Citizen News Service (CNS)

Go well Dr Radium Bhattacharya

2009-12-30T12:23:00.004+05:30

Go well Dr Radium Bhattacharya

Dr Radium Bhattacharya breathed her last in early morning wee hours of Sunday, 20 December 2009. She was one of the first veteran AIDS activists in India to take up the fight against AIDS in 1980s. Her contribution to HIV prevention options for women and enabling civil society working on AIDS-related issues to network and collaborate effectively to improve HIV response was a benchmark indeed. Read more

She was the founder-president of Indian Network of NGOs on HIV/AIDS (INN) - national network of non-governmental organizations working on HIV/AIDS issues in India that she had founded in 1994. Today INN is a network of more than 500 NGOs working on issues-related to HIV/AIDS across the country, with several state-level networks too. Dr Radium was leading the Gujarat AIDS Prevention unit (GAP) from her humble office in Ahmedabad.

My association with Dr Radium began in second half of the year 2000 when she convinced me repeatedly to document and raise awareness about women's specific needs for HIV prevention options - and above all, familiarised me with the word that was "Micro... what?" then to me - Microbicides. At the annual national convention of INN in February 2001, in Ahmedabad, Megan Gottemoeller from Global Campaign for Microbicides (GCM) along with Mitchell Warren from Female Health Foundation were there at this INN convention in Ahmedabad contributing enormously in raising awareness about and mobilizing INN partners to respond to HIV prevention needs of women. Microbicides and female condoms both were in spotlight at the 2001 INN national convention. Megan, during her presentation then, had asked the participants how many of them had ever-heard of microbicides, only three hands went up. As the years rolled by, majority of INN partners contributed in pushing the microbicides advocacy agenda in India. It was indeed Dr Radium's commitment to the cause that was instrumental in strategically mobilizing civil society to advocate for accelerating microbicides research and advocacy, with the government, researchers and other stakeholders, and also to lobby for improved representation of civil society as equal partners in microbicides development as research went ahead. Lori Heise, then-Director of Global Campaign for Microbicides (GCM) along with her dedicated team had built the competence of advocates from civil society in India on a range of ethical issues related to microbicides research, and Dr Radium surely took up the mantle to sensitize INN partners in states where microbicides research was taking place and push for regular interface between researchers and civil society to ensure ethical standards were being met as research advanced.

In 2002, during one of her visits to Delhi, she dropped in at the office of PATH India. Mr Vinay Kumar from PATH was very supportive and PATH's commitment to microbicides research further enhanced the advocacy for HIV prevention options for women. National Working group on Microbicides, National Workshops on HIV Prevention option for women, National Policy Workshop on Microbicides, National Stakeholder Meeting on Microbicides, were some of the most tangible outcomes in 2003 and years that followed, strengthening microbicides advocacy and engaging civil society meaningfully as the research progressed ahead in India. Not surprisingly, she was the co-chair of the Community and Advocacy (Track D) Committee of the International Microbicides Conference in New Delhi, India (2008).

Dr Radium along with INN partners, particularly those like Naz Foundation International (NFI) and Bharosa Trust that have contributed to addressing the HIV prevention needs, and improving the sexual health and human rights of marginalised males who have sex with males (MSM), their partners and families, took up the mantle of raising the neglected issue of rectal microbicides research in Indian perspective. There was no microbicide-candidate product being researched upon in India for rectal use - and MSM being recognized by the National AIDS Control Organization (NACO) as one of the key high-risk population for HIV, it made sense for INN to work with partners to raise the understanding of HIV prevention needs among the community, and also explore if rectal microbicides were something Indian MSM communities might want to advocate for. With support from GCM, INN convened a national workshop with MSM networks and since then, the advocacy has only upped for rectal microbicides in India.
In one such state-level advocacy workshop on microbicides to sensitize INN partners on ethical issues in microbicides research and encourage them to get involved with microbicides research in their own state of Tamil Nadu, she began the first national dedicated electronic discussion group (eGroup) for information exchange and discussion on issues around Microbicides research, advocacy and community involvement in India, on 11 June 2005. In time, this eGroup connected more than 900 people. Now with Microbicides Society of India (MSI) taking leadership in India, of which Dr Radium was the board member, this eGroup is used currently by MSI.

HIV prevention option for women is just one area where Dr Radium’s defining contribution in terms of building up the civil society response as research progressed ahead, was a landmark. Back in her own state of Gujarat, her contribution to HIV/AIDS response in general was phenomenal. She was one of the veterans to step up the fight against AIDS in India in 1980s, undoubtedly, and recognize early-on the vital role of partnerships and of civil society representation in the AIDS response which led to formation of INN in 1994.

It is an enormous personal loss to me - as she meant no less than my mother. Similar expressions abound as condolences pour in. I have a confession to make too – as I feel very guilty of not keeping promises I made to Dr Radium. When I met her last in Ahmedabad, she was bravely recovering from her illness, and I, was one of those who had promised her to contribute in taking the INN responsibilities while she was recuperating. Despite of my best intentions, I could never keep the promise I made to her and hope for her forgiveness. The only redemption could be to complete the unfinished task, and contribute truly in improving the AIDS response.

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Lucknow Journalists commit to the cause of child rights

2009-12-29T14:32:00.004+05:30

Lucknow Journalists commit to the cause of child rights

Anjali Singh, CNS

Lucknow journalists joined hands with an organization working on child rights to sign a petition to stop child abuse. The media fraternity of Uttar Pradesh capital city has also urged the government to set up a Child Protection Unit in the state to put a stop to the rising incidences of crime against children. Read more

It has never happened before, thus it’s relevance is doubly important, specially so when the Fourth Estate unites for a worthy cause like child rights. That’s exactly what the media fraternity did in Lucknow, Uttar Pradesh, when they joined hands with an organization working on child rights to sign a petition to stop child abuse.

They also urged the government to set up a Child Protection Unit in UP to put a stop to the rising incidences of crime against children.

Informs, Saaksham Foundation, an organization addressing violations of child rights in Uttar Pradesh who led the petition campaign, “The media is fed up of writing and reporting on cases of inhuman attacks on children and not seeing anything done to stop it. So they were more than willing to raise they voice to tell the government that this cannot go on. And for the first time in history scribes from the city all joined hands to say enough is enough and asked the state government to do something to ensure safety of children in UP. Journalists from all the leading news papers and electronic media in the city including Times of India, Hindustan Times, Hindustan Hindi, Indian Express, The Pioneer, IANS, Aaj Tak and Times Now gave their overwhelming support to the petition when we approached them. The petition was handed over to the Chief Cabinet Secretary, Chief Minister Mayawati’s office, Shantha Sinha, Chairperson, National Commission for Protection of Child Rights and Congress Youth Leader Rahul Gandhi.”

Adds Sharat Pradhan, Senior Journalist and Chief of Bureau IANS UP, who lend his full support to the petition as well, “I think this is a very encouraging move by the media. Its high time they start thinking about writing and getting sensitized about issues what they feel is not fashionable enough to report about. Now is the time journalists should get committed to social issues and take the initiative to shake their morality back to consciousness. I feel it is issues and campaigns like the joint media petition that will help them to that as most of them don’t think much of what is wrong and what is right unless they are motivated to get involved in such issues.”

Rightly said so, as the jointly signed petition not only demands setting up a Child Protection Unit in the State to address the increasing numbers of brutal attacks on children, but interestingly the scribes and the social organization have sought the provision of child friendly police station and police personnel to be placed at every thana in 71 districts of UP. The provision for which has been made in the Juvenile Justice Act 2006 and the directives of the National Human Rights Commission.

So why did the media react to the issue of child rights?

Answers Ravi Krishna, News Editor, Times of India, Lucknow, “Acts of violence against children are generally underplayed in the media unless an incident of the magnitude of Nithari happens. TV channels too use incidents to sensationalize the issue rather than substantiate it. This trivializing of news has resulted in poor public response to crimes against children. So it’s important from time to time to be a part of such initiatives so that the fourth estate is not taken lightly when sensitive issues like women and child rights are concerned.”

More so Krishna feels, “Sensationalism has ensured that crimes against children get a knee-jerk response form government agencies, including the judiciary at a time which has to grapple with weak prosecution. Thus there is a need to set up specific cells in the police department under the watch of registered NGOs and monitor their functioning at macro level. The government should work on a two-pronged strategy -- prevention and rehabilitation of victimised children. This petition hopefully will start a movement to help make it happen.”

A fact that is further corroborated by Siddarth Mathur, Principal Correspondent, India Express, Lucknow, “It’s quite frustrating when despite writing about the sensitive issues like child rights not much has changed. I hope that such moves like signing a petition together by the media fraternity can alter things and change mindsets. I know it won’t happen right away but in the future gradually a change can be brought in if repeated efforts are made to highlight such issues effectively.”

And efforts to ensure that consistent attempts are made to address children’s issues regularly, organizations like UNICEF Lucknow too are playing an important part in sensitizing the media in the city towards issues related to children.

Their fortnightly programme Media for Children held at the Lucknow Press Club has served as a effective catalyst to take the discussions on child rights to a appropriate level by the media.

Says Augustine Veliath, Communications Specialist, UNICEF Lucknow, “I have never before seen media respond to children’s issues as a group. They have openly told the state government that they are tired of reporting on children’s issue after issue and not seen any action to stop their victimization. It’s remarkable as they have taken this stand in the 20th year of the Convention for the Rights of The Child. I believe that media has a great role to play in protecting children and this joint petition by the media bears testimony to that. Media is the voice of the voiceless and children have no voice of their own. I am very thrilled that the media in Lucknow have regrouped to give children a voice.”

And what is the government speak on the petition?

On receiving the petition and going through the contents Vijay Shanker Pandey, Chief Cabinet Secretary expressed his concern over the issue and assured Director Saaksham Foundation that he will be looking into the matter and also call a meeting to discuss setting up a Child Protection Unit in UP soon.

Shantha Sinha, Chairperson, National Commission for Protection of Child Rights who also received a copy of the petition expressed her concern over the fact that children were being subjected to such brutal attacks and said she will take up the matter strongly and also expedite the process of setting up a State Commission for Protection of Child Rights in UP.

Amen to that!

Anjali Singh

(The author is a Special Correspondent to Citizen News Service (CNS) and also the Director of Saaksham Foundation. Email: anjali@citizen-news.org)

Lack of immunization ups fatal diseases like diphtheria

2009-12-28T08:50:00.002+05:30

Lack of immunization ups fatal diseases like diphtheria
Kulsum Mustafa

Low percentage of routine immunization in Uttar Pradesh is resulting in the resurgence of diseases like diphtheria and whooping cough in children. While in some districts of UP, immunization is less then 20 percent, in others it is between 20-40 percent. Professor (Dr) Yogesh Govil from Department of Paediatrics, Chhatrapati Shahuji Maharaj Medical University (CSMMU, upgraded King George's Medical College - KGMC) said that in Tamil Nadu the immunization is 92 percent while in Karnataka it is 84 per cent.

