Hepatitis C: Cure and control, right now!

Hepatitis C (Hep C) is preventable

World Hepatitis Day: 28 July
Hepatitis C virus (HCV) co-infection occurs in an estimated one quarter of HIV-infected persons in Europe, Australia, and the United States. "As use of highly active antiretroviral drugs has markedly reduced opportunistic infections, HCV-related liver disease has emerged as a leading cause of death. HIV infection adversely affects both the natural history and the treatment of hepatitis C" said Dr David L Thomas, Division of Infectious Diseases, Johns Hopkins School of Medicine, USA. Read more


For people living with HIV (PLHIV) Hepatitis C (Hep C) is a major public health challenge that can and should be controlled.

“We have a serious condition and we have clear evidence that it can be controlled” said Dr David Thomas.

Two clear solid grounds why it is important to control HCV are: It is common and very severe.

The incidence of Hep C is scary – in Baltimore, Europe or Australia, HCV occurs in 70% to up to 100% among PLHIV who acquire infection through injecting drug use (IDU).

In India, whether it is Chennai in South India, or north-east India, Hep C rates among PLHIV who acquire HIV through injecting drug use are very similar and shocking. However there are several others who just have HCV and not HIV, said Dr David.

Hep C also infects PLHIV who acquired infection through heterosexual or homosexual routes.

60% of persons who acquire HCV go on to have chronic hepatitis infection. HCV viral load is also high if person is co-infected with HIV.

“HIV decreases response to HCV treatment – can have half of treatment outcome than HIV negative individuals” said Dr David Thomas. HCV treatment costs are over USD 20,000 per person.

HIV infection adversely affects all stages of Hep C or HCV infection.

“Risk of liver failure was higher among individuals living with HIV than those individuals who were similar with regards to HCV but HIV negative” said Dr Thomas.

The antiretroviral (ARV) therapy is not sufficient to:
- Reduce the HCV RNA load
- Restore treatment response
- Prevent cirrhosis or liver failure

However antiretroviral therapy (ART) significantly reduces mortality among people co-infected with HIV and HCV.

“Markedly lower survival for HIV/HCV co-infected persons was observed in Denmark (2000-2005)” said Dr Thomas.

HCV transmission can be prevented. Dr Thomas listed few clear points of action to prevent HCV:

- Transfusion transmission has stopped where screening is done
- Nosocomial spread reduced where bloodborne precautions observed
- HCV incidence among IDU has declined

“Even in places where harm reduction measures are in place, HCV continues. HCV is more transmissible than HIV, so measures to control HIV are not going to be enough, they need to be intensified” said Dr Thomas.

Very few people co-infected with HIV and HCV are currently receiving testing, and treatment for HCV.

There is a clear need for harm reduction measures to intensified and expanded, testing for HCV to be expanded and HCV treatment be made available widely.

“Let’s rejoice in the fact that today we have treatments that work... what we need I the political will to go the extra mile to deliver universal access” had said J Montaner, which is so much in context to improve responses to HCV and HIV co-infection.

Bobby Ramakant – CNS 


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Prevent TB: IPT works, IPT is safe

TB is preventable: IPT works!

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. 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. Read more



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.

22 COUNTRIES WITH THE WORLD'S HIGHEST NUMBERS OF TB CASES COULD EARN SIGNIFICANTLY MORE THAN THEY SPEND ON TB DIAGNOSIS AND TREATMENT 
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.

Bobby Ramakant - CNS 


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AIDS: Where Goes the Money?

JUST how much money are the recipients of AIDS funds putting into programmes that have a real impact on communities affected by the disease without hip- hopping around the world or engaging in endless AIDS workshops? It appears that unless there is serious public account of where exactly AIDS dollars are going, we are in for a long ride with the epidemic.

In order to make real progress in the response to AIDS, the whole concept of what money means to the response has to be rethought. Because where the money is going in many cases is doing little tochange the course of the epidemic. Except make some people rich and fat and making a glitz out of the disease.

The AIDS community in many parts of Africa is very dispassionate; there is no real anger, and the business of the day consists of filling in donor proposals and donor reports pasted with pictures ofpeople supposedly living with HIV and AIDS. The AIDS response in Africa is so air-conditioned that its ineffective: it lacks vigour for real change. Read more.

