Experts Tout Condoms in AIDS Fight -  Jul. 12, 2004

BANGKOK, Thailand  - Scientists, activists and policy-makers touted condoms Monday as a trusted weapon in the fight against AIDS, dismissing President Bush's policy of abstinence as a "serious setback" in efforts to control the pandemic.

Ugandan President Yoweri Museveni was the only big-name speaker at the International AIDS Conference to support Washington's ABC policy: Abstinence, Being faithful and Condoms, in that order.

Museveni said loving relationships based on trust are crucial, and "the principle of condoms is not the ultimate solution."

"In some cultures sexual intercourse is so elaborate that condoms are a hindrance," he told a plenary session. "Let the condom be used by people who cannot abstain, cannot be faithful, or are estranged."

However, U.S. Rep. Barbara Lee and other delegates urged the world's rich countries to spend more on condoms and other HIV-fighting programs for the developing world.

"In an age where 5 million people are newly infected each year and women and girls too often do not have the choice to abstain, an abstinence-until-marriage program is not only irresponsible, it's really inhumane," said Lee, a California Democrat.

Proponents say there is no better way to prevent HIV than by using condoms and giving clean syringes to intravenous drug users. Their philosophy is known as CNN, or Condoms, Needles, Negotiating Skills. The Bush administration maintains that emphasizing condoms promotes promiscuity among youth.

During a debate titled "CNN vs ABC," Steven Sinding, director general of the International Planned Parenthood Federation, said "condoms will remain key preventive tools for many, many years to come."

He said condoms should be seen as the key element of a comprehensive strategy including abstinence. The U.S. policy of emphasizing abstinence is a "serious setback to the AIDS control effort," he said.

By the end of the debate, ABC proponent Dr. Edward Green, a Harvard researcher and member of the President's Advisory Council on HIV/AIDS, suggested that a combination of ABC and CNN was the best solution.

Condoms have been promoted as a front-line defense against AIDS by countries such as Thailand, where a campaign to get sex workers to insist on condoms yielded a more-than-sevenfold reduction in HIV rates in 13 years.

Some 25 million of the 38 million infected with HIV worldwide are in sub-Saharan Africa, but the virus is taking root increasingly in Asia, where 7.6 million are infected.

In Asia, the sex trade has been the main engine behind infections in countries such as Thailand and Cambodia, where epidemics exploded by the late 1980s _ sparking aggressive responses, including campaigns to boost condom use.

Uganda has waged a successful battle against HIV in a rare success story for sub-Saharan Africa _ though some experts say it's unclear how the success has been achieved. Musaveni credited abstinence.

Uganda has brought its infection rate down from more than 30 percent in the early 1990s to about 6 percent of the country's 25 million people last year.

A young Ugandan, Simon Onaba, who gave an impassioned speech during the CNN vs. ABC debate, said abstinence works if people have the will.

"It is possible for young people to abstain. We are motivated, we are empowered. If I can start having sex, I can also stop having sex," he said.

However, epidemiologists tracking Asia's emerging epidemics told conference delegates the world's most populous continent face HIV problems largely driven by prostitution, and that promoting condoms is the best way to block further spread.

"I disagree with (Museveni). ... Condoms are greatly shortchanged in Africa as a prevention method," said Tim Brown, of the Hawaii-based think tank East West Center. "If you increase condom use by 50 percent, I guarantee you that HIV will go down by 50 percent."

There was consensus at the six-day conference, in its second day, that fighting the epidemic needs money that can only come from rich countries.

By 2005 an estimated $12 billion will be needed annually to fight the disease in developing countries, but current annual global spending now amounts to less than $5 billion.

"The $200-$300 billion spent in Iraq probably could have eradicated this illness," actor Richard Gere _ one of several celebrities at the meeting _ told a panel discussion.    

Study paints bleak picture of gay life - July 13, 2004

An alarming number of gay, lesbian and bisexual Thai youths are forced into having sex, pioneering research by the Ministry of Public Health and the US Centres for Disease Control found.

In a study of 1,725 Chiang Rai vocational students aged 15 to 21, 26 per cent of the gay and bisexual males and 32 per cent of the lesbian and bisexual females said they had been forced "either mentally or physically" into having sex against their will.

Among heterosexual youths surveyed, about 5 per cent of males and 20 per cent of females reported having been forced to have sex.

"Sexual coercion has been found to be associated with . . . depression, suicide, unwanted pregnancy, STDs [sexually-transmitted diseases], and HIV infection," the researchers said, calling for counselling services and preventative measures, such as teaching children what to do when someone tries to force them to have sex.

The homosexual or bisexual youths surveyed were also about five times more likely to sell sex than their heterosexual peers.

"We do not have any good explanation for why sex in exchange for money, gifts or favours is more frequent among [homosexual and bisexual] youths," the researchers wrote.

One reason "may be that they have already crossed sexual boundaries in the face of moral disapproval by society . . . [which] may make it easier for them to engage in other morally dis-approved behaviours such as selling sex", they speculate in the article "The Prevalence of Homosexual and Bisexual Orientation and Health Risks Among Adolescents in Northern Thailand".

The research was conducted in 1999, but the data relating specifically to homosexual and bisexual youths was not published until April of this year, in the Archives of Sexual Behaviour.

The delay was caused in part by disputes over the words used to describe sexual orientation, one of the researchers said. They had been accused of lumping homosexuals and bisexuals together and had to spend a year rewriting the article, he said.

"The field of sexology is quite tacky with a lot of camps and everybody disagreeing," he added.

However, no matter which words you use to describe them, the study paints a bleak picture of the lives of Thai youths who are sexually attracted to members of their own sex - 9.1 per cent of males and 11.2 per cent of females surveyed.

In particular, the study found a high level of sexual activity and alienation among young gay and bisexual males. On average they start having sex two years earlier than their heterosexual peers (14.7 years versus 16.8 years), have more partners, experience greater social isolation, are more likely to suffer depression, and though they seldom use condoms rarely get tested for HIV.

The study also found that patterns of alcohol and drug use among Thai homosexual and bisexual youths differed from patterns in Western countries, with males using less and females using more than their heterosexual peers.

It found that homosexual, bisexual and heterosexual youths had one thing in common - a high rate of unsafe sex. The researchers called for more and better education and motivation programmes to discourage youths from having unsafe sex.