Professor Govil gave this information in his presentation titled ‘Routine immunization-bitter facts’. Prof Govil was interacting with the journalists at ‘Media for Children’ programme, a bi- monthly media- sensitization event held at the UP Press Club on Friday, 25 December 2009. The programme was organized by Media Nest, a forum working for the welfare of journalists and their families and is supported by UNICEF.

Vaccinations for diphtheria, whooping cough, polio, tetanus and measles are necessary and a right of every child. Prof Govil said that when we do not give these life-saving vaccinations to our children we subject them to life threatening diseases. The doctor bemoaned the fact that the lack of immunization is resulting in the resurgence of these diseases and the results are fatal in many cases.

“All these vaccinations just cost less then Rs 5, but they provide the child with an armour of health,” said Dr Govil adding that only after a child gets all these vaccinations that we can say that he is 100 per cent immunized.

“We got 107 cases of diphtheria in our hospital but could only save 41. Sixty six children were lost because somebody somewhere did not think it important that the child was given the vital and necessary vaccination for diphtheria,” said Dr Govil.

Urging the media to come forward and help in focusing the attention of the masses on this issue Dr Govil said that it is important that those who draft and execute the state health policies are subjected to greater accountability.

On a suggestion by a scribe whether the government focus and priority being pulse polio has affected the routine immunization he answered in the affirmative. However he agreed to a suggestion coming from another journalist in the audience that routine immunization be linked the pulse polio programme.

Kulsum Mustafa
(The author is a senior journalist and Secretary-General of Media Nest)

Let Heaven And Earth Rejoice

2009-12-25T12:28:00.006+05:30

Let Heaven And Earth Rejoice

It is Christmas time once again. It is the season of rejoicing; of giving and receiving; of raising our hands in Thanksgiving. Christmas no longer belongs merely to the Christians. It is more of a universal celebration. The festivities of Christmas have seeped into the ethos of all nations. As I write this, I am inhaling deep, the festive spirit pervading the streets of a misty morning Bangkok, whose 92% population, of over 6 million, is Buddhist and a mere 1% Christians. Yet, there are fairy tinsel lights, white Christmas trees (a few coloured ones too, but none green) and breathtaking decorations in and outside the malls. The petite Thai waitresses, even in small eating joints, have donned red pixie caps and the warm air of the city reverberates with the sounds of laughter and joy. The peak tourist season adds to the gaiety, with honeymooning couples strewn all over the place.

Santa Claus, or Father Christmas (can’t we have Mother Christmas? was the innocent remark of my friend’s 5 year old son) has long overpowered the infant Jesus Christ. We now have even the ‘Best Santa’ contests, with Jimmy Chan of Hong Kong being voted this year’s top Santa Claus of the world. The corporate world has added its own embellishments by way of greeting cards, expensive gifts, Christmas Eve Balls, special Christmas dinners, etal. I wonder, if the proverbial stockings are still hung in homes (we did that in our very Hindu home), as the modern day gifts would rarely fit into them. So it is more of a display of wealth and an excuse to splurge in the ever expanding shopping malls. The humble manger, with the infant Jesus swathed in rags, is almost forgotten. Yet, there have been some well meaning improvisations. The Green Santa Claus from Japan, who instead of doling out gifts, talks about preserving the environment to have peaceful and beautiful Christmas times in future.

The birth of Christ is an event which teaches humanity the lessons of austerity and humility. It teaches us to respect the poorest of the poor and to accept the graces, as well as tribulations of life with equanimity. Let Christmas not be reduced to a fashionable and commercial venture. Let us not forget the real meaning of Christmas, which is of forgiveness and humility. Let the massed ringing of cash registers in shopping malls not drown the jingling of the reindeer’s bells, bringing joy to the uncluttered hearts of children.

Yet, this time of the Yuletide season, always reaffirms my faith in the goodness of humankind. It really seems that God is in her place in heaven and all is right with the world. So be it. May peace and goodwill always prevail on earth.

A Merry Christmas and A Very Happy New Year to all of you, from Citizen News Service.

Shobha Shukla

(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Another Setback in Noor Bano case

2009-12-23T21:46:00.003+05:30

Another Setback in Noor Bano case

Anjali Singh, CNS

Once again the case of seven year old Noor Bano came to a dead end on Dec 22 with the Child Welfare Committee (CWC) forwarding the case to the government Railway Police (GRP) for ivestigation and action. The case was first brought before them for hearing by Saaksham Foundation on Dec 15.

While the CWC remained indecisive then, yesterday on Dec 22 a three member committee comprising of Dr VV Brigeetha, DK Chaudhary and Shyam Kumar again sat on judgment of the case and issued a letter to GRP Police once again to investigate the case.

The CWC letter was delivered yesterday evening to the thana incharge of GRP seeking lodging of First Information Report in the Noor Bano case.

Interestingly what was omitted was the fact that the case had already been referred to the Krishnanagar Thana by the DGP who instructed them to lodge an FIR when the case was put up before him.

But the Krishna Nagar thana refused to lodge the FIR and forwarded it to GRP saying the case came under GRP's jurisdiction.

The CWC also did not to make use of their suo motto powers to give verbal orders to lodge an FIR to Krishnanagar Thana to investigate the case. Neither did they consider the fact that the child was in immediate need of rehabilitative care and medical compensation.

Saaksham Foundation in its letter addressed to the CWC Chairperson had categorically mentioned that the case be registered at the Krishna Nagar thana and investigation into kidnapping, physical abuse and disfiguring of the child be ordered immediately. The GRP had no jurisdiction in this case as the child had gone missing from Alambagh and is a resident of Kanausi, Manaknagar which is under the Krishnanagar Police circle.

Yet decision on the case was delayed and when a judgment was finally delivered a week later all the details were not taken into consideration and the case was forwarded to GRP.

This will not only further dilute the case but also hamper delivering of justice to the child and her family.

As requested on behalf of the child, letter from CWC should have been shot off to the DGP and the DIG Range to immediately get the FIR on the case lodged in the relevant thana so that proper investigation on the matter could begin. It should have also instructed the state officials responsible to ensure rehabilitative care due to Noor Bano her as per her right.

But none of the above was done and the buck continues to be passed on in the Noor Nano case even by the Committee which is a foremost representative and protector of child rights in UP.

Anjali Singh
(The author is a Special Correspondent to Citizen News Service (CNS) and also the Director of Saaksham Foundation. Email: anjali@citizen-news.org)

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Will cancer-stricken commissioner get justice on 14 January 2010?

2009-12-23T09:23:00.008+05:30

Will cancer-stricken commissioner get justice on 14 January 2010?

Kulsum Mustafa

Mumbai: The Commissioner of Customs at Mumbai, Deepak Kumar, and members of anti-tobacco lobby are anxiously looking forward to heralding in the New Year. On 14th January, 2010, will be pronounced a landmark judgment in the case that has already gone down in annals of history. Whatever the verdict the case is India’s first such complaint to be filed by a serving officer.

Deepak Kumar has registered a case at Maharashtra Consumer Disputes Redressal Commission in Mumbai. on December 2. He has demanded compensation of Rs. 1 Crore (INR 10 million or USD 200,000) from ITC Ltd, Kolkatta for severe physical damages, including loss of natural voice, incurred due to tobacco consumption without awareness of the dangers posed by the product.

After nearly 40 years of regularly smoking cigarettes, he had developed throat cancer. Kumar's larynx – the voice box has been removed. So severe was his ailment that his treatment entailed two surgeries and radiation therapy, just to keep the cancer from spreading. The dream of the man who wanted to become an attorney after he retired from the Customs department today lies shattered. His resonant voice is gone Mr. Kumar can barely utter just a few words, and that also with great difficulty and after first covering the hole in his larynx with his palms. From his neck hangs a white gauze bib- an attempt to hide the gaping whole left by the surgery.

“It is not money, it is not personal vendetta, I await this judgment because it is in larger interest of tobacco consumers. The consumer must know he is inhaling and chewing poison,” Mr. Kumar told media persons at a national level media interaction organized in Mumbai by Healis Sekhsaria Institute for public Health.

The judgment Mr. Kumar hopes will make tobacco companies accountable, pressurize government bodies to curb tobacco products in India and make public aware of the ill effects of tobacco and draw attention to the hardships faced by users of tobacco.

“I have seen death, pain and suffering. On the hospital bed I took a vow- if I survive I will devote my entire life to anti-tobacco campaign. I do not want others to suffer what I have…... “ says Mr. Kumar, his voice choked with emotions. Mr. Kumar was operated in the Tata Memorial Hospital in November 2008.

Not able to take on the strain of speaking through prosthetic voice box Mr. Kumar addressed the media through power point presentation. He went on to describe his journey from a 16 year old boy, thrilled and excited at smoking his first cigarette. In the next 40 years the number increased to 40 sticks a day. In those days there was no warning about cigarette smoking being injurious to health. This came to be printed on cigarette packs only in mid eighties. "If I had made an informed choice 40 years ago, it would be a different story. But when I began smoking, which started as just a cigarette or two during my pre-college and early college days, there were no warnings. Nothing. How could I -- or the millions of others in India who started then -- have known that cigarette smoking is more addictive than heroin? It was intentionally made glamorous, through marketing. I used to smoke Wills Navy Cut, an ITC brand. I'll never forget that advertisement campaign they ran: a beautiful young girl, a handsome young man, and between them a pack of Wills Navy Cut. The slogan? Made for each other," said Mr. Kumar in a remorseful voice.

"More than anything, I regret smoking that first cigarette. Ultimately, it ruined my life. How many more lives must be ruined by tobacco in this country?" he asks, adding that education and awareness for the people is the most important step especially in India which has more tobacco users than almost any country in the world.

Kulsum Mustafa
(The author is a senior journalist and Secretary-General of Media Nest)

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Orphanages are viable options for some children: Study

2009-12-18T00:49:00.002+05:30

Orphanages are viable options for some children: Study

A Duke University study of more than 3,000 orphaned and abandoned children in five Asian and African countries has found that children in institutional orphanages fare as well or better than those who live in the community.

The findings contrast sharply with research that associates institutions with poorer health and well-being, and the policies adopted by many international agencies/governments.

"Our research is not saying that institutions are better. What we found is that institutions may be a viable option for some kids," said study leader Kathryn Whetten, director of the Center for Health Policy at the Duke Global Health Institute. "As the number of orphans continues to rise worldwide, it is vital not to discount orphanages before assessing whether they are harmful to the millions of children for whom they care."

Whetten’s research team compared the physical health, cognitive functioning, emotion, behaviour and growth of orphaned or abandoned children ages 6-12, half of them living in institutions and the other half dwelling in the community. The study found that children in institutions in five countries reported significantly better health scores, lower prevalence of recent sickness and fewer emotional difficulties than community dwelling children. These findings suggest the overall health of children in orphanages is no worse than that of children in communities.