So while there is an ongoing clamour by AIDS activists for increased funding – and rightfully so – it is an undeniable fact that significant AIDS resources have only gone to fatten people’s pockets in Africa, creating a class of the noveau riche. AIDS tourism, defined as multiple trips to world-class cities to attend conferences and workshops and discuss the disease is literally like a virus run amok in many AIDS circles. It is prevalent not only in Africa but in many cities around the world.Of course, trips and workshops come with hotels and the beloved per diem, and we are only left to wonder where all the money is going. Too much of the money for AIDS flies in wads at the grasstops while the grassroots suffer.

The Global Fund on AIDS, TB and Malaria has been forced to withdraw its funding in Kenya, Zambia and Zimbabwe for reasons related to mismanagement of the funds.

For many of the people in HIV and AIDS work, its a chance to cash in while speaking highly about the things that need to be done. AIDS has become almost academic, so to speak. A considerable chunk of AIDS funding today is going to groups of people that have formed organizations that are there to to pocket in on the disease. Many of these organizations continue to engage in endless research on communities without actually directing material and financial resources where they are needest most: the community level.

The problem with HIV and AIDS has become that there is too much theorizing and with it has risen a class of so-called AIDS professionals that know everything about the disease yet don’t do jack to make a real impact to the women and girls persevering everyday with meager resources to take care of their sick.

In a way, AIDS has become a syndrome to slickness.

To state it bluntly, there has been a mushroom of self-appointed AIDS institutions that are like vampires sucking on AIDS funding. It appears the question that is missing is exactly how is AIDS money being used. Once that question is sufficiently answered, maybe we will embark on a new pathway to better use of money which the world has availed to combat this problem.

Chief K Masimba Biriwasha

(The author, born in Zimbabwe, is a children's writer, poet, playwright, journalist, social activitist and publisher. He has extensively written on health, worked till recently with UNESCO in France and is presently in South Africa. His first published book, The Dream Of Stones, was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)

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TB Cough-in/Coffin March: TB on IAC agenda as never before

(photographs): It was one of those defining moments in history of legendary AIDS activism at the International AIDS Conferences when the TB cough-in/coffin March began at the penultimate day of the XVIII International AIDS Conference (IAC) in Vienna, Austria. At least half a thousand people had assembled, with t-shirts, placards, cardboard coffins (no more TB deaths), stop TB handkerchiefs/ bandanas, vuvuzelas, drums, banners, and mascots to name a few. AIDS activism has been a cornerstone of AIDS conferences, but TB was on the IAC agenda this time, as never before. Read more



Hundreds of marchers were coughing into the handkerchiefs/ bandanas intermittently and then the growing sloganeering at deafening decibels of ‘When you cough, when you sneeze, cover your mouth to stop TB’ was raising awareness of the need for better TB infection control. “Anyone with known infectious TB or who has an undiagnosed cough is kindly asked to refrain from joining the march, for infection control reasons” read the March flier.

“No more people living with HIV (PLHIV) dying of TB”, “HIV Positive, Prevent TB”, “To make TB a disease of the past, we need to turn declarations into deeds and promises into programmes that transforms lives”, “We cannot win the battle against AIDS if we do not also fight TB”, “Know the fact, a vaccine for TB is possible”, “No more HIV, no more TB, help set us free”, “If a virus (HIV) and a bacteria (TB) can work so well together, then why can’t we?”, “On the move against TB”, “MOSOTOS = Death” (MOSOTOS is a campaign promoted by TB Alert, and stands for “More Of Same Old Talk, Opinions and Speeches - MOSOTOS), “When you invest in HIV and TB, Africa wins”, “Know your facts: One in four AIDS deaths are due to TB”, “We demand access to HIV-TB services everywhere”, “ART clinics not transmitting TB”, “No more empty commitments”, “Stop TB”, among others (photographs).

The two black coffins had poignant messages: “Saved from HIV, but died from tuberculosis”, “Stop TB”, “If a virus (HIV) and a bacteria (TB) can work so well together, then why can’t we? – Michel Sidibe”, “No more PLHIV dying of TB”, “TB = one in four AIDS deaths”, “Stop PLHIV dying of TB”, “Saved from HIV but died of TB” among others (photographs).

The March began from the ‘Global Village’ and went around the ‘village’ at IAC and the procession swelled enormously with people from different booths and exhibitions joining in.

