Complete Wellness

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)

Interview with Clarissa Brocklehurst, UNICEF Water and Environmental Sanitation Chief

UNITED NATIONS, Sep 17 2007 (IPS) – When it comes to discussing the critical health problem of inadequate sanitation, few politicians want to take the lead, despite the mountains of scientific evidence that poor hygiene and lack of proper toilet facilities are the cause of many deadly but preventable diseases.

Clarissa Brocklehurst at UNICEF House Credit: UNICEF/Susan Markisz

Still, Clarissa Brocklehurst, chief of UNICEF s Water and Environmental Sanitation division, is optimistic that the upcoming International Year of Sanitation in 2008 will put this issue much higher on the policy-making agenda.

IPS correspondent Nergui Manalsuren spoke with Brocklehurst at UNICEF headquarters in New York. Excerpts of the interview follow.

IPS: There are an estimated 2.6 billion people living without adequate sanitation, of whom 980 million are children. How is UNICEF working to resolve this problem?

CB: Whereas water supply is often a community decision, and a community responsibility, we find that sanitation is a household decision. Many families actually want to have a toilet for the privacy, convenience and the dignity that it offers. And we value that too, particularly because we work a lot with women as mothers of children. For those women, the health impact of the toilet is less important than the impact it has on their dignity and comfort, not having to go and defecate out in a public place.

We are finding that once families are convinced of the need for sanitation, they are willing to go to great lengths in order to provide their family with sanitation, which means building a toilet. And that means making sure that sanitarian equipment is available on the local market, and that we have lots of different designs of toilets so that people can chose the one that they think is the most appropriate to them.
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IPS: Why is sanitation considered one of the most neglected of all the U.N. s Millennium Development Goals (MDGs)?

CB: It is pretty easy to see why sanitation is neglected; it s something that people are embarrassed to talk about. It s what one author called the last taboo . It s embarrassing, it s seen as a very personal, private issue. It s not the one that is seen as particularly sexy or interesting. It doesn t lead to a nice photograph.

One of the things we ve been trying really hard to do is to get positive photographs of latrines, the same way that UNICEF has lots of wonderful positive photographs of water supply. And you can imagine how difficult that is, right? So in a way we compare ourselves in the sanitation sector to the people who pioneered HIV/AIDS. When the issue of AIDS first came up, advocates had to break through the fact that in order to talk about HIV and AIDS, you had to be willing to talk about people s sexual practices, and this was very difficult, but they did it. And it became very matter of fact, and people realised that it is something that needed to be discussed if the disease would be combated.

If the health MDGs are going to be met, we have to improve water supply, improve sanitation, and improve people s hygiene practices, particularly washing their hands with soap. And that means that we have to talk about people s defecation practices the same way that we had to talk about people s sexual practices. And this is a difficult thing to do, because people get embarrassed and shy, and start to giggle. So it s something that we have to address head-on.

IPS: How do you think you can generate more media and donor attention for NGOs that deal with sanitation issues?

CB: One way is through scientific evidence. There are studies available today that were not available even five or 10 years ago. They show very clearly the link between sanitation and health and particularly between hand washing with soap and health. When I say sanitation, I mean toilet, solid waste management, rubbish management, hand washing with soap, and hygiene practices, we see them all as the same thing.

It is women whose dignity and even security are threatened when there s no proper sanitation, women who have to wait all day for darkness of night to be able to go out and go to the toilet. So we want to help women to push sanitation up on the agenda, not as a health issue, but as a quality of life and a dignity issue.

IPS: Why is the subject of sanitation and human waste so rarely aired in public, and what can be done to change this mindset?

CB: It is a brave politician who will get up and talk about sanitation and publicly say that he or she supports investment in more toilets. Politicians usually like to talk about investments in modern equipment projects and things like that. But we do find brave politicians who are willing to break through the taboo and talk about it.

Sanitation is also an institutional orphan, in the sense that the agency or ministry that is responsible for water supply in a country is not necessarily the agency that is responsible for sanitation. So there will be a ministry of water, for instance, that is responsible for water resources and water supply. But then sanitation will be buried in the ministry of health. The ministry of health would be much more interested in curing a disease than in sanitation, which is sort of poorly resourced, and an embarrassing topic. So we do a lot of work to raise the profile of sanitation within health ministries.

IPS: What are the consequences of lack of sanitation among children?

