Intravenous drug use raises AIDS spectre in Maldives

Thirty years since the first reported cases of acquired immunodeficiency syndrome (AIDS) in 1981, the response to the HIV/AIDS epidemic has been unprecedented, especially in terms of global and national initiatives.

Substantial progress has been made, such as a 31 percent reduction in the number of new infections between 2001 and 2009 in South-East Asia. A revolutionary new approach to treatment endorsed by UNAIDS and WHO, which includes improved, lower-cost drugs, simplified HIV diagnostic technologies, improved delivery systems, and innovations  in prevention of HIV infection, give hope for achieving universal access to prevention, care and treatment of HIV/AIDS, even in resource-constrained settings.

Yet, the challenge is far from over. HIV still remains a formidable foe, affecting 33.3 million people globally, including 2.5 million children. Despite years of concerted global efforts and investments, there is still neither a cure nor an effective vaccine for the disease.

However, over time, the profile of the HIV epidemic is evolving from a life threatening to a chronic disease, thanks to availability of more effective drugs and efficacious service delivery models involving communities and people living with HIV/AIDS. With changing realities, it is time, then, to reflect and re-strategize in the long-drawn war against HIV/AIDS. Fundamental to success is acknowledging that HIV/AIDS is a social and developmental issue as much as a health one.

The impact on women and children is devastating. An estimated 1.3 million women aged 15 and above currently live with HIV in the WHO’s South-East Asia Region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste).

The estimated number of children living with HIV has increased by 46 percent during 2001 – 2009. Of the 448 million cases of sexually transmitted infections that occur globally, 71 million are in South-East Asia. Due to low coverage of the prevention of mother-to-child transmission (PMTCT) programme in the South-East Asia Region, a large number of babies born to HIV-positive mothers acquire HIV infection in the womb.

Despite considerable diversity in the HIV epidemic among the countries of the Region, unsafe sex and injecting drug use are the main drivers. Five countries -India, Indonesia, Myanmar, Nepal and Thailand – account for a majority of the disease burden. Sexual transmission accounts for the majority of cases in Bhutan, India, Myanmar, Sri Lanka, Thailand and Timor-Leste.  The HIV epidemic among people who inject drugs is significant in Indonesia, Myanmar, Nepal, Thailand, and some regions of India.

The Maldives has a growing threat of the HIV epidemic due to injecting drug use.

The evolution of the epidemic from life threatening to a chronic disease, with better drugs and better access to drugs, has resulted in prolonging survival and quality of care for people living with HIV/AIDS. This necessitates evolution of an HIV care model that is in line with chronic disease management, with primary care providers playing an important role.

The spectrum of HIV care needs to evolve into a comprehensive primary care model that has an integrated, patient-centered approach, and is linked to specialist care where and when needed. It also needs to address the various socio-cultural issues that take the response beyond the health sector into the families and communities.

Other key challenges include late diagnosis of HIV, stigma and discrimination faced by people with HIV and most-at-risk population; limited capacity of health systems; high prices of antiretroviral drugs especially the second line drugs, and lack of sustained finances.

The health sector can only overcome these challenges if it collaborates with other sectors in order to tackle the social, economic, cultural and environmental issues that shape the epidemic and access to health services.

WHO’s  Health Sector Strategy on HIV for South-East Asia has been endorsed by all the eleven Member States of the Region. It envisions “Zero new HIV infections, zero AIDS-related deaths and zero discrimination in a world where people living with HIV are able to live long, healthy lives.”

The four strategic directions to achieve the goal include: optimising HIV prevention, care and treatment outcomes; strengthening strategic information systems for HIV and research; strengthening health systems to ensure that the expanded response to HIV will build effective, efficient and comprehensive health systems in which HIV and other essential services are available, accessible and affordable; and fostering supportive environment to ensure equitable access to HIV services.

WHO continues to work with countries to achieve universal access to comprehensive HIV prevention, treatment and care and to contribute to health-related Millennium Development Goals (MDGs), particularly MDG 6 (combat HIV/AIDS, malaria and other diseases). Together, we hope to move closer to a world free of AIDS.