The high decibel chant of “When you cough, when you sneeze, cover your mouth and stop TB” echoed in the conference corridors. There were other slogans, like “Stop TB”, “No more – TB deaths” among others that undoubtedly left an indelible imprint on over 20,000 delegates at XVIII IAC as the March traversed its way out of ‘Global village’ and through the corridors to session rooms. It went inside the session room II where a session on “No more people living with HIV dying from TB” was about to begin (1-2pm) with Michel Kazatchkine, Executive Director of the Global Fund to fight AIDS, TB and Malaria (GFATM/ Global Fund) as the Chair and former President of Portugal Dr Jorge Sampaio who is also the UN Secretary General Special Envoy to stop TB, Marcos Espinal, Executive Secretary of the Stop TB Partnership, Michel Sidibe, Executive Director of the joint United Nations programme on HIV/AIDS (UNAIDS), and Timur Abdullaev from Ukraine were the keynote speakers.

This March had surely provided a very powerful thrust to this session – and with two coffins and scores of placards kept all around the session hall – the message was clear: time to be complacent about TB among PLHIV is over – and affected communities demand action – to bring in the desired change in terms of optimal TB and HIV programme performances on the ground.

Bobby Ramakant – CNS

To see photographs of the TB cough-in/coffin March, click here 


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Why?

When I question why
a public bus over speeds
or cars and trucks park wrongly
most simply stare... Read more



When I ask why
a municipal water pipe leaks
for years without repair
or garbage lies everywhere
people hardly care

Dysfunctional traffic lights
hol(e)y roads, uneven side walks
open drains even during rains
callous government schools and hospitals
eve teasers, tree cutters, road blockers
My complaints cause flares


I am imperfect too
But rarely at another's expense
So I will question why
Until from the earth I fly...

Humbly dedicated to all those who protest singly, bravely, relentlessly


Pushpa Achanta - CNS

Stop TB Partnership signs MoU with UNAIDS to improve TB-HIV responses

Marcos Espinal (L)- Michel Sidibe (R)

In a historic and a (very) long overdue moment, finally, the Stop TB Partnership signed a memorandum of understanding (MoU) with the Joint United Nations programme on HIV/AIDS (UNAIDS) to work together in improving responses to TB and HIV. Marcos Espinal, Executive Secretary of the Stop TB Partnership and Michel Sidibe, Executive Director of UNAIDS, signed the MoU today (22 July 2010), in presence of hundreds of delegates at the XVIII International AIDS Conference in Vienna, Austria. Read more




Dr Jorge Sampaio, former Portugal President, and United Nations Secretary General’s Special Envoy on TB, convened the MoU signing ceremony.

This MoU sets out a roadmap of how both pivotal agencies (UNAIDS and Stop TB Partnership) are going to halt TB deaths in people living with HIV (PLHIV).

This MoU will help the two global lead agencies on TB and HIV, to synergise and work together to generate new responses to TB-HIV, to work towards new tools for diagnosing TB in people living with HIV, to strengthen the capacities of affected communities to engage meaningfully in TB-HIV responses, to support the development of TB-HIV human rights task force, among others.

The photograph of MoU signing ceremony is available online here

Bobby Ramakant - CNS 


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TB-HIV co-infection: Giving ART and Treating TB slow HIV progression

Dr Gabriel Chamie UCSF

GIVE ART TO ALL HIV INFECTED TB PATIENTS REGARDLESS OF CD4 COUNT
The message was clear: Putting TB-HIV co-infected people on the anti-retroviral treatment (ART) do slow down HIV progression to AIDS. However ART induced immune maintenance and recovery have no difference on the outcome of anti-TB treatment in studies done in different parts of Asia and Africa, presented on second day of the XVIII International AIDS Conference (IAC) in Vienna, Austria. Read more




"The hypothesis of our study was whether the induced immune maintenance and recovery in people co-infected with both: TB and HIV, due to anti-retroviral treatment (ART), will have any clinical, radiological or microbiological responses on TB therapy," said Dr Gabriel Chamie from Department of Medicine, University of California, San Francisco. The study outcome was that there is no difference in TB therapy outcome of putting TB-HIV co-infected people on ART. Dr Chamie conducted his study in Uganda.

Similar study outcomes were in Thailand: Dr Weerawat Manosuthi, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand also didn't find any significant difference in TB treatment outcome among those TB-HIV co-infected people who were put on ART or not. "Thai study provides promising long term clinical data of nevirapine 400 mg per day based ART in people living with HIV (PLHIV) who were diagnosed with active TB and were receiving rifampicin based anti-TB treatment" said Dr Weerawat.

But these studies should not be confused – the positive health outcomes of starting antiretroviral treatment (ART) in TB-HIV co-infected people are undisputed – regardless of their CD4 count – because it slows down HIV progression to AIDS.

