Complete Wellness

Joyce Mulama

NAIROBI, Oct 15 2008 (IPS) – The war against HIV/AIDS, it is emerging, will not be won unless sexual and gender-based violence is tackled.
Participants at a recent regional meeting looking at linkages between violence against women and girls and HIV/AIDS described the two as dual pandemics that needed to be addressed concurrently for the HIV/AIDS fight to be successful.

We have continued to treat these two issues separately, yet they go hand in hand. The complexity of HIV/AIDS calls upon us to join together and seriously address sexual violence, noted Ludfine Anyango of the United Nations Development Programme.

Held in Nairobi, the conference on Strengthening Linkages between Sexual and Reproductive Health and HIV/AIDS Services, gathered donors, civil society and government officers working in the health sector in 13 countries in East, Central and Southern Africa.

The severity of sexual violence in Africa was reiterated by Nduku Kilonzo, the director of Liverpool VCT, a Kenyan non-governmental organisation advocating for HIV prevention, treatment and care, which organised the conference.

Sexual violence is fundamentally a public health problem that often times results in HIV/AIDS. We know that due to violence, many women are prone to the risk of contracting HIV/AIDS. For this reason, we must start to look at sexual and gender-based violence as a key intervention when addressing HIV/AIDS, she asserted.
Related IPS Articles

Her remarks echo those of the World Health Organisation (WHO) which has it that the risk of HIV transmission is greater when sex is forced and therefore the need to address sexual violence in countries HIV/AIDS plans. A report by WHO, presented at the meeting shows that 39 percent of sexually active girls in South Africa say they have been forced to have sex. This in a country with approximately 5.7 million people living with HIV/AIDS, the highest in the world, according to 2008 statistics from the joint United Nations Programme on HIV/AIDS (UNAIDS).

Sexual and gender violence is also widespread in East Africa, where states like Kenya have continued to record an increase in the number of sexually abused women and girls. The 2003 Kenya Demographic Health Survey (which is the latest) indicates that 43 percent of 15-49 year old women reported having experienced some form of gender based violence in their lifetime, with 29 percent reporting an experience in the previous year. About 16 percent of women reported having ever been sexually assaulted, up from 13 percent in the previous year.

Statistics like these have prompted critics to ask why legislation outlawing sexual violence is failing. International and regional instruments that require signatories to address violence against women and girls have come under the spotlight.

Examples that come to mind include the Convention on the Elimination of All Forms of Discrimination against Women adopted by the United Nations General Assembly in 1979, which recognises women s right to violence-free lives, the Beijing Platform for Action adopted in 1995 which calls upon governments to take measures to address violence against women.

More recently, the UN Security Council declaration 1325 passed in 2000 made an urgent call to end impunity for sexual violence. In 2005, a Protocol condemning violence against women and girl children was ratified and added to the African Charter on Human and People s Rights.

It is argued that lax implementation of these instruments stems from the fact that there are no sanctions or punitive measures against countries that fail to adhere to them.

Domestic laws that seek to address sexual violence have been criticised as lenient and overtly flawed. In Kenya and Uganda, the maximum sentence for rape is life imprisonment, but the minimum sentence for rape is life imprisonment, but the law is silent on the minimum sentence.

Kenya s Sexual Offences Act, passed two years ago, leaves it to the discretion of the magistrate civil society groups are concerned that this paves the way for magistrates to hand down sentences sentences that would not reflect the severity of sexual offences.

However, even as the clamour for these laws intensifies, the issue of rape within the context of marriage is even more serious. In most countries across Africa, marital rape is not acknowledged by the law as a form of sexual violence, exposing many women to the HIV infection by their partners.

The WHO report presented at the Nairobi meeting indicates that increasing numbers of married women are getting infected due to their partners behaviour. The report cites three studies in India, in which over 80 percent of HIV positive women were monogamous.

This scenario is reflected in several parts of Africa where where women even those who know their partner are HIV positive are unable to practice safer sex.

Many women are afraid to say no to sex with their spouses because they may be beaten. They cannot even ask their partners to use condoms because they will be battered or suspected to be having other affairs. In the end, they are forced to have sex without protection and may end up getting infected, Vivian Sebahire, coordinator of Solidarity Women for Development in Congo, told IPS at the conference.

Such incidents are causing fear of increasing cases of HIV/AIDS in a country whose prevalence rate is at 4.1 percent.

What came out clearly at the conference was the fact that in most African countries, organisations working on the prevention of violence against women are not specifically addressing women s vulnerability to HIV/AIDS infection and vice versa, jeopardising effective action.

It is therefore imperative, analysts argue, that countries enact laws that recognise and specifically address sexual violence particularly within marriage in order to win the war against HIV/AIDS.

Diego Cevallos

MÉRIDA, Mexico, Dec 4 2008 (IPS) – With cutting-edge science, social organisation and a strategy that puts an emphasis on prevention and environmental controls, Cristina Díaz and her team checked the spread of dengue in Cuba, while María Monroy did the same with Chagas disease in Guatemala.
Díaz has a doctorate in biochemistry and won Cuba s National Science Award in January, and Monroy has a PhD in medical entomology and won the National Science Award from Guatemala in 2004.

The Cuban researcher is fighting a disease that affected 866,000 people in Latin America and the Caribbean between January and October alone, while the Guatemalan scientist is working to curb a disease that has infected more than 10 million in the region.

The achievements of Díaz and Monroy, and of several other women involved in the field of ecohealth, were celebrated during the Dec. 1-5 International Ecohealth Forum 2008, which drew some 600 academics, scientists, government experts and activists from dozens of countries around the world to Mérida, on Mexico s southeastern Yucatan peninsula, to discuss the relationship between health and the environment.

In separate interviews with IPS, Díaz and Monroy both pointed out that climate change, which is modifying temperatures and seasonal cycles, and the destruction of ecosystems, are increasing the spread of the two diseases, which are transmitted by insect bites.

DENGUE DROPS TO ZERO
Related IPS Articles

This year, we have not had any cases of dengue in Cuba, we have it under control. If there are cases, they are all imported (by carriers of the disease visiting from other countries), the Cuban researcher said with obvious pride.

Díaz attributed that success to the multidisciplinary approach that she said was followed in her country, where cases of dengue fever were counted in the thousands in the not-so-distant past.

In fact, it was in Cuba that the first epidemic of the potentially deadly dengue hemorrhagic fever occurred in the Americas, in 1981, with more than 10,000 cases.

The health sector pays the costs of dengue fever, but the causes of the problem are found in the environment, said the expert.

