Complete Wellness

BUENOS AIRES, Mar 29 2012 (IPS) – A novel research study in Argentina explored women s knowledge and beliefs about cervical cancer, in the provinces with the highest mortality from this highly preventable form of cancer, to design more effective policies.
Although there are now effective tools to prevent cervical cancer, and vaccination against human papillomavirus (HPV) is free and mandatory for 11-year-old girls, the death rate from cervical cancer is not declining in Argentina, and the geographical distribution of the burden is extremely unequal.

This scenario was the starting point for the study titled (What Women Think: Knowledge and perceptions about cervical cancer and the Pap test , published by the Argentine Health Ministry and the Pan American Health Organisation (PAHO).

The study concluded that women have only a vague understanding of this health problem, and that most are unaware that HPV, a sexually transmitted disease, can cause cervical cancer.

Medical research has established that persistent infections with certain types of HPV cause nearly all cases of cervical cancer. Left untreated, invasive cervical cancer is almost always fatal, according to the World Health Organisation (WHO).

They do not always know what the Pap smear is for, say the authors, referring to women’s understanding of the Papanicolau screening test, which involves taking a small scraping of cells from the cervix – the narrow lower portion of the uterus where it joins with the top end of the vagina.
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Examination of the sample in a laboratory can detect pre-cancerous lesions before they develop into cancer, a potentially life-saving step if it is followed by prompt treatment.

One of the authors, Dr. Silvina Arrossi, who is the scientific coordinator of the , told IPS the goal of the study was to find out about women s perceptions and knowledge about this type of cancer, in order to incorporate their views into prevention strategies at the design stage.

In Argentina, cervical cancer is the second cause of deaths from cancer in women aged 35 to 64.

We wanted to know if there were problems with the information women have about it, in order to design user-friendly educational materials that could help to overcome those difficulties, Arrossi said.

The interviews were carried out with women in the eastern province of Buenos Aires – the most populous and in the northern provinces of Jujuy, Salta, Misiones and Chaco, which have the highest cervical cancer mortality rates.

The national average for cervical cancer mortality is 7.5 deaths per 100,000 women. But in these four northern provinces, the mortality rate rises to as many as 15 deaths per 100,000, while in the city of Buenos Aires it falls to four deaths per 100,000 women, so the study examined both statistical extremes.

The interviews with the women were revealing. A considerable number believe the cancer lives in the body in a latent state, and is awakened by events like an abortion, rough intercourse, or insertion of an intra-uterine device (IUD).

According to this view, the Pap smear, seen as an invasive procedure, could also disturb or awaken the dormant cancer, the study says. One woman said her 52-year-old mother-in-law had never had a Pap test because of this fear.

Another mistaken idea that cropped up frequently in the interviews is that older women do not need to have Pap tests if they are no longer sexually active and are feeling well. There s nothing wrong with me, so why should I go to the doctor? one woman remarked.

The women referred to other difficulties, related to their home-making role, that cause them to put off their own needs. Who ll serve your father his dinner? one woman asked her daughter, when the younger woman urged her mother to go in for a Pap test.

The study also found that women are not always well enough informed about the continuing precautions they need to take to prevent the illness.

A 38-year-old mother of nine from Chaco has never had a Pap test in spite of the many times she has attended health clinics for antenatal care and childbirth. Evidently the health system is failing here, the authors said.

The women s most common sources of information about cervical cancer are television, radio and other women. The health system, in contrast, was not frequently cited as a source of knowledge.

Several women call cervical cancer la pudrición ( rot or putrefaction), because of the fetid odour of vaginal discharge when the cancer is in an advanced state. They are fatalistic and pessimistic about the disease, and in some cases they say directly that there is no cure.

Another worrying finding is that some women have a Pap test, but do not return for the test result. According to the authors, this would seem to indicate that they do not fully understand the importance of having the test and then following it up.

In general, the respondents also showed a complete lack of knowledge that untreated HPV infection is the main cause of cervical cancer.

In October 2011, the Health Ministry added HPV vaccination to the mandatory series of routine shots for 11-year-old girls. Arrossi believes the vaccination campaign will help spread knowledge of the association between the virus and cervical cancer.

The study, by Arrossi, Nina Zamberlin and Laura Thouyaret emphasises that in spite of these highly effective and low cost preventive measures, cervical cancer continues to be one of the main causes of cancer deaths among women in developing countries.

Experience in the industrialised world shows that screening women with the Pap test is effective in reducing incidence and mortality, the researchers point out. However, in Latin America incidence of cervical cancer has not declined because of the low coverage of screening, the study says.

Mortality from cervical cancer in Argentina has not declined significantly in the last 40 years, and the distribution of the burden (of deaths) is extremely unequal, it says.

In 2009, the Health Ministry found that only 46 percent of women aged 35 to 64 in the northeast and northwest of Argentina had had a Pap test in the two years prior to the survey.

Based on the information collected by Arrossi and her colleagues, a photo-novella has been designed in which a woman tells her daughter she (the mother) does not need to have Pap smears any more because of her age. But the daughter explains to her mother that, in fact, she really does need to keep having the test.

Training will be given to health centre personnel who offer women health advice, in order to ensure that they engage women in dialogue and exchange of information, rather than just send them away with a leaflet, Arrossi said.

Many of the women interviewed for the survey admitted that they felt embarrassed when they had Pap smears taken by male doctors. The study therefore recommends that health centre teams always have a woman available to take samples for the Pap test.

RIO DE JANEIRO, May 4 2012 (IPS) – María dos Prazeres de Souza has lost count of the number of births without a single death she has attended as a midwife, an occupation that there is renewed interest in strengthening in traditional communities in Brazil where state services are not available or are not entirely acceptable for cultural reasons.

In countries like Mexico, where this indigenous baby was born, and Brazil, many mothers still give birth at home, attended by midwives. Credit: Mauricio Ramos/IPS

The 74-year-old de Souza says that prior to 2008 she attended 1,000 births in her home city of Jaboatão dos Guararapes, in the rest of the state of Pernambuco, and in neighbouring states in Brazil s impoverished Northeast.

