aug05-4

About one million people in developing and transitional countries were receiving anti-retroviral therapy (ART), compared with 400,000 in December 2003 when the "Three by Five" initiative was launched.

Nun or prostitute? Tibet's women face few choices

By Lindsay BeckThu Aug 18, 8:25 AM ET

It's evening in Shigatse and the lights are coming on.

In the Chinese district of the Tibetan mountain town, strings of twinkling lights flicker around rows of shopfronts where women perch waiting for customers and men stumble out from backroom corridors.

"There are a lot of prostitutes here. They're all from the countryside. Maybe they don't have parents to look after them or anything else to do," says Jirga, an 18-year-old vendor.

Hundreds of miles away in a nunnery in Tibet's capital, Lhasa, a group of young Buddhist nuns sit stitching yards of maroon cloth into the robes that are the iconic uniform of the clergy.

"The life here is very good. If I wasn't doing this, I'd probably be a farmer," said nun Ani La, 30, speaking over the din of a thunderstorm that rolled in from the mountains.

The Lhasa nuns and the prostitutes of Shigatse may have little in common on the surface, but both are part of the same demographic group -- young, rural, Tibetan women -- and analysts say their ranks are growing.

As development draws herders and farmers to towns in search of wage labor, Tibet's women find themselves with few choices and little know-how for getting by in a market economy.

"Often where there is a concentration of nuns there is concentration of sex workers. The same forces are drawing young women away from villages," said Charlene Makely, a Tibet specialist at Reed College in the U.S. state of Oregon.

FEW OPTIONS

Jirga, the vendor, shakes her head when asked how much schooling she has had. The answer is none. Her parents run a small stall selling jewelry and trinkets and she was raised to do the same.

At the Lhasa nunnery, more than 100 nuns live within the quiet yellow courtyard filled with potted plants and the sounds of chanted prayers, an oasis from the jumble of narrow streets of the city's old quarter.

Of the eight children in Ani La's family, three are nuns and two are monks. The others work on the family farm and one is a driver.

"This nunnery is popular because it's in the city, but the ones in the countryside are pretty popular now too," she said.

The nuns say their numbers have grown by a third in the past decade and would be higher if it weren't for government restrictions, imposed as part of a series of controls to keep nuns, who along with monks have a history of political activism, in check.

China imposed communist rule in Tibet in 1950 and has faced periodic unrest since. Tibet's spiritual leader, the Dalai Lama, led a failed uprising in 1959 that led to his exile. Trouble flared throughout the late 1980s, too.

Most famous among Tibet's activist women were the "singing nuns," imprisoned for speaking out against Chinese rule and who became renowned after secretly recording songs in prison. The tapes were smuggled out and circulated underground.

The last of the singing nuns was released in 2004.

But in Tibet, where rural incomes are well under $1 a day, some young women don't make it as far as the nunnery in their efforts to find security.

Their flight from village poverty ends in the sex trade.

"Men can go outside and look for work but for women it's not that easy. They can't do that," said 19-year-old Da Wa Qu Zong, who lives with relatives in Lhasa, looking after their son.

"PROSPERITY OF THE FEW"

Many grow up in remote villages or in nomad families, herding yak and doing farmwork as Tibet's cities and towns experience a boom fueled by massive central government investment -- a boom critics say benefits more skilled Han Chinese migrants at the expense of Tibetans.

"Tibetans are not only poorer, their extremely low level of education makes their chances of getting a steady and lucrative job in the cities as good as nonexistent," the Tibet Information Network said in a report documenting the rise in prostitution.

"In Tibet, prostitution is not just a symptom of poverty, but is triggered also by the growing prosperity of the few," the report said.

It's also a problem officials are loath to recognize, let alone begin to address.

"There is no prostitution here," said Bian Ba Ci Ren, an official in Shigatse. The government compound where he addresses reporters is just blocks from the city's red-light district.

HIV/AIDS cases are below 100 in the region, according to World Health Organization figures. But views such as Bian Ba Ci Ren's have raised concerns the disease could spread, especially as the number of sex workers increases.

The official's pronouncement will also come as news to the young women in the shopfronts of Shigatse's euphemistically named "beauty parlors."

"I'm used to it by now," says one woman from the countryside when asked about what she thinks of her city vocation.

She returns to watching the street, where groups of men stumble drunkenly from shop to shop, leering at the women in the doorways.

Global AIDS fund quits Myanmar, cites restrictions

The Fund, which agreed in August 2004 to spend nearly $100 million over 5 years fighting all three diseases in Myanmar, said its decision was regrettable given the serious epidemics threatening the impoverished Southeast Asian nation.

The former Burma, ruled by the military since 1962 and receiving little Western aid after decades of sanctions, has up to 610,000 people living with HIV/AIDS and one of the highest rates of tuberculosis in the world.