Díaz and her team at the Pedro Kouri Institute of Tropical Medicine in Havana convinced the authorities that it was necessary to incorporate environmental controls and wide social participation in the fight against dengue.

As a result, starting in 2002, areas that served as mosquito breeding grounds were identified, and the authorities, along with local residents, got to work.

The dengue virus is carried by the Aedes aegypti mosquito, which transmits the disease by biting an infected person and then biting someone else.

Although there is neither a cure nor a vaccine for the disease, the symptoms generally abate if the patient follows a regime of complete rest, continued hydration intravenous in severe cases and treatment with acetaminophen. But complete recovery can take up to a month.

Symptoms include a high fever, rash, severe headache, pain behind the eyes, muscle and joint pain, loss of appetite, nausea and vomiting. Most infections result in relatively mild illness, but some cases progress to dengue hemorrhagic fever, which can be fatal.

Prevention efforts involve making sure that water does not accumulate in containers, like discarded tires, flower pots or old oil drums in shady areas close to human dwellings in urban areas, where the mosquitoes thrive because they prefer to lay their eggs in clean water.

According to the Pan-American Health Organisation (PAHO), nearly 866,000 people in the region were infected by dengue fever this year as of late October, and 238 patients died. The countries of South America, with Brazil at the head, were hit hardest.

If the vector appears, it means we have an environmental problem, which has to be attacked, said Díaz.

The multi-disciplinary approach goes beyond the spraying of affected zones, which is not effective on its own, said the researcher.

FEWER FORESTS, MORE CHAGAS

Three weeks ago, Guatemala became the first country in Central America to be declared free of Chagas disease transmission by the WHO (World Health Organisation), said Monroy, the founder of the laboratory of entomology and parasitology at the University of San Carlos School of Science and Pharmacy in Guatemala.

The Swiss-educated scientist said that a decade ago, hundreds of cases of Chagas disease were reported annually in her country. But this year, after several years of work with local communities, we have controlled the problem, using a holistic approach, she said.

There is no cure or vaccine for the often deadly Chagas disease, and in most cases only treatment of symptoms is possible.

The disease is caused by the bite of the reduviid bug, which lives in crevices and gaps in poor rural housing like thatch, mud or adobe huts in a number of Latin American countries.

The bug transmits a protozoan parasite named Trypanosoma cruzi through its faeces, which human victims unwittingly rub into the bite wound left by the bug, or into their eyes, mouth or nose. The parasites thus enter the victim s bloodstream and gradually invade organs of the body, often causing severe damage to the heart, digestive tract or nervous system.

The disease has three stages: acute infection, in which symptoms occur soon after infection; an asymptomatic phase, which can last months or years; and chronic infection.

In the first stage, which only a small minority of patients suffer, symptoms include swelling of the eye on one side of the face, exhaustion, fever, enlarged liver or spleen, swollen lymph glands, a rash, loss of appetite, diarrhea and vomiting.

Symptoms in the chronic stage can appear years or even decades after infection. Health problems include serious, irreversible damage to the heart or intestinal tract.

Monroy said that most reduviid bugs live in the forests, and that when we cut down the forests, the bugs have to go somewhere, and we provide them with ideal conditions. What temperature does the bug like? 23 degrees Celsius, the same temperature I prefer, so they come to our homes where it is warm, slightly damp, and dark, she said.

We provide the conditions that make Chagas disease a public health problem, said the scientific researcher.

Monroy works with health authorities in Guatemala to combat the spread of the disease, with the direct participation of affected communities. Local communities are taught about the disease and its characteristics, and with that information, they adapt their homes to keep the reduviid bug out and to live in harmony with the environment, she said.

Only an integrated approach that leaves aside spraying as the sole method for fighting the disease is effective, said the scientist.

PAHO reports that the socioeconomic impact of Chagas disease in Latin America is extremely high, ranking it behind respiratory infections, diarrhea and HIV/AIDS.

In Guatemala we have curbed the disease; we no longer have a significant number of cases, thanks to the integral approach. If this strategy is applied in the rest of the countries, the battle will be won, said Monroy.

Nergui Manalsuren interviews THERESE DOOLEY, UNICEF sanitation advisor

UNITED NATIONS, Feb 6 2009 (IPS) – While 2008 declared by the U.N. as the International Year of Sanitation came and went with 2.6 billion people, including almost one billion children, still living without basic facilities, UNICEF s sanitation and hygiene senior advisor, Therese Dooley, says there is reason for hope.

Therese Dooley Credit: Nergui Manalsuren/IPS

Hundreds of organisations are now working alongside governments and U.N. agencies to build safe, hygienic waste disposal systems, as well as to change cultural norms so that dangerous practices like open defecation are abandoned in the poorest communities.

It is almost like a social movement, she told IPS. It is about everybody working together.

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

IPS: According to recent U.N. statistics, every 20 seconds, a child dies as a result of a poor sanitation. That s 1.5 million preventable deaths each year. How does UNICEF hope to help resolve this global problem? TD: Sanitation is a huge issue for children. On the ground, we ve got water, sanitation and hygiene projects in about 96 countries at the moment operational. I m going to speak specifically on sanitation and hygiene because you can t distinguish sanitation from hygiene because even by building toilets and latrines, they have to be properly used, so that s when the hygiene component comes in. And, indeed, hand washing by soap after using the toilet is critical because [not doing so] is responsible for about 44 percent of diarrhea diseases.

Some of our great successes is Community-Led Total Sanitation. It s basically following a model where communities work for themselves to improve their own sanitation. We re moving away from the idea of subsidised individual latrines that may or may not be sustainable. We re getting exceedingly positive results in Asia and in Africa.
Related IPS Articles

If I take Zambia for example, it s been introduced in Zambia a year ago, in 12 communities to start with. What happens is the whole process followed by bringing the community together, the one who decides to make a change.

It s not about demonstrating shame to the community, it s about pride, and it s about the community wanting to have a clean, open defecation-free community. Within three months, all 12 communities declared themselves open defecation-free. Which means no one in those communities goes and defecates openly. And, the figures now are about 100 open defecation-free communities in Zambia. It s not just Zambia; it is Sierra Leone, Mozambique and Cambodia.

IPS: How did the International Year of Sanitation help to spotlight the problems of sanitation, mostly in the developing world? TD: The International Year of Sanitation had many achievements. The overall aim was to increase awareness among a number of different target groups. Primarily we were looking at influencing aid administration, governments, and implementers, but also the general public. We have reports that we re currently evaluating, but the preliminary results were really positive.