She said she never ceases to be amazed every time a mother s expression changes from pain to joy.

A woman in labour feels pain, but when her baby is born she smiles and cries with happiness, she told IPS, recalling the tears of emotion she has shed herself at each birth she has attended.

De Souza, an indigenous woman, learned her skills as part of her cultural heritage. Her mother, grandmother and great-grandmother taught her the skills from childhood.

At first I would attend the births of cats, dogs and other animals, but later on in emergency situations, when my mother was not available, I began to attend women in their homes, she said. Subsequently she trained as an obstetric nurse and worked in hospitals for 20 years.
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Now retired, she still attends home births, sometimes in exchange for just a thank-you hug, like many of her colleagues who are midwives in the poorest parts of the country.

It is undeniable that the technologies and practices of the official health model have brought great advances, but we must try to achieve a balance between the traditional and the biomedical approaches if we want to guarantee the health of mothers and children, not just physically but also mentally and spiritually, said Paula Viana, coordinator of the in Pernambuco.

Because of their wisdom and experience, in, not excluded from, the health system, Viana said in an interview with IPS.

The Curumim programme has shown that traditional midwives contribute to earlier identification of problems in pregnancy, and that as natural leaders they help in cases of women who have been raped, in vaccination campaigns or in HIV/AIDS prevention programmes.

Midwives have contributed to the increase in prenatal checkups at public health facilities and healthy practices like breastfeeding, while they provide therapies such as massages, relaxing baths and emotional support.

The Curumim Group, on the occasion of International Day of the Midwife this Saturday May 5, is launching a campaign for recognition of the value of the role of traditional midwives among indigenous people and in quilombolas , communities of descendants of escaped slaves.

The campaign is also seeking recognition of home births attended by midwives within the Sistema Único de Saúde (SUS), the Brazilian national public health system, as well as the designation of midwives knowledge and practices as part of Brazil s intangible cultural heritage.

Traditional midwives are the bridge between the community and the health services. In many places where there are no doctors, they provide primary health care for the general population, and at other times they are the only person with the connections to get a sick person to hospitals or health clinics in nearby cities, Viana said.

De Souza has personal experience of the isolation of many rural, riverside or jungle communities. Once she attended a birth on the second floor of a half-built house that still did not have a stairway, so she had to climb up a rope rigged precariously by two police officers.

After the birth I had a lot of trouble getting down on my own, because one of the police officers was carrying the baby and the other was carrying the mother, she said.

According to Health Ministry statistics, 41,000 women a year give birth at home in this country of 192 million people, most of them attended by midwives. But the authorities admit the number may be higher.

Although health policies and projects officially take home births into consideration, the fact is that these births mostly take place in marginalised and isolated communities, without the involvement of the SUS, Viana said.

Traditional midwives can probably teach more than they can learn, but like any other health professionals they must train to improve and update their skills, and must have access to adequate materials and equipment, as well as means of transport for emergencies, she said.

De Souza said many of her colleagues in Brazil have no social benefits or labour rights, and receive no recognition for their work.

The government has to address this issue, especially as we have had a Brazilian president who was brought into the world by a traditional midwife, the expert said, referring to former president Luiz Inácio Lula da Silva (2003-2011), who is from the Northeast.

Viana emphasised that risk is inherent to childbirth, whether it takes place in a woman s home or in a hospital. But the danger of a serious health complication would increase if women in labour were deprived of the support of traditional midwives, she said.

That is why the Curumim Group s representative is calling for both healthcare models, the traditional and the biomedical, to join together, especially in remote and isolated communities.

In de Souza s view, pregnancy is a natural process, but many women have got it into their heads that they are ill, or else they don t want to suffer pain and they ask for a caesarean. SUS figures for 2008 show that half of the three million births registered that year were by .

The maternal mortality rate has declined steadily in Brazil since 1990, when there were 140 maternal deaths per 100,000 live births. By 2010 the figure was 58 per 100,000 and it is expected to drop still further. The main causes of childbirth-related death among women are hypertension, haemorrhages and postpartum infections.

The infant mortality rate has also fallen, to 15.6 per 1,000 live births in 2010, 47 percent lower than in 2000, according to the latest census.

In these circumstances, Viana said, the full range of regional obstetric care should be considered in order to achieve further improvement.

The more the scientific community endeavours to establish the biomedical model of health, the more we need to analyse the consequences of the excessively interventionist and medicalised nature of childbirth, she said, pointing out that the number of traditional midwives is in decline.

De Souza, the midwife who has brought more than 1,000 babies into the world, says: We have been blessed, and we continue to be blessed. We have thousands of years of history behind us, and that must command respect.

UNITED NATIONS, Jun 11 2012 (IPS) – The headline in a New York newspaper last March captured the essence of a future potential threat to political stability the world over: U.S. Report Sees Tensions Over Water.

The study, a collective vision of the U.S. intelligence community, warned that during the next 10 years, many countries important to the United States will almost certainly experience water problems shortages, poor water quality or floods that will contribute to the risk of instability and state failure, and increase regional tensions.

Carrying drinking water in a low-income Cairo district. Credit: Victoria Hazou/IPS

Still, there are fears that next week s U.N. Conference on Sustainable Development, also known as Rio+20, may marginalise both water and sanitation when it finalises its plan of action titled The Future We Want.

So is there a future for water in the U.N. scheme of things?

Not really, says Karin Lexen of the Stockholm International Water Institute (SIWI), a Swedish policy institution that seeks sustainable solutions to the world s escalating water crisis.

Many people are losing faith in the U.N. system and a weak Rio+20 outcome will build on to this mistrust, she told IPS.

We would of course like to see a strong outcome with concrete and forward thinking commitments, she added.

Lexen said that an agreement on Sustainable Development Goals (SDGs) would be one important outcome.