In high burden countries, there is a need to test all TB patients for HIV (through provider initiated HIV testing) and of those HIV-positive we must provide immediate cotrimoxazole preventive therapy and ART as soon as possible. "The most recent WHO advice issued in November 2009, is to give ART to ALL HIV infected TB patients regardless of CD4 count and to give it as soon as possible after the anti-TB treatment" said Prof Anthony Harries, Senior Adviser, International Union Against Tuberculosis and Lung Disease (The Union).

Dr Anushka Naidoo from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) shared her study where she looked at the ART regimens. 6% people on ART switched from the 1st line therapy out of which 1.8% did so due to toxicity or contra-indication and 4.2% did so due to virologic failure.

The interactive question-answer session further made it clear that the recommendation to give antiretroviral treatment (ART) to all people co-infected with TB and HIV has promising benefits, but doesn't affect the anti-TB treatment outcomes.

Bobby Ramakant - Citizen News Service (CNS) 
(The author is supported by the Stop TB Partnership and PANOS Global AIDS Programme, to write from the XVIII International AIDS Conference in Vienna, Austria, for PANOSCOPE) 


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Spain should increase investment in tuberculosis R & D

The Spanish government was encouraged to invest in tuberculosis research and development (R&D) as part of its policy of international cooperation in health. "Spanish government should support and fund the tuberculosis (TB) research and development (R & D) because we don't have adequate health tools to face the TB pandemic globally: more effective tools are needed. Research and development is essential part of international cooperation policies," said Laia Ruiz Mingote from Planeta Salud, who had a poster discussion on this issue at the XVIII International AIDS Conference (IAC) in Vienna, Austria. Read more

Why Spain? "Spain has a historical relationship with tuberculosis (TB) being one of the most TB high burden countries in Europe” said Laia. TB anywhere is TB everywhere, so Spain, being rich and powerful nation, should invest in a public health cause that does affect its own people too with increased immigrants in the country" said Laia. "No matter where the people came from, they should have access to proper healthcare they need" added she.

"The most commonly used TB diagnostic tool is sputum microscopy, which is more than 100 years old" said Laia. It detects only half of the cases of TB in patients tested, and is particularly ineffective for diagnosing TB in people living with HIV (PLHIV). As a consequence, many TB-HIV co-infected patients die without ever receiving a diagnosis. Without proper treatment, approximately 90% of HIV-positive patients die of TB within months of infection. "That is why we want the Spanish government to fund the TB R&D" said Laia.

The Bacille Calmette-Guerin (BCG) vaccine, which is more than 85 years old, provides some protection against severe forms of TB in children but is unreliable against pulmonary TB, which accounts for most of the worldwide disease burden. BCG vaccine is not recommended for infants known to be infected with HIV, due to increased risk of serious BCG-related complications. "This is another reason why we want Spanish government to fund the TB R&D" said Laia.

An advocacy strategy was implemented to include TB research and development in the agenda of key stakeholders in order to achieve political and economical support from the Spanish government, said Laia.

"We organized seminars in 2008 and 2009, and the third seminar will be held this year soon, bringing together 40 or so stakeholders to push TB research and development agenda" said Laia. They have come up with toolkit for politicians, media, organized official hearing in the parliament, among other ways to mount pressure on Spanish government to come ahead and fund the TB R&D.

As a result of sustained advocacy in Spain, the Spanish government has declared that it will explore ways to support and fund the TB research and development (R &D). "Our next target is to obtain a formal commitment by end of this year 2010" said Laia.

Bobby Ramakant – CNS

(The author is supported by the Stop TB Partnership and PANOS Global AIDS Programme to write for PANOSCOPE from the XVIII International AIDS Conference in Vienna, Austria. The above article was published first in PANOSCOPE on Thursday, 22 July 2010)  


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Punitive laws limit access to HIV services for MSM and transgender people: UN Study

John Godwin

Listen to audio podcast here
The United Nations Development Programme (UNDP) released a study analyzing evidence in Asia-Pacific on how punitive and discriminatory laws and human rights violations limit access to HIV prevention and care services for men-who-have-sex-with-men (MSM) and transgender people. The study report "Legal environments, human rights and HIV responses among men who have sex with men and transgender people in Asia and the Pacific:An agenda for action" is co-published by the UNDP and Asia Pacific Coalition for male sexual health (APCOM). Read more

"There is improving body of evidence that HIV prevalence rates are much higher in MSM and transgender people compared to those in general populations" said John Godwin, Human Rights Lawyer from Australia and key author of this study. According to the data in this study, HIV prevalence was up to 50% in MSM and transgender communities compared to low prevalence in general population.

