาก Web2 มาใช้และเข้าร่วม Ronin Network โดยกราวิตี้คาดหวังว่าการเข้าร่วม Ronin Network ของ Ragnarok: Monster World นั้น จะทำให้ผู้เล่นมีความเชื่อมั่นมากยิ่งขึ้น  คำพูดจาก สล็อตเว็บตรง

Ronin มีโทเค็นที่ใช้ EVM (Ethereum Virtual Machine) ที่สร้างขึ้นมาเป็นพิเศษโดย Sky Mavis เพื่อเพิ่มความเร็วในการเล่นเกม ซึ่งเปิดตัวครั้งแรกเมื่อปี 2021 โดยมีผู้เล่นต่อวัน (DAU) จำนวน 1.3 ล้านคน และมีวอลเล็ตอยู่ประมาณ 17.6 ล้าน

เมื่อเดือนมิถุนายน 2023 บริษัท กราวิตี้ ได้ร่วมมือกับบริษัทเชี่ยวชาญด้านเทคโนโลยีบล็อกเชนอย่าง Zero X And (0x&) และได้เริ่มร่วมกันพัฒนาเกม Ragnarok: Monster World ซึ่งมีแพลนที่จะเพิ่มโซลูชั่น NFT Rental ภายในเกม Ragnarok: Monster World เพื่อให้ผู้เล่นสามารถที่จะเช่า NFT เพื่อครอบครองไอเท็มภายในเกม หรือว่าจะนำ NFT ที่ตัวเองมีอยู่ไปปล่อยเช่าให้ผู้เล่นคนอื่นได้อีกด้วย

ทั้งนี้ ผู้เล่นยังสามารถสะสมและอัพเกรดมอนสเตอร์เกม Ragnarok และนำไปต่อสู้ในโหมด PvP ได้ ซึ่งจะได้รับของรางวัลและเลเวลเพิ่มขึ้นได้อีกด้วย นอกจากนี้ยังมีคอนเทนต์ที่หลากหลายอย่างเช่น PvE, GvG อีกเป็นต้น ซึ่งคาดว่าจะเปิดเผยเร็วๆนี้ ในช่วงครึ่งปีหลัง 2024 นี้จะเปิดตัวอย่างเป็นทางการในประเทศไทย ซึ่งตอนนี้กำลังอยู่ในขั้นตอนของการพัฒนาและจะให้บริการโดย Zero X And (0x&) เนื่องจากบริษัท Zero X And (0x&) นั้นมีความสนใจในด้านบล็อกเชนและตลาดคริปโตที่คึกคักในประเทศไทย จึงมีแพลนที่จะพัฒนาเกมรูปแบบ Web3 โดยใช้ IP ของเกม Ragnarok เป็นต้นแบบ

คุณ Bang Jiwon หัวหน้าทีม Global Business ของกราวิตี้ได้กล่าวว่า “เกมนี้เป็นเกมที่นำมอนสเตอร์ของโลก Ragnarok มาผสมกับเทคโนโลยีบล็อกเชน เลยหวังว่าผู้เล่นจะสนุกไปกับมอนสเตอร์ที่น่ารักน่าเอ็นดู และแน่นอนว่าผู้เล่นจะสัมผัสกับประสบการณ์การเล่นเกมที่หลากหลายได้อีกด้วยค่ะ” อีกทั้งยังกล่าวเพิ่มเติมว่า “เราได้ร่วมมือกับพาร์ทเนอร์ของเราที่เป็นผู้เชี่ยวชาญในด้าน NFT เพื่อเตรียมเปิดให้บริการอย่างเป็นทางการอย่างสุดความสามารถและหวังว่าเหล่าเกมเมอร์ที่รักและชื่นชอบใน IP เกม Ragnarok จะให้ความสนใจกับโปรเจกต์นี้ด้วย”

[Gravity Official Homepage] http://www.gravity.co.kr

[แนะนำบริษัท Gravity Co., Ltd.]

Gravity เป็นบริษัทเกมภายในประเทศที่ก่อตั้งเมื่อเดือนเมษายน พ.ศ.2543 และเป็นบริษัทเกมระดับโลกที่จดทะเบียนในตลาดหลักทรัพย์ Nasdaq ซึ่งมีจำนวนบัญชี Ragnarok IP สะสมทั่วโลกรวมมากกว่า 160 ล้านคน (สถิติ ณ วันที่ 31 กรกฎาคม พ.ศ.2566) อีกทั้งยังถูกบันทึกเป็นอันดับ 2 ของเกมเกาหลีที่เป็นที่ชื่นชอบมากที่สุดใน Global Korean Trend ติดต่อกันเป็นระยะเวลา 5 ปี นับตั้งแต่ปี พ.ศ.2562 นอกจากนี้ Ragnarok Online ยังได้พิสูจน์ถึง Ragnarok IP Power ในทั่วโลก โดยขึ้นเป็นอันดับ 1 ในหัวข้อเกม PC/Online เกาหลีที่ได้รับความนิยมมากที่สุดใน 6 ประเทศ (บราซลิ, อินโดนีเซีย, อังกฤษ, อิตาลี, สหรัฐอเมริกา, ฝรั่งเศส) จากการสำรวจ ‘ผู้ใช้บริการเกมเกาหลีในตลาดต่างประเทศปี 2023’