CB: The thing that we re most worried about is diarrheal diseases. Most are fecal or oral, which means that you catch that disease by coming into contact with human fecal matter. And obviously in an environment where there are no toilets, if there is human fecal material available, it gets on people s hands, it gets to some people s feet, it gets into food, and it gets into water, and then we have a very high risk of diarrheal diseases like cholera, and they are deadly to small children. We also worry about worm infections. And most worm infections are caused by poor disposal of human feces and animal feces.

Then there s an issue of lost days of school. If children don t have clean toilets to go to at school, their parents are most likely to keep them at home. Especially girls, when they start menstruating. So we find that for girls, school toilets are just as important for menstrual hygiene as they are for defecation, and that means we have to design many tools to respond to those needs.

IPS: What regions of the world are most affected by lack of proper sanitation?

CB: The coverage rate for sanitation in India and China has a huge impact on the coverage rate for Asia overall. And India and China, advanced as they are in many ways, have very low, surprisingly low rates of sanitation. India is not on track to meet the sanitation target. China overall comes out as being on track, but what that hides is that there s enormous rural China that is not on track. Russia is not on track as well. Most of Africa is not on track to meet the sanitation target.

Haider Rizvi

UNITED NATIONS, Oct 13 2007 (IPS) – Despite its enormous wealth and highly advanced technology, the United States lags far behind other industrialised countries and even some developing ones in providing adequate health care to women during pregnancy and childbirth.
The U.S. ranks 41st in a new analysis of maternal mortality rates in 171 countries released by a group of U.N. public health experts on Friday. The survey shows that even a developing country like South Korea is ahead of the United States.

Women are unnecessarily dying from pregnancy and childbirth complications because the U.S. is moving in a wrong direction, said Beneva Schulte of Women Deliver, a Washington-based group campaigning for women #39s reproductive rights and access to public health care.

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.

The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.

Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities.
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We must ensure that pregnant women are covered, Congresswoman Lois Capps, a California Democrat, told IPS. Even if we have the best technology, not everyone has the access to health care.

Capps also said the scope of the problem could be even worse than it appeared. We have to improve our data collection, she said. I don #39t think we have all the data.

U.N. experts who prepared the analysis said they developed a new approach to estimating maternal mortality that seeks both to generate estimates for countries with no data and to correct available data for underreporting and misclassification.

They hold that inconsistency in data on deaths and on classification of those deaths creates broad uncertainties in many places, even in developed countries. But all estimates almost certainly understate the problem.

Responding to inquiries by IPS, a U.S. public health official identified racial disparity as the most significant factor underlying the high U.S. maternal mortality rate. Black women are four times more vulnerable than whites, Eve Lackritz, chief of the Maternal and Infant Health branch of the Centres for Disease Control (CDC), told IPS.

In Lackritz #39s view, obesity and hypertension are two leading causes of pregnancy-related risks in the United States. We have to be more responsive, she said. This is one of our big problems.

The U.S. situation within the industrialised world aside, the other end of the spectrum shows there are 10 countries all of them in Africa except for Afghanistan where high fertility and shattered health care systems are causing extreme risks for pregnant women.

According to researchers, in countries like Somalia, Mali, Chad, and Niger, on average more than one in every 15 women is likely to die of pregnancy-related causes. In Niger, the estimate suggests that one out seven women is vulnerable to death during pregnancy.

Their analysis comes at a time when many development activists and U.N. officials are trying to evaluate how far the world has progressed in meeting the Millennium Development Goals agreed upon by the world leaders some seven years ago.

When the world leaders attended a summit in New York in September 2000, they agreed that the MDGs must be achieved by 2015. That commitment included policy initiatives to reduce maternal mortality by 75 percent.

Many experts believe that in the past seven years nothing much has changed for the millions of poor women with regard to their economic wellbeing and access to health care.

As reported by the British medical journal the Lancet this week, at the current pace, there is almost no hope that the world will be able to achieve the 75 percent target.

Annually, about 20 million women undergo unsafe abortions, which, according to the journal, is a major factor in maternal deaths and illness.

Reproductive rights activists say that governments must take drastic steps to reverse the situation if they are serious in meeting the MDGs on reducing the maternal mortality rates in the next seven years.

We still have the situation we had 20 years ago, said Ann Starrs of the independent group Family Care International in a statement. Half a million women die every year from the complications of childbirth.

A recent study by Harvard University professor Ken Hill found that between 1990 and 2005, maternal deaths did fall, but by less than one percent a year. Hill and many other researchers estimate that at least 10 to 20 million women suffer injuries from the complications of childbirth every year.

Experts say this suffering could be easily avoided if international donors contributed just 6.1 billion dollars over the next seven years.