The research team has been following the 3,000 orphans involved in the study for three years, and they plan to continue tracking them into their late teens and early 20s to determine how their childhood affects their life course.

Published in the interactive open-access journal PLoS ONE, this is one of the most comprehensive studies of orphans ever conducted. Data were collected between May 2006 and February 2008 from children and their caregivers in 83 institutional care settings and 311 community clusters. The study assessed five culturally, politically and religiously-distinct countries that face rising orphan populations. Sites included Cambodia, Ethiopia, Hyderabad and Nagaland in India, Kenya, and Tanzania.

"Very few studies cross a span of countries like ours does," said Whetten. "The design flaw of past studies is that they compared a small number of orphanages against community houses. Those limited results can’t be generalized to other places."

Some of the most influential studies on child institutions were conducted in eastern bloc countries. But the greatest burden of orphans and abandoned children is in sub-Saharan Africa and Southern and Southeastern Asia.

Of the estimated 143 million orphans and abandoned children worldwide, roughly half reside in South and East Asia, according to UNICEF. An estimated 12 percent of all children in Africa will be orphaned by next year as a result of malaria, tuberculosis, pregnancy complications, HIV/AIDS and natural disasters, according to the World Health Organization.

The Duke study included less formal institutions in Asia and Africa that were not studied before, and not easily recognized. Researchers spent the first six months meeting with members of each community to identify and map orphanage locations. In Moshi, Tanzania, the research team found 23 orphanages, after initially learning of just three from local government officials.

"What people don't understand is that, in many cases, the institutions are the community’s response to caring for orphaned and abandoned children," said Whetten. "These communities love kids and as parents die, children are left behind. So, the individuals who love children most and want to care for them build a building and that becomes an institution. These institutions do not look or feel like the images that many in this country have of eastern bloc orphanages, they are mostly places where kids are being loved and cared for and have stable environments."

The research findings run contrary to global policies held by childrens rights organizations such as UNICEF and UNAIDS, which recommend institutions for orphaned and abandoned children only as a last resort, and urge that such children be moved as quickly as possible to a residential family setting.

"This is not the time to be creating policies that shut down good options for kids. We need to have as many options as possible," said Whetten. "Our research just says ‘slow down and let’s look at the facts.' It’s assumed that the quality of care-giving is a function of being institutionalized, but you can change the care-giving without changing the physical building."

Whetten said more studies are needed to understand which kinds of care promote child well-being. She believes successful approaches may transcend the structural definitions of institutions or family homes.

"Let's get beyond labeling an institution as good or bad," she said. "What is the quality of care inside that building, and how can we help the community identify cost-feasible solutions that can be delivered in small group homes, large group homes and family homes?”

The study was supported by grants from the National Institute of Child Health and Development. Other Duke researchers involved in the study include Rachel Whetten, Jan Ostermann, Nathan Thielman, Karen O’Donnell, Brian Pence and Lynne Messer.

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Mounting pressure on UP state government to set up Child Protection Unit

2009-12-17T10:01:00.001+05:30

Mounting pressure on UP state government to set up Child Protection Unit

The fight for child rights got a fillip with a the media fraternity in Lucknow joining hands with Saaksham Foundation, an organization addressing violations of child rights in Uttar Pradesh, to fight for the rights of child facing inhuman attacks. Journalists from all the leading news papers in the city including The Times of India, The Hindustan Times, Dainik Hindustan, The Indian Express, The Pioneer, Aaj Tak and Times Now gave their support to the petition to setup a Child Protection Unit in the state.

It is noteworthy here that as per the Juvenile Justice Act 2006 amendment it is mandatory to set up social police to address cases related to children. Furthermore as per National Commission for Protection of Child Rights (NCPCR) Directions and Guidelines a social police station and a child friendly police personnel is a must in every state. But UP as of now has none.

In a jointly signed petition that demanded setting up a Child Protection Unit in the State to address the increasing numbers of brutal attacks on children, scribes and the social organization also sought the provision of child friendly police station and police personnel.

The petition has been submitted to Additional Cabinet Secretary Vijay Shanker Pandey and to the Chief Minister's office on December 8. On receiving the petition and going through the contents Mr Pandey expressed his concern over the issue and assured the Director of Saaksham Foundation that he will be looking into the matter and also call a meeting on the issue of seting up a Child Protection Unit in UP soon.

A copy of the petition was also handed over to UPCC Chief Rita Bahuguna, on December 6 at the Congress Party office. She promised her full support to the issue and also said that she would hand over the petition campaigning for the cause of protection of children to Rahul Gandhi on his visit to the state capital on December 8.

Ms Shantha Sinha, Chairperson, National Commission for Protection of Child Rights (NCPCR) was also given a copy of the petition on December 8 when she was in town to attend a State Level consultation on the Right To Education Act. She expressed her concern over the fact that children were being subjected to such brutal attacks and said she will take up the matter strongly and also expedite the process of setting up a State Commission for Protection of Child Rights in UP.

Microbicide trial results signal end of one chapter, focus turns to promising ARV-based candidates

2009-12-14T16:24:00.003+05:30

Microbicide trial results signal end of one chapter, focus turns to promising ARV-based candidates

While acknowledging disappointment in the trial results announced today, the Global Campaign for Microbicides noted that the failure of PRO 2000, a candidate microbicide gel, to show effectiveness against HIV was only the “end of the beginning” in the search for a safe and effective product. This comment came in response to the UK-based Microbicides Development Programme’s announcement that its MDP 301 trial, which enrolled over 9000 women in four African countries, has shown conclusively that PRO 2000 was safe but did not reduce women’s risk of acquiring sexually-transmitted HIV.

Microbicides are being developed as products that could be topically applied by a receptive sex partner to reduce risk of becoming HIV infected during sex. Microbicide candidates are being formulated as vaginal gels, suppositories, foaming tablets or slow-releasing vaginal rings.

Last February, the release of promising results from another PRO 2000 study, HPTN 035, signaled that PRO 2000 might be effective—a hope that was disproven by the MDP 301 results. “We all knew that the trend observed in HPTN 035 could have been due to chance,” noted Yasmin Halima, Director of the Global Campaign. “While we are deeply disappointed to learn definitively that PRO 2000 is not effective, it is our responsibility as advocates to turn our full attention now to the candidates currently in clinical trials”, she continued. “These candidates, being tested as oral pills as well as microbicides, contain antiretroviral drugs or ARVs, the same life-saving medications used as treatment by people living with HIV. In laboratory and animal studies, they appear to be many times more potent than any of the non-ARV-based candidates”, she added, noting that results of the first effectiveness results from this new class of products are expected next year.

Dr. Sheena McCormack, Principal Investigator for the PRO 2000 trial, observed that adherence rates (participants’ use of the test product as directed) were high in this study. “We know that women and their partners liked the gels and used them”, McCormack stated. The trial used multiple methods to determine how frequently women were using the gel and all indicated a high level of use. “Women reported that using it increased sexual pleasure and fostered intimacy by helping women talk about sex with their partners,” McCormack added, “So we know that we have the method right. Now we just need a product with the potency to stop HIV.”

Because the MDP 301 trial featured a much stronger social science component than any previous HIV prevention trial, it has also generated a substantial body of data on sexual behaviors that can be immediately applied to existing HIV prevention research and programming. The findings, which will be published over the coming months, confirm that the majority of trial participants liked using the gel, noting it made condom use easier and more pleasurable. “We have heard this in other large-scale microbicide trials as well”, Halima added.

Samu Dube, leader of the Global Campaign’s Africa team noted that, while communities participating in the MDP 301 trial are understandably disappointed by the trial results, they are nevertheless proud to have participated in it and determined to see microbicide and other prevention research continue. “As African women, we cannot afford to feel defeated,” Dube stated. “We know that research is a painstaking process and that the challenge of finding safe and effective products is not easy. But women are engaging in the process because we must find a tool to save the lives of our daughters and sisters. Giving up is not an option for us,” she said.

Reiterating this sentiment, McCormack quoted the words of one of the South African women who volunteered for the MDP301 trial participants who said that, “[e]ven though the gel proved not to be effective, we played a role in the fight against HIV. We learnt a lot about caring for ourselves, such as using condoms. We also learnt to encourage others to test for HIV and we gained confidence in helping those who were already infected.”

Global Campaign for Microbicides is a network of advocates and nongovernmental organizations (NGOs) working to expand HIV prevention options for women and encourage ethical research that involves civil society. Since 1998, GCM has worked to accelerate product development, facilitate widespread access and use of existing tools, and protect the needs and interests of users and communities, especially women.

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36 million people with TB cured: New WHO Data released

2009-12-13T20:28:00.004+05:30

36 million people with TB cured

Up to 8 million lives saved through 15 years of DOTS programmes, but millions still unable to access high quality care

Some 36 million people have been cured of tuberculosis (TB) over the past 15 years through a rigorous approach to treatment endorsed by WHO. New data, released by WHO, also indicate that up to 8 million TB deaths have been averted, confirming DOTS/the Stop TB Strategy as the most cost-effective approach in the fight against tuberculosis.

(To download/ read the Global Tuberculosis Control Report 2009 Update, click here)

DOTS was first developed in 1994 and was later incorporated into the WHO Stop TB Strategy as its main component. DOTS has five elements: political commitment with increased and sustained financing, case detection through quality-assured bacteriology, standardized treatment with supervision and patient support, an effective drug supply and management system, monitoring and evaluation system and impact measurement.

Steady progress in curing TB and saving lives
Since the launch of DOTS, the number of people being cured has increased regularly. Data from the latest 12 month period now shows that the highest ever number of infectious patients – 2.3 million people – were cured. With 87% of treated patients being cured, the 85% global target was exceeded for the first time since it was established in 1991. Furthermore, a total of 53 countries surpassed this treatment milestone.

The WHO update shows continued progress on addressing the lethal combination of TB and HIV. Between 2007 and 2008, 1.4 million TB patients were tested for HIV, an increase of 200, 000. Of those who tested HIV positive, one-third benefited from life-saving HIV anti-retroviral therapy (ART) and two-thirds were enrolled on co-trimoxazole prophylaxis to prevent the risk of fatal bacterial infections. In addition, screening for tuberculosis and access to isoniazid preventive therapy for TB among people living with HIV more than doubled, although the total number is still far short of what it should be.

"Fifteen years of TB investments are bringing visible results in terms of human lives saved. Together, national programmes, WHO, UNAIDS, the Global Fund and other partners have helped save millions of lives from TB," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "But the current pace of progress is far from sufficient to decisively target our goal of TB elimination."

Not all receiving the treatment they could
Although more and more patients are being cured, there are millions who are being let down because they are unable to access high-quality care. TB remains second only to HIV/AIDS in terms of the number of people it kills. In 2008, 1.8 million people died from TB including half a million deaths associated with HIV - many of them because they were not enrolled on ART.