As a cross-cutting resource and the bloodstream of the green economy, water is an obvious candidate for one overarching SDG, but it also should be reflected in the other SDGs, particularly those on food and energy, she added.

The summit, to be attended by over 120 heads of state and government, will take place Jun. 20-22, and is a follow up to the 1992 Earth Summit in Rio de Janeiro.

Secretary-General Ban Ki-moon said last week he expects the summit to make progress on some of the building blocks of sustainability: energy, water, food, cities, oceans, jobs and the empowerment of women.

The U.N. Special Rapporteur Catarina de Albuquerque has already made a strong pitch urging member states to fully support the human right to safe drinking water and sanitation at Rio+20.
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In an open letter to member states negotiating the final outcome document, she expressed concern that a clear recognition of the human right to water and sanitation is at risk of being suppressed from the original text after three rounds of informal-informal negotiations held in New York in the past three months.

Some States suggested alternative language that does not explicitly refer to the human right to water and sanitation; some tried to reinterpret or even dilute the content of this human right, she said.

De Albuquerque, the first U.N. special rapporteur on the human right to safe drinking water and sanitation, said that water already has been recognised as a human right under international law, including by the General Assembly and the Human Rights Council in 2010.

When agreeing on a sustainable development target for water and sanitation, she said, governments have to integrate the human right to water and sanitation and aim at achieving access to safe and affordable drinking water and sanitation for all without discrimination.

They should also be available in sufficient quantities to protect human health and dignity, particularly for the most marginalised.

SIWI s Lexen told IPS that action to improve the wise and sustainable management of water is also critical to outcome at Rio.

By 2030, in a business as usual scenario, humanity s demand for water could outstrip supply by as much as 40 percent.

This, she warned, would place water, energy and food security at risk, increase public health costs, constrain economic development, lead to social and geopolitical tensions and cause lasting environmental damage.

Therefore, the foundation for a resource efficient green economy must be built upon water, energy and food security and these issues must be addressed in an integrated, holistic manner and be reflected in the Rio outcome and also as a cornerstone in the SDGs, she said.

Asked if water has found its rightful place on the international agenda since the first Stockholm Conference on the Human Environment back in 1972, Lexen said that given the fundamental role water has for all life, for wealth and economic development and being a source for conflict but also a tool for cooperation, water has not been given the prominent role it should have.

Water has a place in the Rio draft, but the different thematic areas are still very much compartmentalised.

Take the energy section, for example: water is not mentioned once in the remaining texts despite the fact that it is an essential resource for energy production, she said.

Other issues, like the recognition of access to drinking water and sanitation as a human right, and transboundary waters, are still under discussion now, only a few days before the Rio Summit begins.

She said The Friends of Water group has played a role in pushing water into the global environmental agenda.

But we have important work in the final week ahead, and at the summit, to ensure that a wider group priorities water and ensure concrete commitments and a strong outcome document is produced in Rio, Lexen said.

Sex workers march through a street in the Indian city Kolkata to condemn U.S. denial of visas to attend an AIDS conference. Credit: Sujoy Dhar/IPS.

KOLKATA, Jul 26 2012 (IPS) – Bare-chested and beaming in the company of many like him, London-based male sex worker Thierry Schaffauser wipes the beads of sweat trickling down his face on a humid Kolkata evening, and slams U.S. President Barack Obama.

“He is against sex workers. His policies are actually killing sex workers across the world and hindering HIV/AID prevention,” says France-born Thierry.

Thierry and thousands of sex workers from across the world who are gathered in Kolkata Jul. 21 to 27 at the ‘Sex Workers Freedom Festival’ are critical of the U.S. government for denying them visas to attend the international HIV/AIDS conference being held this week in Washington.

The International AIDS Conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic.

But sex workers, who are the most HIV/AIDS prone community, were denied entry in the U.S. under laws which limit travel for sex workers.

The sex workers community chose instead to hold a parallel meeting in this eastern city. Nearly 800 sex workers and activists turned up from 41 countries to join thousands of Indian counterparts at the Kolkata meet.

Sex workers from India were also vocal against the U.S. laws. “I am here because this is like a festival for us,” says a transsexual sex worker from south Indian state of Andhra Pradesh. “But we are also protesting the U.S. visa denial. It is like denying one’s human rights.”

Anna, who represents the Canadian sex workers’ organisation Stella, says the Kolkata conference will send a strong message.

“I am a worker. A sex worker is a real worker. You should decriminalise the profession and accept us as workers. It is strange that the U.S. does not understand that,” says Anna, marching with hundreds of others holding a red umbrella, now a sex workers symbol of resistance against discrimination.

Visitors from across the world are overwhelmed by the organisational skills of the host organisation Durban Mahila Samanwaya Committee (DMSC).

With 65, 000 members, DMSC is the world’s largest association of sex workers. It operates out of Sonagachi in Kolkata, the hub of more than 10,000 brothel-based sex workers.

Akhila Sivadas, executive director of New Delhi-based Centre for Advocacy and Research, which is partnering with the Global Network of Sex Work Projects (GNSWP), the All India Network of Sex Workers (AINSW) and DMSC to organise the conference, says the Kolkata gathering is the manifestation of a bold stand taken by the community.

“This conference is an affirmative statement where sex workers from diverse cultures and economies have come together. There are differences but the overall similarities are the same. If you do not decriminalise you will lose the battle.”

According to Dr. Smarajit Jana, chair of the conference and father figure of the sex workers’ movement in Kolkata, the U.S. is continuing with an earlier restriction on visa denial to sex workers. “So when they were denied visa by the U.S., we in Kolkata came forward. The government in India does not have such restrictions on entry of sex workers.

“Despite all our failures and social taboos, India is transparent about fighting AIDS and so we could bring down the HIV population from five million to 3.5 million at the moment,” says Dr. Jana. “The policy in India is effective and progressive.”