They also said that parents, teachers, healthcare providers and youth councillors needed to be made aware that there were many homosexual and bisexual youths in Thailand and that they faced particular health risks and problems.

This information, however, is proving difficult to disseminate, says Rainbow Sky, a group that provides HIV/Aids outreach programmes to Thailand's gay community.

The group's secretary, Rapeepun Jommaroeng, said that officials at the Ministry of Education

won't even speak to them. "They don't want homosexuals to exist," he says.

Elderly just as prone to disease as youngsters - July 13, 2004

Elderly people are just as likely as youths to contract HIV/Aids through sexual contact, especially when their children migrate to the cities, an HIV/Aids activist said yesterday.

Prasert Dechaboon, adviser to a Chiang Mai-based network for people living with HIV/Aids, said the elderly could become lonely and sexually active, even without the aid of nightclubs and brothels.

Five per cent of people who die of Aids-related illnesses in Chiang Mai are elderly, said another activist, but there is currently no data available on the number of elderly living with HIV/Aids.

Usa Khiewrord, regional project manager of HelpAge International, said the elderly are not targeted by mainstream HIV/Aids projects and therefore practise unprotected sex because they lack up-to-date information.

Prasert said the disease is often considered a form of punishment for wrongdoing and is associated with promiscuity.

"There is a social stigma for young men who get infected, but the social stigma is double for the elderly, who are expected to be respectable," he said.

A 10-year veteran of HIV/Aids campaigns, Prasert believes social movements like songs, books and other media are very important to teach people about the elderly.

But he said the elderly are often left literally "holding the baby" when their own grown-up children die of Aids-related illnesses.

In Thailand and Africa, where the elderly expect to be taken care of by their children, many elderly folk end up being parents again.

HelpAge said two of every three Aids patients in Thailand are under the care of parents or their elder relatives, while 30 per cent of the 42 million elderly people in African are taking care of grandchildren whose parents died of Aids-related illnesses.

Half of the children of Thai HIV/Aids patients are under the care of their parents, while 20 per cent of Zimbabwean orphans are under the care of the elderly.

Boon Srimai, 62, from Chiang Mai, became a parent again when her son died of an Aids-related illness years ago. Now she faces psychological and financial problems as she struggles to raise her 10-year-old granddaughter.

Asia at high risk of developing drug resistant AIDS: experts - July 13, 2004

BANGKOK, HIV patients in parts of Asia run a serious risk of developing resistance to antiretroviral drugs due to the range of drugs available to them, stop-start treatment and lack of counselling and monitoring, experts at the world AIDS forum warn.

In China, where Nevirapine is a standard component of antiretroviral triple therapy, 50 percent of 500 rural patients who took the drug for up to 11 months have become resistant, said Shao Yiming, director of the China Centers of Disease Control's Department of Virology and Immunology.

The problem, Shao told AFP, was that China provided the free drugs last July without proper preparation.

Patients were not briefed by medical personnel that they had to take the tablets consistently.

Many stopped taking them for a while and then resumed and stopped again -- a perfect recipe for building resistance to a drug. Others quit taking the drugs altogether because of side effects, such as vomiting and headaches.

"We should not have put so much pressure on short-term gains. Instead we have paid attention to obtaining long-term gains," Shao admitted.

"The free-drugs program was meant to be save lives, but we should have considered whether it was sustainable."

Patients who develop drug resistance to Nevirapine now need to take different types of drugs, which are much more expensive and patented.

Nevirapine is an older AIDS drug whose patent has expired, and is copied by China's pharmaceutical industry. The switch to second-line patented drugs can triple the cost of treatment.

"Unfortunately, what's happening in most of the developing world is that the generic drugs which are being manufactured are simply the ones that they can make, which doesn't necessarily mean that the combinations put together are the most ideal," said Kevin Frost, director of TREAT Asia, a nonprofit group promoting safe AIDS treatment.

"There's a lot of concern that we're going to begin seeing resistance to Nevirapine on a more widespread basis here and I think that's of significant concern when it's such a critical component of every first-line treatment regimen in the region."

In countries where no free drugs are provided, the problem is worse.

In Vietnam, for example, patients buy cheap black market drugs or only take the drugs when they can afford them, stopping when money runs out and restarting again.

Many countries are only now becoming aware of the need to monitoring drug resistance.

Malaysia has been subsidizing HIV treatment since the mid-1990s, but is only now getting around to building a lab to do resistance testing, said Adeeba Kamarulzaman, head of the infectious diseases unit of the University of Malaya.

A China-based international expert, speaking on condition of anonymity, argued that the resistance problem could be averted if countries introduced "a simple mechanism" of encouraging compliance with the drug regimen.

"If the job is to make some people take it, just like taking birth control pills, do you really need the world's most well-trained doctors? Think about how China did family planning. They monitored every woman's menstrual cycle!"

Resistance to drugs occurs because the virus can undergo genetic mutations when it replicates.

A Darwinian survival-of-the-fitness phenomenon occurs. Strains of HIV which are impervious to a specific drug because it has been used in insufficient or irregular doses come to dominate the virus community.

That means another treatment has to be brought into use to attack this tenacious foe.

What complicates matters even more is that people who develop a resistance to a certain drug are more likely to become resistant to the entire class of drugs.

There are only three classes of AIDS drugs, which means poorly thought-out drug programs could leave patients much fewer treatment options and force them to take newer, more expensive drugs.

A longer-term worry is that the present generation of antiretrovirals could be wrecked if resistant strains of the virus emerge quickly and spread fast through the population by infection.

World Health Organization (WHO) expert Don Sutherland said that, despite these fears, "We're convinced this is good quality treatment when all the conditions are in place.

"When you consider what people are facing now, this is a good choice. It's better to start and improve upon it than wait, because patients cannot wait," Sutherland said.

"If you don't give the drugs to them, you have 100 percent failure. What's wrong with saving 50 to 60 percent of those lives?"

Youths want more say in efforts to fight pandemic - July 14, 2004

Representatives from the Joint United Nations Programme on HIV/Aids (UNAids), the United Nations Children’s Fund (Unicef), the United Nations Population Fund and the International Aids Society received a letter from the youths.

The youngsters demanded the creation of partnerships between youth organisations and international organisations working on the disease as they placed stickers reading “Honorary Youth” on officials’ shirts.

On Monday afternoon, five youths staged a far-reaching presentation for Carol Bellamy, Unicef’s executive director, ranging from basic facts and figures on the world’s HIV/Aids situation to original solutions to tackle the pandemic.