ปัจจุบัน Gravity มีบริษัทย่อยคือ ‘Gravity Neocyon (เกาหลี)’ และมีเครือข่ายระดับโลกที่แข็งเกร่ง โดยมีสาขาต่างประเทศ ได้แก่ ‘Gravity Communications (ไต้หวัน), Gravity Game Link (อินโดนีเซีย), Gravity Interactive (สหรัฐอเมริกา), Gravity Game Arise (ญี่ปุ่น), Gravity Game Tech (ไทย), Gravity Game Hub (สิงคโปร์), Gravity Game Vision (ฮ่องกง) โดย Ragnarok IP Game ได้ร่วมมือกับบริษัทย่อยและสาขาต่างประเทศในการขยาย Global Publishing Company ที่เฟ้นหาและเผยแพร่เกมในแพลตฟอร์ม ประเภทต่าง ๆ เช่น PC, Mobile, Console, IPTV ฯลฯ รวมถึงกำลังขยายอิทธิพลและการตระหนักรู้ไปทั่วโลก

นอกจากนี้ยังกำลังอยู่ในช่วงดำเนินธุรกิจ Contents ที่ใช้ Ragnarok IP เช่น MD, อนิเมชั่น, สร้างเว็บตูนเพื่อแสวงหา IP ใหม่ๆ พร้อมทั้งก้าวเข้าสู่แขนง Golf Simulator, Brand Collaboration ฯลฯ

-. เกมยอดนิยม
MMORPG ‘Ragnarok Online’ (launching in 2002), ‘Ragnarok M’, ‘Ragnarok Origin’, ‘Ragnarok X: Next Generation’ ฯลฯ

0x& Gravity Ragnarok: Monster World Zero X And

กรุงเทพฯ, ประเทศไทย (วันที่ 8 สิงหาคม พ.ศ. 2567) – เน็ตมาร์เบิ้ล ผู้พัฒนาและผู้เผยแพร่เกมมือถือคุณภาพสูงชั้นนำ ได้ปล่อยอัปเดตเกมใหม่สำหรับ Seven Knights Idle Adventure พร้อมต้อนรับอัปเดตอัศวินเลเจนด์คนใหม่และคอนเทนต์สุดสนุกที่ผู้เล่นไม่ควรพลาด !

อัปเดตใหม่ในครั้งนี้ ผู้เล่นจะได้พบกับ บรันซ์ & บรันเซล อัศวินเลเจนด์ใหม่ประเภทระยะใกล้ สองฝาแฝดที่กำเนิดจากวัลคิรีแห่งแดนสวรรค์และเผ่าปีศาจ บรันซ์ & บรันเซล เป็นสมาชิกแห่งดาร์คไนท์ ผู้มอบบัฟที่จะเพิ่มพลังโจมตีสุดท้ายและความเสียหายคริติคอลสุดท้ายให้กับพันธมิตร เมื่อสองแฝดสร้างพลังโจมตีคริติคอลสำเร็จ พวกเขาจะได้รับบัฟเพิ่มพลังโจมตีหน่วยระยะใกล้แต่ละคนในทีม บรันซ์ & บรันเซล ยังจะได้รับบัฟอมตะเมื่อต่อสู้ไม่ได้ โดยจะจำกัดที่ 1 ครั้ง

นอกจากนี้ บรันซ์ & บรันเซล ได้รับโล่ป้องกันเมื่อใช้สกิลแอคทีฟของพวกเขา อีกทั้งยังอยู่ในสถานะต้านทานผลการควบคุมทั้งหมดเมื่อผลโล่ป้องกันคงอยู่ นอกจากนี้ พวกเขายังสร้างความเสียหายอย่างรุนแรงในพื้นที่รอบ ๆ เป้าหมายที่กำหนด พร้อมลดอัตราคริติคอลและอัตราบรรเทาของเป้าหมาย ผู้เล่นสามารถสนุกไปกับกิจกรรมเรียกพิกอัปบรันซ์ & บรันเซลได้แล้วถึงวันที่ 21 สิงหาคม มอบโอกาสให้ผู้เล่นได้รับอัศวินเลเจนด์ใหม่ คอสตูมสำหรับ บรันซ์ & บรันเซล ก็ได้ถูกเพิ่มเข้ามาในอัปเดตครั้งนี้อีกด้วย !

ยิ่งไปกว่านั้นยังมีอัปเดตคอนเทนต์อื่นอีก อาทิ การเริ่มต้นสเตจ 20,001 ถึง 20,800 และ ดันเจี้ยน EXP อัศวิน ได้รับการขยายถึงขั้นเลเวล 700 นอกจากนี้ ผู้เล่นสามารถท้าทายหนอนทะเลทรายในดันเจี้ยนอุปกรณ์รายสัปดาห์ถึงวันที่ 14 สิงหาคม ซึ่งผู้เล่นสามารถรับอุปกรณ์สุดปังไปได้ !