On Oct. 18-20, more than 1,500 world leaders will convene in London for Women Deliver , a global conference that will focus on creating political will and strengthening health systems to prevent the deaths of one woman every minute of every day during pregnancy or childbirth .

David Vargas

ASUNCIÓN, Nov 8 2007 (IPS) – A sea of green stretches as far as the eye can see on both sides of the dirt road leading to the communities of Lima, Capiibary and Guayaibí, 250 km from the capital, in the northern Paraguayan department (province) of San Pedro, one of the country s poorest.

Credit:

The huge fields are planted with genetically modified soy, Paraguay s leading export product. But as it takes over more and more land, the crop is leaving sick people, displaced communities and trampled rights in its wake, according to the documentary Soberanía violada (Violation of Sovereignty).

The documentary, produced by a Paraguayan team, portrays the drama of campesino (small farmer) communities that experience the spread of soy plantations as a threat to their survival.

The economic interests of large landowners most of them foreigners and multinational corporations are destroying entire communities, felling forests, polluting streams and rivers, making children sick, causing miscarriages, killing campesinos and forcing them to abandon their land and their culture, says the synopsis of the 40-minute documentary.

Paraguay has become the world s fourth largest exporter of soy, after the United States, Brazil and Argentina. According to the Agriculture Ministry, soy is grown on 2.4 million hectares of land and accounts for 38 percent of the country s agricultural production.

The Paraguayan Chamber of Cereals and Oilseeds Exporters (CAPECO) announced that their goal for 2008 is to expand soy cultivation to four million hectares and to double export revenues from the commodity, which in the first quarter of 2007 amounted to 780 million dollars.
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But that figure fails to reflect the social and environmental consequences of the expansion of soy cultivation, which are reflected in the documentary through dozens of testimonies from campesinos.

The idea for the film came from the provincial Coordinating Committee for the Defence of Sovereignty, an umbrella group for representatives of organisations and leaders of different communities in San Pedro, Arturo Peña, one of the producers of the documentary, told IPS.

Soberanía violada has been included on the programme of the One World Berlin Film Festival to be held this month in the German capital, where it is due to be screened on Nov. 18.

The filmmaking team s general coordinator was Catalina Servín, and the documentary was written, directed and filmed by Malu Vázquez and edited by José Elizeche, with music by W. Krauch.

Their aim, they said, was to create a tool that could be used to raise awareness on the problem, which has got worse over the last five years as transgenic soy has expanded in the area.

Thousands of families have already left the province after selling their land, usually because they were surrounded by the soy crops and endangered by the spraying of toxic agrochemicals. They had no choice, said Peña.

The soybean boom has also brought unemployment. It requires little labour, and in the east of Paraguay soy has displaced cotton, which used to employ large numbers of people, the documentary says.

Small farmers, who make up a large proportion of the country s six million people, have been displaced by large-scale soy producers.

According to a study by the non-governmental social research organisation Base-IS, 70 percent of Paraguay s farmland is presently in the hands of foreign landowners, who are mainly Brazilian.

Some small farmers, however, have refused to budge. One example is Manuel Cuevas, who has cultivated beans, maize and other subsistence products near the village of Lima for 30 years. His 10-hectare property is surrounded by Brazilian-owned soy fields.

Cuevas has received several offers for his land, but he and his family have turned them all down. So far we re doing alright, he says in a resigned tone of voice.

I will never leave. I have everything I need here: land, running water, electricity. There is no reason for me to leave my land, says Reinaldo Casco, another farmer, who adds proudly that his parents were among Lima s first settlers.

These are just two testimonies out of the dozens shown in the documentary, which reflect the abandoned state of these rural villages, left to fend for themselves for decades, with obsolete health systems, authorities who serve the interests of the big landowners, and roads in terrible condition, Peña told IPS.

And now they are also threatened by the crushing advance of the agroexport model, he said.

Sociologist Tomás Palau, one of the authors of the book Los refugiados del modelo agroexportador (Agroexport Refugees), described the main effects of the rise of soy monoculture on rural communities.

There is strong pressure on the campesinos land, because the market value has sky-rocketed, he told IPS.

The campesinos are displaced in various ways: their land is bought or leased, or they are forced to leave because of massive spraying with agrochemicals.

There are also armed groups operating in the area. It s really an eviction army, he said.

Spraying with toxic agrochemicals has negative effects on both human and animal health, causing illnesses ranging from allergies and respiratory problems to cancer, foetal malformation and miscarriage, Palau said.