A persistent challenge that is being largely left unchecked in many parts of the world is multidrug-resistant TB (MDR-TB) and its even more dangerous form, extensively drug-resistant TB (XDR-TB). Of the estimated half a million MDR-TB cases occurring per year, almost 30 000 were officially reported and 6 000 were known to be treated according to WHO international standards in 2008. A major expansion of services is currently in an early and difficult phase but almost 29 000 people are expected to be treated in 2010.

Of the estimated 9.4 million TB cases in 2008 (including 1.4 million TB/HIV cases), 3.6 million cases occurred among women.

"Half a million women died from TB last year. It is a disease that destroys lives, damages families and stifles development," said Dr Mario Raviglione. "Without help to fill the US$ 2 billion funding gap for TB care and control in 2010, the most vulnerable people will continue to miss the benefits so many others have seen."

The new report provides the most accurate information on the global burden of tuberculosis. It also features updates about the work of the Global Laboratory Initiative, the WHO Global Task Force on TB Impact Measurement, and describes the success of a new initiative in 2009 in which global TB data collection went online.

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30% school kids need mental healthcare

2009-12-13T19:27:00.005+05:30

30% school kids need mental healthcare

"Thirty per cent of the so called ‘normal’ schools going kids require mental healthcare otherwise they will be forced to live in ‘learnt' helplessness," said Dr Alok Bajpai, Psychiatric based in Kanpur. Dr Bajpai was the key speaker at the fortnightly Media4Children, organized by Media Nest and supported by UNICEF at the UP Press Club. The session meant to sensitize journalist on different development issues was presided over by psychologist Dr Manju Agarwal.

Asserting that 90 per cent behavioral disorders in children are due to the environment and society. Dr Bajpai said that 70 per cent of these behavioral problems are because of the education system. He said most of the time the parents do not know what they want from their child and the child also grows up confused.

Apart from practicing general psychiatry, Dr Bajpai’s consistent focus and work has been with child and adolescent mental health, and have established a child and adolescent mental health centre, Uttar Pradesh’s first at Kanpur.

He has been instrumental in awareness campaigns. and workshops especially with schools and training teachers aimed at increasing sensitivity towards childhood problems. An extension of this work is an ongoing School mental health project.

These workshops were conducted in various cities in India like Noida, Varanasi, Lucknow, including Gujarat. A three day workshop in Chennai included 300 children and parents from various strata of schools in Chennai. 'NO KIDDING' was immensely useful. These workshops depending on the group and time focus on the children in form of brainstorming, or life skills events, with teachers and parents on knowing the child and his/her problems. The purpose is to enhance positive mental health rather than focus on disease.

A decade of work is now slowly creating an awareness of Dyslexia and other childhood problems in population.

He said it makes him sad when he meets children in the age group of 8 to 14 and they tell him that they do not feel like doing anything. That they would just prefer not to do anything.

“These are serious utterances. If the child is not given a chance to de-stress this same child will grow up to become violent and aggressive and will one day become a burden on both the family and society, “said the doctor.

He suggested that we teach ‘critical thinking to our child, understand what we really want out of our kid and evaluate what the child is capable of doing actually.

“Goal of education is and must be to free the mind, it must not enchain and produced individuals with wrapped personality,” said Dr Bajpai.

Agreeing with what Dr Bajpai had to say that in a country like India going to a psychiatric hospital is a taboo or a stigma it is not easy to heal the scars in a child’s mind, but he stressed that each school and in fact all health centers must have a mental health counseling cell.

Dr Augustine Veliath, UNICEF’s communication specialist, said that December 11, being the birthday of UNICEF he hopes that there is a healthier, happier state for Uttar Pradesh’s children.

“Mental health is a forgotten right of child development and we are glad Media Nest has focused media attention in that direction,” said Mr. Veliath while addressing the media. He said as parents what we can really give our children is not money and expensive gifts but a patient ear.
The programme was conducted by the secretary general of Media Nest, Kulsum Talha.

Kulsum Mustafa
(The author is a senior journalist and Secretary-General of Media Nest)

Jurmil Morcha and CPJ Karnataka enlighten Bangaloreans about Chattisgarh's marginalized

2009-12-11T19:42:00.031+05:30

Jurmil Morcha and CJP Karnataka enlighten Bangaloreans about Chhattisgarh's marginalized

Jurmil Morcha, a local people’s movement from Chhattisgarh participated in a recent series of events in Bangalore as a response by the Campaign for Justice and Peace, Karnataka (CJPKar) to the gross human rights violations on adivasis and dalits in that state. From 4th-9th December, four Jurmil Morcha members highlighted the prevalent injustice towards adivasis and other excluded minorities using powerful and lively folk music and puppetry in parks, colleges, auditoriums and streets across Bangalore. Alongside the Jurmil Morcha activists, CJPKar volunteers (some of whom had visited Chattisgarh earlier this year) informed the general public, concerned individuals, civil society groups and community based organizations about the need to pressurize the State to follow Supreme Court directives to rehabilitate displaced adivasis and restore civil administration in affected areas of Chhattisgarh. CJPKar sources have revealed that nearly 3.5 lakh adivasis in 700 villages have been displaced while their resource rich land is being sold off to Indian and foreign mining corporations.

Jurmil Morcha performs at Cubbon Park, Bangalore

Meaning United Front, Jurmil Morcha, formed in January 2009 is based in Ambargarh Chouki block of Chattisgarh's Rajnandgaon district. Its core group consists of five talented and energetic yet economically backward and barely literate dalit and adivasi women empowered by challenging patriarchy. They include Pandwani artist Budhan Bai Meshram, orator Bhan Sahu and Jaswanta who all live in an Ashram (a refurbished Kothar or crop storage space) in Paangri, a remote, yet picturesque adivasi village with a primarily dry river surrounded by dense forest and hills. Through songs and oral narratives, Jurmil Morcha has been actively mobilizing communities and increasing awareness about social discrimination, child rights, migration, health and women’s problems in Chattisgarh. A founder member of Chhattisgarh Visthaapan Virodhi Manch (a state level coalition for joint action against displacement of adivasis and other marginalized communities), following its emergence, the group raised the demand for implementation of the Famine Code in all drought hit areas of Chattisgarh including Ambagarh Chouki block. Apart from highlighting the issue of long delayed payments of wages under the NREGS, the group also organized a children led padyatra on 2nd October invoking women's independence and joy for all villagers particularly kids.

Jurmil Morcha's core group plans to initiate the formation of Naanchun Morcha (children’s front). It dreams of establishing a centre for cultural expression and publish a children’s newspaper to strengthen kids' voices. Despite financial hurdles due to its reliance on the minimal contributions from the extremely marginalized people with whom it associates, Jurmil Morcha continues to invest more time and energy in them. The group is scheduled to formalize its constitution and leadership next year. Its three fold strategy is to:

* Demand smooth and transparent operation of government’s welfare schemes for the excluded
* Endeavour collective production by marginalized communities
* Resist programmes, policies and processes leading to further marginalization

Further, CJPKar comprising civil society groups, students, lawyers and individuals who condemn Operation Greenhunt demands that the Governments of India and Chhattisgarh:

Withdraw all paramilitary forces in adivasi areas and disband Salwa Judum
Implement the Supreme Court’s order on rehabilitating adivasis in Chhattisgarh
Repeal the Unlawful Activity (Prevention) Act & Chhattisgarh Special Public Security Act
Cancel all existing MOUs with large corporations (especially those engaged in mining minerals) and start dialogue with adivasi representatives

Agreeing that mobile phones had become omnipresent even among the economically excluded thanks to the government's 'initiatives', Ajeet Bahadur, a theatre director and Jurmil Morcha activist observed, "Gehoon, anaaj nahin, lekin iski aadat tho lagwaadiya sarkar ne!"

Pushpa Achanta
(The author is a freelance writer, a Fellow of Citizen News Service (CNS) Writers' Bureau, and a community volunteer based in Bangalore, India)

Not respecting confidentiality is unethical in TB Care

2009-12-09T00:15:00.002+05:30

Not respecting confidentiality is unethical in TB Care

Why are people who might be having TB not going in for TB testing in Lesotho? "When it comes to confidentiality in TB care, going for testing often means that entire community comes to know of your TB status. This is a violation of human right" said Maketekete Alfred Thotolo, Treatment Literacy and Advocacy Coordinator at Adventist Development and Relief Agency (ADRA Lesotho) which works closely with AIDS and Rights Alliance in Southern Africa (ARASA). Alfred was sharing his experiences from Lesotho at the 40th Union World Conference on Lung Health.

People who might have TB need to have supportive and safe healthcare facilities that don't expose them to TB related stigma, says Alfred. Going for TB test is like taking a risk as healthcare facilities providing TB services are insensitive to the human rights of people who are seeking services from them.

"Normally we are told that somebody's illness is a private matter. But in clinics doctors identify TB patients violating confidentiality and trust. Lack of confidentiality further breeds stigma and discrimination related to TB for this patient" said Alfred. This fear of TB-related stigma and eventual discrimination at different levels, discourages people from going to existing TB-care services. We speak of intensified TB case finding, want people to complete anti-TB treatment successfully and prevent latent TB from becoming active TB disease by taking full course of isoniazid preventive therapy, but unless we address TB stigma and reduce discrimination, it will be difficult to achieve what we are aiming for in TB control, says he.

"In Lesotho, Isoniazid Preventive Therapy (IPT) to prevent latent TB infection from becoming active TB disease, is not available for ordinary citizens but only for health workers. Those people who have latent TB infection have a right to protect themselves and access IPT services to prevent latent TB from becoming active TB disease. I consider these people have a right to get IPT. Everybody has a right to health, when it comes to TB prevention" said Alfred. The Global TB/HIV Working Group of the Stop TB Partnership has clearly stated that: IPT works, IPT is safe, and IPT works with ART or by itself. TB is a major cause of illness and death in people living with HIV, even in those taking antiretroviral therapy. TB could be prevented in millions of people infected with both HIV and TB through the use of IPT. IPT is an important intervention for preventing and reducing active TB in communities affected by HIV - preventing active TB can prevent millions of people from being infected in the community and in health care services.

IPT is safe and effective and the treatment lasts for 6-9 months. It is only given to people who have confirmed latent TB infection (not to be given to those with active TB disease). Effective IPT treatment reduces the development of active TB disease in 40-60% of patients.

Despite of the potential public health outcomes of using IPT effectively in high burden TB countries, and IPT being one of the key interventions recommended by WHO in 1998 to reduce the burden of TB in people living with HIV, the uptake of IPT has been very low. Clearly there is a need to mobilize TB-HIV affected communities and other stakeholders to integrate IPT as part of the package of health services.

Everybody has a right to health - and this includes the right to access TB services - without any fear of healthcare facilities not respecting one's confidentiality or being denied IPT if one has latent TB and putting oneself at risk of developing active TB disease.