HIV prevalence among transgender people in few major cities in Asia presented in this study is: 49% in Delhi (India), 42% in Mumbai (India), 37% in Phnom Penh (Cambodia), 34% in Jakarta (Indonesia), 30.8% in Bangkok (Thailand), and 29.3% in Yangon (Myanmar).

HIV prevalence rate among general population is obviously quite low in Asia-Pacific like India estimates it to be 0.2-0.3%.

According to the Commission on AIDS in Asia report released in 2008, by the year 2020, 50% of new HIV infections will be in MSM and transgender communities, said Shivanand Khan, who was conferred upon the Order of British Empire (OBE) by the British Queen in recognition of his contribution to HIV prevention among sexual minorities. Shivanand Khan is also the Chief Executive Officer (CEO) of Naz Foundation International (NFI). NFI is the first Global Fund to fight AIDS, TB and Malaria (GFATM) recipient for regional work in south Asia.

Shivanand Khan, OBE

"Punitive laws and law enforcement practices exist in majority of countries. In Asia-Pacific, such punitive laws and law enforcement practices exist in 19 countries, and that doesn’t include India which is awaiting Supreme Court confirmation of decriminalisation" said John Godwin.

"Interestingly where we have criminalisation (of same sex behaviour) we also have prioritisation" said John Godwin. The governments in Asia-Pacific increasingly include MSM in national policies and 22 countries in the region list MSM as a priority – "and also criminalise at the same time" said John Godwin.

"Countries that criminalise have English common law or Islamic Sharia traditions" said John Godwin. Sixteen countries that were British colonies in this region include: Bangladesh, Brunei, Malaysia, Maldives, Myanmar, Pakistan, Singapore, India, Sri Lanka, Cook Islands, Kiribati, Naura, Papua New Guinea (PNG), Samoa among others.

Speaking about indirect impact of criminalising policies, John Godwin said: "stigma drives MSM and transgender populations away from existing services as MSM and transgender people are reluctant to go to these services."

"Such punitive laws and law enforcement practices lends legitimacy to discriminatory and unethical healthcare practices" said John Godwin.

Two countries that have ended discrimination against MSM and transgender people in the region are Australia and New Zealand.

Bobby Ramakant - CNS 

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Make Art, Stop AIDS

Daniel Goldstein, sculpture and artist

There are three sculptures in the hall with session rooms at the XVIII International AIDS Conference (IAC) which are bound to attract delegates. “Sometimes it gives you a way within, sometimes it gives you a way to express your emotion, sometimes it gives you a way to express what you are going through. It also gives other people a chance to know what people living with HIV are going through” said San Francisco based visual artist Daniel Goldstein. Read more

Sculpture 1: Medicine Mother, 2010

This piece was made following Daniel Goldstein’s 2009 visit to South Africa where he met with people living with HIV to discuss his Medicine Man sculpture and to learn about their concerns regarding the side effects of HIV medications. The sculpture consists of their medicine bottles, combined with few from the artist. The pregnant female figure is surrounded by beaded “spikes” made by South African crafters working in Durban. These brightly coloured spikes are coordinated with the words written on the white disc below the figure, which list the six major side effects of HIV medications (diarrhoea, nausea, lipoatrophy, skin rash, fatigue and neuropathy). Many of the drugs being distributed to HIV positive South Africans are drugs that were used in the United States fifteen years ago – particularly Stavudine, a drug associated with many unpleasant side effects.

Medicine Mother, 2010

Sculpture II: Invisible Man, 2010Inspired by the Eastern European emphasis of this year’s conference on concerns around HIV and injecting drug use (IDU), Invisible Man, is made of 864 syringes surrounding a human-shaped void. In this sculpture syringes embody both danger and hope. The piece can be viewed as resembling a pincushion or iron maiden or alternatively as rays of light emanating from the absent figure. It is a representation of what the artist likes to call “the presence of absence.” The invisible is made visible by the objects and forces that surround it.

Sculpture III: Medicine Man, 2007In the mid 1990s, Daniel Goldstein started to collect his HIV medicine bottles. In 2002, his collaborator, John Kapellas, did the same. Medicine Man, is made of their bottles as well as bottles belonging to their partners, both dead and alive. The iconic floating figure is surrounded by 166 syringes that create a mandorla, the body halo often seen in religious imagery. This sculpture was commissioned by MAKE ART/ STOP AIDS for recent exhibitions in Los Angeles and three cities in South Africa: Durban, Johannesburg and Cape Town.