But new travel curbs imposed in July on U.N. staff overseeing Fund-financed programmes and bureaucratic hurdles to procuring medical supplies had violated Yangon's agreement with the Fund, said spokesman Jon Liden.

"Obviously we are extremely sorry and concerned that we have to do this," Liden told Reuters. "But you cannot work at this scale effectively if you can't even travel around to watch what you are doing".

"Global Fund or not, the world should be providing assistance to this country. To abandon this country and its people, I can't see how it is justified," said a worker at one NGO that was due to receive $2.5 million from the Fund.

Liden said anyway that funding had not reached the point where it was supporting drug treatments for HIV/AIDS patients, meaning no one would be cut off.

The Fund -- an independent organisation of governments, business and private groups first proposed by U.N. Secretary-General Kofi Annan in 2002 -- has so far committed $3.5 billion to more than 300 programmes in 127 countries.

In recent weeks other international NGOs and U.N. agencies have complained of restrictions on their staff and humanitarian activities in Myanmar.

The head of the U.N. World Food Programme, James Morris, flew to Yangon earlier this month to press for the free movement of aid workers and a lifting of barriers to delivering food aid.

It is the first time the Global Fund has withdrawn from a country in which it was working, and the move is likely to stir controversy within the NGO community.

Critics have accused the United States, a major contributor to the Fund and a staunch critic of the junta, of seeking to limit its activities in a country labelled an "outpost of tyranny" by U.S. Secretary of State Condoleezza Rice.

They say the Fund's safeguards, aimed at ensuring monies go to affected people and not the government, are too restrictive and politicised the delivery of humanitarian aid.

But Liden said the system has worked well in 45 so-called "fragile" countries so far.

"They are not draconian. If you can't watch your own programme activities unhindered, that's not an unreasonable safeguard," he said.

Libya seeks Bulgarian "blood money" to save nurses

TRIPOLI (Reuters) - Tripoli is urging Bulgaria to offer "blood money" to families of hundreds of Libyan children infected with HIV, to save five Bulgarian nurses sentenced to death for causing the infections, a senior diplomat said.

But Bulgaria again refused a deal, saying the nurses were innocent and should be released.

Mohamed Zawi, the Libyan ambassador to London, said he outlined the proposal during a meeting with top British and U.S. diplomats in Tripoli on Wednesday.

"The parties in this issue are very clear. They are the Bulgarian government and the children's families. The two sides can reach a solution which will have a positive impact on the case, according to sharia (Moslem law)," Zawi said.

Libya's supreme court will rule in November on an appeal by the five Bulgarian nurses and a Palestinian doctor.

The medics, convicted last year for deliberately infecting more than 400 children at a hospital in Benghazi, insist they are innocent and that the only evidence against them is confessions extracted under torture.

The United States and the European Union have slammed the verdicts, which have impeded Tripoli's efforts to emerge from decades of diplomatic isolation and renew ties with the West.

Bulgaria, whose new Socialist-led government took office this week, said payment was out of the question and pointed to evidence from HIV experts who have testified the outbreak began before the nurses arrived in Benghazi.

"There is evidence, including the opinions of world experts, which do not confirm the guilt of the Bulgarian nurses," said incoming Foreign Minister Ivailo Kalfin. "There are no grounds for Bulgaria to enter talks for compensation."

He said the new government would soon call for new measures with the help of Washington and the EU to solve the dispute, which could include humanitarian aid for the infected children.

"I don't want to raise false expectations, but we will think of what more can be done," he said.

Libyan officials said the involvement of Zawi, whom they describe as being instrumental in negotiations with London and Washington over Lockerbie and prohibited weapons, underscored Libya's eagerness to reach a settlement and clear one of the last hurdles for a full return to the international community.

The officials said that if Sofia offers compensation and the families accept the "blood money", the death verdicts would be turned into less harsh sentences based on Moslem law.

"Zawi met with Britain and U.S. representatives because Britain is chairing the European Union and the U.S. is a strong voice backing Sofia on the case of the nurses," a senior Libyan official told Reuters.

At least 40 of the 426 infected children have died of AIDS, fuelling widespread outrage in Libya over the case.

R U OK? South Africans tackle AIDS with texts

GUGULETU, South Africa (Reuters) - When AIDS counsellor Nobafunti Dondolo's mobile phone started beeping one Sunday afternoon, she knew someone was in trouble.

"It was a message from one of my clients who was very sick," said Dondolo. "She was vomiting blood -- the family didn't know what to do."

With a flick of her thumb, Dondolo sent a top priority alert message from her mobile phone to healthcare managers who within seconds dispatched an ambulance to fetch the patient from a rickety shack in this sprawling township near Cape Town.

"She survived," said Dondolo, who is also HIV positive. "This phone makes life so much easier."