So, in some countries there were sanitation policies put in place, in some they started looking at strategies, or the development of standards for sanitation. In some countries it meant that it s increased the budget allocation made by government.

We also looked at multilateral and bilateral donors have they done anything special for sanitation? Have they increased their budget allocations? I think all in all the proof will come in the next six to eight months. I don t think the year is over, I think the year is just started for sanitation.

IPS: Are there any estimates of how much of funding is needed to provide adequate sanitation to the 2.6 billion people suffering from the lack of it? How much of this funding is available now? TD: There s huge difference in opinion because in some cases you have much higher investments needed for urban and urban infrastructure if you like large-scale sewage systems versus rural. But you have to do both. And, the issue is how much then is needed for ongoing maintenance and repair.

How much is currently invested is a very difficult question to answer and how much more is needed. Because one of the problems with sanitation is that it doesn t have its own ministry, or its own investment line. It can be split across the ministry of environment, the ministry of urban development, the ministry of rural development, the ministry of health.

But the reality is there s still not enough investment in sanitation. There s not enough investment at all. We re not coming near anywhere what is needed.

IPS: Are developing countries themselves doing enough to help resolve the problem? What are the success stories in the developing world? TD: There are countries that have really achieved such tremendous coverage. If you take a country like Malawi or a country like Sri Lanka, you ve got practically full coverage. If you look at the map, you sort of see that we re not going to achieve MDGs [Millennium Development Goals], but then you ve got these jewels in the middle of that map who basically are doing very well, and are achieving success.

I think what you ve got to look at is the statistics showing us that people may not be achieving the MDG but they are moving up by the ladder of success. So, the change is really desired, and people are really changing and moving. The whole issue is how we take to the next step.

The International Year of Sanitation has given us motivation and encouragement to do something, and the whole thing now is not to let it stop. And, to keep working with our colleagues and governments in developing world not only to achieve the MDG on water and sanitation, but to get best results for other MDGs. Because, sanitation affects girls, it affects schooling, health, and economy. Improving sanitation has so many benefits, but because it s so basic, people tend to forget about it.

IPS: What role does the private sector and non-governmental organisations (NGOs) have in sanitation? The World Toilet Association (WTA) in Korea is currently funding sanitation projects in several developing nations, including Ghana, South Africa, Cameroon, Mongolia, Indonesia and Laos. What are your thoughts on this? And does UNICEF work with NGOs on the ground? TD: The role of NGOs and private sector is absolutely enormous in this whole process. UNICEF works with governments and through other partners: NGOs, private sector, community-based organisations, faith-based organisations.

I think it is crucial for sanitation because if we talk about sanitation it is almost like a social movement, the role of NGOs is very important. So, we definitely work with many of them. The WTA is one of hundreds of NGOs actively working in sanitation, and without NGOs and community-based organisations, without people who out there on the ground whether governmental or non-governmental, we can t do sanitation alone. It is about everybody working together.

Marwaan Macan-Markar

BANGKOK, Mar 12 2009 (IPS) – Thousands of Asian women flock to the affluent sheikhdoms of the Middle East annually, seeking jobs as domestic workers. For many this quest for a livelihood comes to a humiliating end when they test positive for HIV.
The women learn about their HIV status when they go and get tested before their job contract is renewed, says Malu Marin, director of the Manila-based Action for Health Initiative, or Achieve , a member of a regional non-governmental organisation (NGO) network dealing with migration.

This test is mandatory and done every two years, but without any counselling services available, she added.

Once they are identified as having HIV, the employer is informed, and the women are placed in a holding centre in a hospital until their departure is processed, Marin said during a telephone interview from the Philippines capital. These holding centres are to restrict the movement of these vulnerable women.

They are not allowed to go out and they are deported with no chance of packing their belongings or even getting salaries due to them, she revealed. They can never go back to work in those countries.

The scale of the problem faced by these women from countries such as Bangladesh, Pakistan, Sri Lanka and the Philippines was singled out in a report released this week by the United Nations Development Programme (UNDP) and the Joint U.N. Programme on HIV/AIDS (UNAIDS).
Related IPS Articles

(The women) often leave for overseas work under unsafe conditions, live in very difficult circumstances, and are often targets of sexual exploitation and violence before they depart, during their transit and stay in host countries and on return to their countries of origin, states the report, HIV Vulnerabilities of Migrant Women: from Asia to the Arab States .

With little or no access to health services and social protections, these factors combine to make Asian women migrant workers highly vulnerable to HIV, it adds.

Migrant women often have limited or no access to justice and redress mechanisms, especially in Gulf countries, the report reveals, referring to places like Bahrain and the United Arab Emirates (UAE) that were among those surveyed for the report.

If they are found HIV positive, they face deportation and back in their countries of origin they experience discrimination and social isolation in addition to the difficulty of finding alternative livelihoods, the report said.

Cases of HIV among domestic workers have been recorded in a number of migrant-sending countries, including Indonesia, the Philippines and Sri Lanka, the report adds. As it is often the case in countries with low HIV prevalence, such as Bangladesh, Pakistan, the Philippines and Sri Lanka, migrant workers represent a large percentage of those identified as living with HIV.

In fact, the U.N. report was prompted by concerns expressed by Pakistan during the annual assembly of the World Health Organsation s (WHO) member states in Geneva in 2007. The South Asian nation had been worried at the increasing number of its citizens labouring as migrant workers in the Arab region being forced back after having been infected by the virus.

During that assembly, Pakistan convened a meeting with other Asian countries to discuss the issue of migrant workers being deported from the Arab region because of HIV, Marta Vallejo, an editor of the UNDP-UNAIDS report, told IPS. It is a sensitive issue in the Arab states.

Concerns by the Asian countries that send the female migrant workers to the Middle East is understandable due to the substantial amounts of foreign exchange these women plough back to their home countries. Women migrants from the region generate substantial economic benefits to their countries of origin and their host countries, states the report.

Filipinos working in Arab countries sent back 2.17 billion US dollars in 2007 according to the report. Current remittances by migrant workers from Sri Lanka amount to three billion US dollars, it added.

As for impoverished Bangladesh, remittances sent home by its workers resident in the UAE alone reached 804.8 million dollars in the last fiscal year which ended in July, according to the Bangladesh Bank. That figure represents 7.4 percent of all remittances sent to Bangladesh in the last fiscal, which totalled almost six billion dollars.

According to the International Labour Organisation (ILO), there are an estimated 9.5 million foreign workers in the Gulf Cooperation Council (GCC) states, of which 7.5 million are from Asia. The GCC includes Bahrain, Qatar, Kuwait, Oman, Saudi Arabia and the UAE.