The presentation was based on the preliminary findings from two days of meetings among youth leaders from 15 countries including Thailand. They met as a run-up to the conference.

Through brainstorming and bringing to the table examples of the situations from their homelands, the youth leaders discovered that youths everywhere, from Cambodia to Egypt, face the same hurdles and difficulties.

Young people, they said, need more knowledge, information and skills to prevent HIV infection and stay healthy. They also need more safe and supportive environments, access to services as well as testing and treatment.

According to UNAids, more than one-third of all individuals with HIV/Aids are under 25 years old, and the age group accounts for more than half of all new HIV infections each year. Those between the ages of 15 and 24 are particularly hard hit, especially girls and young women, who comprise the majority of young people living with the disease.

People between 15 and 24 with HIV/Aids live in:

·  Sub-Saharan Africa, 62 per cent,

·  South and Southeast Asia, 18 per cent,

·  Eastern Europe and Central Asia, 6 per cent,

·  Latin America, 6 per cent.

Young people are uniquely vulnerable to contracting HIV, but they also are critical in responding to the epidemic, according to the Henry Kaiser Family Foundation. Where youths have been asked to get involved in campaigns, HIV transmissions have been reduced, particularly among their peers.

Several factors make youth particularly vulnerable, including their age, biological and emotional development and their financial dependence, according to a UNAids report.

Many surveys have shown that although more young people in the world now know about the disease, awareness is not universal.

Many are still ignorant about protection or have misconceptions about transmission.

Many sexually-active young people at risk of contracting HIV do not think they are at risk, according to UNAids.

Patcharin Khamjan, a Thai youth participant from Chiang Rai, said the younger generation in some countries do not even know what Aids is and oftenl do not know how the virus is transmitted.

Youths themselves can help to solve the problem if adults give them opportunities to speak out.

“They should give us the biggest say in what we need to protect ourselves from infection,” said Patcharin.

As another youth leader from Trinidad and Tobago put it, “We are the solution, not the problem.”

Drug war thwarts HIV battle - July 14, 2004

Thailand’s successful fight against HIV/Aids in the early 1990s, which has often earned the Kingdom international praise, has been undermined by a climate of fear in the wake of the government’s war on drugs that has driven injecting drug users underground, Human Right Watch said on Monday.

The war, launched in February of last year, has caused the deaths of more than 2,000 people and drove countless drug users into hiding and away from what few services exist to protect them from HIV, said Joanne Csete, director of HIV/Aids programmes.

The number of injecting drug users is increasing. Between 70 and 80 per cent of an estimated 274,000 heroin users currently fuel their addictions via syringes, according to a Human Rights Watch report. The report stated that drug users would account for 30 per cent of new HIV infections by 2005.

The Kingdom enjoys an international reputation as a “best practice” model in the fight against Aids largely due to its “100 per cent condom” campaign in the 1990s.

But with respect to drug users, the government has rejected similarly progressive HIV prevention programmes in favour of arbitrary arrests, mass incarcerations and forced drug treatments, said Jonathan Cohen, a Human Rights Watch researcher.

Cohen said his organisation had documented cases of drug users and traffickers becoming targets of state-sponsored killings and mistreatment, instead of being treated as victims or patients.

Many users were coerced into treatment during the war out of fear of arrest, while those who enrolled were given substandard treatment, often consisting of military-style drills in camps, he said.

“You cannot on the one hand say the people who use drugs are people who have a medical problem who need treatment and medical attention and on the other hand, command violence against people associated with the drug trade,” he said. “It creates a climate of fear that undermines any efforts to deliver comprehensive medical services to people who use drugs, and the government cannot have it both ways.”

Doctors back four drug regimens - July 14, 2004

With all the anti-retroviral drug combinations currently available on the market, people living with HIV/Aids often have their work cut out just keeping track of the numerous cocktails.

Four regimens of drug combinations are recommended above all others. But even trained physicians have trouble deciding which ones are best.

This is the biggest question faced by the World Health Organisation and UNAids, who plan to treat three million HIV-infected individuals worldwide by 2005. They have struggled to decide on the suitability of cocktails.

The ambitious treatment plan is called “Three by Five”.

“In retrospect, these regimens are well chosen,” Dr Sanny Chen, of Johns Hopkins Bloomberg School of Public Health, wrote in a study presented at the International Aids Conference yesterday.

By analysing HIV/Aids cases and mortality surveillance data in San Francisco, Dr Chen and his colleagues found that the four drugs used in initial regimens yielded the best odds of survival.

They also found no significant difference between them as initial regimens, although 3TC-D4T-Efavirenz seemed to yield a slightly better chance.

Chen said the study should be treated with caution, but he insisted it provided solutions to problems that were previously unapproachable.

Although far from conclusive, Chen said his study gives people living with HIV/Aids another piece of assurance that “Access for All” is also the best for all.

Grim situation: July 14, 2004

·  The number of the Aids orphans increased in the past two years from 11.5 million to 15 million, with 12.3 million of them living in sub-Saharan Africa.

·  In Botswana, the adult infection rate is 38 per cent, the highest in the world.

·  More than 90 per cent of HIV-infected people do not know they carry the virus and this undermines global Aids prevention efforts, experts say.

·  Last year the World Health Organisation and UNAids announced the “3 by 5 initiative” with the goal of treating three million people living with HIV/Aids by the end of 2005. This means every day at least 5,000 people need to be brought into treatment. To achieve this, experts say that each day 500,000 people will need to be tested.

·  India has only one trained doctor for every 10,000 people living with HIV. Of these 500 doctors, only 25 can “be considered fully trained in all aspects of HIV treatment”, said N Kumarasamy of the YRG Centre for Aids Research and Education in the southern Indian city of Madras.

·  There are less than 200 trained doctors available for 840,000 HIV-positive people in China, say officials from the New York-based American Foundation for Aids Research's Asia network.

·  There are 27 local generic drug manufacturers in eight Asian countries compared to just one in Africa.

·  UNAids, the United Nations programme on HIV/Aids, estimates that 1.7 million people in Asia need antiretroviral treatment, but less than 100,000 currently receive it.

·  The discrepancy of physician preparedness ranges from one doctor for 24 HIV-infected people in Japan to one doctor per nearly 11,250 infected people in Vietnam, according to the TREAT Asia (Therapeutics Research, Educa-tion and Aids Training in Asia) report.