“The Through Positive Eyes is a participatory photography project. We handed over cameras to people living with HIV (PLHIV), provide them training in photography and ethics of photography, and then they explore their own lives and their own journeys capturing these impressions through their camera” said Rajeev Varma, Director of Make Art/ Stop AIDS – India. “It is more important how they learn about themselves through this initiative and come to terms with what they have been through as they start photographing their lives, and start looking back at their lives on how they lived it” said Rajeev.

“This project has been an empowering process for the participants to get to know their ownselves and resolve issues that were lying unaddressed within themselves. One example is of a participant who was blind, and that participant said how amazing it was to use photography to express the experiences, perspectives or feelings one goes through” said Rajeev Varma.

Bobby Ramakant – CNS

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Can TB patients say "Rights Here, Right Now"?

It is beyond doubt that community-led health responses have yielded satisfying results, yet genuine involvement of affected communities in TB control, is far from optimal. Nevertheless there are significant advancements made over the past years to push TB control stakeholders to meaningfully engage TB patients at every level of the TB response. "The theme of this year's XVIII World AIDS Conference is Rights here, Rights now, and from the Roadmap of HIV/TB sessions it is very encouraging to see that the Rights of TB-HIV co-infected patients are well represented during what promises to be a very full and interesting week" said Dr Anthony Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease (The Union). Read more



Over the past years, one of the turning points for TB control policy is the drafting of the Patients' Charter for Tuberculosis Care (The Charter), which was a result of a widely consultative TB-patients' led process seeking input from high burden countries. The Charter presents rights- and responsibilities- based framework to improve TB responses by mobilizing communities as equal partners effectively.  The Charter is an official part of the global Stop TB Strategy, and is potentially a powerful tool to mobilize affected communities in advocating for, and achieving International Standards for TB Care (ISTC) in their local contexts. But have we rolled The Charter out? Is it really getting the support and mandate that it ordains? And, if not then why not?

"Which Charter are you talking about? Even being able to get my medicines is a big relief for me. I am so weak, and at times, it is so difficult to reach the DOTS centre. So many problems (are there in my life). I have never seen this Charter document in any clinic, but what I do want is: to not stand in long queues, not to be seen as someone who has done some wrong by contracting TB, not to be seen as helpless. I want to take care of my family, drive my rickshaw and fend for the needs of my wife and son" was an outburst of a rickshaw puller who was waiting to get TB treatment at a DOTS centre in Barabanki, India (name withheld upon request). What he wants, is actually, guaranteed to him by The Charter that is a part of the India’s national TB programme - Revised National TB Control Programme (RNTCP).

"Doctors at the AIDS clinic at the CSM Medical University are supportive and sensitive, they do treat me with respect and dignity, but when I go to other clinics like TB clinic or skin clinic or general medicine OPD, or other health centres in my town, I am looked down upon when I disclose my HIV positive status" said another person living with HIV for 7 years who had earlier completed TB treatment successfully in Lucknow. "There were times, I didn’t want to go to DOTS centre and get discriminated or stigmatised, it made me feel humiliated, but then thought of my family, and gathered courage to complete the TB treatment successfully," said he.

What people dealing with TB and HIV seem to want is healthcare with dignity, as a matter of a basic human right. They want to be treated respectfully, and not with disdain due to an illness or a condition. They want their family to be healthy. This is exactly what The Charter talks about. Despite of The Charter being an official component of the global Stop TB Strategy, and of India's RNTCP, there is a very long road to the point where The Charter can be implemented optimally and yield significant results in terms of improving TB and TB-HIV responses at the community level.

Let’s hear from Delhi-based people whether India's national capital Delhi, has rolled out The Charter. "I have never seen the The Patients' Charter for TB Care displayed in any TB clinic, ever. I am glad to hear about a Charter that talks about both: the rights and responsibilities. I agree with this approach because rights' based advocacy demanding treatment and other services with dignity are as much justified, as are the responsibilities people have towards public health. I will suggest that we should do a self-assessment on where are we right or wrong, and change our behaviour accordingly. For example, talking about rights is good, but it is our responsibility as people with TB or TB-HIV co-infection to remain away from all kinds of addictions like alcohol. It is also our responsibility to be aware of our duties towards our families, our communities or society we live in. We need to truly love ourselves" said Hari Singh, who is a National GIPA (greater involvement of people living with HIV/AIDS) Coordinator with the Indian Network for People Living with HIV/AIDS (INP+), and an Executive Board Member, Delhi Network of people living with HIV (DNP+).