เกม Seven Knights Idle Adventure ได้ถูกสร้างขึ้นตามแฟรนไชส์หลักและเป็นผู้สืบทอดต่อจากเกม ‘Seven Knights – เซเว่นไนท์’ ดั้งเดิม ซึ่งได้รับการพัฒนาใหม่เป็นเกมแนว Idle RPG โดยคำนึงถึงการใช้พื้นที่อุปกรณ์ต่ำ สเปกต่ำ และแนวทางการเล่นที่ง่ายดาย ผู้เล่นจะได้สัมผัสกับเรื่องราวเพิ่มเติมไปพร้อมกับเอพพิโซดที่ซ่อนอยู่ของเหล่าอัศวินเซเว่นไนท์ดั้งเดิม รวมทั้งเพลิดเพลินไปกับการเก็บสะสมและเลี้ยงดูเหล่าอัศวินแห่งเซเว่นไนท์อันเป็นที่โปรดปรานของเหล่าแฟน ๆ ที่ได้ถือกำเนิดใหม่เป็นตัวละครรูปแบบ SD สุดน่ารัก !คำพูดจาก เว็บสล็อตใหม่ล่าสุด

Seven Knights Idle Adventure เกมภาคต่อของเกมระดับตำนานอย่างเกม ‘Seven Knights –เซเว่นไนท์’ ที่มีผู้เล่นมากกว่า 60 ล้านคนทั่วโลก โดยเกม Seven Knights Idle Adventure จะเป็นอีกหนึ่งเกมเพิ่มเติมอันน่าตื่นเต้นที่พร้อมให้เหล่าแฟน ๆ ได้เรียนรู้และสนุกเพลิดเพลินไปกับอัศวินคนโปรดโดยไม่ต้องลงทุนใช้เวลาเยอะ

สำหรับข้อมูลและรายละเอียดเพิ่มเติมเกี่ยวกับเกม Seven Knights Idle Adventure นั้น โปรดติดตามผ่าน เว็บไซต์ทางการ สำหรับการอัปเดตในอนาคต ซึ่งเกมจะมีการแนะนำอัศวินและโหมดต่าง ๆ อีกมากมายในเดือนต่อ ๆ ไปอีกด้วย

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เกี่ยวกับเน็ตมาร์เบิ้ลคอร์ปอเรชั่น

เน็ตมาร์เบิ้ลคอร์ปอเรชั่น (เน็ตมาร์เบิ้ล) ก่อตั้งขึ้นในประเทศเกาหลีเมื่อ ค.ศ. 2000 โดยเป็นผู้พัฒนาและให้บริการเกมมือถือที่ทำรายได้สูงชั้นนำทั่วโลก ด้วยการคัดสรรสุดยอดแฟรนไชส์และทำงานร่วมมือกับสุดยอด IPชั้นนำ เน็ตมาร์เบิ้ลมุ่งมั่นที่จะสร้างความบันเทิงและมอบสุดยอดประสบการณ์ให้แก่แฟน ๆ ทุกเพศทุกวัยทั่วโลก ในฐานะบริษัทแม่ของ Kabam และ SpinX Games และผู้ถือหุ้นรายใหญ่ที่สุดของ Jam Cityและ HYBE (ซึ่งชื่อเดิมก่อนหน้าคือ Big Hit Entertainment)เน็ตมาร์เบิ้ลได้สร้างสรรค์ผลงานผ่านเทคโนโลยีสุดล้ำและมอบประสบการณ์สุดตื่นตาตื่นใจให้กับผู้เล่นมาแล้วมากมาย ไม่ว่าจะเป็น Solo Leveling: ARISE, Seven Knights Idle Adventure, Tower of God: New World, Lineage 2: Revolution, MARVEL Future Fight, Ni no Kuni: Cross Worlds และ The Seven Deadly Sins: Grand Cross สามารถดูรายละเอียดเพิ่มเติมได้ที่ https://www.netmarble.in.th/home

Netmarble Seven Knights Idle Adventure

Ann De Ron

BRUSSELS, Mar 1 2007 (IPS) – A growing number of people are getting addicted to tranquillisers and other prescription drugs, and this abuse is set to exceed illicit drug abuse, the International Narcotics Control Board (INCB) warns in a report published Thursday.
Thanks to prevention campaigns youngsters are thinking more that heroin is something for losers, INCB vice-president Robert Lousberg told IPS. The mean age of heroin addicts is rising those are the existing junkies that are aging. Also the number of cocaine junkies is reducing.

India is an exception. Cocaine used to be too expensive there, but these days the newly emerging rich are turning towards it, Lousberg said.

The report is significant. The INCB is an international organisation headquartered in Vienna. It was set up in 1968 to monitor implementation of the United Nations international drug control conventions.

While the organisation sees a fall in abuse of drugs such as heroin, it sees new dangers arising. The other side of the medal of the decrease in hard drug addicts is the abuse of prescription drugs. Those seem more innocent than hard drugs, but they are not, Lousberg said.

The report says people addicted to painkillers, stimulants, sedatives and tranquillisers often explicitly choose these drugs. They do not use them as an alternative for an illegal hard drug.
In the United States, abuse of prescription medicines has gone beyond the abuse levels of practically all illicit drugs, with the exception of cannabis. In 2003, 15 million North Americans abused prescription drugs, says the report. That is almost double the figure of 1992.

Such abuse of prescription drugs is serious also in parts of Africa, South Asia and Europe. In Nigeria pentazocine, an analgesic, is the second most common drug injected.

The analgesic buprenorphine, prescribed as substitution treatment for drug dependency, is the main injected drug in most parts of India. In France and the Scandinavian countries it is trafficked and abused in tablet form.