May be TB care and control programmes can get some lessons in reducing stigma and discrimination from other disease control programmes. Engaging community meaningfully at all levels of AIDS programmes has certainly yielded results - and reduced stigma, discrimination and increased access to AIDS services in different parts of the world. Community engagement is certainly suboptimal in TB care and control programmes in reality. There are good examples where genuine involvement of community, particularly cured TB patients, have improved TB programme performances in different parts of the world. But this is certainly not a generalized statement to the global TB control.

The WHO Global TB Strategy and the Global Plan to Stop TB (2006-2015) gives a major thrust to community engagement. The Patients' Charter for Tuberculosis Care (PCTC, The Charter) is an integral component of the WHO Global TB Strategy, as a tool to empower communities for advocating to achieve the International Standards of Tuberculosis Care (ISTC). Many national governments have adapted the Charter as official component of their national TB programmes. But in reality, genuine engagement of cured TB patients at all levels of TB programmes is a distant dream, despite of increasing number of examples where community has demonstrated their competence in improving TB responses locally. After all, why are governments reluctant to engage communities - which can address so many current impediments to TB care and control at local level?

A 2007 World Bank research report "The Economic Benefit of Global Investments in Tuberculosis Control" found that 22 countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths. Highly affected African countries could gain up to 9 times their investments in TB control. When the economic benefits of effective TB care and control are estimated to be greater than the cost, it is all the more reason for governments to not delay any further the improvement of TB responses by engaging communities with dignity as equal partners in TB care and control at all levels.

Community-led monitoring and advocacy is improving TB response in Zimbabwe

2009-12-07T20:01:00.000+05:30

Community-led monitoring and advocacy is improving TB response in Zimbabwe

Despite of the Patients' Charter for Tuberculosis Care being an integral part of the Global Stop TB Strategy, and major thrust on community engagement in the Global Plan to Stop TB, communities are yet not optimally engaged by the TB programmes in high burden countries. However there are promising examples where community engagement has led to improved TB programme outcomes, and health outcomes over all.

At the 40th Union World Conference on Lung Health in Cancun, Mexico, co-chairs Dorothy Namutamba, East African Regional Coordinator for International Community of Women with HIV/AIDS (ICW) and Erin Howe from Public Health Watch, moderated a very interactive session on community engagement in TB responses. Albert Makone from Community Working Group on Health (CWGH) shared an inspiring example of how communities were engaged and mobilized for the uptake of intensified TB case finding in HIV-care settings.

"Our role has been over the past years to encourage community participation and to build mechanisms so that community can engage - our motto is health is your right and also your responsibility" said Albert Makone. "We began working on HIV in 1998 and integrated TB issues too in 2007" informed Albert. "The evidence that was coming from the civil society on people getting impacted by both: HIV and TB - led us to integrate TB in our initiatives."

"We engaged parliamentarians, national TB programme (NTP) managers, and other stakeholders" said Albert. "We elected the parliamentarians and we thought that engaging them will increase accountability of them towards their own electorate" said Albert. "The Abuja Declaration that demanded 15% budget allocation for health was a great tool to push parliamentarians for upping domestic funding on health. We believe one day we will invest more than 15% of budget on health" shares Albert.

"We began working closely with regional campaign for essential medicines. Nokia, mobile phone manufacturer, distributed mobile phones to every health centre and clinics so that clinics can communicate with the health centres and inform them about depleting drug stocks. This was an intervention in response to drug stock-outs in Zimbabwe" said Albert.

"There were reports about theft in dispensaries so we mobilized funds for security guards so that drugs go to the people who need it most" said Albert.

Speaking about community monitors called "TB Monitors" at village level, Albert says: "We were able to do community monitoring by training people to be TB monitors at the village level. These monitors were trained for five days on HIV and TB issues and screened local people to boost intensified new TB case finding - and increase treatment literacy for better treatment outcomes" says Albert.

"One of the key challenge was vertical programming of TB and HIV - and we need to find solutions to up the collaborative TB/HIV activities on the ground" remarks Albert.

The lack of coordinated mechanism between the new agencies addressing TB has required Albert's organization to take on a leadership role in pushing the TB/HIV advocacy agenda in Zimbabwe.

"It was a long process to engage parliamentarians as their awareness on health was low. We finally organized two days workshop with parliamentarians to sensitize them on health and emphasize the TB/HIV epidemics in Zimbabwe. We focussed on reaching out to the portfolio committee on health and slowly the role of community was becoming evident to policy makers - that community is there not only to criticize but also to help give input and shape solutions as informed and treatment literate partner" said Albert.

"Issue of infrastructure is there as it is in a very dilapidated state in Zimbabwe. Laboratory capacity is weak and domestic funding is low" shares Albert.

"NTP managers should consider community as equal partner and listen to their voices. If they don't involve affected communities in a meaningful manner, it will be a missing link. We will have good laboratories, diagnostics, drugs but continue to have higher infection rates. We need to listen to community voices and resolve the issues they face to improve TB programme performances" said Albert.

As a result of the growing movement for TB/HIV collaborative activities, a quarter of the AIDS service organizations in two districts of Zimbabwe are offering TB screening to their clients and referring them for diagnosis and treatment of TB.

Global Fund approves TB funding for government and civil society led proposal in India

2009-12-07T18:12:00.004+05:30

Global Fund approves TB funding for government and civil society led proposal in India
A defining moment in the history of tuberculosis control in India

A proposal that will launch a massive effort to address two of the main challenges to tuberculosis (TB) control in India has been approved for Round 9 funding by the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The grant is by far the largest ever made to TB control in India, the country which bears the highest TB burden and also has highest estimated incidence of multi-drug resistant TB (MDR-TB) in the world.

The proposal submitted by the Government of India in partnership with civil society has three principal recipients – the Government’s Central TB Division, The International Union Against Tuberculosis and Lung Disease (The Union) and World Vision India – who will be responsible for implementing the five-year project.

“We’re very pleased to learn of the success of this proposal”, said Dr Nils E Billo, Executive Director of The Union. “In particular, the strengthening of civil society participation demonstrates the new awareness that health systems alone can not solve problems like TB control. Broader social commitment is required”.

The first component of the project will focus on providing universal access to MDR-TB diagnosis and treatment. It will establish and scale-up capacity for quality-assured rapid diagnosis of MDR-TB in 43 referral laboratories in India by 2015. In addition, it seeks to scale up care and management of MDR-TB across India in its 35 states and territories resulting in the treatment of 55,350 additional MDR-TB cases by 2015.

The second component seeks to strengthen civil society involvement in TB care and control to improve the reach, visibility and effectiveness of India’s Revised National Tuberculosis Control Programme (RNCTP) in 374 districts across 23 states, reaching about 744 million people by 2015.

While India has already made great strides in providing access to basic ‘DOTS’ (the globally recognised strategy for TB control), this project will provide better access to TB services, especially in geographically difficult areas, vulnerable communities and tribal populations.

Additionally, RNTCP will be supported and strengthened at the sub-district, district, state and national levels. The involvement of multiple stakeholders across civil society, from private practitioners and NGOs to technical agencies and community groups, on such a large scale, is expected to develop functional and sustainable networks, increase information sharing and accountability, and empower community monitoring and ownership of TB care and control.

The Global Fund Board has approved funding for the initial two years of the five-year proposal that seeks a total grant of US$ 199.54 million. The actual funding amount for the two years will be finalised in the next few months.

India's first cleft toll-free helpline launched

2009-12-07T17:47:00.003+05:30

India's first cleft toll-free helpline launched
Kulsum Mustafa

VARANASI: A historic step was taken in the direction of cleft treatment when India’s first cleft and palate patients’ toll-free helpline was launched from Varanasi- the world’s cleft treatment capital recently.

Declaring 18001800125 as cleft patients’ helpline, Dr Subodh Kumar Singh of G S Memorial surgery hospital and trauma centre, Varanasi, said this will give the parents of cleft children the welcome chance to get answers to all their queries. The launch was part of the celebrations of ‘Muskan festival’-the annual event organized by the hospital for the last several years. This year the celebrations had been up-scaled as the awareness campaign for cleft has received an impetus after the Smile Pinkie documentary on cleft received the Oscar award. Pinkie hails from Mirzapur in Varanasi and it was Dr Singh who performed the operation on her at G S Hospital that changed her life for ever.

The vice president of Smile Train, Mrs. Delois Green wood declared the helpline open at the hospital on November 21. Ms Greenwood and a galaxy of Smile Train associates and supporters were in Varanasi as special invitees from US on the special day. They included US Television popular star Jane Kaez Mareck, Meg, Karen, Robert, Yuan, US industrialists Mr. Clark Kokich, Lisa Kokich Strain, Suzie Kokich Strain,

“Participating in the ‘Smile festival’ organized annually at Varanasi is a truly ‘heavenly’ experience,” said Jane as she interacted with several parents of cleft children.
The hospital was abuzz with activities. The hospital premise, situated in the heart of the Holy City, is decorated with balloons and buntings on this special day. It is the venue of thanks giving by those cleft kids who have returned for the annual check-up. There were hundred of parents carrying their babies waiting to get dates for the operation. While many have come from nearby villages some of them have traveled hundreds of miles, from other districts and states to reach the ‘world capital of cleft treatment.’ Additional corrective surgery, after the miraculous operation. There were hundreds of new cleft patients who had come with hope and faith in the miracles of modern day surgery. Over five hundred cleft children were registered by noon and the dates of operations given to them for the next few months. According to rough estimates 15,00 cleft operations are conducting here monthly.

“From misery to joy it is simply a matter of just an hour’s surgery and all totally free. The transformation in both the physical and psychological is unbelievable,” said Mr Satish Kalra, South Asian representative of Smile Train.

Overwhelmed by the traditional welcome and the sight of hundreds of cleft children, some just a few months old Lisa had to fight back tears as she said how happy she was to be part of the endeavor that is giving “children another chance.”

Dr Subodh Kumar Singh, the miracle surgeon for cleft in India heads the hospital which is affiliated to ‘Smile Train’- the international NGO that works in 76 countries and offers totally free treatment for poor children with cleft. In India alone they have supported two lakh cleft surgeries in the last nine years.

Known as the surgeon who put the smile on the lips of Pinkie- the protagonist of Oscar winning documentary ‘Smile Pinkie” Dr Singh has through Pinkie given all cleft patients a hope. He has made them believe that cleft is not permanent, that there is a new life waiting for them after a simple operation. He is the doctor who has made gifting smiles his business. He has been doing so for the last five years.

“Smile train has given back the smile to 500, 000, mainly poor children and their parents. But India is special, and more so is Varanasi because this is the city of Pinkie- the little girl who told an extraordinary story to the world and created awareness through her film. We want to make more Pinkies Smile.” She said.

Dr Singh while welcoming this awareness generation that has taken place with the support of the media said, “Our work is not over, In fact it has just begun. In India we have a backlog of 10,000 children of cleft who need to be operated upon.”