“The roadmap ahead is to clearly strengthen partnership at every level,” says Akhila Sivadas. “The community is designing, shaping, fighting economic injustice to fight HIV/AIDS.

“We will focus more on social entitlement and economic justice,” she says. “Here DMSC is the ideological vanguard because they started at a time when tolerance was not there. But while they are at the vanguard, those taking inspiration from them have to also innovate in their environment in each area, in different milieus.”

BUENOS AIRES, Sep 17 2012 (IPS) – The Argentine government has opened legal aid centres in slum neighbourhoods, to provide a range of services, from assistance for immigrants and victims of domestic violence to dental care services.

“Many of the situations can be solved by picking up the telephone,” said Ariel Pereira, coordinator of the centre that is operating in Villa 1-11-14, a shantytown on the south side of Buenos Aires.

People living in the neighbourhood seek help from the centre in applying for pensions or identity documents, and filling out paperwork in the case of immigrants. They also file reports of domestic violence and application forms for social assistance payments or exemption from taxes or fees for certain services.

“In our centre, the people who come for help are mostly foreigners and battered women,” Pereira told IPS.
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In both cases, the obstacle that leads them to turn to the centre is the police themselves, who often pay no attention to reports of domestic violence, considering them minor incidents, or simply because of discrimination.

To apply for residency in Argentina, immigrants, mainly from Bolivia and Paraguay, need to show proof of address, which has to be issued by the federal police after they verify where the applicant lives.

But “since this is a ‘villa’ (slum), the police don’t come here, and people get desperate because their appointment date is coming up (in the immigration office) and they don’t have the proof of address,” he said.

In such cases, the legal aid centre takes a hand in the matter, to get the police to issue the necessary document.

In the case of domestic violence victims, the police do not take down the women’s complaints, “sending them instead to the courts in the centre of the city, which makes things difficult for the women,” he said.

The legal aid centres, by contrast, offer the women support from lawyers, social assistants and psychologists, who inform them of their rights and, in case they file a legal complaint, help them every step of the way.

Of the total number of people who turn to the legal aid centres for help, 63 percent are women and 45 percent are foreigners of either sex.

Applying for a certificate of poverty

Some 15 people were waiting in line for assistance when IPS visited one of the legal aid centres set up in Villa 31, a long-time slum in the central neighbourhood of Retiro.

Three public employees are on duty from 10 AM to 4 PM every day in the legal aid centre, which is just two by six metres in size. It is next to a Catholic church in this poor neighbourhood which according to the 2009 census was home to just over 26,000 people, 51 percent of whom were from neighbouring countries, mainly Bolivia, Paraguay and Peru, and 20 percent of whom from Argentina’s provinces.

IPS randomly interviewed seven of those waiting in line, and found that they were all immigrants who had come to apply for a “certificate of poverty” – the name given to the document they need to be exempted from a 300 peso (65 dollar) fee for applying for an Argentine identity card.

Also waiting in line were people seeking other documents, or people who wanted to talk to the lawyer, like Sandra, a 31-year-old Peruvian woman who needed legal aid for obtaining custody of her daughter.

“Her father doesn’t give me money, and I know he’s here (in Argentina),” said Sandra, who wants to visit her two other children who are living with a relative in Peru. But in order to take her seven-year-old daughter with her on the trip, she needs authorisation from the father, who has not shown up.

Mediators

The first five legal aid centres were created in 2008 in Buenos Aires. These pilot centres found the need for offering a wider range of services. Another 33 were gradually opened, several of them in the provinces, Florencia Carignano, the head of the National Office for the Promotion and Strengthening of Access to Justice, told IPS.

“There are economic, social, cultural and geographic barriers standing in the way of everyone having access to the same rights. For that reason, rather than sporadic interventions, what we are seeking at the centre is to provide a stable state presence,” she said.

Once it was clear what kinds of assistance would be sought in the centres, Carignano’s office, which is under the Justice Ministry, signed cooperation agreements with other ministries and public offices, as well as with universities and foreign consulates.

In some cases, these different institutions supply their own staff to the legal aid centres where their services are needed.

“The paperwork of foreigners is often bogged down in their countries of origin,” Carignano said. “In these cases, we set up mobile units. Consuls come to take note of the needs, and in 15 days they come back with the papers.”

The centres also act as mediators, and they raise awareness – through pamphlets and conferences on new laws that expand rights, for example, in the areas of immigration, mental health or domestic violence

The Justice Ministry’s office of Social Readaptation, which helps ex-convicts rejoin society, also has representatives in the centres.

In addition, young people from the Labour Ministry’s “More and Better Jobs” programme work as administrative employees at some of the centres. These youngsters are completing their secondary school studies and seeking to join the labour market.

The elderly seek help at the centres in applying for a pension, exemption from taxes or fees, or benefits to which they are entitled by law, but which they do not know how to claim. One example is the right to receive a free digital TV converter box.

Under an agreement with the Health Ministry, the centres also provide vaccines or dental care when there is no nearby public clinic offering such services.

According to a study by the National Office for the Promotion and Strengthening of Access to Justice, the legal aid centres have provided assistance in more than 152,000 cases since they were created.

Because the centres were overwhelmed by the number of people seeking help, nine mobile units were added this year, which go from neighbourhood to neighbourhood in Buenos Aires. These mobile legal clinics demonstrate the success of the programme and how important it is for the justice system to reach out to those who are claiming their rights.

UNITED NATIONS, Oct 26 2012 (IPS) – As the Millennium Development Goals (MDGs) limp towards their target date of 2015, the United Nations is shifting its focus to another long-term action plan: a new set of Sustainable Development Goals (SDGs).

Indigenous baby and mother in Chihuahua, Mexico. Social movements want indigenous rights and gender equity included in the concept of sustainable development. Credit: Mauricio Ramos/IPS

A follow-up to a decision taken at the Rio+20 Conference on Sustainable Development last June, the will be a list of post-2015 development and environmental goals touted as a logical successor to the eight MDGs adopted by the General Assembly back in 2000.