The INCP report estimates that in France between 20 and 25 percent of the drug is diverted to the illicit market.

In Brazil, Argentina, the Republic of Korea, the United States, Singapore and Hong Kong there is a rising trend of abuse of anorectics for slimming.

The demand for such drugs has worsened the problem of illegal production and sale of medicines. The World Health Organisation estimates that 25 to 50 percent of medicines consumed in developing countries are counterfeit.

What is really new is that the illegal sales are now extending to include addictive products, said Lousberg.

Three types of medicines flow into illegal sales: medication produced without licence, fake medicine containing no active ingredient, and medicines that were produced legally but landed in the illegal circuit through theft by people visiting several doctors and getting them to prescribe drugs they will not consume themselves.

In developing countries it is easy to get medicines on street markets. In the west the distribution is taking off through illegal Internet pharmacies.

Those pharmacies are a new phenomenon that greatly worries us, said Lousberg. Internet pharmacies are a good thing to ease the communication between physicians and pharmacies, but the small percentage of illegal ones is a serious threat to public health.

These pharmacies often accept faxed prescriptions, which makes forging easy. Also there is usually no contact between physician and patient, and often the medicine is more expensive than at a regular pharmacy, Lousberg said.

A lot of people will know the pharmacies by the emails they send to sell Viagra if you go to the websites you will notice they often sell highly addictive medication as well.

The report warns of other dangers where users create their own drugs with the help of instructions on the Internet. They may often extract the active ingredient from medications to make a more powerful drug.

The International Narcotics Control Board has asked all governments to alert their law enforcement officers to rising trafficking and abuse of pharmaceutical products. It is also asking governments to collect data on abuse of pharmaceutical preparations in surveys on drug abuse.

Joyce Mulama

NAIROBI, Apr 7 2007 (IPS) – Just two months remain before the international community is scheduled to take a critical step forward in addressing global health threats, marked by the entry into force of the updated International Health Regulations .
Described by the World Health Organisation (WHO) as a key milestone in public health , the beefed up rules will give both the WHO and states party to the regulations greater responsibilities for monitoring and responding to national health threats that have the potential to become global emergencies. The International Health Regulations (2005) or IHR(2005) revises the 1969 version of the IHR, and is the first legally binding agreement of its kind.

But while IHR(2005) looks good on paper, can it realistically be implemented in countries such as Kenya, which are already struggling to meet public health needs?

Health experts interviewed by IPS agreed that the limited resources and facilities of the East African country would present a challenge concerning the new regulations.

We are required to report cases of diseases immediately (but) we do not have adequate laboratories. When there is a real need to get results out quickly, we cannot, said Ahmed Ogwell, head of international health relations at the Ministry of Health.

But that does not mean that we do not strive to meet the stipulations of IHR(2005), because the cost of not doing it is a lot higher than our cost of stretching resources. So we are stretching our resources to meet the regulations, which Kenya has signed up to.
Information from the WHO country office in Kenya shows government has increased the national health budget from about 217 million dollars in 2001/2 to some 333 million dollars in 2006/7.

Nonetheless, certain departments that are considered critical for controlling the spread of illnesses remain underfunded, noted Ogwell. These include the port health authority, which lacks sufficient facilities to place in isolation people who have contracted infectious diseases, upon their entry into Kenya. We have not adequately funded port health; we need three times what we have, Ogwell said.

Shortages of staff for both public and veterinary health departments and constraints on employing more personnel aggravate matters.

We have skilled personnel who are well trained. The problem is that they are old and are soon retiring and we have not recruited any new persons for over ten years, said Simon Kimani, chief veterinary field officer at the Department of Veterinary Services in the Ministry of Livestock and Fisheries Development.

The dangers of this situation have been highlighted by the outbreak of avian influenza that began in south-east Asia four years ago, showing anew the need for governments to maintain their ability to monitor health threats.

Millions of chickens have been culled in an attempt to contain the H5N1 virus that is responsible for this epidemic and which has also claimed a number of human lives. There are fears that the virus could mutate into a form that is very infectious for humans.

Kenyan authorities have responded by training farmers to be on the look out for signs of avian influenza.

We have encouraged farmers to report any dead bird or unusual happenings on farms, for example an unusual number of birds dying en masse. Farmers have also been told how to handle dead birds, Kimani said.

To date, no cases of avian influenza have been reported in Kenya. Hundreds of birds were found dead in Kasarani on the outskirts of the capital, Nairobi, last year; however, the birds were later diagnosed as having died from Newcastle disease, a highly contagious illness that is also fatal.

The African country currently in the front lines of the avian influenza epidemic is Egypt, where the number of people testing positive for the virus reportedly stood at 33 this week. Thirteen Egyptians are said to have died from bird flu since it was first detected in the country last year. The North African state reportedly also has the highest number of confirmed bird flu cases amongst humans outside of Asia.

The cross-border health threats that Kenya is grappling with also include polio, this after the country s northern neighbour Somalia became re-infected with the virus in 2005.

Three cases of polio were reported recently in Eastleigh, a suburb of eastern Nairobi that is home to thousands of Somalis, many of whom remain in contact with relatives in their homeland. Each of the cases was traced back to Somalia, according to government.