The flow from Indonesia is largely female; they are concentrated in Saudi Arabia, says Manolo Abella, chief technical adviser at the ILO s Asia-Pacific office. Migrant workers from Sri Lanka are 75 percent women, and from the Philippines, 85 percent are women.

What has made these female migrant workers so vulnerable in the Middle East is that domestic work is not covered by labour laws, Abella said in an interview. That means if you have complaints about non-payment of salaries or a violation of your labour rights you have no access to a formal procedure.

And even if there is some protection offered in the employment contract, female domestic workers have little access to mechanisms that protect their rights, since they are confined in a home, adds Abella. The domestic workers are completely beholden to their employees.

It is very very tough to actually to take the active role of a complainant, says Abella. There is very little the domestic workers can do when abused.

Thalif Deen

UNITED NATIONS, Apr 7 2009 (IPS) – When the United Nations concluded its International Year of Sanitation (IYS) last December, it left behind some 2.5 billion people worldwide waiting in line for toilets that did not exist or were in short supply.
The most positive outcome of IYS is that it raised the profile of sanitation and gave it more political prominence, says David Trouba of the Water Supply and Sanitation Collaborative Council (WSSCC) in Geneva.

In an interview with IPS, Trouba said: The IYS also highlighted the fact that sanitation work is changing from a government-led minor service provision sector to a huge market-driven human activity.

During IYS in 2008, he pointed out that governments allocated more funding to sanitation; parliaments made commitments to incorporate sanitation as a basic human right in national constitutions; and policies and action plans on sanitation were signed in many developing countries.

Doing sanitation right takes time, so you don t see progress automatically overnight, Trouba said.

It is difficult and hard work, combining social sciences, political, institutional and technical work. It is slow steady work, house by house and community by community.
Related IPS Articles

I feel, however, that the IYS acted as a springboard which in the end will accelerate progress on the ground for those 2.5 billion people without adequate sanitation, Trouba added.

The 2.5 billion people a figure that keeps popping up in endless U.N. studies on health care comprise about 38 percent of the world s population, mostly in sub-Saharan Africa and Southern Asia.

The worrying conclusion of a 2008 report of the Joint Monitoring Programme (JMP) authored by the World Health Organisation (WHO) and the U.N. children s agency UNICEF is that at the current rate, the world will miss the sanitation target in the U.N. s Millennium Development Goals (MDGs) by more than 700 million people.

Of the countries not yet on track to meet the sanitation target but making rapid progress five are in sub-Saharan Africa: Benin, Cameroon, Comoros, Mali and Zambia, according to JMP.

If we are to reach the MDG target, we need to provide at least 173 million people per year with access to improved sanitation. And to do that, commitments must become the day-to-day reality of the sector, said Trouba.

Meanwhile, the Geneva-based Global Sanitation Fund (GSF), created in March 2008, is trying to boost progress on sanitation particularly towards MDGs and beyond.

The eight MDGs, which also include reduction of poverty and hunger by over 50 percent, have a target date of 2015.

But according to U.N. Secretary-General Ban Ki-moon, the MDGs are being undermined by the ongoing financial and food crisis.

Jon Lane, executive director of GSF, told IPS the Fund is just getting underway, so its difference-making contribution is probably a year or two down the road. Symbolically, it showed that there can be creative financing mechanisms in sanitation something which is necessary.

In operation, he said, the GSF will not embark on the construction of kilometres of sewerage pipes and other huge construction projects, since top-down investments in the sanitation sector don t reach the poorest people.

Instead, it will support programmes that have been developed through decision-making processes involving local communities, and will concentrate on hygiene education, raising awareness and creating demand.

The GSF has an aspiration to grow to around 100 million dollars per year large enough to make a difference on the ground for millions of people and also large enough to show what works, and thus attract more investment in sanitation, either through the GSF or other mechanisms, Lane added.

As part of several pilot projects, the GSF has provided assistance to at least seven countries: Burkina Faso, India, Madagascar, Nepal, Pakistan, Senegal, and Uganda.

But several other developing nations have also been knocking at the GSF door seeking assistance.

Asked about the major shortcomings in meeting the sanitation needs of developing nations, Trouba said that in the past, shortcomings have been many: lack of political will; the subject of sanitation does not have the appeal of its better-known cousin, water; insufficient funding; top-down, government-led, subsidy-driven programmes.

The sanitation sector is wide and complex. It involves many stakeholders and is marked by a major feature: the need for habit and awareness change at all levels, from households to donors to presidents, Trouba noted.

Supply-driven centralised policies are singing their last swan song. The winds of change for demand-creation and hygiene are blowing.

We know that sanitation is vital for human health, generates economic benefits, fosters social development, protects the environment and is doable, Trouba said. I think you will see more focus on sanitation and progress in the sector in the years to come, he predicted.

MEXICO CITY, May 12 2009 (IPS) – Scientists around the world are trying to decipher the influenza H1N1 virus in order to develop a vaccine, while others are tracking its origins to fight its spread more effectively.

Surgical masks have become part of the Mexican police uniform. Credit: Marcos Ferro Tarasiuk/IPS

Laboratory tests show that the virus strain initially believed to be swine-based is actually a subtype of influenza virus A that contains genetic material from swine, human and avian strains. It easily mutates and recombines, which is what makes it potentially so dangerous.

The microbiology laboratory at Canada s Public Health Agency took a step forward in announcing May 6 that it had decoded the genetic sequence of three samples of the H1N1 virus collected in that country and in Mexico.

This virus already existed. It has been mutating and will continue to mutate. My hypothesis is that we are faced with several subtypes of A/H1N1, pulmonologist Fernando Cano, former director of Mexico s National Institute of Respiratory Disease (INER), told Tierramérica.

There have been several documented cases of swine flu in humans, including a non-fatal contagion in 2007 that affected 12 people at a rural fair in the midwestern U.S. state of Ohio, said Cano, who is coordinator of the bioethics and clinical medicine faculty sponsored by UNESCO (United Nations Educational, Scientific and Cultural Organisation).
Related IPS Articles

The people affected by that outbreak were tested and it was found that 60 percent had antibodies to fight that flu strain, added Cano, former director of the Autonomous National University of Mexico (UNAM) medical school. According to Cano, the Ohio virus is likely to be an ancestor of the current strain.

In a Tierramérica interview, Eduardo Sada, INER head of microbiology research, pointed to reports from 1957 and 1977 on swine flu in humans. Undoubtedly the original virus and the current one circulated at a low volume for several years until something that we haven t discovered yet triggered the epidemic, he said.