Dr. Samlee Plianbangchang is the Regional Director of the World Health Organisation for the South-East Asia Region.

By Samlee Plianbangchang | November 28th, 2011 | via Minivan News

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Posted in: Health / HIV

“Don’t give in to fanatical minority”, Reporters Without Borders urges government

Reporters Without Borders (RSF) have issued a statement urging the government “not to give in to the fanatical minority” and to do “all it can to ensure the media are free to tackle any subjects they choose.”

The statement came in response to the Islamic Ministry’s ordering of the Communications Authority of the Maldives (CAM) to block the website of controversial blogger, Ismail Khilath “Hilath” Rasheed, on the grounds that it contained anti-Islamic material.

“The increase in acts of religious intolerance is a threat to the Maldives’ young democracy”, RSF said its statement, requesting the “immediate reopening of [Hilath’s] blog.”

RSF noted that there were harsh penalties for blasphemy under Maldivian law following new regulations enforcing the 1994 Religious Unity Act, which bans the media from circulating any material that “humiliates Allah, his prophets, the Koran, the Sunnah or the Islamic faith”.

Incidents involving media workers are rare in the Maldives, RSF observed, “but that is only because most of them prefer to censor themselves and stay away from subjects relating to Islam, unlike Ismail Khilath Rasheed.”

“According to Rasheed, the Islamic Affairs Ministry had his blog in its sights because he is a Sufi Muslim, not a Sunni like most Maldivians, and has always been highly critical of religious fundamentalism.”

RSF compiles the annual Press Freedom Index. The Maldives is currently ranked 52nd out of 178 countries.

President Mohamed Nasheed’s Press Secretary, Mohamed Zuhair, acknowledged that the decision would affect the Maldives’ reputation for press freedom.

“The government has a responsibility to protect the tenets of Islam,” Zuhair said, but urged Hilath to appeal the decision: “I believe there should be more dialogue and discussion before action is taken.”

“Blocking a website containing undesirable material is not an option for the Maldivian government. The Internet is larger than 1-2 Maldivian bloggers. Should we shut out all content deemed undesirable by Islamic scholars, and is it even technically possible with filtering?”

Zuhair noted that the Maldives had benefited from having one the highest rates of Internet penetration in the region.

According to Facebook statistics, one third of the Maldives population have accounts on the social network, the vast majority of them aged between 18-35.

By JJ Robinson | via Minivan News

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Posted in: News,Society

Blog crack-down “is just the beginning”, warns censored blogger

The website of controversial Maldivian blogger Ismail ‘Hilath’ Rasheed has been shut down by Communications Authority of the Maldives (CAM) on the order of the Ministry of Islamic Affairs. The Ministry made the request on the grounds that the site contained anti-Islamic material, a CAM statement read.

CAM Director Abdulla Nafeeg Pasha told Minivan News the Islamic Ministry has the power to regulate website content.

Pasha did not wish to comment on the procedures for closing down a website, but said “if the ministry tells us to shut it down, that’s what we do. We do not make the decision.”

Once closed, Pasha explained, a website can only be re-opened by order of the court.

Islamic Minister Abdul Majeed Abdul Bari had not returned calls at time of press, and Permanent Secretary of the Ministry Mohamed Didi had not responded to enquiries.

In a statement issued today Hilath defended his blog as an expression of his Sufi Muslim identity.

“I am a Sufi Muslim and there is nothing on my website that contradicts Sufi Islam. I suspect my website was reported by intolerant Sunni Muslims and Wahhabis,” he claimed.

Under the Maldivian constitution every Maldivian is a Sunni Muslim. The constitution also provides for freedom of expression, with Article 27 reading “Everyone has the right to freedom of thought and the freedom to communicate opinions and expression in a manner that is not contrary to any tenet of Islam.”