RETRO-VIRALS: Major pact for cheap drugs  - Jul 14, 2004

New six-nation league will give its signatories to generic, low-cost HIV/Aids medication

A landmark agreement between six countries – including Thailand – will give priority to increasing production of low-cost, generic versions of anti-retroviral medicines.

The agreement could improve access to medicines for as many as 10 million people.

Thailand, Brazil, China, the Russian Federation, Nigeria and the Ukraine formed a network to endorse the enforcement of major provisions of the Doha Declaration.

Low-cost, generic versions of branded anti-retroviral medication will be made by and for the populations of these six countries.

“Public health must come before commercial [interests],” said Alexandre Domingues Grangeiro, director of the Brazil Health Ministry’s National Aids Programme.

The Doha Declaration, adopted at the World Trade Organisation ministerial meeting in 2001, confirmed provisions made under the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (Trips) that allow developing countries facing a public health crisis to use compulsory licensing measures to produce generic medicines.

When the network’s production of generics is up to scale, the price of brand-name drugs will drop, said Grangeiro, benefiting, in his opinion, those in need of life-saving treatment.

According to the United Nations Joint Programme on HIV/Aids’ latest estimates, there are 3.6 million people living with HIV/Aids in Nigeria, 840,000 in China, 570,000 in Thailand, 860,000 in the Russian Federation and 360,000 in the Ukraine.

Using his own country as an example, Grangeiro said the price of anti-retroviral drugs in Brazil had already dropped by as much as 80 per cent.

The network also agreed to promote research and development of medications, including vaccinations, for HIV/Aids care, and build the capacity of respective health sectors through the exchange of knowledge, experience, technology and resources.

In order to implement the agreement, network countries say they will convene technical meetings during the course of this year to map out a detailed work plan. They are also looking to expand their coalition.

According to Grangeiro, India and South Africa were making their final decisions on joining the network.

“We are strong enough to face any future pressure,” he said.

Grangeiro said the initiative fund of US$1 million (Bt40 million) for the establishment of the network came from the Ford Foundation.

Preliminary discussions on forming the network began last September, and the pact was finally realised on Monday at the 15th International Aids Conference in Bangkok, when all of the member countries, minus Thailand, signed the agreement.

Deputy Public Health permanent secretary Pakdi Bhothisiri will sign the agreement today on behalf of Thailand.

Most of the countries’ representatives were ministerial- level officials.

Grangeiro said China was capable of supplying chemicals for the production of generic drugs, whereas the Russian federation was equipped with high technology for medical diagnosis.

He added that Monday’s agreement received positive responses from international non-governmental organisations, including WHO, UNAids and Medecin Sans Frontieres.

So far, there has not yet been any response to the network’s establishment from pharmaceutical giants.

Japan's Aids time bomb - July 14, 2004

The focus of most of the delegates to the International Aids Conference in Bangkok is on the enormous problems posed by the disease to developing countries.

But it is not just the poor who are unprepared to deal with Aids.

In Japan, one of the world's wealthiest societies, awareness of the risks posed by the disease is almost non-existent among many young people, and yet their sexual behaviour is increasingly risky.

While HIV infection rates in Japan remain officially low at around 6,000, experts fear the real total could be higher, and will get a lot worse unless attitudes begin to change to a disease many Japanese believe only foreigners can catch.

One Friday a month, gynaecologist Dr Tsuneo Akaeda visits Club Jamaica, one of dozens of places in Tokyo where young Japanese party till sunrise. He gives free blood tests for HIV - with almost immediate results.

University student Kuki Uchikawa, who has taken the test, said: "It's always been somewhere in the back of my mind, HIV, but I'm afraid I've never done much to protect myself in the past. This is the first time I've decided to come and find out more about the disease."

Among the volunteers helping Dr Akaeda is Mariko - she is 18, and has only just become aware of the risk HIV poses to her generation.

Poor education

"We never had much sex education at school. We were taught little about contraception, or how you catch HIV or other diseases. Teachers just don't feel comfortable talking about sex," she said.

Her friend, Madoka Izumi, also a high school student, agreed.

"I go to a girl's school, and we've never been able to learn what boys think about sex. They've taught us some of the physical sides of sex, but none of the emotional aspects, so we're not really prepared to deal with it," she said.

Yusuke Izumi, a university student, said: "I don't remember getting any sex education at school - we just talked about it among ourselves, about the things we did with girls."

Adults are probably oblivious about teenagers' sexual activity, Mariko said.

"Parents always think their children are different. They can't imagine them having sex or having abortions. They can only think of them studying hard at school."

By the age of 17, more than a third of teenagers in Japan have already had sex at least once.

There are other statistics which Dr Akaeda finds even more alarming. Sexually-transmitted diseases are rising rapidly among young women - a sure sign of having sex with multiple partners but without using condoms.

"Teenagers these days are very casual about sex. They're happy to have sex with anyone they meet - they use phrases like 'let's play together?'

"I gave away vouchers for free STD tests to girls, and found that 82% them were infected.

"It's incredible. I suspect a lot of them may have HIV as well."

In Japan, sex has become a freely-traded commodity, seemingly unconstrained by moral concerns.

Dozens of pornographic cable TV channels on sale here, and yet sales of condoms have been falling for several years.

Condom dearth

"We're very concerned about the negative image of condoms among young people, because it's not just HIV, but other sexually-transmitted diseases which are spreading," said Toshiaki Ishii, of the Okamoto Condom Co Ltd.

"We're trying to find ways to make them more appealing, but so far without success. I think the lack of sex education is partly to blame for this," he said.

The absolute number of people infected with HIV in Japan is still quite small - but unlike other developed countries, every year that number keeps rising.

And yet there is still a marked reluctance here to discuss the problem openly, or to run the kind of hard-hitting awareness campaigns that would wake this country up to the danger it faces.

That reluctance prevails even in the corridors of Tokyo's city government. Ida Mami, of the Medical Service's Division, is sounding the alarm over Aids awareness, but said getting more explicit sex education in schools is not easy.

"It is a sensitive issue. We have to start with what's possible, and avoid provoking a reaction from conservatives. If we push too hard on discussing condoms and safe sex in classrooms, some people may demand we stop all HIV education," she explained.