To assert that this H1N1 subtype originated in Mexico at this point is just speculation, agreed Cano and Sada. The virus has now been detected in more than 20 countries.

The first confirmed case of the new virus was in the small, impoverished community of La Gloria, in the southeastern Mexican state of Veracruz. From mid-March to early April, a rare outbreak of flu affected 600 people in the town, located some 10 kilometres from a pig farm.

Medical samples from the sick individuals in La Gloria were sent to laboratories in the United States and Canada. One of them, from a five-year-old boy who presented symptoms on Apr. 1, contained the new virus, said a report released on Apr. 23.

The same report, from Canada s National Microbiology Laboratory, in Winnipeg, confirmed that a woman who died of pneumonia on Apr. 13 in the southern Mexican state of Oaxaca, and who apparently had no contact with La Gloria, had also contracted the virus. But they weren t the only early cases. In the city of San Diego, California, near the Mexican border, a boy fell ill on Mar. 30 with an atypical respiratory illness. A similar case occurred shortly afterwards, involving a girl in the nearby town of Imperial.

The U.S. Centres for Disease Control and Prevention (CDC), in the southeastern U.S. city of Atlanta, analysed samples from both cases and confirmed the presence of the new H1N1 virus.

In 1999, young people and pigs died of a strange virus in Malaysia. It was believed to be Japanese encephalitis , which is transmitted by mosquitoes that feed on both humans and pigs.

After several months of research and the slaughter of hundreds of pigs, the scientists discovered that the problem originated at a farm where some of the animals had eaten fruit remnants that had been contaminated by bats, which are asymptomatic carriers of the virus. Further, it was determined that transmission to humans occurred through pig saliva.

With that information, the authorities were able to stop the spread of the virus, which was dubbed Nipah, although they were not able to eradicate it.

Teams from the World Health Organisation (WHO) and researchers from several countries are trying to track down the origins of the new influenza, popularly known as swine flu . But they agree it will be difficult to determine where it originated.

Cano believes the deaths caused by the H1N1 virus, nearly all of which have occurred in Mexico, are related to delays in medical attention or inappropriate treatment, but does not rule out the possibility that the severe cases may have been caused by variants of this virus strain. In any case, the new virus is generally not very lethal, and that is fortunate, although it should not be forgotten that it could mutate and generate a severe pandemic in the future, he warned.

On Apr. 23, Mexico decreed a health emergency after confirming the presence of the new virus. On Apr. 24, the WHO also declared a public emergency. It then elevated its epidemiological alert from phase three to four, and later to five (out of six).

On May 4, Mexican authorities announced the stabilisation of the epidemic, calling for the gradual return to normal school and business activities, which had been largely paralysed since Apr. 23.

Every year, between 250,000 and 500,000 people around the globe die from the various strains of seasonal influenza that usually present during the colder times of year, says the WHO.

At first, the appearance of the H1N1 virus confused the scientific community, because the strain circulating mostly affected young adults. However, of the more than 1,000 cases confirmed in Mexico, nearly half were people 19 and younger.

Another issue to be clarified is why the people who died from the virus have nearly all been Mexican, and why some of the infected are able to recover without complications or pharmaceutical treatment, while others end up in the hospital.

For now, there are more questions than answers about the traits of the new virus, its origin and its mutation profile, after Canada confirmed that some pigs had contracted the virus from a sick farm worker.

Cano recommended that people continue to get vaccinations against seasonal flu, which even if it does not specifically target the new strain, does provide additional protection.

The H1N1 virus, which is spread in the same way as any other influenza virus, reacts well to antiviral medications if they are administered in a timely manner, though scientists fear new mutations could mean the pharmaceuticals will become less and less effective.

The first analysis by a multidisciplinary team from UNAM and the National Polytechnic Institute, set up to study the virus, confirmed that it has a great capacity to mutate, said microbiologist Antonio Lazcano, who considers it highly probable that there are different varieties of H1N1 circulating in Mexico alongside other flu viruses.

(*This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.)

Thalif Deen

UNITED NATIONS, Jun 15 2009 (IPS) – The global economic crisis, which has pushed millions more into extreme poverty, is threatening to have a devastating impact on the health of women and children.
A new study, released Monday, says the most elusive of the U.N. s eight Millennium Development Goals (MDGs) are the ones relating to health: reducing child mortality (Goal 4), improving maternal health (Goal 5) and combating HIV/AIDS, malaria and other diseases (Goal 6).

If we balk now in our efforts to achieve the Health MDGs, we will put our present and future generations at risk, warns Secretary-General Ban Ki-moon. But if we rise to the challenge, we can set the world on course for long-term prosperity and stability.

The study, published by the Global Campaign for the Health Millennium Development Goals on behalf of the Network of Global Leaders, focuses on the health of mothers and children, and highlights practical ways to reduce the continuing and unnecessary death toll in developing countries.

Thoraya Ahmed Obaid, executive director of the U.N. Population Fund (UNFPA), which is at the forefront of the U.N. campaign for the health MDGs, told IPS: We welcome this report s timely emphasis on the need to increase investments in women s health despite the current economic crisis.

She said that even before the crisis, the MDG5, to improve maternal health, was lagging the furthest behind.
Related IPS Articles

So we need to make greater progress, Obaid added.

Focusing largely on the world s poorer nations, the study calls for scaling up health services to the tune of 36-45 billion dollars by 2015, over and above the current spending (and cumulatively about 114-251 billion dollars from 2009 to 2015.)

The priority countries range from Afghanistan, Bangladesh, Benin and Burkina Faso to Vietnam, Yemen, Zambia and Zimbabwe.

According to the report, the increased financing could become a reality through mechanisms such as solidarity levies on airline tickets, currency transfers and tobacco tax, along with frontloading investments and private sector donations.

It is hoped that the G8 meeting in July will further close the funding gap, the report says.

The summit meeting of the world s eight major industrial powers (G8) the U.S., Britain, France, Germany, Italy, Japan, Russia and Canada is scheduled to take place Jul. 8-10 in L Aquila, a city in central Italy.

The study was released Monday at a luncheon ceremony hosted by Foreign Minister Jonas Gahr Store of Norway, a country taking a lead role in the global campaign for the health MDGs.

The campaign itself was launched in New York in September 2007 by Norwegian Prime Minister Jens Stoltenberg.

The Network of Global Leaders was formed at the invitation of Stoltenberg to provide political backing at the highest possible level.