New regulations published by the government in September, enforcing the 1994 Religious Unity Act, bans the media from producing or publicising programs, talking about or disseminating audio “that humiliates Allah or his prophets or the holy Quran or the Sunnah of the Prophet (Mohamed) or the Islamic faith.”

“This also includes the broadcasting of material (on other religions) produced by others and recording of such programs by the local broadcaster, and broadcasting such material by the unilateral decision of the local broadcaster,” the regulations stipulate. Under the Act, the penalty for violation is 2-5 years imprisonment.

Hilath claimed he was being censored for expressing his version of Islam, and called for more freedom of interpretation within the faith.

“I call upon all concerned to amend the clause in the constitution which requires all Maldivians to be Sunni Muslims only,” his statement read.

“‘Unto you your religion and unto me my religion,’ and ‘There is no compulsion in religion’,” he said, quoting Qur’an 109:6 and 2:256.

Hilath believes the block of his website has a political edge. “If Sunni Muslims are the conservatives, then the Sufi Muslims are the liberals,” he told Minivan News. “I think this is a conservative attack on the site. They think if you’re not a Sunni, you’re an unbeliever.”

Hilath said he would approach the issue from its constitutional roots. “If I want to unlock my blog I will have to go to court, where they will say I’m an unbeliever which is illegal. So I will have fight the larger issue of the constitution,” he said.

The label of ‘unbeliever’ was tantamount to ‘enemy of the state’, he said, adding that bloggers such as himself were afraid of the consequences of being labelled as such. Hilath is one of only a few Maldivian bloggers who write under their own names.

In January 2009 the Islamic Ministry shut down several blogs for allegedly publishing anti-Islamic material. The action closely followed then-newly elected President Mohamed Nasheed’s statement that the Maldives would be a haven of free expression.

Hilath said he was ashamed of the government’s maintenance of its original declaration for a liberal democracy. “I know the President said this was a liberal democracy, but I am ashamed that the Islamic Ministry has assumed so much power,” he said. “I call upon the president to address this issue.”

A 2009 review endorsed by UNESCO’s International Programme for the Development of Communication defined freedom of expression in the digital age as dependent on “neutral” networks “in the sense that the flow of content should not be influenced by financial, cultural or political reasons.”

“In particular, in the case of filtering, the origin of filtering lists and the underlying criteria and processes should be publicly available,” read the report.

The report made three recommendations for the Maldives:

1) To stop blocking websites as was done in March 2009;

2) If blocking is necessary, it should only be pursued following a favorable court decision;

3) To foster open discussions on internet regulation among citizens, government members, NGOs and international parties.

To Hilath’s knowledge, this is the first time a websites has been blocked since January 2009. He believes his website is part of a “bigger conservative fight against the [ruling] Maldivian Democratic Party” and is only the beginning of a new wave of censorship.

“This time I think the conservatives behind the Islamic Ministry think they can put pressure on the government to see all these things as anti-Islamic, like with the SAARC monument issue. More blogs will probably be blocked. I think this is just the beginning.”

The opposition to Hilath’s blog “is a minority of the population, but it’s very vocal and active,” he said. By contrast the younger generation, which composes approximately half of the Maldives population, may take a different view, he claimed.

“The younger generation is educated and enlightened about religion and freedom and Islamic principles. I think the majority will support my move. But few feel free to speak out,” he said.

Mohamed Nazeef, President of Maldives Media  Council (MMC), said he was not familiar with the blog in question. However he said that the media – even bloggers – were subject to the society it served.

“Even when you talk about democracy there are ethics, and you have to respect the prevailing culture of the country and the needs of its people. Even in the name of freedom there are boundaries. That’s why we have a media code of ethics.”

When asked whether a citizen’s blog could arguably represent or oppose the greater good, Nazeef explained that a balance between people and the law was important.

“The constitution must be respected because people are under the constitution. Nobody is above the law. If you want to do something that is not allowed you have to properly amend the law.”