The 193-member General Assembly has been mandated to appoint a still-to-be-named Working Group of about 30 countries as part of an intergovernmental process which will be entrusted with the task of articulating a list of post-2015 SDGs.

The recommendations of this group will eventually be integrated with that of a High Level Panel (HLP) of Eminent Persons comprising Indonesian President Susilo Bambang Yudhoyono (chair), Liberian President Ellen Johnson Sirleaf and British Prime Minister David Cameron.

The HLP plans a meeting in London on Nov. 1, to be followed by a dialogue with civil society on Nov. 2. The latter event is scheduled to be live-streamed on www.worldwewant2015.org.

Meena Raman, legal advisor to the Penang-based Third World Network and an active participant in the Rio+20 summit, told IPS that any post-2015 development agenda should be based on an analysis of the factors that hinder or threaten development in developing countries.

Just having a set of goals and targets, as was the case in the initial approach to MDGs, is clearly inadequate, she noted.

The eight MDGs include the eradication of extreme poverty and hunger; universal primary education; empowerment of women; reduction of child mortality and improvement of maternal health; eradication of HIV/AIDS, malaria and other diseases; environmental sustainability; and a global partnership for development.

But most developing nations are expected to miss some or most of these goals by 2015.

Raman said there is a need to spell out international factors that undermine development in developing countries, such as the unstable and speculative-based financial system which has distorted the global economy; the unfair trading system, including free trade agreements that are skewed against the global South; and an investment system that has unfair investor-State dispute mechanisms (allowing companies to sue governments for important measures governments take to protect the public interest).

Additionally, she said, there is an intellectual property system that hinders technology transfers and raises costs of essentials.

All these are worsened by the global economic crisis which will overwhelm development prospects, Raman predicted.

Asked if the SDGs will focus more on the environment and sustainable development (as the name implies) or on enhanced MDGs, Manish Bapna, managing director of World Resources Institute, told IPS there are currently two tracks.
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But, ultimately, these tracks should converge into one framework that incorporates sustainability, without losing the importance of reducing global poverty and improving human well-being.

The proposals on the table are incredibly wide-ranging, including topics like biodiversity, oceans, sustainable cities, and changing consumption patterns; and proposals for MDG-like goals focused on poverty, health, education, and gender, he added.

There are also numerous groups advocating for the addition of a particular theme, such as peace, the private sector, and climate rights.

The challenge will be to create goals that are few in number, focused, and simple, he said.

While tough choices need to be made, prioritisation of the goals will be essential for their success, said Bapna, who participated in last week s U.N. Special Event Panel on Conceptualizing a Set of Sustainable Development Goals, which took place before an audience of senior policymakers and U.N. ambassadors and delegates.

Asked if the SDG process will be any different from the MDG process, Raman of the Third World Network, told IPS, The SDGs should cover all three pillars of economic, social and environment in a balanced manner and not just focus on one pillar like the environment over the other two pillars.

It is important to have a holistic approach in developing the goals, and not just focus on the goals, but also address how to implement them, including the means of implementation, she added.

Raman also pointed out that the development of the SDGs should be guided by the Rio+20 outcome document.

She said all the existing shortcomings must be addressed and corrected as a prime approach to the new U.N. development agenda.

There is a need for economic production to take place in developing countries which is supported by and not hindered by global factors like destabilising finance, unfair trade and overly strict intellectual property regimes.

She said incomes and jobs, complemented by good social policies, should be the focus of development policies, and this should be enabled and not hindered.

Goals and targets alone cannot be sufficient, Raman said.

Asked about inputs from civil society, she pointed that this is what the Rio+20 outcome document also recommends.

This must be followed through, and efforts must especially be made to ensure the participation of civil society from developing countries, she added.

Asked about the participation of non-governmental organisations (NGOs), Bapna said, We believe that the process will be open, bringing in perspectives from NGOs, civil society and more.

He said WRI is currently working with a diverse group of civil society organisations to provide input and we intend to be deeply engaged going forward .

We recognise that an inclusive, consultative process that engages the global poor and historically disenfranchised is crucial for achieving the goals that emerge, Bapna said.

This is particularly true, he said, compared to 20 years ago because the international aid landscape is much more complicated.

Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men. Credit: Robbie Corey-Boulet/IPS

ABIDJAN , Dec 1 2012 (IPS) – When Emmanuel Kokou, a 28-year-old sex worker, moved from his native Togo to Abidjan, Côte d’Ivoire in 2010, he knew there was a good chance that he had previously been exposed to HIV. But he had no intention of getting tested.

“I had done a lot of silly things,” said Kokou, whose name has been changed to protect his identity. “But I never got a test because I was afraid.”

That changed only after he visited Clinique de Confiance, a compact one-story facility tucked behind an unassuming blue gate in an upscale section of this West African nation’s economic capital. The test came back positive, and since then Kokou has learned how to manage his health and avoid transmitting HIV to others – namely, by insisting his clients wear condoms.

“If the clinic wasn’t here I wouldn’t have had the courage to do this,” he told IPS, referring to the process of learning his status and how to live with it. “There are people here who give us advice and reassure us.”
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Clinique de Confiance was the first clinic in Côte d’Ivoire to begin targeting men who have sex with men (MSM), starting in 2004 with sex workers and their partners before expanding to all MSM in 2007. Although two other clinics offering similar services have opened recently, Clinique de Confiance remains by far the most established.

As such, the clinic has played a critical role in Côte d’Ivoire’s bid to lower the adult HIV prevalence rate, one of the highest in West Africa. Staff members estimate that roughly 1,000 MSM have visited the clinic over the years – only a portion of the total population (for which there are no good estimates), but still a significant achievement.

Activists warn, however, that unless something is done about the heavy stigmatisation that MSM face in Ivorian society – especially those who are HIV positive – it will be difficult to build on progress the clinic has made so far.