“A child who had been looked upon by society as a curse, and treated as a bad omen by her neighbors, gets a totally new face, personality in a matter of minutes. And the child does what he has never done before- smile. Seeing a post operative cleft child smile can make the eyes of most stout man turn misty,” said Dr V C Gupta, chief anesthetic, in his vote of thanks at the function.

Kulsum Mustafa
(The author is a senior journalist and Secretary-General of Media Nest)

Community-led monitoring of anti-TB essential medicines in Uganda

2009-12-07T04:19:00.004+05:30

Community-led monitoring of anti-TB essential medicines in Uganda

The Global Pan to Stop TB (2006-2015) identifies a need to empower communities to take ownership and drive the agenda for TB elimination. Communities are vital partners for policy makers and implementers in addressing TB, MDR-TB and TB-HIV, and diverse strategies are required to support their full participation.

Community-led monitoring of drug supply and procurement can be a vital tool to document challenges people with TB might be facing and also to lead to solutions. A good example rests in Uganda. "My organization was monitoring a list of 15 essential medicines in Uganda. After a training I underwent with Treatment Action Group (TAG) and ICW, I understood the importance of TB and HIV drugs and the need to monitor them as well. After considerable efforts, I could convince my organization to add the TB/HIV drugs to the list of essential drugs we monitor" said Prima Kazoora, Coalition for Health Promotion and Social Development, Uganda. "During monitoring of essential medicines, we discovered that there were frequent drug-stock outs and there were times when TB drugs were not available for more than three months! There were patients with TB who were put on anti-TB treatment who got their treatment disrupted due to drug stock-outs lasting months at times. This could lead to increase in drug resistance and poor treatment outcomes" shared Prima.

"We also found out that the TB laboratories were often out of reagents and therefore unable to conduct any TB test" said Prima. "TB treatment is available in public sector hospitals only. It is not available in private sector hospitals. Anti-TB drugs are also not available in pharmacies. So when government-run centres had drug stock-out, people with TB were left with no other option" said Prima Kazoora.

"Lack of paediatric formulations was another major challenge. Health workers were asked to break down tablets in equal parts for children" said Prima.

So Prima's organization continued monitoring, documenting and reporting these issues. They investigated using community networks that the problem due to which drug stock outs occur in Uganda are mostly in distribution system and interruption in funding cycles. Uganda government was mostly relying on external funding to procure these drugs. So when Uganda government wasn't able to access funds from the Global Fund to fight AIDS, TB and Malaria (GFATM), it led to stock outs.

"Government should earmark funds for essential medicines to ensure no drug stock outs occur" suggested Prima.

"Stop Medicine Stock-Out Campaign engaged a wide network of organizations and began lobbying to ensure regular drug supply of essential medicines. During this campaign, we highlighted issues and build pressure on authorities to respond. Eventually the President of Uganda came up with drug monitoring unit for drug distribution and procurement campaign increasing access and availability of essential medicines" said Prima.

Prima's work has allowed TB/HIV activists to be recognized as crucial partners in the fight against TB in Uganda. She was selected to serve on the Technical Working Group on Medicines that advises the Ugandan government on policies related to purchase and accessibility of essential medicines.

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The year 2010 is declared as Year of the Lung

2009-12-07T01:13:00.002+05:30

The year 2010 is declared as Year of the Lung

The Forum of International Respiratory Societies (FIRS) convening at the 40th Union World Conference on Lung Health in Cancun, Mexico, declared the year 2010 as the Year of the Lung. This was done to recognize that hundreds of millions of people around the world suffer each year from treatable and preventable chronic respiratory diseases. This initiative acknowledges that lung health has long been neglected in public discourses, and understands the need to unify different health advocates behind one purpose of lung health, informed Dr Nils Billo, Chair of FIRS. The FIRS partners include the International Union Against Tuberculosis and Lung Disease (The Union), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociacion Latinoamericana de Torax (ALAT), European Respiratory Society (ERS), Pan African Thoracic Society and American College of Chest Physicians (ACCP).

The New York Times carried a series of articles on different parts of human body, but forgot the lungs! It is difficult to remain alive without lungs for more than few seconds!

The Declaration signed by the partners of the Forum of International Respiratory Societies (FIRS) read as following:

[Begin]
WE NOTE WITH GRAVE CONCERN THAT:
Hundreds of millions of people around the world suffer each year from treatable and preventable respiratory diseases, including tuberculosis (TB), asthma, lung cancer, H1N1, pneumonia, chronic obstructive pulmonary disease (COPD).

WE RECOGNIZE THAT:
Despite the magnitude of suffering and death caused by lung disease, lung health has long been neglected in public discourse and in public health decisions.

WE CALL UPON OUR PARTNERS TO:
Enact smoking cessation legislation and programs to reduce the prevalence and stigma of tobacco-related lung diseases.
[Ends]

There are a range of health and environmental factors that affect our lung health. This includes tuberculosis (TB), tobacco smoke, biomass fuel smoke, chronic obstructive pulmonary disease, asthma, pneumonia among other respiratory infections. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach among health programmes at all levels.

Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds, 1 child dies of pneumonia every 15 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming.

More than 2 billion people or a third of the world's total population, are infected with mycobacterium tuberculosis. Tuberculosis is now the world's seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of the three primary diseases that are closely linked to poverty, the other two being AIDS and malaria.

Tobacco smoking is unquestionably the primary risk factor for COPD. More than 5 million deaths are attributed to tobacco use every year. Smokers have two fold higher risk of developing active TB disease. Tobacco smokers have 2 times more risk of dieing of TB. Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis. The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.

Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.

Asthma is yet another major lung health challenge. It is a chronic disease that affects airways. When people have asthma, the inside walls of their airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that they are allergic to or find irritating. When airways react, they get narrower and lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night. When asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that vital organs do not get enough oxygen. People can die from severe asthma attacks.

More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies. The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met. Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.

According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. Effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.

Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.

Host of other conditions that affect the lungs, are preventable, and often treatable.

Let us hope that 2010 Year of The Lung initiative of FIRS puts the spotlight on the long neglected part of human body which New York Times missed, the lungs.

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Human rights violations in people with TB

2009-12-06T19:26:00.003+05:30

Human rights violations in people with TB

Human Rights have long been ignored in TB 'Control', but are a foundation for improving care as outlined in the International Standards for TB Care (ISTC) and the Patients' Charter for TB Care (PCTC). At the 40th Union World Conference on Lung Health, delegates spoke about human rights violations that challenge TB care and control on the frontlines in their national contexts.

"Dominant human rights violations in TB patients are in those who have co-infection of HIV. There is absolutely no doubt in my mind or in those who work in the field, that when you have HIV combined with TB, there is immense stigma and shame apparently associated with HIV. My own sense is that TB patients are partially discriminated against it is not as extreme not as severe and not as comprehensive open system that we have against HIV. But I am speaking in southern African environment and it might be different in other parts of the world. Certainly the struggle against both, stigma and discrimination against TB and HIV, or any other diseases, because sexually transmitted diseases are also discriminated against, should be fought against vehemently. In the case of TB and HIV one of the drawbacks of this discrimination and isolation of patients is that it drives the disease underground and actually leads to greater public health damage by being widespread and therefore is fundamentally a bad result from public health point of view not only from ethical or moral point of view" said Professor Hoosen Coovadia, noted paediatrician and expert in perinatal HIV transmission, former Head of the Department of Paediatrics at the University of Natal until 2000 and Victor Daitz Professor for HIV/AIDS research at the University of Natal, South Africa.

"Every TB patient has the right to get high quality standards of prevention, treatment and care services. At present TB programmes don't reach every patient who needs care in India. Some issues like working hours of TB-services which don't suit some patients, need to be addressed by adjusting timings. TB patients should get proper diagnosis and other services as required in reality - just drugs available on paper is not enough, the services must reach the patients. One of the good TB strategies should be to engage TB patients. The cured TB patients can advocate with new TB patients and in communities to improve TB responses. These cured TB patients can spread the message that TB is curable, thereby reducing TB-related stigma. They can also be engaged in strengthening social movement to eradicate TB" said Dr D Behera, Union Karel Styblo Awardee for Public Health 2009 and Director of LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.

"The literacy rates among TB patients are low, they are less aware of their own rights and responsibilities related to TB care and services. There is enormous social stigma related to TB prevalent in our society that further put them at risk of human rights violations. Patients of TB are often not comfortable with disclosure" said Dr Darakshan Badar, Programme Manager, Provincial TB control Programme (PTP), Lahore, Pakistan.

"Bangladesh is a success story in terms of TB control. However previously we had lot of TB-related stigma due to which TB patients were isolated at times from their families. Now TB patients go on their own to seek TB care" said Dr K Zaman from ICDDRB Bangladesh. All is not good too in Bangladesh. "Lot of TB patients go to general practitioners outside DOTS and get treated with a range of antibiotics instead of being referred to DOTS" says Dr Zaman. "I conducted study in the past, where 50% of new TB patients were found to be resistant to at least one anti-TB drug, and 5.5% had MDR-TB" adds Dr Zaman.

"In DRC, we have organizations of cured TB patients to help other patients to minimise stigma. TB patients can share their difficulties and concern with each other in this network during the treatment and successfully complete DOTS. These TB patients' groups have been there in DRC for the last ten years. In Kinshasa, many TB patients were defaulting earlier so NTP realized the importance of engaging cure TB patients and counselling new TB patients on taking TB treatment on time. These TB patients' led groups have upped the TB cure rate in DRC to 90%" said Dr Jean Pierre Kabuayi Nyengele, Deputy NTP Manager, Democratic Repubic of Congo (DRC).

"It is a right of TB patients to access prevention, diagnosis, treatment and care services. But that is not happening because of range of reasons including weak health systems, suboptimal infrastructure, lack of facilities" says Dr Peter Kimuu, TBCAP, Kenya.

"In our context, female TB patients have more problems in accessing existing services for TB. Female TB patients find it difficult to get engaged, married or those who are already married, often get divorced due to stigma related to TB" shares Dr Ejaz Qadeer, National TB control Programme (NTP), Pakistan.

"Female TB patients face a lot of problems and we need to establish protocol and guidelines to address gender-specific issues in TB programmes" suggests Dr Razia Fatima, Programme Officer, National TB Control Programme (NTP), Islamabad, Pakistan.

There are many more points to ponder and decide whether these qualify as human rights violations too:

- Requiring patients pay for any diagnosis and treatment of TB, a declared "threat to public health".
- Denying patients social support through peer-groups and hotline services.
- Forcing innocent people to take toxic drugs that are not quality assured by WHO standards.-
- Not adhering to treatment for infectious TB and knowingly putting others at risk.
- Refusing to treat extra-pulmonary MDR-TB because it is non infectious.
- Not informing patients of their Rights and Responsibilities (PCTC/ISTC).
- Requiring public healthcare personnel to work without adequate infection control.
- Not providing palliative care for MDR/XDR patients for whom treatment is not available or viable.

Do they and many other such situations people with TB deal with on daily basis, qualify as human rights violations? Speak your world!