Renewed conflict in Somalia has undermined efforts to halt the march of polio. A transitional government for the Horn of Africa state was inaugurated in 2004 in a bid to end more than a decade of lawlessness sparked by the toppling of dictator Mohamed Siad Barre; however, this administration has since become embroiled in a power struggle with an Islamic grouping.

Every time war breaks out in Somalia, we have to conduct a polio campaign to ensure that children below the age of five are immunised to keep them safe, said Ogwell. But, the conflict in Somalia complicates our ability to respond .

The particular risk posed by global health threats is in the spotlight this week with World Health Day (Apr. 7), which is focusing on the need for international cooperation to deal with these threats under the theme Invest in health, build a safer future .

Marwaan Macan-Markar

BANGKOK, May 15 2007 (IPS) – For nearly a week the advertising pages of Thai and English-language dailies have been the stage for debates on Thailand s decision to break patents on anti-AIDS drugs in the interest of public health.
A lobby championing the cause of the powerful pharmaceutical companies ran full-page spreads in the morning newspapers with an eye-catching warning in large, bold text, which said: The Wrong Prescription for Thailand.

The charge was supported by allegations that Bangkok s decision was fraught with errors, such as Thailand is refusing American and European medical technology at the expense of the poor and sick of Thailand. Another levelled by USA for Innovation , the organisation leading this pro-pharmaceutical company drive, declared that Most of Thailand s AIDS patients will not have access to the world s best medicines.

But if those warnings were meant to trouble men like Boripat Dornmon, a 40-year-old who has been living with HIV for 11 years, they have made little headway. I disagree with this group, USA for Innovation. It shows that the big drug companies do not care about people like me, he said in an IPS interview.

Boripat echoes the views of the group he belongs to, the Thai Network of People Living With HIV/AIDS, when he says that Bangkok was correct in issuing compulsory licenses to secure cheaper, generic drugs. We need the new, cheap drugs to live longer.

It was a sentiment conveyed in the full-page advertisements taken out by a coalition of AIDS activists, humanitarian groups and a university to lash back at the pro-pharmaceutical lobby s campaign. The generic anti-retroviral (ARV) drug produced by the state s pharmaceutical body has made a phenomenal contribution in reducing the number of deaths among Thai AIDS patients from an average of 7,282 per year between 2001-2004 to 3,862 in 2005 and to 1,613 in 2006, states the advertisement.
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And a meeting this week between officials from Abbott Laboratories and Thai officials from the Food and Drug Administration (FDA) confirmed that Bangkok has not caved into pressure from the pharmaceutical lobby and the U.S. government over a groundbreaking move to secure cheaper drugs.

In fact, a health ministry official was quoted in the local media hinting that Bangkok may not have finished issuing compulsory licenses for ARVs produced by Abbott, given that a significantly lower priced generic version of Aluvia, a second-line anti-AIDS drug, is being offered by an Indian company.

If the public health ministry chose to buy drugs at prices higher than offered by other sources, it must be able to give the public a good reason to justify its decision, says Vichai Chokewiwat, head of the health ministry s panel on compulsory licensing, in Tuesday s Bangkok Post newspaper.

Thailand s efforts have also received a boost at the on-going World Health Assembly in Geneva where health minister Dr. Mongkol Na Songkhla is defending his country s case. International supporters have entered the debate, saying that they will support Thailand on the issue in every way, he was quoted as having told the state-run Thai News Agency (TNA).

International organisations belonging to the Third World Network as well as national groups from Brazil, Germany, India, Malaysia and the Philippines had met with him and praised Thailand on the issue, adds TNA.

Thailand s determination to use available provisions in international trade to break patents emerged late last year, when Bangkok broke the patent on the ARV Efavirenz , produced by the U.S. pharmaceutical giant Merck Sharp and Dhome. That was followed by a compulsory license issued here for Kaletra , another ARV produced by the U.S. pharma multinational Abbott Laboratories. In January, the patent for Palvis , a blood-thinner made by Sanofi-Aventis, was broken.

But it was only Abbott that hit back at Thailand s use of the special provisions under the World Trade Organisation (WTO) for developing countries to break patents on drugs when faced with a public health emergency. In March the U.S. multinational refused to register seven new drugs here, including Aluvia, a drug that can be easily stored in tropical climates.

Abbott s hopes of steamrolling over Thailand were dealt a blow last week from a quarter close to home the foundation of former U.S. president Bill Clinton. At a ceremony in New York, with the Thai health minister Mongkol by his side, Clinton endorsed Bangkok s decision to break the patents on the life-prolonging ARVs.

No company will live or die because of high price premiums for AIDS drugs in middle-income countries, but patients may, Clinton said during an event that announced the foundation s success at further slashing the price of second-line drugs, such as Abbott s Kaletra and Aluvia.

While in April, Abbott announced it had reduced the price of Kaletra in Thailand to 1,000 US dollars for annual dosage per patient, from the 2,200 US dollars for the same course it had charged a month before, the Clinton Foundation announced it had an even cheaper offer. Matrix Laboratories, an Indian drug maker, was producing the generic version of Aluvia for 695 dollars for a year s dosage.

Thailand s lead in securing better care for its HIV/AIDS patients is in keeping with other pioneering efforts it has embraced to deal with this killer disease. This South-east Asian country has over 600,000 people infected with HIV and has recorded 300,000 deaths due to AIDS.