Again, what Hari Singh is talking about is engrained in The Charter – it talks about responsibilities of TB patients.

The Patients' Charter for TB Care talks about the responsibility to share information, to provide the healthcare giver as much information as possible about present health, past illnesses, any allergies, and any other relevant details; to provide information to the health provider about contacts with immediate family, friends and others who may be vulnerable to TB or may have been infected by contact; to follow the prescribed and agreed treatment plan and to conscientiously comply with the instructions given to protect the patient’s health, and that of others; to inform the health provider of any difficulties or problems with following treatment or if any part of the treatment is not clearly understood; to contribute to community well-being by encouraging others to seek medical advice if they exhibit the symptoms of TB; to show consideration for the rights of other patients and healthcare providers, understanding that this is the dignified basis and respectful foundation of the TB community; among other salient points on rights and responsibilities based framework.

"How ethical is it to providing treatment for anti-TB drug resistance without quality counseling? The treatment literacy, infection control, toxicity and side-effects related to the treatment, adherence and a range of other issues need to be addressed in counseling sessions," believes the activist from the West Bengal Network of people living with HIV (BNP+) in India. He legitimately needed information on TB treatment adherence, related side-effects, drug toxicity and other related issues. Being living with HIV, he had relatively much more AIDS-related treatment literacy and awareness about his rights and responsibilities than he had on TB-related care.

Unless the healthcare workers and people with TB/ drug-resistant TB or TB-HIV co-infection are provided an environment of dignity and respect, to participate as equal partners of TB care and control, how else are we going to improve the responses to TB and HIV?


The people with TB, particularly those who have successfully completed the anti-TB treatment, are central to improving the TB response. The communities have a key role in increasing TB case detection, reducing TB-related stigma, partnering with health care 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. Let's hope the XVIII World AIDS Conference in Vienna, can give enough thrust to push stakeholders to proactively roll out The Charter and use it as a tool effectively to mobilize communities, engage them as equal partners with dignity and achieve higher standards of TB Care.

  Bobby Ramakant - CNS
(The author is supported by PANOS Global AIDS Programme and the Stop TB Partnership to write for PANOSCOPE that is an on-site daily newspaper at XVIII IAC) 


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Fund the Global Fund to save lives from AIDS, TB, Malaria: "Here I Am" ambassador

Since its inception in 2001, the Global Fund to fight AIDS, TB and Malaria (GFATM/ The Global Fund) has saved approximately 5.7 million lives, and another 4000 deaths are averted each day of people dealing with AIDS, TB and malaria. In order to continue its existing programmes and rapidly scale up towards achieving the Millennium Development Goals (MDGs) in 2015, The Global Fund would need its donors to pledge at least USD 20 billion for the period 2011-2013 during its Replenishment conference 4-5 October 2010 in New York. With the HERE I AM campaign, civil society advocates support the resource mobilization for the Global Fund by showing its incredible impact on the ground. Read more

“The Global Fund has a very positive impact on thousands of people’s lives. It saves about 4,000 lives every day – of people dealing with HIV, TB and malaria” said Michael Gwaba, an Ambassador of HERE I AM Campaign, who lives in Zambia and works with Community Initiative for Tuberculosis (TB), HIV/AIDS and Malaria Plus related diseases (CITAM+).

“When it comes to HIV treatment, 10 years ago, before the Global Fund was started, people were dying, and because of the Global Fund, we have reduced mortality and morbidity related to HIV because governments were putting in money in the Global Fund basket. If governments don’t fund the Global Fund now, we will go back to the position where we were ten years ago! Death rates associated with AIDS, TB and malaria will increase, sickness will increase” said HERE I AM Campaign ambassador Michael Gwaba.

“When people begin taking the anti-retroviral treatment (ART) they are told that ART medications are for life, the promise has been made that these medications will be given for free and for life” said Michael. “Countries like South Africa, where not only the disease burden is high, but also unemployment, poverty and conditions that put people at risk of contracting AIDS, TB and malaria are raging high, have the very communities that cannot afford to buy medications that the Global Fund is providing” said Michael.

“If governments don’t fund the Global Fund, then we will have almost genocide because all those people currently on treatment might die” said Michael.