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Hard talk on association between public health advocates and pharmaceutical companies

2009-12-06T02:00:00.003+05:30

Hard talk on association between public health advocates and pharmaceutical companies

Is it ethical for public health advocates to accept funding from pharmaceutical companies, or organizations directly/ indirectly affiliated to them? Should all direct/indirect engagement with Pharmaceutical companies should be declared openly and publicly? The delegates at the 40th Union World Conference on Lung Health in Cancun, Mexico, responded differently to this contentious issue.

The World Health Organization (WHO) and many other indexed publications ask people to sign a declaration form to declare any association with tobacco companies. The Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC, the global tobacco treaty) give teeth to the treaty which states, "in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law." The WHO FCTC Article 5.3 guidelines include the following recommendations, rooted in the principle that the tobacco industry has a fundamental and irreconcilable conflict with public health:
- governments should reject partnerships with the tobacco industry;
- conflicts of interest such as the "revolving door" between the tobacco industry and public health offices, government investments in the tobacco industry and tobacco industry representation on tobacco control bodies should be avoided;
- government interaction with the tobacco industry should be strictly limited and transparent;
- the tobacco industry should be required to be transparent about its activities, a measure which will help to counter interference by Big Tobacco's front groups and allied organizations.

Similar examples exist where people need to declare their association openly with formula food companies for instance. So is it ethical for public health advocates to take funding from pharmaceutical companies? Should it be declared openly?

When asked to respond to this question, Professor Hoosen Coovadia, noted paediatrician and expert in perinatal HIV transmission, former Head of the Department of Paediatrics at the University of Natal until 2000 and Victor Daitz Professor for HIV/AIDS research at the University of Natal, South Africa, said "unfortunately there is no simple yes or no answer to this. I guess in many instances that association [between pharmaceutical companies and public health advocates] has to be acknowledged and expressed fully. For example many of the good journals will not accept an article unless that association with food company, pharmaceutical company, depends what the company is, is openly acknowledged."

"People do believe in taking pharmaceutical companies' support in undertaking [clinical/ research] trials. It happens in National Institute of Health and many other institutions or these [public health] products will simply not have been tested. You can imagine a world where new drugs for TB and HIV are not available or not acceptable because those [clinical trials/ research] studies were not done" adds Professor Coovadia.

"There are some extreme examples on refusal to accept money [from companies]. One instance is taking money from tobacco companies because of their egregious behaviour of denying the damaging effects of tobacco. I am a paediatrician and we have been through decades of fighting formula food producing companies for the damage they do in developing world and probably in other parts of the world too in promoting their products in absence of support for exclusive breastfeeding for first six months. I think in those two instances public health advocates will take the position that any association with food company or tobacco company is inherently unacceptable" asserts Professor Coovadia.

"Any such association [between pharmaceutical companies and public health advocates] has to be declared openly. One of the examples is of one of the best drugs that we initially started off with to prevent mother to child transmission of HIV. It is a drug called nevirapine and we had the support from the manufacturers of nevirapine to do those studies. Now that is openly acknowledged, publications mention their association clearly, mention the role of drug company, and say in absolutely unambiguous terms that those companies have no influence on whatsoever in collection of the data, certainly not in the analysis of the data, or in the conclusions. In other words the scientific content of the paper or the article or the document was uninfluenced by that type of association. I think association with pharmaceutical companies can continue as long as those restrictions are adhered to" further adds Professor Coovadia.

"Pharmaceutical companies have enormous amounts of money that should be spent on research and development. It should be made mandatory for pharmaceutical companies to earmark funding for research and development, particularly in high burden countries" says Dr Darakshan Badar, Programme Manager, Provincial TB Control Programme (PTP), Punjab, Pakistan.

However, Dr Badar's colleague at the National TB Control Programme (NTP) in Pakistan, Dr Ejaz Qadeer, has a different opinion: "Public health advocates should not take money from pharmaceutical companies. There is an obvious conflict of interest and taking money from pharmaceutical company is risky for the [TB/ health] programme and also for the government. All association with pharmaceutical company of public health advocates should be open and [information regarding interaction should be] accessible to the public and other stakeholders to see what interaction is taking place between public health advocates and pharmaceutical companies."

"In Bangladesh, taking funds from pharmaceutical companies for TB is not common. Pharmaceutical companies are not willing to fund TB programmes because TB drugs are not available over-the-counter and given free to TB patients through DOTS" says Dr Zaman from Bangladesh.

"We can accept money from pharmaceutical companies to help TB patients but this should be open and publicly declared" says Dr Jean Pierre Kabuayi Nyengele, Deputy Manager, National TB Control Programme (NTP), Democratic Republic of Congo (DRC).

"The association between pharmaceutical companies and public health advocates should be openly declared" says Dr Peter Kimuu, TBCAP, Kenya.

"I don't think it is unethical to accept money from pharmaceutical companies. [However] the pharmaceutical companies shouldn't do unethical actions like promoting drugs or irrational use of drugs [after giving money]. It [association between pharmaceutical companies and public health advocates] should be declared openly and publicly, just like [we treat] tobacco companies" said Dr D Behera, Director, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Dr Behera was also awarded the Union Karel Styblo Public Health Award for this year 2009 at the 40th Union World Conference on Lung Health.

"For public health advocates, it is not ethically right to take money from pharmaceutical companies. All association between public health advocates and pharmaceutical companies should be open, and the agenda should be made public too" says Dr Razia Kaniz Fatima, M&E (Monitoring and Evaluation) ACSM Officer, NTP, Pakistan.

Well, there might be extreme difference of opinion on how ethical it is to engage with pharmaceutical companies and taking funding from them, but there is clear support to making this association open and public. Dr Coovadia's example of how manufacturers of nevirapine funded the research but had no control on scientific outcomes is worth remembering. The debate is certainly on, and more viewpoints and perspectives on this contentious issue be coming forth.

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Responding to TB, HIV, COPD and tobacco smoking needs coordinated approach

2009-12-06T00:40:00.003+05:30

Responding to TB, HIV, COPD and tobacco smoking needs coordinated approach

Tobacco smoking, TB, HIV and chronic obstructive pulmonary disease (COPD) are all burgeoning problems in resource poor settings. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach for control, said delegates at the 40th Union World Conference on Lung Health, in Cancun, Mexico.

Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming. But is there a link between TB, HIV, COPD and tobacco smoking? Do they increase the risk of each other?

"At the beginning of 21st century we really are facing convergence of several epidemics like HIV, TB, COPD and tobacco smoking among others" said Richard N van Zyl-Smit work works with Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa.

"Tobacco smoking is unquestionably the primary risk factor for COPD. The importance of "total burden of inhaled particles" (occupational, household, environmental) is increasing" said Richard.

"Smokers have two fold higher risk of developing active TB disease" said Dr Madhukar Pai from McGill University and Montreal Chest Institute in Canada. Dr Pai was referring to three meta-analysis studies from 2007/2008. "Tobacco smokers have 2 times more risk of dieing of TB" added Dr Pai, referring to the data from India. India has enormous tobacco use and COPD rates, and also the highest TB burden in the world. "It is not a universal estimate, and is population specific" cautioned Dr Pai, outlining the need for more research on the association between TB, tobacco smoking, COPD and HIV. "There is very little data to study association between TB and passive smoking" said Dr Pai. However there are studies to show that passive smoking escalates risk of developing active TB disease by three times. "How can passive smoking have higher risk (three times) for developing active TB disease than active smoking (two times), so we do need more data in this regard" said Dr Pai.

Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis, said Richard.

At least 15 more studies have been published since the three major meta-analyses in 2007/2008. All studies report a positive association between tuberculosis and tobacco smoking. Studies also show that current male smokers have a higher risk for active TB disease than former smokers. In a study conducted in India, 900 non-medical staff monitored 1.1 million people for 3 years for cause of death taking place in this population. TB was the biggest cause of death reported in this study in India, and 66% of those who died of TB during the study, were active smokers.

The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.

"Mortality rates, particularly from Asian countries suggest that there is an urgent need to target TB patients for smoking cessation interventions" said Dr Pai. However he stressed that tobacco cessation should be encouraged regardless in all disciplines of medicine because of proven public health outcomes.

The second edition of the International Standards of Tuberculosis Care (ISTC), which is an official component of the WHO Global Stop TB Strategy also mentions tobacco smoking cessation among other measures to improve TB treatment outcomes. The ISTC standard 17 says: "This plan should include assessment of and referrals for treatment of other illnesses with particular attention to those known to affect treatment outcome, for instance care for diabetes mellitus, drug and alcohol treatment programs, tobacco smoking cessation programs, and other psychosocial support services, or to such services as antenatal or well baby care.

Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.

Although lethal association between tobacco smoking, COPD and TB was becoming clear, we needed more discussion on association between smoking with HIV. "Tobacco smoke increases the risk of human papiloma virus (HPV) and HPV increases the risk of HIV" said Richard in response to a question on the link between HIV and smoking.

Kristina Crothers from Department of Internal Medicine, Yale School of Medicine in USA, shed more light on this association with HIV. She was referring to long term complications of HIV and progression to AIDS, which does get influenced by the above risk factors.

TB continues to be the biggest cause of mortality among people living with HIV (PLHIV) worldwide. However, HIV related long-term complications get aggravated by noxious agents which include tobacco smoke. The risk to develop pulmonary infections and respiratory tract colonization is also upped. The history of childhood illnesses, low socio-economic status, malnutrition among PLHIV does increase their vulnerability to further severe the HIV-related long-term complications. All these are contributing factors for PLHIV to develop chronic lung disease, and COPD in case of smokers, among other conditions that include fibrosis, pulmonary hypertension and lung cancer.

Kristina cited smoking prevalence among PLHIV in northern America. Although tobacco smoking prevalence among general population in USA is 22%, yet the tobacco smoking prevalence goes up among PLHIV to 54%.

In India, in a study conducted by Tuberculosis Research Centre at Madurai, the following results were reported: 66% of PLHIV men were smokers.

In another study, those PLHIV who reported 12 pack years of smoking, had 37% of emphysema, and those who reported 25 pack years of smoking, had 46% of emphysema.

"HIV is associated with chronic lung disease, particularly COPD" said Kristina. "This chronic lung disease can substantially contribute to morbidity and mortality" added Kristina. However long term impact of HIV infection on lung health is unknown, said she.

Studies show that smoking may impact progression to AIDS among PLHIV, said Kristina.

Although more research and data may further clarify the lethal synergy between the epidemics of TB, HIV, tobacco smoking and COPD, among other public health challenges, there is no doubt that collaboration between different single disease or health programmes will be truly beneficial and have major public health outcomes.

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TB Voice network has improved TB responses locally

2009-12-04T18:42:00.003+05:30

TB Voice network has improved TB responses locally

"TB Voice network is led by cured TB patients and other stakeholders and provides community treatment supporters in developing countries with the technical expertise they need to implement sustainable TB control programmes" said Chief Austin Arinze Obiefuna, who is the founder-President of Afro Global Alliance and National Coordinator for Stop TB Partnership in Ghana. Chief Austin was speaking at a pre-conference meeting of the 40th Union World Conference on Lung Health in Cancun, Mexico.