The global leaders include President Michelle Bachelet of Chile, Prime Minister Jan Peter Balkenende of the Netherlands, Prime Minister Gordon Brown of UK, President Armando Guebuza of Mozambique, President Jakaya Kikwete of Tanzania and President Lula da Silva of Brazil, among others.

Norwegian Foreign Minister Store said important progress has been made to halt and reverse the spread of HIV/AIDS, malaria and childhood diseases.

However, efforts to reduce maternal and newborn deaths through the MDGs have so far failed miserably, he added.

To make significant strides towards the MDGs by 2015, we all need to invest more, work more closely together and secure systems that must deliver on our commitments, he said.

Among the steps proposed are: increased political mobilisation; adequate financing and effective delivery; streamlined and harmonised aid operations; free services for women and children at the point of use and the removal of access barriers; skilled and motivated health workers at the right place at the right time; and accountability for results with robust monitoring and evaluation.

Obaid told IPS that investing in the health and well-being of women and girls is the right strategy to generate economic growth and improve people s lives.

It is good for public health, it saves lives, and it is smart economics.

She said it is imperative for governments to increase health budgets and development assistance for health, especially sexual and reproductive health, if we want to promote economic recovery and growth.

Partners agree on an effective package of reproductive health services to save the lives of women, which includes voluntary family planning, skilled attendance at birth and emergency obstetric care.

Providing voluntary family planning services is a cost-effective intervention that must be prioritised. Family planning alone can reduce maternal mortality by 25 to 40 percent and result in government savings in the long-run.

She said studies show that each dollar invested in contraceptive services will save up to four dollars in cost on maternal and newborn health and up to 31 dollars in social spending (housing, sanitation, education, etc.) and other expenses.

For each additional 10 million dollars received for family planning, we can avert 114,000 unintended pregnancies, 50,000 unplanned births, 48,000 abortions, 15,000 miscarriages and more than 3,000 infant deaths, Obaid said.

The eight MDGs include a 50 percent reduction in extreme poverty and hunger; universal primary education; promotion of gender equality; reduction of child mortality by two-thirds; cutbacks in maternal mortality by three-quarters; combating the spread of HIV/AIDS, malaria and other diseases; ensuring environmental sustainability; and developing a North-South global partnership for development.

A summit meeting of 189 world leaders in September 2000 pledged to meet all of these goals by the year 2015.

But their implementation has been undermined by the shortage of funds, cuts in development aid, and most recently, by the global economic crisis.

Sherazad Hamit

NEW YORK, Jul 8 2009 (IPS) – How is it that you can buy a 99-cent cheeseburger but not even a head of broccoli? wonders Michael Pollan, author and co-narrator of the new documentary Food, Inc. .

Joel Salatin of Polyface Farm and his grass-fed herd. Credit: Food Inc.

Without question, since the rise of the fast food industry in the 1930s, the race to deliver food faster, fatter, bigger and cheaper has changed the food industry dramatically.

When McDonald s is the largest purchaser of ground beef, potatoes, pork, chicken, tomatoes, lettuce and apples, they change how [this food] is produced, says Eric Schlosser, author of the bestseller Fast Food Nation and co-narrator of the film.

This in turn impacts the price of certain foods. Instead of small local farms and a diverse range of products at the supermarket, there are a handful of companies and factories that process animals and crops to resemble foods we love.

It is in this context that director Robert Kenner and narrators Pollan and Schlosser seek to unveil the truth about Agrarian America , a pastoral fantasy spun by the U.S. food industry.

The explicit point of the film is that the multinational-dominated industry has evolved into a dangerous animal. It is heavily subsidised and protected by the government and yet is barely accountable to any public food safety or regulatory body.
Related IPS Articles

In fact, the industry itself is largely responsible for self-policing food safety and quality standards a Supreme Court-sanctioned freedom that has allowed it to control farmers, minimise oversight and feed the U.S. appetite while simultaneously incurring significant human and environmental costs costs hidden from the public by droves of corporate lawyers, the film argues.

In stepwise fashion, Schlosser and Pollan take us to the corn fields of middle America. We are told that in order to understand why foods like cheeseburgers are in fact cheaper than broccoli, we need to look at the impact of corn subsidisation and technology on the industry.

Subsidies make it possible for corn to be sold cheaply to multinationals which use it as feed for animals ill-equipped by evolution to properly digest it. In the case of cattle, the result is a mutated and virulent strain of bacteria E.coli 0157:H7 that when shed in manure, spreads from one animal to another.

High-tech industry, Pollan maintains, has compounded these circumstances. No longer is the food industry looking to better the conditions of feeding operations. It is looking for quick fixes.

When approximately 400 animals are slaughtered each hour, and one meat patty consists of meat from thousands of animals, the odds of contamination increase exponentially, says Pollan.

Kenner s inside footage of putrid chicken farms and ground beef being cleansed in ammonia packs a subversive punch. For those who dismiss the food debate as an issue dwelled on by the nutritionally and socially conscious, Kenner makes clear: anyone who eats three meals, whether you eat meat or not, is at risk.

It is this consistent reality check that causes even the most apathetic viewer to question the safety of our food and the existence of adequate laws.

To that effect, perhaps the most shocking revelation is the narrow scope of authority of the U.S. Department of Agriculture, one of the main food safety bodies. Described as toothless , the USDA is given the blunt end of the sword although perhaps even its critics are too kind.

Through the tireless work of featured food safety advocate Barbara Kowalcyk, we are made to understand the true extent of its impotence owed to the slew of officials ensconced in government regulatory bodies like the Food and Drug Administration, Environmental Protection Agency and USDA who are now working to protect their former multinational employers.

While the notion of corporate cover-ups is unsettling, even more so is the responsibility of multinationals for a system of worker-slavery at food-processing factories. Through hidden-camera footage of factory working conditions and exchanges at border crossings, we are privy to part of the real human cost of producing food cheaply, an arrangement allegedly granted tacit approval by corporate higher-ups.

The remainder of that human cost is, of course incurred by consumers. Underscoring that fact is an encounter with a working-class family from Los Angeles struggling to make ends meet and put food on the table a family for whom the food debate is truly a luxury, a pre-occupation of the wealthy.

The family s two adolescent daughters are living proof a generational endemic obesity the biggest predictor of which is income-level. One in three U.S. citizens born after 2000 will have early onset diabetes. That figure jumps to one in two amongst minorities. These are staggering statistics even to those who strongly believe obesity is a crisis of personal responsibility.