A start of sorts has been made in one of Tokyo's most elite girls' schools. They invited Dr Akaeda to educate, not the pupils, but their mothers - though only a handful turned up.

His use of graphic illustrations and even more graphic statistics had its intended effect - to shake any illusions they may have that their daughters are somehow immune to the wave of adolescent promiscuity sweeping Japan.

Social taboo

Actually talking about sex to their children, though, is another matter.

"Well it's rather difficult to bring this subject up in a casual way. If I can find the right opportunity, I hope I will feel able to discuss it," said one mother.

"I think this is a subject our children are already interested in, so I guess they'll understand if we raise it with them," another said.

Young people often seem like Japan's golden generation, unburdened by the work ethic of their parents, enjoying more leisure, more affluence, more security.

In such a cosseted environment it is hard to imagine the spectre of Aids. But it is here, and they don't seem to realise.

INDIA: HIV Prevention Among Sex Workers in India - July 14, 2004

According to the current study, HIV rates of only 10 percent have been observed among sex workers in Calcutta, compared to rates ranging from 50-90 percent in Bombay, Delhi and Chennai. Condom use has also risen in Calcutta in recent years, from 3 percent in 1992 to 90 percent in 1999. Such figures may reflect the impact of the Sonagachi Project, a sustainable community-level STD/HIV intervention.

The World Health Organization selected the Sonagachi Project as a model of STD/HIV intervention. To demonstrate under controlled conditions that the project was responsible for the results in Calcutta, project staff designed and conducted a two-community trial to document the efficacy of the program. An external research team designed the assessment and conducted the analysis.

Two small communities in northeastern India were matched on size, socioeconomic status and number of sex workers and randomly assigned to an intervention and control condition. Each community's red-light area consisted of about 350 sex workers; 100 such workers were randomly selected in each area.

The Sonagachi Project was replicated including community organizing and advocacy, peer education, condom and social marketing and establishment of a health clinic. The enhanced intervention group included training by a team of local peer educators. The goals were to build skills and confidence in providing education and to foster empowerment and advocacy for local sex workers. The investigators conducted a baseline assessment with three follow-up assessments every 5-6 months over a 15-month period.

The researchers found overall condom use increased significantly in the intervention community (39 percent) versus the control community (11 percent), and the proportion of consistent condom users increased 25 percent in the intervention community compared to a 16 percent decrease in the control community.

"This study supports the efficacy of the Sonagachi model intervention in increasing condom use and maintaining low HIV prevalence among sex workers," the researchers found. "Too often, effective interventions are conceptualized based on theories of social change launched by university researchers. This intervention was designed by the community, is sustained by the community, and is taken to new communities by sex workers," they concluded. "Greater emphasis must be placed on interventions arising from communities if HIV prevention programs are to be sustained and broadly implemented."ì

Debate rages on drug patents - July 14, 2004

Drug patents have emerged as one of the hottest debate topics at the International Aids Conference.

While multinational pharmaceutical corporations claim no innovation is possible without patents, their opponents ask what the point of innovation is when patients cannot afford the drugs.

Yesterday’s forum on intellectual property rights failed to reach a consensus on whether patents were a barrier to increased access to anti-retroviral drugs.

Some of the speakers claimed that protecting drug discoveries with exclusive commercial rights was a key incentive for companies to pour money into research and development, while others claimed this was a myth fabricated by the pharmaceutical companies.

Opponents of drug patents claimed that much of the research carried out on new drugs in the market today was usually based on studies by public-funded health and scientific institutions. They said the drugs were expensive because of marketing costs, not investment in R&D.

Hank McKinnell, president of Pfizer, defended the position of the drug companies, but his comments were somewhat overshadowed by scores of activists who marched into the venue carrying mock corpses wrap-ped in black plastic with the slogan “killed by pharma patent abuse”.

They were counterbalanced by 10 young protesters carrying banners supporting drug patenting and capitalism as prerequisites for new HIV/Aids treatments.

McKinnell said people in poor countries living on less than US$2 (Bt80) a day had not access to drugs, either generic or patented.

Public institutions and the private sector should help them by providing financial and technical assistance, he said.

“Let me assure you that your enemy is not patents,” he said.

“Its Aids that is your enemy. Now we have the [US] President Emergency Plan and the private sector is are also working hard to ensure patients get the treatment they need.”

Walden Bello, a sociology professor at the University of the Philippines and a prominent anti-globalisation activist, said the discovery of AZT by Burroughs Wellcome, now part of GlaxoSmithKline, was actually the work of staff at the government-funded National Cancer Institute and Duke University in the United States.

“Big pharma says it is developing 73 Aids drugs,” Bello said.

“Then they are quietly admitting that most of the firms doing this research are in fact receiving substantial government aid via publicly-funded researchers with the National Institute of Health.

“In other words, they are siphoning off taxpayers’ money for essential research and development.”

Thai Aids activist Nimit Tienudom said people living with the disease need to recognise that access to drugs is a basic right that every government should provide. They do not want assistance based on the mercy of pharmaceutical firms, he said.

The government should exercise compulsory licensing as allowed by the World Trade Organisation, he said. This would facilitate the production of an anti-retroviral drug known as NRTZ, now under patent by a pharmaceutical firm.

The drug could be available to 20 per cent of Thai patients who are allergic to the generic GPO-Vir, currently produced by the Government Pharmaceutical Organisation at inexpensive prices.

Free ARV drugs prompt many to declare HIV+ status - July 14, 2004

BANGKOK, : There might be a dispute over how successful the government has been in checking the onslaught of AIDS, but there’s no doubt that its decision to provide free anti-retroviral drugs to about one lakh people by the end of this year is already showing results.

According to the Indian Network of Positive People, the step has encouraged HIV-postive people to come forward and declare their status. The organisation has noted this trend in its centres spread across 13 states and 60 districts. According to the figures, the organisation was helping 6,000 AIDS-affected people since it was formed in 1997. But it has registered at least 4,000 more patients in the past six months.

People have heard about the free treatment and are coming forward and declaring their positive status in the hope of getting free drugs,’’ says Abraham Kurien, president of the Indian Network of Positive People.

The Women’s Group has also witnessed a similar trend. The trend is confirmed by international organisations as well. Julian V. Howes, the Interim Regional Coordinator of the Global Network of Positive People, says: ‘‘The availability of ARV therapy is one of the things that can lead a person to confirm his HIV status.’’ But there are conflicting figures in the 2004 Report on Global AIDS on the number of deaths. ‘‘When there are no exact numbers with the government, how can it give the number of estimated deaths,’’ said a NGO member.