"Till today, in most developing countries DOTS (directly observed treatment shortcourse) which underpins the Stop TB Strategy, has improved greatly but now without challenges like inadequate public health personnel, inconsistent drug supply, more effective and accessible tools for testing and treating TB and community involvment" said Austin. "In order to address these challenges, Afro Global Alliance and Chest Department of Korle-Bu Teaching Hospital, with financial support from the Stop TB Partnership's Challenge Facility for Civil Society, created the initiative of TB Voice Network (TVN)" further explains Austin.

The TB Voice Network is committed to reinforce the role of community treatment supporters in the national policies and TB and HIV programmes in developing countries. Through its network of experts, TB Voice Network trains stakeholders in all areas of prevention, testing and comprehensive care related to TB and TB/HIV. It also assists in community DOTS implementation and conducts situational analysis of community treatment supporters in the field of TB. It provides counselling on DOTS adherence, referral and contact tracing of TB patients, among other community-led roles in TB programmes locally.

The TB Voice Network has also developed a website to give voice to the network of people who got cured of TB (www.tbvoice.net), informs Austin.

"75% population in Ghana lives in rural areas. There are many misconceptions related to TB - including the belief that offending Gods may get a person infected with TB" says Austin. Not surprising, the TB-related stigma and discrimination rages high in these communities and blocks access to existing TB services on prevention, treatment and care. This was a key motivation to bring cured TB patients together and establish ways in which they can have a voice to reduce TB-related stigma and increase access to existing services.

"The voices of cured TB patients are needed to help people understand that TB is curable" asserts Chief Austin. The TB case detection rates have gone up in communities TB Voice Network works, suggesting the role of community involvement in improving TB responses at all levels.

The National TB Programme (NTP) in Ghana also uses the TB Voice Network in its advocacy, communication and social mobilization initiatives. "TB Voice Network is one of the success stories of NTP" says Austin.

"We are meeting parliamentarians to declare TB as a national emergency and also demanding laboratories in Ghana [to test for anti-TB drug resistance]" says Austin.

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Patients' Charter for TB Care is in favour of doctors, not against them

2009-12-04T15:48:00.005+05:30

Patients' Charter for TB Care is in favour of doctors, not against them

It was not surprising to hear from a community activist at the World Health Organization (WHO) Stop TB Symposium before 40th Union World Conference on Lung Health opens in Cancun, Mexico, that when she asked TB programme managers on why are they not implementing the Patients' Charter for Tuberculosis (TB) Care [PCTC], she got the response: "doctors say that it [PCTC] actually goes against them." Blessina Kumar, TB/HIV activist from India was addressing the WHO Stop TB Symposium in Mexico.

This is not surprising to hear because despite of community-centric Global Stop TB Strategy and rising mandate for community engagement in TB programmes, there are healthcare providers like the one quoted above who still belong to old school where TB was a medical problem and response too was medical.

The WHO Global Stop TB Strategy and Global Plan to Stop TB (2006-2015) support community involvement. The Patients' Charter for TB Care (PCTC) is an official part of the Global Stop TB Strategy which is meant to be a tool to mobilize and empower communities in achieving the International Standards of TB Care (ISTC). It is an official component of national TB programmes in many countries including India. However there is no doubt that the investment and efforts that have gone into rolling out the Charter, are grossly inadequate. It is not just a "chart" in the clinic, as commented a delegate yesterday.

The Charter (PCTC) is not against what doctors are trying to achieve in TB care and control - it is a tool to make their task easier in improving TB programmes - in terms of achieving earlier diagnosis, active TB case finding, counselling, contact tracing, adherence counselling, reducing stigma and discrimination related to TB, among other benefits this tool can provide if used in the right spirit.

"We need to raise awareness about the rights and responsibilities of people with TB, use the Charter as a tool for empowering the communities and mobilizing them to advocate for enhancing the standards of TB treatment and care in their localities" asserts Maxime Lunga, Vice President of World Care Council (WCC).

In South Africa, a MSF report released earlier this year on World TB Day (24 March) showed how community-based approaches to drug-resistant TB have improved treatment outcomes considerably.

The people with TB, particularly those who have successfully completed the anti-TB treatment, is central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with healthcare staff, community awareness, screening of household contacts, encouraging rapid diagnosis to decrease the delay before starting treatment, improving treatment protocols, providing education and adherence counselling for patients and implementing infection control measures in clinics, patients' homes, and in the community, believes Maxime.

Experts at the WHO Stop TB Symposium had earlier listed out the high risk populations the TB programmes should reach out to for earlier diagnosis of TB. With different levels of multi-faceted stigma-related to TB, how will the doctors operationalize these policies on active TB case finding? The answer honestly lies in The Charter among other approaches.

Affected communities need to be engaged meaningfully at all levels of TB programming to use the Charter as a tool to achieve higher standards of TB care (ISTC). They need to be treated as equal partners in TB care and control, and treated with dignity, along side other stakeholders including doctors. Innovative solutions often come up from among the affected communities - since they know what works in their communities best. Affected communities are more than passive recepients of pills - their rightful place as equal partners in solving issues that affect them most on daily basis - has been long denied to them.

"Unless TB patients are diagnosed earlier, the quality of life will be compromised despite of successful anti-TB treatment" said Dr M Muniyandi, Health Economist, TB Research Centre, Indian Council of Medical Research (ICMR). "To attain better quality of life, it is important to diagnose people earlier for TB and treat them successfuly" emphasized Dr Muniyandi.

Thanks Dr Muniyandi for speaking up - the point you make is right on-spot: quality of life. This should be an explicit and core aim of TB programmes to EARLY diagnose and treat people with TB successfully so that they can enjoy highest attainable standards of health and life. And in passive case finding, it is a distant dream. Engaging communities can up the active case finding among many other benefits TB conference is raising (and has been raising in past years).

The absence of the Charter (PCTC) in the local stop TB strategy operationally is often the very barrier that blocks access to existing TB care services. Long waiting hours, stigma and discrimination related to TB, lack of confidentiality at times, unfriendly healthcare services for people with certain conditions, are well documented barriers that impede access to existing services. Other obstacles that limit the impact of TB programmes which are now coming to light over past years, were the realities people with TB were dealing with. Long distances they have to travel to clinics, economic impact on their livelihood during anti-TB treatment which may further exacerbate vulnerabilities to TB and other conditions of them and their families/ communities, are just some of them. Communities knew it before, and knew it best. Empowering them will not only bring problems in light sooner, but also give them a right and responsibility as equal partner to come up with effective solutions that work in their own contexts.

HIV/AIDS programmes have shown remarkable outcomes by genuine community engagement at all levels, however the involvement of communities in TB programmes is clearly sub-optimal, if not absent.

The outcome of not implementing the Charter is what no nation can afford - affected communities need to be supported by the Charter, to use the rights and responsibilities framework it promotes in mobilizing them to work as equal partners with other stakeholders (including doctors) to achieve higher standards of TB care (ISTC).

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Denying IPT to people-with latent TB is a human rights violation

2009-12-03T18:00:00.002+05:30

Denying IPT to people-with latent TB is a human rights violation

"In Lesotho, Isoniazid Preventive Therapy (IPT) to prevent latent TB infection from becoming active TB disease, is not available for ordinary citizens but only for health workers. Those people who have latent TB infection have a right to protect themselves and access IPT services to prevent latent TB from becoming active TB disease. I consider these people have a right to get IPT. Everybody has a right to health, when it comes to TB prevention" said Maketekete Alfred Thotolo, Treatment Literacy & Advocacy Coordinator, Adventist Development and Relief Agency (ADRA), Lesotho, who also represents AIDS and Rights Alliance for Southern Africa (ARASA). Alfred was speaking to this Key Correspondent on the sidelines of pre-conference sessions before the 40th Union World Conference on Lung Health opens in Cancun, Mexico this week (3-7 December 2009).

The Global TB/HIV Working Group of the Stop TB Partnership has clearly stated that: IPT works, IPT is safe, and IPT works with ART or by itself.

TB is a major cause of illness and death in people living with HIV, even in those taking antiretroviral therapy. TB could be prevented in millions of people infected with both HIV and TB through the use of IPT. IPT is an important intervention for preventing and reducing active TB in communities affected by HIV - preventing active TB can prevent millions of people from being infected in the community and in health care services.

IPT is safe and effective and the treatment lasts for 6-9 months. It is only given to people who have confirmed latent TB infection (not to be given to those with active TB disease). Effective IPT treatment reduces the development of active TB disease in 40-60% of patients.

Despite of the potential public health outcomes of using IPT effectively in high burden TB countries, and IPT being one of the key interventions recommended by WHO in 1998 to reduce the burden of TB in people living with HIV, the uptake of IPT has been very low. Clearly there is a need to mobilize TB-HIV affected communities and other stakeholders to integrate IPT as part of the package of health services.

Alfred is possibly right on-spot: everybody has a right to health - and this includes the right to access IPT services to prevent latent TB infection from becoming active TB disease. It also means increasing TB screening in the communities so that people go for TB test to ascertain whether they have latent TB or active TB disease or no TB at all. IPT advocacy boosts the effort behind scaling up TB screening among people living with HIV - so that appropriate services can be provided and this does include IPT if the person has latent TB. Is denying IPT and putting people at risk of developing active TB disease,not a human rights violation?

Integrating IPT services for TB prevention doesn't mean upping the cost at country level, possibly. A 2007 World Bank research report "The Economic Benefit of Global Investments in Tuberculosis Control" found that 22 countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths. Highly affected African countries could gain up to 9 times their investments in TB control. When the economic benefits of effective TB care and control are estimated to be greater than the cost, governments shouldn't delay improving TB responses by preventing TB in those who have latent TB effectively.

After all, Alfred is right: health is a fundamental human right and this includes right to have IPT for those who are eligible for it.

Implementation of right to health of indigenous peoples essential to Stop TB

2009-12-03T13:36:00.003+05:30

Implementation of right to health of indigenous peoples essential to Stop TB

"Basic human rights as enjoyed by others have not benefitted indigenous peoples. Therefore the respect and recognition of the rights of indigenous peoples is critical to our dignity and survival. In particular, implementation of our right to health is essential if we are to stop TB" said Wilton Littlechild, Regional Chief, Assembly of First Nations, on the sidelines of the TB and human rights session before the 40th Union World Conference on Lung Health begins in Cancun, Mexico this week.

There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.

"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" had said Chief Littlechild.

Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.

Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild had earlier said to this Key Correspondent that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. In response to another question then, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."

The inequities faced by indigenous peoples are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous peoples has gone up. In prisons too there are a significant number of indigenous peoples. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" had said Chief Littlechild to this Key Correspondent.

The strategic framework to control TB among indigenous peoples was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

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