We have now come full circle to the cheeseburger and the broccoli, and are reminded that there are more forces at work than one s ability to resist fast food. There is a systemic skew towards cheaper, nutritionally deficient foods in our supermarkets. It is at this point that we are cued to ponder over nutritional alternatives and a plan of action to change the status quo.

We are presented with organic . In an interesting us vs. them framework involving Stonyfield dairies and the Walmart super-store chain, respectively, we become proponents of the organic cause. The obvious downsides, namely price and availability, are immediately squared away and we are launched into a discussion on the profitability and sustainability of organic brands.

The conclusion is that organic brands can take down the giants if consumers leverage their purchasing powers.

It is an easy decision to support organic. If it is clear that the customer wants it, it is easy to get behind it, says Walmart executive Tony Arioso.

After much food for thought, the documentary closes with prescriptions ranging from buying produce in season and eating organic to changing school meals and writing to political representatives.

While good in intention, the list falls short of addressing the main problem of the working class: that of getting a head of broccoli on the dinner plate in an affordable way. In lacking this dimension it falls prey to the prevailing criticism it set out to defeat: that the food debate is open only to the better-off.

What is required is a list that includes more avenues for involvement at different economic levels and a marketing strategy that goes beyond limited release viewers. Overall, Food, Inc is as enjoyable as it is informative.

BALI, Aug 12 2009 (IPS) – The scant presence of mainstream media organisations at the 9th International Conference on AIDS in Asia and the Pacific (ICAAP) was a sad reflection of how the press was overlooking the big story on HIV/AIDS, say some journalists and development analysts at Asia s largest meeting on the pandemic.
If journalists are attending ICAAP this week, they are here not so much to contribute to discussions around media s awareness of the pandemic and their role in reporting on its sensitively and in a knowledgeable manner, but as mere reporters, these observers add.

The poor presence of mainstream media is a sign that the Fourth Estate is failing miserably in its role as a good source of information, says Trevor Cullen, head of journalism at Australia s Edith Cowan University.

The problem is that very few mainstream journalists are here at the conference. Up to 80 percent of people don t get their news from international journals or research reports; they get it from the media, Cowan said at a session on how the media are talking about HIV and AIDS.

The entire ICAAP, which has more than 100 sessions from Aug. 9-13, only has one session on the media – and just an oral abstract one at that. This is really not good enough, he rued.

It is unfortunate that we got a very small abstract session at this international conference of more than 3,000 people, because I see the need for the role of the media to be discussed more openly and debated upon, Cullen told the less than 30 listeners in the room, a number that dwindled to less than 20 much later.
Cullen, who has been involved in research on HIV/AIDS reporting for the last 12 years, criticised the lack of imagination, initiative and linkage of the mainstream media that is in the business of finding new angles .

We re very blinkered. We ve narrowcast instead of broadcast these issues. In Australia, for instance, you won t have any story on HIV/AIDS unless it s absolutely sensational, he added.

By the mid-1990s, or more than a decade after the earliest HIV cases were reported, HIV/AIDS had become just another health story , he pointed out.

Others had similar views about what the lack of interest in following HIV and AIDS closely either at the ICAAP or in general.

But Michael Tan, who is a columnist in the English-language daily ‘Philippine Daily Inquirer apart from being chair of the University of the Philippines anthropology department, also looked into the lens that media often wear when they report on the pandemic these days.

It used to be that the media training sessions needed to be heavily focused on the use of sensitive language on HIV and AIDS. But media s challenge now is look deeper into the social and other aspects related to the pandemic, as the disease also evolves.

We ve moved from the use of sensitive language. The journalists know how to be politically correct (these days), but the problem is they re still using the same old moralistic brains, he said, specifically referring to case of the Philippines.

It will take more then language to reframe their mindsets on gender and sexuality, Tan said at a press conference Tuesday.

Rosalia Sciortino, associate professor at Thailand s Mahidol University, lamented the small number of journalists at the Tuesday press conference after a plenary session around the social inequities that help fuel the spread of HIV.

ICAAP organisers had designed more discussions around themes outside the biomedical aspects in order to have more public awareness of the social contexts that deprive some of the most vulnerable groups of the help they need.

We wanted to focus on the power dynamics as well, Sciortino said. Already, she explained, media too often report on HIV as a health issue and put such articles only on the health page, when it is much more than a medical, scientific or health issue.

But going back to the basic journalism rule of putting the ‘5Ws and H in stories, Cullen added that media have omitted the why and the how when reporting on HIV and AIDS.

Unless the media are engaged in a meaningful way, then the same pattern will keep happening, said Imelda Salajan, media and public awareness consultant of the Jakarta-based advocacy group On Track Media.

Consistency in promoting the issue should be on top of the agenda. But as it is, communications is always given a very small place in the budgetary plan by donors. It can t be a one-time programme. The media should think of a long-term strategy and there are creative ways of doing it, she said.

Syed Qamar Abbas, deputy manager of the AIDS control programme of Pakistan s Sindh province, suggests the use of creative tools to reach public audiences. Innovative methods, such as tele-films, are effective in changing attitudes and lifestyles. In our research, we found out that programmes such as films made for television have 30 percent more impact than the traditional ways of presenting news or issues, he said.

For their part, proponents of community and cable radio report positive results in efforts at the grassroots level to raise awareness about HIV/AIDS.

Nalamdana ( Are you well? in Tamil), is a non-government organisation that runs a popular cable radio programme at a government hospital in the southern Indian state. The show aims to raise awareness about and decrease the stigma of women undergoing anti-retroviral treatment (ART) in the hospital.

We have noted the positive response of women undergoing ART in a government hospital in Tamil Nadu, said Nalamdana project director R Jeevanandham.

We use cable radio to address depression among women and enable them to access special counselling. We also send messages via popular songs and dramas tackling key issues on HIV/AIDS, he pointed out, adding that counsellors are on hand to discuss the disease on-air.

But tackling HIV and AIDS even in alternative media spaces such as community radio is not always smooth sailing, due to the same cultural and religious factors that constrain public discussion and openness about the pandemic.

There are still many people especially in rural areas that have little or no knowledge about HIV/AIDS. Community members are still trapped in terms of morality and religion.

Thus, discussion about the issue doesn t really take off. And then, there are still doubts and fears of breaking cultural traditions and discussing taboo topics, said Dina Listiorini of the Atma Jaya University of Yogyakarta, Indonesia.

For a long time, the mass media have stuck to portraying HIV and AIDS as the 3H — Haiti, homosexuals, and heroin junkies, she said, citing previous studies.

But we have to use all different media to get the message across, said Cullen. Use all media, but try to go for quality. For this, you need to train people. We re just reporting the tip of the iceberg, only 20 percent of the story. We need to realise that HIV/AIDS is a massive story that affects all aspects of our lives.