Unlike most HIV/AIDS counsellors in South Africa, who toil with pen and paper to keep track of the country's estimated 6.5 million sufferers, Dondolo and her colleagues rely on an easy-to-use text message system.

Specially tailored mobile phones are programmed with a list of questions aimed at monitoring patients on anti-retroviral (ARV) drugs: Is the patient experiencing side effects? Is she eating healthily? Does she have clean water?

During home visits to AIDS sufferers, counsellors ask the questions and immediately text the answers to a database at the University of Cape Town. Doctors and health workers monitor the database and can respond to urgent requests.

Most importantly, counsellors count how many ARV pills are left and forward the details, keeping tabs on whether patients are correctly taking the complex cocktail of drugs and also encouraging them to be rigorous about their medication.

"It is real time," said Jalal Ghiassi-Razavi, project manager. "The carers may not know the situation is critical but the doctors receiving the message might and they can respond. A piece of paper won't be dealt with until following week."

South Africa is struggling with the biggest caseload of HIV sufferers in the world and the government has been accused of doing too little to halt the disease and treat those infected.

Researchers at the University of Cape Town started the text messaging project, called CellLife, in 2000 to harness technology to help tackle one of South Africa's biggest killers.

CellLife works with the Desmond Tutu HIV/AIDS Research Centre and clinic. Around 1,000 patients from Guguletu are logged onto their system.

Patients say the technology makes the process more systematic. Knowing their counsellor is just a text message away is also reassuring.

"At first it was hard to remember to take all my drugs but I knew my counsellor was counting the pills and would come and visit if I was too ill to travel to the clinic," said Eric Makubalo, 35, who discovered he was HIV positive in 1998 and started taking ARV drugs last year.

Makubalo's girlfriend died of AIDS seven years ago after keeping her illness secret for fear of being ostracised. After that Makubalo vowed to help others deal with AIDS and became a counsellor at the Guguletu centre, where he is also a patient.

Only a fraction of those living with HIV in South Africa have access to life-saving ARV drugs and even those who do get the pills sometimes fail to take them as prescribed.

Makubalo's colleague Lindelwa Burns, 32, is also HIV positive but gets her drugs from a different clinic and says she envies patients in Guguletu.

"At my clinic they don't even do home visits they just screen you, give you drugs and leave you to get on with it," she said between coughs.

Burns knows from experience that ARVs can cause nasty side effects and says it is tempting to skip pills.

"I know what would happen if I didn't take my ARVs so I take them, but I know I could cheat because no one is checking. I'm sure plenty of patients don't stick to the regime," she said.

CellLife has launched a second site in a remote village in South Africa's rural North West province, and secured funding from pop star Elton John's AIDS foundation to open five more.

The project harnesses the technology of one of Africa's most successful growth sectors -- mobile phones. The number of Africans owning a mobile phone has leapt some 1,000 percent in the past five years to about 8 percent of the population.

As well as monitoring individuals, researchers in the CellLife project use data collected by counsellors to track trends and collate valuable information in a field where comparatively little research has been carried out.

"It helps us tell if one particular batch of a drug or one manufacturer is causing problems," said Ghiassi-Razavi. "It is a pity, but Africa is really the testing ground for the fight against AIDS."

The government began heavily subsidising antiretroviral (ARV) treatment for people living with HIV/AIDS after receiving a US $15 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004. This year another US $6 million from the national purse was added.

Some 2,600 Ghanaians are now receiving the life-prolonging medication. "Treatment is so readily available, unlike what pertained a few years ago - people who were on the verge of death are now looking healthy and going about their everyday duties," Eric Pwadura, an official at Ghana's AIDS Commission, told IRIN.

Although more people were receiving ARVs than ever before, it was still difficult to get a job and a place to live; even retaining relations with friends and family was not easy, according to Kakra Ankobiah, programme director of the West African AIDS Foundation (WAAF).

The WAAF operates a hospice specialising in HIV/AIDS treatment and care, and also runs outreach programmes in the capital, Accra.

"More people are alive today - thanks to ARVs - but no one wants to employ them; landlords or other tenants are evicting and ostracising people who openly reveal their status. These are problems we have yet to deal with as a society," said Ankobiah.

While the Ghana AIDS Commission estimates that about 90 percent of Ghanaians are aware of HIV/AIDS, health officials concede that the stigmatisation of people living with the virus remains the biggest challenge.

According to Sakyi Awuku Amoa, head of the commission, earlier campaigns inadvertently contributed to creating the problem by associating AIDS with death and focusing too heavily on the fear factor.

"The epidemic of stigma, discrimination, blame and collective denial is making all preventative interventions ... very difficult," Awuku Amoa admitted.

Patients and health workers agreed that enabling people living with HIV/AIDS to afford treatment, keep their jobs and not be dependent on their families could go a long way towards combating stigmatisation.