The project for providing free medicines, the brainchild of former health minister Sushma Swaraj, has not found favour with the new government. In the past six months, just 900 people have been put on therapy. ‘‘If the people keep on registering, and there is no promise of medicine, the numbers might start decreasing again,’’ says Ramachandran. ‘‘The medicine, if discontinued after starting, can be fatal,’’ he adds.

Experts call for world's largest HIV vaccine trial to be scrapped - July 15, 2004

BANGKOK, Health experts and activists said Thursday that the world's largest HIV vaccine trial in Thailand is an expensive flop and demanded that it be scrapped.

The multi-million dollar trial involves tests on 16,000 Thai citizens and is the third and last hurdle before the vaccine can be registered and administered freely.

Already one year behind schedule and with fewer than half the volunteers needed, influential scientists, activists and non-governmental organisations have all called for the part US-funded project to be abandoned.

The co-discoverer of AIDS, Robert Gallo, headed a group of 22 US-based HIV experts calling in January for it to be halted saying it is clear the vaccine will not work.

The tests were launched in the hope that if successful, the therapy would give life-long protection against the HIV virus that causes AIDS.

But the Doctors Without Borders group told AFP at the 15th International AIDS Conference here, that it appeared everyone, save the Thai and US governments, thought it was now a waste of money.

"The vaccine is two vaccines in one, and one of the vaccines already trialled has already been proven to be totally ineffective," said Thailand coordinator Paul Cawthorne.

"The voice of people, including renowned scientists, who say this is not going to work is getting louder and louder."

The trial is being held in the two eastern provinces of Chonburi and Rayong, where 47 screening centres and eight vaccine injection centers have been established.

Thai health officials have started administering a combination of two vaccines developed by Aventis Pasteur and VaxGen delivered every six months. The volunteers are monitored for three years.

The vaccine component that has already failed a separate phase three trial is gp120. Thailand's Ministry of Health has combined this with another component ALVAC, which it claims will boost the effectiveness of the first.

But Cawthorne poured scorn on the claims. "Combining together one drug that has been proven not to work and one that's proven to have minimal effect, I cannot see how we are going to move any further forward," he said.

"It's a huge trial with a lot of money invested and for the Thais it's difficult to backtrack because they don't want to loose face."

Thai AIDS campaigners at the summit said the vast sums being pumped into the project would be better spent on prevention and treatment.

"We spent millions of dollars for this no-hope project rather than spending that money on providing antiretroviral drugs for patients," campaigner Paisarn Suwanwong told AFP, adding that Thailand's much celebrated condom campaigns were being starved of funds.

A UN report released earlier this month said the Thai government's budget for prevention programs has been slashed by nearly two-thirds since 1997, to just two million dollars a year.

It also revealed there were clear warning signs of a new wave of infections in Thailand, threatening the good work of the 1990s, when it conducted a no-nonsense 100 percent condom use campaign.

Despite the criticism, and countless stumbling blocks, the Thai Government has vowed to press on with the trial, but admitted it was lagging behind schedule.

The US -- which has committed 119 million dollars to the trial -- defended it and said the combination should be given a chance of success.

The trial is a collaborative effort between the United States Military HIV Research Program, the Royal Thai Army Medical Department and the US National Institute of Allergy and Infectious Diseases.

UN envoy blasts US for "ideological agenda" on abstinence to combat AIDS  - July 15, 2004

BANGKOK, UN Secretary General Kofi Annan's envoy for AIDS in Africa has savaged the US promotion of abstinence and fidelity to combat HIV as an outmoded "ideological agenda" that threatened women's lives.

"It's completely out of date... an ideological distortion," Annan's representative, Stephen Lewis, said in an interview on Wednesday of the so-called ABC campaign, a major part of the US strategy to discourage the spread of the human immunodeficiency virus (HIV) in sub-Saharan Africa and elsewhere.

ABC stands for Abstinence, Being faithful and using Condoms if need be.

Lewis, interviewed on the sidelines of the International AIDS Conference here, derided the doctrine as simplistic and unworkable in Africa, where millions of women were forced into early marriage and exposed to coercive sex.

"What do you do if you are one of the many, many thousands of women married at an early age, what do you do when your husband, who is a minimum of six years older and probably many more years than that, refuses to wear a condom?" he asked.

"What use is abstinence, what use is fidelity, if he is already infected and he brings it into the marriage? People who are fixated by ABC have to start thinking more broadly about other measures of protection."

Lewis was speaking after US President George W. Bush's envoy on AIDS, Randall Tobias, on Wednesday heaped praise on the ABC campaign being conducted in Uganda, where the tide against HIV infections apparently has turned.

"Tobias has an ideological agenda, and the ideological agenda is abstinence over condoms as a matter of public policy. But that ideological agenda, with respect, is wrong, and most of the experts and scientists understand that it's wrong," Lewis said.

He voiced doubt that ABC in Uganda had been nearly as effective as Tobias had suggested.

He noted that the UN agency UNAIDS last week had revised downwards its estimate of the prevalence of HIV/AIDS sufferers in Uganda in the 1990s, as for many other African countries, in the light of more accurate data and better statistical tools.

"If you are correcting your figures retroactively, then it's possible that the prevalence rates you attribute to Uganda in the 1990s were not as high, so the drop is not as dramatic as suggested," Lewis said.

"Even so, all of the people I talked to, and in the UNAIDS report, make it clear that condoms were every bit as important as abstinence and fidelity in responding to the pandemic in Uganda."

He added: "We're caught in this ideological distortion. Instead of people calmly thinking, 'how do we find the best preventive vehicle? Do we look at fidelity? Do we look at laws against early marriage? Do we look at the empowerment of women in different ways? Do we put a tremendous emphasis on female condoms or microbicides? Do we vary the constellation of factors? Instead of that, we get caught in a foolhardy, ideological destructive debate."

Africa accounts for 25 million out of the estimated 38 million people with HIV, and the vast majority of infected Africans are women.

Young women and girls are particularly vulnerable because they are expected to be submissive to their partners, Lewis said.

Of the 6.2 million infected Africans aged between 15 and 24 years, 4.65 million are female.

"Women in marriage have higher prevalence rates than the non-married women in the community around them," said Lewis.