We have to stand up to the pressure from the pharmaceutical companies and the U.S., Jiraporn Limpananont, associate professor in the pharmaceutical science faculty at Bangkok s Chulalongkorn University, told IPS. If more countries issue compulsory licenses, it will get the point across that this is the right tool for developing countries.

Julio Godoy

BERLIN, Jun 23 2007 (IPS) – The weather conditions in the heart of Europe were abnormal last year the summer too hot, too dry, and too long, and the winter too warm. But they were excellent for some foreign species, which, benefiting from the changed weather, settled in Germany, and have become a headache or worse for farmers and just about everybody else.

Adult deer tick. Credit: Scott Bauer/Agri.Research Service, USDA

The Culicoides imicola, for instance, a very small midge whose normal habitat is in sub-Saharan Africa, migrated to Europe during the last few years, and apparently has taken a liking to the new weather conditions in Germany.

The problem is, this midge transmits several viral diseases, including African horse sickness, and bluetongue disease, also known as catarrhal fever, affecting horses, sheep and, less frequently, cattle, goats, and even buffalo and deer.

This spring, in Germany alone, some 1,000 sheep have been affected by bluetongue. Although the disease is not transmittable to humans, 80 percent of the infected animals die.

We do not know much about the imicola, Helge Kampen, a researcher at the University of Bonn s Institute for Medical Microbiology, Immunology and Parasitology, told IPS. The university is located at the centre of the area where the midges and the disease have been identified in recent months.

We do have an approximate idea of which sort of midge is responsible for this epidemic, but our detailed knowledge is limited, he added.
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In August 2006, the researchers were aware that bluetongue disease is transmitted by the Culicoides imicola, which carries the virus. Both the vector and the virus are known from their impacts in tropical and subtropical areas, but had never before been detected in Germany.

However, at the time, the researcher at the University of Bonn found no traces of the bluetongue virus in the imicola midges found near Aachen, in the western border area with Belgium and the Netherlands.

It can be that our sample of the midges was too small to identify the virus, Heinz Mehlhorn, director of the Institute for Parasitology and Zoology at the University of Düsseldorf, some 100 kilometres north of Bonn, said in an interview.

One thing Mehlhorn could prove: The virus found in Germany has been common in the sub-Sahara region. Mehlhorn believes that the midge was transported to Europe through illegal animal imports, and that the hot summer and the warm winter in 2006 helped the midges and the virus to survive, until 2007.

We had hoped that a cold winter would kill all midges and virus, Mehlhorn told IPS. Instead, the weather helped the vector and the virus to survive until today.

A similar fate has favoured the proliferation of another insect species in Germany. The deer tick has profited from the abnormally warm temperatures of the last 12 months to proliferate, especially in southern Germany, leading to a medical alarm, and to scarcity in vaccines against borreliosis, or Lyme disease, and tick-borne meningoencephalitis or encephalitis, two diseases transmitted by the small arthropod.

In both cases, the viruses are transmitted by the tick through bites. Especially meningoencephalitis and the encephalitis, infections of the brain, or of the membrane surrounding the brain and spinal cord, can be mortal for humans, if not treated immediately.

The booming tick population in southern Germany has led to a run on vaccines, and to their scarcity. Drugs producers have announced that the vaccine won t be available again until mid-November, but pharmacies and other medical outlets have said the vaccine should be available again in a couple of weeks.

Yes, it is true that drugs producers are not delivering right now, but I think that the vaccines will be on the market by the end of June as the latest, said Hans Hillerbrand, spokesperson of the pharmacists association in Kelheim, a small Bavarian city some 400 km south of Berlin, and which has been one of the most affected by the proliferation of ticks.

While the warmer weather conditions have helped these species to multiply more rapidly, they are killing other animals, such as herring, the small oily fish typical of the North Atlantic and the Baltic seas.

Around the northern German seaside resort of Heiligendamm, on the Baltic, and which hosted the Group of Eight summit Jun. 6-8, hundreds of thousands of herring have been found dead, washed up on the beaches by seawater that is too warm for them.

Similar phenomena have been observed in other areas in the North Atlantic, around the German island of Sylt, just west of the Danish coast.

According to Harald Asmus, sea biologist at the Alfred Wegener Institute for Sea and Polar Research, the reason for the herring die-off is the proliferation of algae, which, when it dies, produces bacteria which take oxygen from water, and practically asphyxiate the herring.

The warm weather during the spring, and special wind and sea stream cycles helped the algae to grow in such a way that herrings could not survive, Asmus told IPS. We did measure only 17 percent of oxygen at the heart of the algae bushes, against more than 110 percent in water regions without algae, he added.

Other German biologists have found that abnormally warm seawater, even without algae, kills fish. Hans-Otto Poertner and Rainer Knust, also of the Alfred Wegener Institute, proved that fish in sea water warmer than 17 degrees Celsius have lower growth and higher mortality rates.

For their research paper titled Climate Change Affects Marine Fishes Through the Oxygen Limitation of Thermal Tolerance , Poertner and Knust used eelpout, a bio-indicator fish species for environmental monitoring from the North and Baltic Seas, to analyse the evolutionary consequences of too warm water.