*TerraViva at ICAAP 09 (http://www.ipsterraviva.asia)

Zofeen Ebrahim interviews NAFIS SADIK, special adviser to the U.N. Secretary General and special envoy for HIV and AIDS in Asia

BERLIN, Sep 10 2009 (IPS) – As secretary-general of the International Conference on Population and Development (ICPD) in September 1994, Nafis Sadik had described this groundbreaking event as a quantum leap in reinforcing commitments to addressing infant and maternal mortality, education and reproductive health and family planning.

Nafis Sadik (right) Credit: Global NGO Forum

The programme of action that came out of that historic global summit the Cairo Consensus that has today reached its 15th year had the potential to change the world , the former head of the United Nations Population Fund (UNFPA) had predicted at the time.

Sadik spoke to IPS on the sidelines of a Sep 2-4 forum here that took stock of progress in implementing the Cairo agenda, called Global Partners in Action: NGO Forum on Sexual and Reproductive Health and Development Invest in Health, Rights and the Future .

She also talked about how sexual and reproductive health and rights has been undermined by extremism and militancy in her native Pakistan, and what can be done to breath new life into efforts to counter these.

IPS: In the Pakistani context, do you think extremism has been a death blow for sexual and reproductive health and rights?

NAFIS SADIK: I think the whole Taliban movement is very detrimental to the progress of the sexual and reproductive health and rights movement. They deny women and girls the right to education, which is fundamental. They are also opposed to family planning and sexual and reproductive health and rights and want women to be in bondage, not to be seen or heard. This is totally against Islamic concepts.
Related IPS Articles

IPS: What can the government do to address this extremist assault?

NS: Governments can do so much. To my mind, one way to counteract this onslaught is for all sections of society to form an alliance. Today, there is a movement against, what is known as Talibanisation. The non-governmental organisations, civil society and the corporate sector must forge forces with the government.

The way to go about it is to work at the community level. Firstly, because of insidious poverty, the people are compelled to send the children to madrasah (religious seminaries). We have to counteract this. We must find the source from where these madrasah are financed and stop this. At the same time, we need to improve our own school systems. We must get our primary schools in order.

Secondly, we need to find champions from within the local communities, both men and women who will talk about the real and right aspects of Islam. Our society is very traditional and people believe everything told to them. Some of the theologians are distorting religion. So we must concentrate on finding an intellectual group, in sufficient mass, countering that.

IPS: Where do we get such a learned, progressive mass of people?

NS: There are many movements now to educate men and women scholars that aim at enlightening them. It s not a question of getting them; it s about changing minds. That s the change in society that we need. I understand it can t be done overnight, and cannot certainly be done by governments. But I think civil society as a whole, and I don t mean just NGOs, can start to play an active role by which I mean boldly and courageously talking, speaking, speaking out against such atrocities.

IPS: You think there is political will for this?

NS: If they are scared enough, and it seems they (government) are now, then now is a good time. I think there will be some leaders emerging from all that is going on in Pakistan today.

IPS: Would it be prudent to use Islam as a way to get back at extremism?

NS: Yes, I think we also have to invoke religion because, in my opinion, we cannot take on religion. You can never win if you take on religion. We do not choose our religion and yet we defend it to death. We have the right to choose, but the right to choose religion is denied. I myself am a born Muslim and I defend Islam. It goes against my grain to give in that there are some things in Islam that I don t actually agree with.

IPS: Can women be prayer leaders? For if they can, perhaps they can begin to have a far more influencing role in society than their male counterparts?

NS: Islam allows women to be leaders. In our society, which is really quite backward-thinking, that s like a major shift in attitude, to ask women to lead. I think we should make incremental changes. I would take that on when the time is right. I wouldn t take it up as a first thing, as you might upset the whole movement to change.

IPS: Do you find that there has been any progress in Pakistan with regard to sexual and reproductive health and rights since the Cairo conference of 1994?

NS: I think that there has been a lot of progress in the world, not just in Pakistan. Women are much more knowledgeable. Many, without being empowered, try to empower themselves. There are many brave women in Pakistan.

IPS: What are your views about the recent passage of the domestic violence bill in the lower House?

NS: Now that s the starting point. I am very happy with changes and one can build on these changes and get voices from the community. The only problem is (that) in Pakistan, we all work in silos. These voices remain scattered . If only we could have them together. In that way, the success of the ICPD was that many different disciplines came together under the same umbrella.

IPS: Do you think the Millennium Development Goals have taken away the thunder from the ICPD?

NS: I don t think so. All the issues that we worked on at the ICPD have been incorporated in the MDGs. Every goal of the MDGs has come from the ICPD. The education for all, gender equality, maternal mortality reduction, infant mortality, all were in the ICPD. Five of the eight goals have come straight from the ICPD. The MDGs have caught the attention of all the world governments. This is something powerful and we need them.

IPS: But then the ICPD is now redundant?

NS: ICPD forms the underpinnings of the MDGs. These goals haven t come out of the air. These have come out based on a series of recommendations from conferences on development, population, environment. The one that was omitted on reproductive health for all has now been put back. It was omitted by certain governments, especially the United States. It s now back as a target and a very strong one.

IPS: You were one of the lead authors of the Cairo Consensus, which people here have termed a visionary document. Now on its 15th year, how do you see it?

NS: I think we have made a lot of progress because reproductive health is accepted everywhere. Sexual health is talked about but not necessarily accepted, but that in itself is a big change. And the linkage of sexual and reproductive health and rights to women s empowerment and gender equality is a very strong element and that has been totally accepted.

The fact that you can t have demographic goals from the top down without acknowledging individual choices, especially the choice for women, is a strong part of the ICPD and that is totally accepted in all societies. Coercive policies and top-down imposition of contraception have really gone now.

IPS: So there is reason to celebrate the ICPD at 15?

NS: Part reason to celebrate. I am disappointed that maternal mortality stays the same, that access to family planning is still not universal and those that need them don t necessarily have them.

I am disappointed that while laws have changed as far as women are concerned, the societal attitude and mindset is still slow (to follow). Nevertheless, I am optimistic and we have made progress. You know, issues like rape, incest were hidden, private matters but are now out in the open. I am encouraged that there are more young leaders now, much more involved in their own future and this brings hope.

IPS: So what can we do in next five years?

NS: Maybe we can join forces again. I think NGOs can be more powerful voices if they didn t work in silos. I think the underlying need is the empowerment of women that is a common theme.