"What does that say about vows of fidelity? What does that say about abstinence, which is neither possible nor desirable in marriage? And what does it say about an imbalanced power relationship with a man who says, 'go to the devil, I don't wear a condom'?"

Lewis' criticism was echoed by many other delegates at the Bangkok conference, where prevention of HIV infection is a top theme.

Tobias, speaking to journalists, said that there had been a "mischaracterisation" about the role of abstinence programmes in Washington's AIDS programme.

Of the 15-billion-dollar, five-year Bush plan on AIDS, less than seven percent would be spent specifically on promoting abstinence, and far more would be spent on other prevention strategies, drugs, personnel training and other areas, Tobias said.

Japan trailing donor world in AIDS fight: activists - July 15, 2004

BANGKOK, Activists urged Japan Thursday to do more to help the global fight against AIDS as they slammed the world's second largest economy for contributing just a tenth of its fair share.

Japan spends just 130 million dollars on the AIDS battle through the world's Global Fund and independent arrangements with needy nations.

"Japan is not committed enough," Helene Rossert, vice president of the Global Fund, the world's war chest to fight AIDS, tuberculosis and malaria, told AFP.

"It's not doing its fair share -- less even than France or Italy."

Japan accounts for more than 12 percent of world GDP, which activists said means the country should contribute 1.2 billion of the 10 billion dollars pledged by donor nations in 2001 to spend every year on the pandemic.

"They've committed just a tenth of that and that is truly shameful," said Khalil Elouarighi of the pressure group Act Up Paris. "They're the worst."

The world's leading economy, the United States, has pledged 15 billion dollars a year over five years, but its 900 million dollars committed in 2003 also fell well short of its fair share quota of 3.2 billion, according to Act Up.

Several dozen protestors stormed the International AIDS Conference here this week and threw mock blood over posters of world leaders, including Japanese Prime Minister Junichiro Koizumi, in protest over the funding shortfall.

"It's important to let Japanese bureaucrats know there is international pressure on them," said Masaki Inaba, a board member of the Africa Japan Forum, a group working with people who have HIV/AIDS.

Japan has largely avoided the HIV/AIDS epidemic with only 8,500 people estimated to be infected.

Hopes for anti-HIV gel in "five to 10 years", AIDS forum told  - July 15, 2004

BANGKOK, Efforts to find a vaginal cream that can kill or block the AIDS virus, thus protecting women during intercourse, are at last making progress and a "safe and effective" product may emerge within five to 10 years, the world AIDS forum heard Thursday.

Microbicidal gels have been one of the most underlooked but potentially beneficial fronts in the war against AIDS, said Zeda Rosenberg, chief executive of a new agency, the International Partnership for Microbicides (IPM).

But, she said, candidate microbicides were now making their way through the research pipeline, where they are being tested for safety on human volunteers and on progressively larger scales to see if they work.

"In 2004, there are 10 microbicides under active development for HIV in preclinical tests and 16 in clinical trials, six of which are in or moving into efficacy studies this year," Rosenberg said.

More than 20,000 women will be enrolled into the six studies over the next three years, she said.

"With this leadership, sufficient financial resources, collaborative efforts and product development expertise, we are confident that women in developing countries should have access to safe and effective microbicides within the next five to 10 years," Rosenberg said.

IPM was set up two years ago to drum up funds and channel it into research into microbicides, following the disastrous failure of the only full-scale trial in this arena.

The organisation is backed by the World Bank, the Rockefeller Foundation, the Bill and Melinda Gates Foundation and five European countries -- Britain, Denmark, Ireland, the Netherlands and Norway.

In AIDS' 23-year history, only one microbicide, a detergent molecule called nonoxynol-9, has been fully tested, and it proved to be a disaster.

It was trialled along with a lookalike product among more than 400 sex workers in Western Africa and South Africa and Thailand. Those who used the nonoxynol-9 three times a day or more were almost as twice as likely to get infected with HIV as those who used the placebo.

The apparent reason: the tough chemicals damaged the lining of the vagina, creating tiny lesions that helped HIV enter the bloodstream.

The emergence of a microbicide would add powerfully to the small arsenal of weapons to prevent sexual transmission of the human immunodeficiency virus (HIV).

Apart from abstinence -- an approach derided by many experts as partially useful at best and potentially dangerous at worst -- there is only the condom, male and female version. No vaccine is in sight.

Women are apparently genetically more vulnerable than men to exposure to HIV.

But they are especially susceptible in Africa. Nearly 60 percent of the 25 million Africans with HIV are women, many of whom became infected through their husbands or boyfriends.

They are expected to be submissive in sex, and cannot persuade or force their partner to wear a condom.

So a gel that women could use discreetly, and which would be cheap and able to cope with a hot climate rather than require refrigeration, would be ideal.

According to a 2002 computer simulation by the London School of Hygiene and Tropical Medicine, a microbicide that was only 60-percent effective and used by only 20 percent of women in 73 low-income countries would save 2.5 million infections over three years.

Rosenberg, making a speech at a plenary session on the penultimate day of the six-day International AIDS Conference, said the life-cycle of the AIDS virus offered up many exciting targets for microbicides.

These included compounds to kill HIV in the vagina or disrupt the virus' ability to attach itself to its target cell.

These so-called entry inhibitors are the basic design in five out of the six microbicides that are being trialled or about to head that way.

Another approach, like a class of antiretroviral drugs, would block reverse transcriptase, an enzyme necessary for virus replication.

But, she said, it was essential for any formula not just to be effective but also safe. It had to preserve beneficial microfauna in the vagina that are called lactobacilli and maintain the vagina's acid balance.

Australian researcher Roger Short on Tuesday presented lab tests in which ordinary lemon juice, when diluted, was found to kill HIV -- a finding that he ventured may provide a cheap and effective form of protection for poor women.

But Rosenberg reacted cautiously, warning that any lemon or lime juice microbicide "should go through the same rigorous screen that other compounds have prior to human trials".

Cultural condoms bridge divide in AIDS battle - July 15, 2004

BANGKOK, Condoms packaged with a hint of humour and tailored towards specific cultural groups have proved an imaginative solution to help stem the spread of AIDS, a family planning charity said at the world AIDS forum on Thursday.

Using provocative marketing -- "Snakes are dangerous in the bush, cover its head so it won't bite you" -- the Marie Stopes International charity has targeted Australia's Aboriginal community in its first condom campaign for a developed country.