"It all depends on the financial empowerment ... to support ourselves and our families, have our own accommodation without the fear of being ejected, and have a well-paying job," Haruna, a 38-year-old HIV-positive teacher, told IRIN.

He would never have been able to afford his medication without the government subsidies that allow him to spend 50,000 cedis (less than US $10) a month on ARVs: the commercial retail price of his treatment is between $800 and $850 - far beyond the limits of his $100 a month salary.

"Only when we are empowered can you expect a majority of people living with AIDS to have the confidence to come out and make their status open," Haruna pointed out.

WAAF hospice officials say most of their AIDS patients have been shunned by their families, who can't afford to look after them.

"Our in-patient capacity is limited to 20 beds, and when the hospice is fully booked about 70 percent of all our cases are patients who have been dumped here by their relatives. They only turn up again after the patient is dead to collect the corpse for burial," Ankobiah told IRIN.

"But it is slowly easing up and people are beginning to accept their relatives' condition," said Ankobiah, whose clinic provides free treatment after payment of a 30,000 cedi, or US $10, registration fee.

Nevertheless, Dela, 38, an HIV-positive teacher also on subsidised ARV treatment, said it would be unthinkable to declare her status publicly - she runs her own nursery school and any mention of AIDS would be bad for business.

"I do not think it is time ... to declare my status, due to the possible negative repercussions that can come up," she affirmed.

When her sister first found out Dela was HIV positive eighteen months ago, she urged neighbours to withdraw their children from the school.

"Rumours went around, especially when I started the ARV treatment and initially lost some weight, but now it does not bother me. I know I have the disease and I just have to live with it. Fortunately, I have always been slim, and since I still go about my duties like any active person, the rumours have died down," Dela told IRIN.

Afua, 42, a foodstuff trader who lived in the next suburb, was not so lucky: she died three years ago - just before the government-subsidised ARV programme started.

"When people realised she had the virus, they stopped buying her foodstuffs and she had to depend on her aged mother for her upkeep," Dela said. "As she grew weaker, prior to her death, she was confined to the outer room of her family's rented apartment with her own cup and plate, and prevented from going to the main bedroom area."

UN warns of possible HIV/AIDS explosion in Somalia

NAIROBI (AFP) - The United Nations warned of an explosion of HIV/AIDS in lawless Somalia unless steps are taken quickly to stop the spread of the deadly disease and reduce numerous risk factors.

"The findings show that HIV will soon become a major health problem if concerted efforts are not put in place to contain the vulnerability factors fueling the epidemic," the report said, citing a survey carried out in 2004.

The survey found Somalia's average HIV infection rate to be 0.9 percent but with "zonal variations," particularly in its two self-declared autonomous regions of Puntland and Somaliland, where the average was one and 1.4 percent respectively.

Poor education, high mobility, the transfusion of unsafe blood and negative cultural practices, including female circumcision and commercial sex, were some of the "vulnerability factors" the report said needed to be addressed.

Somalia, a nation of about 10 million people, has been without a functioning government since the 1991 ouster of dictator Mohamed Siad Barre plunged the Horn of Africa country into anarchy.

Humanitarian groups have in the past warned of a possible explosion of HIV/AIDS when tens of thousands of Somali refugees return home if current efforts to restore a government succeed.

Thailand warned of HIV infection rebound

BANGKOK, Aug. 20 (Xinhuanet) -- Thailand should pay more attentionto prevent rebound of HIV/AIDS infection in spite of the fact thatthe country has successfully controlled the disease spread over the decade, said an expert of World Health Organization (WHO).

"Thailand has done a good job fighting against HIV/AIDS, I hopeto see more cooperation,...between the government and independent networks working closely to minimize the epidemic's spread," Bangkok Post on Saturday quoted Daniel Tarantola, a WHO expert on the disease, as saying.

He said that signs have shown threatening rebound of the HIV epidemic in Thailand, especially among teenagers, drug users and housewives.

"Risks are still high given the changing sexual behavior in society," the WHO expert told a press conference held at the Thai Public Health Ministry.

He urged the government to earmark more funds for efforts to prevent the spread of AIDS, and involve youths and communities in the process.

Thailand has cut the number of new patients living with HIV from 17,000 people last year to 15,000 this year.

One third of new HIV infections are among women who have regular sex with their spouses. There were also signs of an increased risk of infection among men who have sex with men.

Besides, local HIV/AIDS expert also noticed increasing infection of sexually transmitted diseases (STDs) among teenagers,which indicate a higher risk of HIV infection.

"We campaigned hard to reduce AIDS transmission almost 20 yearsago. So teenagers now don't know about our strong campaign against the epidemic," said Narongsak Ungkaauwapla, deputy permanent secretary of the Public Health Ministry. Enditem