By Eleanor Johnstone | via Minivan News

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Posted in: Politics / Religion

IDLO Co-hosts the First Regional Roundtable Dialogue on HIV and Law in South Asia

Kathmandu, Nepal - In collaboration with the legal apex body for the South Asian Association for Regional Cooperation (SAARCLAW), UNDP, UNAIDS and the World Bank, IDLO co-hosted a South Asian Regional Roundtable Dialogue on HIV and the Law at the Yak and Yeti Hotel, Kathmandu from 8 - 10 November 2011.

The Roundtable was a direct follow up to the Asia Pacific Regional Dialogue of the Global Commission on HIV and Law convened by the UNDP in February 2011 in Bangkok. It supported commitments to advance human rights to reduce stigma, discrimination and violence related to HIV as well as the region-specific commitments, which were adopted, by the Economic and Social Commission for Asia and the Pacific (ESCAP) in Resolutions 66/10 and 67/9.

Across the region, people living with HIV and populations at higher risk of exposure to HIV including men who have sex with men, transgender people, sex workers and people who inject drugs; routinely face human rights violations. These violations include police harassment, sexual assault and violence, as well as discrimination, job dismissal, unequal access to education, housing and reduced access to HIV treatment.

The aim of the Roundtable was to identify and analyze strategies and initiatives to address these barriers and strengthen the rights-based response to HIV in their respective countries. Seventy five delegates from seven countries across South Asia including community advocates, lawyers, judges, representatives of human rights institutions, parliamentarians and government agencies gathered in Kathmandu to discuss these issues and develop recommendations.

The Roundtable was opened by a welcome reception and formal address by the Vice President of SAARCLAW, Honourable Justice Kalayan Shrestha of the Supreme Court of Nepal, who emphasized the role of the state in the legal response to HIV, stating "No philosophy, no religion and no culture which reinforces discrimination against and denies human rights to [people living with HIV] is acceptable. The state must defend [people living with HIV]…, complacency of any form on the part of the state is also a form of discrimination".

The President of SAARCLAW, Hon. Chief Justice Sonam Tobyge of Bhutan echoed the importance of the rights of people living with HIV and key populations at higher risk of exposure to HIV, stating "the Roundtable Dialogue symbolizes the universal and eternal message of hope and joy in life to the multitude of [persons]affected by HIV in the region".

Over the following two days, participants discussed the impact of rights violations on key affected populations and shared case studies and best practice examples on how to strengthen the legal environment in South Asia. Participants also discussed how stigma, discrimination and criminalization negatively impact upon access to essential HIV related prevention, treatment, care and support.

The Roundtable concluded with a planning session in which participants worked in country groups to develop recommendations aimed at increasing engagement in national legal responses to HIV. The participants’ recommendations will be included in the Roundtable Report.

At the closing session, Hon Sapana Pradhan Malla, Member of Parliament in Nepal, congratulated delegates for the success of the meeting in her key note address. This was further echoed by one of the participants, Abdul Raheem Khan from Naz Male Health Alliance in Pakistan, who said ‘[the Roundtable] was an intensely motivating and profound learning experience for the entire group’. Another delegate, Midnight Poonkasetwatana, Coordinator of Asia Pacific Coalition on Male Sexual Health (APCOM), also noted: ‘it's been really useful for SAARCLAW and the civil society groups to advocate directly with people who are able to help change the law and policy environment in SAARC countries.’

The results of the Roundtable will be fed into relevant regional and global initiatives including the Global Commission on HIV and the Law and the UNAIDS Programme Coordinating Board (29th PCB) and will be shared at the International AIDS Conference 2012.

The Roundtable was supported by the World Bank, UNDP, the Global Fund for AIDS Tuberculosis and Malaria, and OPEC Fund for International Development (OFID) the development finance institution of OPEC member states. OFID provides financial support for socioeconomic development, particularly in low-income countries. www.ofid.org UNAIDS and the South Asian Technical Support Facility provided input and technical support for the Roundtable.

Representatives from Sri Lanka, India, Nepal, Pakistan, Bangladesh Bhutan, Maldives participated at the conference.

Source: IDLO

Further Reading: Sunday Observer

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Posted in: Health / HIV