The environment also suffers. The agrotoxics poison rivers and the earth, kill microorganisms in the fertile layers of soil and increase deforestation, he said.

But according to Palau, the least visible aspect of soy agribusiness is the fact that the revenues from soy exports do not remain within the country, because they belong to large foreign producers and corporations.

Without realising it, we re finding ourselves in a situation where an extremely high percentage of Paraguayan exports is controlled by three or four multinational corporations: Monsanto, which supplies seeds to 90 percent of the producers, and companies like Cargill, Louis Dreyfus and ADM (Archer Daniels Midland), he said.

Soy cultivation in Paraguay began to expand in the mid-1960s and boomed in the late 1990s with the introduction of genetically modified seeds by companies such as Monsanto.

Intensive soy production has caused a fall in traditional activities like timber extraction, cattle ranching and even production of cotton, which used to be the country s main agricultural export. The area under cotton cultivation has dropped from 509,000 hectares in 1990 to only 160,000 hectares in 2006.

Abra Pollock

WASHINGTON, Dec 5 2007 (IPS) – Globalisation, climate change, and the mass production of biofuels are pushing up food prices worldwide, which could jeopardise the livelihoods of the world #39s poorest, according to a report released Tuesday by the International Food Policy Research Institute (IFPRI).

Man working a rice field in Bangladesh. Credit: USAID

Food prices have been steadily decreasing since the Green Revolution, but the days of falling food prices may be over, said Joachim von Braun, lead author of the report and director general of IFPRI.

Titled, The World Food Situation: New Driving Forces and Required Actions , the 16-page report examined how various global trends are impacting world hunger on both the supply and demand ends of the market.

Surging demand for feed, food, and fuel have recently led to drastic price increases, which are not likely to fall in the foreseeable future, von Braun said. But climate change will also have a negative impact on food production.

Similar findings have been reported by the Organisation for Economic Cooperation and Development, the U.S. Department of Agriculture, and the U.N. Food and Agriculture Organisation, according to IFPRI.

Researchers predict that shifting weather conditions resulting from climate change will disrupt rainfall patterns that farmers rely on to nourish their crops and water the grasslands that feed their livestock. As a result, cereal production in South Asia could drop 22 percent by 2080, while wheat production in Africa may virtually disappear by that time, the report said.
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Furthermore, temperature increases of more than three degrees Celsius could in turn lift food prices by as much as 40 percent.

The production of crop-based biofuels renewable energy sources developed in response to climate change may also dramatically impact food supply, and thereby further escalate food prices.

If the countries that have already committed to biofuel production, as well as other high-potential producer countries, carry out their current investment plans, global maize prices would increase by 26 percent and oilseed prices would rise by 18 percent by 2020, according to the report. This is due to state subsidies for biofuels, as well the shift in committing scarce resources toward cultivating biofuel crops.

As biofuels become increasingly profitable, more land, water, and capital will be diverted to their production, and the world will face more trade-offs between food and fuel, the report said.

In the U.S. alone, the use of maize for ethanol production increased by two and a half times between 2000 and 2006.

On the demand side of worldwide food production, globalisation, economic growth, and urbanisation in places such as China and India have impacted people #39s dietary preferences and food choices, the report noted. While demand is on the increase for processed food and high-value agricultural crops such as vegetables, fruit, meat and dairy, demand for grains and other staple crops is declining.

This shift in tastes represents a microcosm of the food costs issue, said IPFRI research analyst Timothy Sulser, who also contributed to the report. As wealthier populations shift to a diet full of meat, fruits, and vegetables, poorer populations will struggle to afford ever pricier food staples.

There will be an even wider gap between affluent people and poorer people in terms of access to a nutritional diet if trends continue, Sulser said.

With many factors threatening the world #39s food supply and demand, immediate action is needed in the areas of international development and global trade policy in order to avert what could be a dramatic hunger crisis, according to authors of the report.

Eliminating trade barriers and programs that set aside agriculture resources is one way that developed countries could help equip developing countries for the rising food prices.

Other suggestions include strengthening policies to promote early childhood nutrition thereby diminishing the risks related to limited food access and incorporating food and agriculture considerations into the agenda for domestic and international climate change policy.

Yet these solutions may only mitigate the effects of a global trend whose causal forces, such as globalisation and climate change, have already been set in motion, say researchers.

The policy suggestions are intended to help minimise some of the impact of these changes, said Sulser. It #39s important now to look at how we can help people adapt to the changing the situation.