Unlike regional neighbours such as Liberia and Nigeria, where the issue of homosexuality has been highly politicised and lesbian gay bisexual and transgender (LGBT) populations have recently been targeted by harsh anti-gay legislation, Côte d’Ivoire does not have a reputation for persecuting MSM. A report broadcast by a Dutch radio outlet last year went so far as to declare that Abidjan was “becoming a gay Eldorado.”

Yet Dr. Camille Anoma, coordinator of the NGO that runs Clinique de Confiance, said discrimination against MSM – at home, at school, at work, in health centres and out on the streets – is common. He noted that no other health facilities were even trying to serve the MSM population before Clinique de Confiance started in 2004.

“Before that, the focus of our activity was female sex workers,” Anoma told IPS. “But the staff at the clinic kept seeing commercial sex workers who were men having sex with men. Our question was, ‘What is the situation of MSM in this country?’ And nobody seemed to know. That’s the reason why we decided to offer services for this group.”

Though the available data is limited, it is clear that HIV prevalence rates are considerably higher for MSM than the general population. , estimates that the national adult prevalence rate was three percent in 2011. Internal numbers from Clinique de Confiance show that figure was 24.5 percent for MSM in 2009.

Claver N. Toure, executive director of the LGBT group Alternative Côte d’Ivoire, said the situation would be far worse without Clinique de Confiance and the two other clinics that welcome MSM. “It would be a catastrophe,” he told IPS. “The MSM are obligated to get their treatment and their prevention from these clinics because they’re not going to the general hospitals,” where they may be treated with derision.

There are a number of factors preventing Clinique de Confiance from expanding its reach, including logistical challenges such as transport costs. But Morley Bienvenu Nangone, head of monitoring and evaluation for Arc-En-Ciel Plus, a group that combats HIV/AIDS and homophobia, said the most formidable challenges were cultural.

He said the stigma associated with homosexuality prevents many men from acknowledging even to themselves that they are gay, making it far less likely that they will seek out HIV prevention and treatment resources. “What needs to be done for health is not just to focus on health, because health problems are linked to socio-cultural problems,” Nangone told IPS.

Nangone said that is why it was essential that Clinique de Confiance maintain a low profile. “If it wasn’t confidential, if there were large signs outside, then it wouldn’t work as well,” he said.

The experience of Kokou, the Togolese sex worker, underscores just how pervasive the stigma can be. He said that even though he had come to terms with his sexuality and his HIV-status, he kept both a secret for fear of how others would react.

“I don’t share my status because people will see me differently,” he said. “You’re seen badly, and people don’t trust you. I haven’t told anybody, not even a friend, not my dad or my mom. Nobody knows outside of the clinic.”

He went on: “As for being open as a gay person, I don’t even know how that would work. I just don’t go out. I just don’t have very many friends.”

SAN SALVADOR, Feb 1 2013 (IPS) – After years of delays and obstacles, a law regulating the pharmaceutical market has come into effect in El Salvador, giving its people access to medicines at more reasonable prices, with discounts of over 50 percent for some drugs sold in high volumes, like diabetes medication.

The Medicines Law is a major step forward for health rights in El Salvador, Margarita Posada, the head of the Salvadoran Association of Community Health Promoters and one of the first activists to present in 2002 a bill to limit the abusive practices of drug manufacturers and retailers, told IPS.

In early January, the Dirección Nacional de Medicamentos (DNM, National Directorate of Medicines), newly created by the law, published maximum retail prices for 4,406 medicines that are on average 35 percent lower than before.
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Within this list of named medicines, the drugs with the highest volumes of sales and the highest costs had their prices slashed by an average of 69 percent, good news for consumers who for decades have been paying high prices fixed by an under-regulated industry which has been accused by social organisations of committing marketing abuses.

For instance, the DNM list shows that a medicine for treating high cholesterol, previously sold at 68 dollars, will now cost 37 dollars, and another for diabetes, formerly 23 dollars, will cost 10.73 dollars. (These are chronic conditions, so savings over a year are substantial.)

The price control measures apply only to prescribed medicines, not to over-the-counter preparations, according to the law that was approved in February 2012, but only came into effect Dec. 29 when the executive branch provided it with the necessary regulations to translate it into policies.

Pharmacies have until Apr. 1 to adopt and display the new prices established by the DNM rules.

The World Health Organisation recommends that medicines should not be priced at over five times the international reference price (IRP), but in this country that multiple has been exceeded many times over, according to studies carried out by the state University of El Salvador.

Of course, there have been abuses on the part of the pharmaceutical industry, said Posada. The same medicine for treating high blood pressure costs the equivalent of four dollars in Ecuador, but 17 dollars in El Salvador.

The prices on the DNM list were arrived at by comparison with the cost of medicines in the rest of Central America and with IRP listings. A new list of around 7,000 products with significantly lower new prices will be issued in February.

In (two) months time, all these products must be labelled with the maximum retail price, the head of DNM, José Vicente Coto, told IPS.

As these prices are announced, the pharmaceutical sector remains as hostile as when the legislation was first being debated.

Pharmacy owners, the final link in the chain that has to absorb the price changes, met in December with DNM officials for clarification of the scope of the new regulations. But the meeting turned into a forum for the business owners to voice their collective disagreement with the enforcement of the law.

They say they will lose out because, in two months time, they will not be allowed to sell products they bought under the old price regime at their original cost.

There is no doubt that we will suffer losses. We cannot lower prices just because the law says so, said Ricardo Iglesias, the owner of La Divina Providencia pharmacy in Chalatenango, in the north of the country.

In general, the pharmacy owners complained that the regulations are forcing them to change their prices, but not the pharmaceutical laboratories that produce the medicines, nor the distributors or middlemen.

The DNM director told them that the law only regulates the retail price, but obviously it is expected that the whole production chain will have to adapt to the new rules, including the laboratories and the distributors.