A cause-and-effect understanding of climate influences on ecosystems requires evaluation of thermal limits of member species and of their ability to cope with changing temperatures, the researchers say in their document.

They add: We show that thermally limited oxygen delivery closely matches environmental temperatures beyond which growth performance and abundance decrease. Decrements in aerobic performance in warming seas will thus be the first process to cause extinction or relocation to cooler waters.

Poertner und Knust found that fish survive a very short time in waters warmer than 21 degrees Celsius. In addition, warmer water reduces fertility among fish, thus contributing to the decimation of future generations.

The main reason for these effects lies again in the smaller amount of oxygen in warmer water, asphyxiating the fish.

The researchers also estimated that the sea water temperatures in the North and Baltic seas near the German coast have increased by 1.13 degrees Celsius during the last 40 years. By the end of this century, temperatures could rise by up to 4.0 degrees Celsius.

Fabiana Frayssinet

RIO DE JANEIRO, Jul 17 2007 (IPS) – A child mown down by a hail of bullets from a rifle aimed by an unseen gunman is one of the drawings kept on file by psychologist Ricardo Parente, and produced in evidence to support his claim that Freudian theory must be revised when treating cases in the violent shantytowns of Brazil.
Children here are victims of an urban war, in which Sigmund Freud s Oedipus complex and other psychoanalytical concepts do not follow their normal patterns.

Parente practices at the child psychology clinic belonging to the non-governmental Women s Union for the Improvement of Roupa Suja district, in Rocinha, a crowded favela (shantytown) that is home to 200,000 people.

This community, one of numerous favelas clinging to the hills surrounding Rio de Janeiro and one of the largest in Latin America, has not experienced a police raid for at least six months, nor have there been any conflicts between rival drug trafficking gangs.

But its children bear the scars of war, on their bodies as well as in their drawings, which depict war between police and drug traffickers, or between different criminal gangs. The United Nations Children s Fund (UNICEF) calls this urban violence, but residents in the favelas of Rio de Janeiro call it urban war. That is how they experience it.

The violence makes a difference in the lives of these children, and completely alters their day-to-day experiences, Parente told IPS.
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The psychologist, who works with children and adolescents referred by the Women s Union, said he had treated a girl from the favela who had been sleeping at home, and woke up with a burn on her hand. It was a bullet that went right through her, he said.

Who fired the shot remains unknown to this day. She was a collateral victim of a shoot-out, hit by a stray bullet.

According to official figures, stray bullets wounded or killed at least one person a day in Rio de Janeiro in January.

As a psychologist, Parente knows that the psychic traces of the bullet will endure longer than the scar itself, and not only in the victim. The girl s younger brother was right beside her, and he saw the blood on the armchair, Parente said.

Although no rule is valid for everyone, these children will often be afraid to relate to others of their age, be more introverted, more timid, will sometimes have symptoms of depression, or emotional limitations; at other times they may be aggressive. These are the defences they create as a consequence of the violence, he explained.

When the police occupied a favela of 65,000 people called the Complexo do Alemao in May, the consequences of the war a term that is not accepted by the government of Rio de Janeiro became clearer.

UNICEF emphasised that the continuous battles between police and drug traffickers meant that from May 2 onwards, children could not attend their schools and were transferred to others, where thousands of pupils share classrooms in four daily shifts lasting only two hours and 15 minutes each.

Attacks on children are unacceptable, and schools should be safe environments for those who are learning to grow, said Ann M. Veneran, executive director of UNICEF.

Parente agrees, but as someone familiar with treating children at risk, he ventures to dig deeper into the causes that are creating a new generation that is fearful, repressed and limited in the expression of emotions.

What I think is very serious and affects children here is not only the violence itself, in the shape of an invasion or a shoot-out, but also the fact that families are restricting their children s freedom to go out, in case they should meet with drug traffickers or be hit by stray bullets, the psychoanalyst said.

In the case of this urban war, where drug traffickers are sometimes better armed than the police, the government can no longer turn a blind eye, said Brazilian Public Security secretary Luiz Fernando Correa.

This is a time when there is a serious historical accumulation of neglect by the state and society. Organised crime was allowed to acquire too much fire power. It is painful, but it is true, Correa said at a press conference at the Foreign Correspondents Association.

Painful, and very difficult to solve within the four walls of a children s psychoanalytic clinic in a favela.

I treated a mother who was so terrified by her surroundings that she shut up her children, aged seven and nine, in the house for two or three days at a time. Where is the freedom of those children to play spontaneously, which is so important for their emotional development? Parente asks.

The analyst, who also treats children and adults in the residential southern district of Rio de Janeiro, wonders whether new parameters are not needed within psychoanalytic theory to deal with the situation in the favelas.

In the favelas the construction of the Oedipus complex in the nuclear family with a mother and a father seems rather irrelevant, Parente says.

These situations produce another set of experiences, another way of living. A child from a nuclear family, with a father and mother, grandfather, uncles even though in upper-income communities things may not be so prevalent any more lives in an environment completely different to that of children in the favelas, where many of them don t have a father, he said.

So where does that leave the Oedipus complex? What construction can be made of the father, the mother, prohibition, what are the limits, what construction can be made? the psychologist asked.