“HERE I AM Campaign came about because we are now in the replenishment year for the Global Fund, governments are supposed to be putting more money. The scenario that has been presented to the Global Fund board, we need at least USD 20 billion for this replenishment period (2011-2013) which will enable us to meet the MDG goals in 2015. Without the USD 20 billion there is no way we are going to meet MDGs because death rates and disease burden is going to increase” said Michael.

“Our leaders had promised universal access by 2010 – we have failed! What makes us so sure that we are going to meet MDGs if the Global Fund is not funded?” ponders Michael Gwaba, and raises key concerns around mobilizing resources for the Global Fund.

The Global Fund is very instrumental in helping us move towards achieving the universal access to treatment. “In Zambia the Global Fund has helped support PPTCT programmes, ART programmes, for both the public and the private sector – police, prisons, defence forces - and they have also provided funds for prevention programmes for the churches which has significantly reduced HIV infection rates that have helped put 400,000 people on ART through the Global Fund and PEPFAR funding” shares Michael Gwaba.

“With the Global Fund, the programmes are country-driven and the mechanism too is country driven where the country decides what interventions it wants to implement in order to move towards achieving the MDGs. Whereas with PEPFAR and other such funding mechanisms usually dictate to the countries on what they want implement” said Michael Gwaba.

Hope funders are listening to the voices of millions of people benefited by prevention, treatment, care and support programmes on AIDS, TB and malaria supported by the Global Fund over the years, and do fund the Fund in coming October 2010 Replenishment meeting!

Bobby Ramakant - CNS 


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Developed countries stop using arm-twisting measures in FTAs

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In Guatemala the prices of some drugs went up by 845,000 times
The European Union’s actions are a direct threat to access to safe, effective and affordable medicines across the developing world. The European Union is demanding longer patents through free trade agreements (FTAs), longer than demanded by the World Trade Organization. Negotiations on drug price with over 90 low income countries become difficult with patents, for example, in countries like Guatemala the prices of some drugs went up by 845,000 times. Read more




European Commission (EC) is demanding such patents from 90 developing countries, including one of the poorest nations in the world. EC is also negotiating such an agreement with India, and want the negotiation to be done by end of this year. “We all know India produces 92% of generic medicines in the world, and what would happen to those countries that rely from imports from India, if India agrees to EC” wondered Sanya Reid Smith from Third World Network.

Anand Grover, UN Special Rapportuer on Right to Health said: “In the year 2000, the price of one year of ART was USD 15,000 that was brought down to USD 80 per year due to generic competition. The World Trade Organisation (WTO) through TRIPS mandated that every country should have patents for 20 years, and also gave the flexibility to developing countries. But through TRIPS Plus/ free trade agreements (FTAs) what developed countries like US, Japan or regions like EU are trying to do actually goes beyond TRIPS. For example, with TRIPS the patent term was for 20 years, they want patent term extension – so patent term will be for a longer duration than 20 years.”

“They (through FTAs) also want other provisions, linking patents with drug regulatory regimes (patent linkage), through data exclusivity. All these actually impact how generics come into the country – they delay the onset of generics in a country. Instead of allowing competition immediately after the patent term is over, they restrict generic competition. It is because of generic competition that we could have such reduced prices. All such measures are what is called as the ‘TRIPS Plus’ measures, attempt to delay the generic competition” said Anand Grover, UN Special Rapportuer on Right to Health.

“These agreements are thrust upon a country when they are not even supposed to have signed TRIPS. For example, countries from the Francophone Africa, they are among the least developed countries in the world, and they were supposed to sign TRIPS by only 2016, but you would not believe it that TRIPS agreement was actually complied with by large number of these countries even before India did. So they have so called ‘good laws’ for the “West” and very bad laws for their own countries” added Anand Grover.

ARM TWISTING MEASURES
“These negotiations aren’t done across the table in arms’ length negotiations. They are done through special conditions put by developed countries on developing countries, like trade barriers. These are the types of arm twisting measures developed countries resort. So any type of FTAs do not allow access to medicine at an affordable price, but delay generic competition and thereby promote monopoly. My report, which is the first report as UN Special Rapportuer, has highlighted this and I will call upon the developed countries not to use such arm twisting measures” said Anand Grover, who apart from being the UN Special Rapportuer is also a reputed lawyer of Supreme Court of India and heads Lawyers’ Collective.

Without the continued supply of safe, effective and affordable generic HIV medicines, the future of universal access looks bleak. Higher prices mean fewer people on ARVs; for those already on treatment newer treatment will not be available when resistance develops.

Bobby Ramakant – CNS
To listen to AUDIO recording, click here 


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