Meanwhile, the Pharmaceutical Chemistry Industry Association of El Salvador (INQUIFAR), which represents the laboratories, said the sector will not survive with the prices set by the law.

Carmen Estela Pérez, the executive director of INQUIFAR, said they have identified a large set of medicines that they will not be able to sell because the prices fixed by the regulations are below the cost of production.

The prices we have seen (on the list) are non-viable, Pérez told a television channel. She underlined that 7,000 direct jobs and 110 million dollars a year from pharmaceutical exports are at stake.

In October 2012 the Supreme Court agreed to try the case of a constitutional challenge from a private citizen against some of the articles in the Medicines Law. This represents the pharmaceutical industry s last card in its bid to have the legislation, and the price cuts, repealed.

Pérez hinted that the law, promoted by the parliamentary bench of the governing Farabundo Martí National Liberation Front (FMLN), might be an attempt to displace national industry in favour of ALBA Médica (Medical ALBA), an initiative she says aims to follow in the footsteps of ALBA Petróleos, an oil company that is a joint venture between FMLN mayors and the Venezuelan government.

Everything related to the Bolivarian Alliance for the Peoples of Our America (ALBA) is a source of severe irritation among conservative sectors in El Salvador, due to the close relationship between leaders of the FMLN, a former guerrilla group, and the Venezuelan government of President Hugo Chávez and his 20th Century Socialism, which promotes this alliance of Latin American governments.

Political analyst Kirio Waldo Salgado said in a television interview that if ALBA Médica enters the market, there is no need for alarm, because that is what the free market, loudly advocated in El Salvador, is all about.

There are many demands on a communal water tap in the Lord Howe Settlement in Honiara in the Solomon Islands. Credit: Catherine Wilson/IPS.

HONIARA, Solomon Islands, Apr 8 2013 (IPS) – The Solomon Islands, a developing island nation in the south-west Pacific Islands, has one of the highest urbanisation rates in the region, and the basic service infrastructure is struggling to cater for the influx of people from the provinces to the capital, Honiara. Thirty-five percent of the city’s population, who live in informal settlements, are facing the health consequences of a dire shortage of clean water and sanitation.

Located on the main island of Guadalcanal, Honiara is a coastal city and port of 64,600 people growing at 2.7 percent a year. Thirty informal settlements in the capital are home to more than 22,500 people. Many have come for economic opportunities and better access to public services, while others were displaced during the ‘Tensions’ (1999-2003), a civil conflict between communities over access to land and resources on Guadalcanal.

Households throughout Honiara experience shortages of clean water for cooking, drinking and washing on a daily basis. But in the informal settlements a household survey has revealed that 92 percent do not have any water supply to their homes, 27 percent use communal stand taps and 20 percent collect water from wells, rivers and streams.

Sanitation coverage in the Solomon Islands is 32 percent, according to the Solomon Islands Water, Sanitation and Hygiene Sector Brief (WASH), while the regional average is 46 percent. In the urban settlements of Honiara, only 2 percent of people have access to flush toilets, 20 percent use pit toilets and 55 percent use the sea, river or nearby land.

According to the United Nations Environment Programme (UNEP) population growth is one factor impacting the availability of fresh water in many Pacific Island nations, as it is in the Solomon Islands.

But much of the water supply and sanitation infrastructure in Honiara was seriously damaged during the ‘Tensions’ and, since then, development funding has prioritised peace and reconciliation, law and justice, governance and economic development.

A spokesperson for the Solomon Islands Water Authority (SIWA), which is responsible for the urban water supply, explained to IPS that the “current (water supply) network is not able to supply the water demand due to pipe restrictions and the limited and aged pipe network cannot meet the demand of the rapidly expanding population in Honiara.”  Thus regular water shortages result when “rationing of water has to be implemented to ensure that everyone has access to water.”

However, in squatter settlements most people live without piped water.

Water for washing and bathing is from the well,” Alison, a resident of Henderson Settlement, home to 3,000 people on the urban outskirts told IPS. “But we have to go far to look for our water for drinking and cooking. We just look for where people have tanks and then ask them if they will allow us to use some of their tank water.”

Lord Howe Settlement, situated adjacent to the city centre, comprises several hundred migrants from the Polynesian island Ontong Java in the eastern Solomon Islands.

The community has access to one communal tap for every three to four families which provides town supplied water during certain hours of the day,” Father Muliava, the local pastor said. “But there are days when the tap is dry and there is no water. We store water in plastic containers and try and manage the supply.”

The state of sanitation is equally critical. “There are about three houses here which have proper sanitation, but most people use the nearby beach, even though it is not safe to use at night,” Father Muliava said.

At Henderson, Ruth and her husband have access to a pit toilet. But she told IPS:  “We cannot use the toilet during the day. It is an open toilet and the other families sit around, so there is no privacy.”

One outcome is regular cases of dysentery, diarrhoea and cholera. According to UNEP, 10 percent of all fatalities of children under five years throughout the Pacific Islands are caused by diarrhoea related diseases. In the Solomon Islands it is 8 percent.

At Henderson, Alison recounted: “I was admitted recently to hospital after I suffered a miscarriage. I didn’t use proper water and developed an infection and became ill. The doctor said I need access to clean water.”

“My little child has skin rashes all over her body from the water,” she added.

Water and sanitation deprivation has also been linked to violence against women, according to a 2011 Amnesty International report.

Women and girls are vulnerable to rape and sexual harassment when they have no option but to walk considerable distances unaccompanied, in some cases round trips of three to six kilometres per day to collect water, use water sources for bathing or when there are only exposed places available for sanitation purposes.

The government introduced a national policy to combat violence against women in 2010. But gender violence remains a concern with the Solomon Islands Family Health and Safety Study confirming that 64 percent of women aged 15-49 years, who have been in relationships, experience some form of domestic abuse.

“If there is no water available, men harass women because it is the role of the woman to go and find water,” Ruth said.