Parente accepts that the interpretation of symbols is culturally conditioned. A middle-class child, accustomed to peaceful surroundings, sees a skull and crossbones as a symbol of a pirate film (like the Hollywood blockbuster Pirates of the Caribbean ) while to a child in a favela it is an image of terror, a symbol of the ultimate bogeyman: the caveirao .

I learned something of the language of symbols from the children s drawings, Parente said.

When I began to work here as a psychologist, a child drew a caveirao . I didn t know what it was, and then I found out it was an armoured vehicle that the police use when they invade the favelas, he said.

It turns up in their games, added Parente, referring to the symbol of two skulls that identifies the feared police vehicle.

Sociologists have a different angle. Most of the victims of Rio s urban war are young people, according to the Security Studies Unit of the Cándido Mendes Faculty in Rio de Janeiro.

They can be found among the innocent bystanders or among the drug traffickers, who co-opt them as soldiers. In the drug rings they have the chance to rise up from nowhere, to wear a world-renowned brand of sports shoes, to earn respect and a salary they can live on, says Silvia Ramos, a sociologist at that study centre.

This is nothing new, for several studies have found that most victims of Rio de Janeiro s violence are young and, specifically, black, living in the poorest areas of the city.

This is a direct result of the absence of the state in the favelas, which the government is proposing to change by means of a controversial policy.

We cannot avoid telling future generations that much of what we are experiencing now is the result of neglect by previous governments, Correa said.

In the preschool centre of the Women s Union for the Improvement of Roupa Suja, five children under four are dancing and singing to the beat of a children s song, miles away from the war that is going on between adults in the streets.

They sing and imitate dance steps from a song by national entertainment star Xuxa, and pose for the journalists who are photographing the scene. Perhaps they will be part of that future generation which will not suffer from neglect.

Karen Yap Lih Huey* – IPS/TerraViva

COLOMBO, Aug 18 2007 (IPS) – Sabina Yeasmin Putul has a silent, determined look with her left fist clenched tight in front of her face a vision of strength, grace, and resilience all in one.
The 17-year-old Bangladeshi has a lot going for her. Mature beyond her age, she has a good understanding of what she has been through, as the daughter of a sex worker, and of how society sees and judges her. And she probably does not know this that her struggles inspired respected Bangladeshi photographer, writer and activist Shahidul Alam.

The way she tackles issues regarding her mother and the people around her is powerful. Of course, among other things, she did martial arts and I thought rather than showing child of a sex worker, I photographed her as this powerful woman who came across with powerful ideas, said Alam, managing director and founder of the Dhaka-based Drik Photo Library.

Posters of her in a martial arts pose was the face for Shahidul #39s photography exhibition, a project produced by a team from Pathshala (classroom), the South Asian Institute of Photography which is the education wing of the award-winning agency Drik. The exhibition titled #39Portraits of Commitment #39, which opened Saturday, was held in conjunction with the 8th International Conference on AIDS in Asia and the Pacific in Colombo, Sri Lanka, which runs from Aug. 19 to 23.

The evocative portraits in this exhibition are from a book of the same name commissioned by The Asia Pacific Leadership Forum on HIV/AIDS and Development of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

South Asians portrayed in the exhibition a Bollywood superstar, a Pakistani journalist to a former Nepali drug user tell of how AIDS has made them better people and have more respect for human rights and individual choice where once there was little.
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Quoted during an interview given on behalf of the exhibition, Sabina says, I gave wrong information to make others afraid, as I had been. I had to go back and give correct information.

The photography project, which started in April, gives fresh insights into the AIDS subject. Essentially, we need to a find a breath of people in terms of AIDS, gender differences, lifestyle and bring relevance to everyone. Finding the balance is one. Finding the distribution is another and then, of course, you try to find individuals who is most inspirational, Alam adds.

While trying to balance between the sensitive and delicate, he says the most difficult assignment was portraying the Rev. Alexander Vadakumthala from southern India, who is the executive secretary of the Health Commission of the Catholic Bishops.

The thing I found difficult was the way he challenges the Church. That has to be tackled delicately. While I recognise this man has something important to say -challenging the status quo I also recognise that he #39s a deeply religious person. He said, #39The Church finds its meaning when it responds to the challenges of the times #39.

He didn #39t do it out of belief, but because he felt that the Church needs to change to adapt to circumstances. So, I portrayed him as a religious person but also a person that is ready to challenge religious beliefs, Alam says.

The photograph of the Rev. Alexander does not look provocative, but the subtle message is clear and strong.

To understand his subjects better, Alam spent time at an AIDS clinic, because, as he recalls, I need to know for myself.

The first time I decided on taking on this project was that I was not sure of myself. If I knew a person is positive, I #39m not sure if I should touch that person or whether we could drink from the same glass, or learn how some body language could be totally disruptive for HIV-positive people, he adds.

Stigma and discrimination still abound and have discouraged demand for counselling, testing and treatment in South Asia. Reducing the stigma associated with HIV and AIDS in South Asia will require greater involvement of civil society organisations, businesses, the entertainment industry, religious leaders and the medical community.

According to UNAIDS, Sri Lanka had about 5,000 people living with HIV at the end of 2005. Officially reported cases are far fewer because of under-reporting, which is mainly due to the limited availability of counselling and testing, the fear associated with seeking services, and the stigma and discrimination associated with being identified as HIV- positive.

(*Terra Viva is an IPS publication)