One of the main challenges facing water resource management in Pacific Island nations is limited technical, resource and governance capacity to address complex infrastructure challenges and implement development strategies.

A current project being conducted in collaboration with the Japan International Co-operation Agency (JICA) is creating 16 new bore holes which will lead to a future increase in the city’s water supply capacity.

The Honiara City Council only provides services to communities that fall within the city’s boundary, but has a long-term strategy to eventually incorporate many of the informal settlements into its urban plan. A spokesperson told IPS that the council had constrained resources, but was subsidising the manufacture of latrines, which are available to people in Honiara and the settlements at reduced cost, monitoring sanitation usage and implementing community awareness of sanitation and health issues.

A spokesperson for local women’s organisation, Vois Blong Mere (Voice of Women), commented that the problems faced by women in the settlements will only diminish when basic services are improved, emphasising that women must be empowered to be involved in the decisions made about the health and safety issues impacting their lives.

Women and children from the village where the Esparza family was murdered by soldiers in Mexico’s “drug war” demand justice outside the schoolhouse.Mónica González /IPS

WASHINGTON, May 25 2013 (IPS) – Following the release of a major draft report on drug policy in the Americas, the secretary-general of the Organisation of American States (OAS), Jose Miguel Insulza, called for the beginning of debate aimed at reforming those policies throughout the region.

“Delivering this report today,” Insulza said Wednesday, “we are encouraged by the sincere aspiration, which I now have the privilege of presenting to the entire hemisphere, that this is not a conclusion but only the beginning of a long-awaited discussion.””A one-size-fits-all response won’t work for complex problems that affect different countries in various ways.” — John Walsh of WOLA

The draft report was shared with the 35 member countries of the OAS and is now scheduled to be discussed in depth at the upcoming organisation’s general assembly, on Jun. 4 in Guatemala.

The call for a new debate comes in light of a strengthened resolve on the issue throughout the region. This relates to the violence associated with drug trafficking as seen along the U.S.- Mexico border, as well as an increased prevalence of drug use and growing demand for health care services to treat addictions.

While acknowledging shortcomings in the implementation of current policies, some countries are continuing to defend the overall approach, and are encouraging a plan of action adopted by the Inter-American Drug Abuse Control Commission (CICAD) branch of the Washington-based OAS. This approach calls for the continued concentration of efforts to reduce both supply and demand, as well as measures in line with United Nations conventions on drug law.

The new OAS discussion will inevitably be energised by the recent surprise legalisation of marijuana in two U.S. states in November.

“A one-size-fits-all response won’t work for complex problems that affect different countries in various ways,” John Walsh, a senior associate with the Washington Office on Latin America (WOLA), an advocacy group here, told IPS.
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“The report points to the need for flexibility to pursue options that may imply national and international reforms, including legal and regulated cannabis markets. And it emphasises that this more open debate is really just now beginning.”

Many of the region’s leaders have expressed frustration with the limits and exorbitant costs of current policies and their desire for a fuller and more creative debate.

But according to Walsh, who participated in writing the OAS report, there is a lot of scepticism over whether the OAS will be up to the task, especially given U.S. domination of the issue. But he also emphasises that the new report represents a good first step in the direction of a more constructive and nuanced debate.

“Drug policy is an international issue as well as a domestic issue and it can be hard to separate them, especially when you’re talking about drugs trafficking across borders – if it’s an issue in Colorado, chances are it is related to the issue in Mexico,” Walsh, who released a on this issue earlier this week, told IPS.

“In the case of cannabis in particular, the U.S. has been the chief advocate for international drug conventions that place strict controls on cannabis. However, as the U.S. begins to revisit and alter its cannabis laws, this will certainly have an effect on how the drug conventions are seen within the U.S. – and, and in turn, in Latin America, because all countries in the Americas are signatories of the same treaties.”

The OAS draft report even explores the potential creation of legal and regulated markets that would reflect these changes taking place in the United States.

“Changing U.S. public opinion towards cannabis is being reflected in changes in state policy, which has already placed the U.S. at odds with the drug conventions,” Walsh notes. “And while some of the Latin American states might be feeling a bit puzzled by the U.S.’s new approach to drug policy, others are seeing an opportunity to have similar proposals.”

Yet significant differences remain in public attitudes on this issue outside the United States. Walsh suggests that while public opinion has led government policy in this county, governments would need to lead public opinion towards legalisation in many Latin American countries.

Cannabis disconnect

Following the November elections here, a looming disconnect has opened up between where the United States seems to be going on cannabis policy and how the U.S. is asking other countries in the region to act. This is most evident in the case of Mexico, with Washington continuing to push the Mexican government to use its security institutions to forcefully crack down on the illicit cross-border drug trade.

For the moment, it appears unlikely that this policy will change. Yet some analysts say they are already seeing a fundamental shift in this dynamic, with Latin American governments taking the lead for the first time, in trying to define drug policies in the region.

Depending on how it proceeds at the meeting on Jun. 4, the new OAS report could be a central component of this shift. Beyond the cannabis issue, for instance, the OAS report offers a range of proposals and alternatives to be considered which, if adopted, would dramatically change the way drug policies are implemented.

This is happening after years in which the U.S. government was able to largely dictate such policy. Very recently, however, Latin American countries have been examining the drugs problems they’re dealing with on an individual level – and to decide on the most appropriate policy responses.

“Most of the considerations of new cannabis policy involve examining the potential to separate the cannabis market from the wider black market for illicit drugs,” Colletta Youngers, a long-time Latin American drugs expert with WOLA, told IPS.

“This is both to protect the people who want to obtain cannabis from having to go into criminal markets, and also to the extent that cannabis is a big part of illicit drug revenues that are for now entirely in criminal hands and to put those revenues into the hands and control of the state.”

Still, she admits that for the time being the issue of legal, regulated cannabis markets is a priority for some U.S. states, but not yet for the national government. But Youngers also points to countries such as Uruguay – where such a law is currently pending – and others that are currently exploring such issues.