The marketing of the "Snake" condoms, packaged in the red, black and yellow of the Australian aboriginal flag, has sparked both comment and sales, according to spokeswoman Rachel Molloy.

"We've tried to approach this very serious issue in a very humorous way because the campaigns that have been most successful are the ones that have been a bit cheeky and a bit naughty," she said.

"Young aboriginals told us they saw condoms as a white man thing and not culturally relevant," she said.

An unexpected bonus has been that the condoms have been snapped up by other Australian teenagers, fewer than half of whom currently use condoms during sex, according to polls.

"All young people are embracing the brand and loads of non-aboriginal kids are buying them as well," said Malloy.

She said the charity had also had a runaway success in India with its "Fire" branded condoms.

China detains four HIV positive people asking for help  - July 15, 2004

Authorities in China's AIDS-hit Henan province have detained four people for trying to protest at inadequate care and other services in the area, rights groups and local police said Thursday.

The four, all HIV positive, were detained in Shangqiu city, Amnesty International said, expressing concern that they could be tortured or ill-treated.

"They may be at risk of torture or ill-treatment, and Amnesty International fears that they may not receive the medical treatment they may need while they are in custody," said the London-based rights group.

Local officials confirmed that people had been detained, but refused to say why.

"I can't tell you anything about this case over the phone," Wang Wanqiang, deputy dirctor of Zhecheng county, told AFP.

Their detention comes as China attempts to face up to its exploding AIDS problem at an international forum in Bangkok.

While Premier Wen Jiabao this week called for stepped up efforts to combat the deadly scourge, translating those words into action in China is a major problem.

In provinces such as Henan, where farming communities have been devastated by the AIDS scandal, officials have stormed villages at night, beating and arresting HIV-infected farmers demanding better care.

Amnesty said Wang Guofeng and Li Suzhi were detained on July 12 as they were about to travel to Beijing to petition the national department.

The couple were said to be concerned that they had not received the medical treatment that the central authorities had promised.

They were also angry that the school their children attended had recently been closed down by the local authorities.

The school had been set up by activist Li Dan for children whose parents were HIV-positive or had died of AIDS.

The two others were reportedly detained on July 9 after getting into an argument with police at a hospital.

They had apparently come to the hospital to petition President Hu Jintao after rumours spread that he was visiting the premises.

Amnesty Says AIDS Is Human Rights Crisis, Faults Thailand's Drug War  - July 16, 2004

Human rights violations and inequalities are contributing to the AIDS pandemic, Amnesty International Secretary-General Irene Khan said at the 15th International AIDS Conference in Bangkok. Targets of discrimination include women, gays, injecting drug users, sex workers, disabled people, migrants, refugees and minorities, said Khan, who cited Thailand for "state-sponsored discrimination" against drug users.

Launched last year, Thailand's crackdown on drug trafficking and use is driving the epidemic underground and cutting users off from treatment and prevention services, she said. Other human rights groups have made similar accusations against the drug war, in which more than 2,500 people have died. Most were killed by rivals or by police in self-defense, the government says. Local and international human rights groups allege many are extrajudicial executions by police.

"Some governments are still looking for a quick fix to HIV, still failing to recognize that human rights violations increase people's vulnerability to infection, and that people living with HIV/AIDS often face grave human rights abuses," Khan said. "Wherever we look, discrimination and inequality are driving the epidemic. Wherever we look, HIV/AIDS exacerbates existing discrimination and creates a fatal combination of stigma and neglect," she said.

Khan asked delegates to demand that China release four HIV- positive people detained in Henan province, an appeal made by Amnesty earlier in the week. Among the four detainees were a mother and father protesting the closure of their children's school, which was set up for pupils whose parents were HIV- infected or had died of AIDS.

"The protection and promotion of human rights is essential if we have any hope of preventing HIV and minimizing the impact of the disease," Khan said. Governments must protect and promote human rights, pass anti-discrimination laws, ensure equal access to health care, and support at-risk groups and HIV-infected people, she said.

Asia's Migrants Carry HIV Along Transit Routes, Need Better Services  - July 16, 2004

Migrant workers, especially sex workers, remain at high HIV risk along Asia's main transit routes and need better health care access near their jobs, UN and CARE International officials said Wednesday. Often, migrant workers are unable to find health care or feel too intimidated to seek treatment because of AIDS stigma in Cambodia, Laos, Vietnam and Thailand, report investigators were told.

"Mobility exacerbates vulnerability to infection, and it also exacerbates vulnerability to the impacts of the disease once you're infected," said Michelle Munro, CARE spokesperson. "These health systems are already stretched," she said. "You've got a disease that people are afraid of... so you're at the edges of health care provision. So you don't go to the hospital, you don't go to the clinic because you're afraid someone's going to be rude to you."

Workers who found support received it from local communities and aid organizations rather than official health care programs, said Munro.

The epidemic is spreading along major roads in India and Pakistan. Road improvements have lead to greater traffic - and HIV prevalence - along routes in China, Thailand, East Timor, Vietnam and Myanmar, also known as Burma, said Lee-Nah Hsu, a UN representative in Southeast Asia.

Companies building highways need to be held responsible for educating rural communities about HIV along the routes. "You need to start when the roads are being built," said Munro.

Fishermen, sailors, farmers and construction workers face especially high HIV risk and move from country to country, said the two reports. Workers in Thai border towns, havens for sex workers, have a high HIV incidence because of lax law enforcement, said Promboon Panitchkpakdi, CARE's Thailand operation representative. In addition, there is a high rate of infection among fishermen - mostly young males - who often visit sex workers after one or more weeks at sea

MALE TO MALE TRANSMISSION: 'Invisible group' issue debated - July 16, 2004

Homosexual men in South Asia, Africa said to be at risk due to cultural taboos

Men who have sex with men (MSM) in South Asia and Africa are arguably one of the most vulnerable groups to HIV/Aids around the world and they face further discrimination as sexual outcasts, according to the findings of several surveys.

This largely invisible group must be addressed if the HIV/Aids epidemic is to be contained, a session at the 15th International Aids Conference was told yesterday.

The situation appears to be most severe in South Asia where many young men's first sexual encounters tend to be with other men as women's sexuality is strictly controlled, said Shivananda Khan, of the Naz Foundation International, which works on the issue in the region.

Khan said cultural factors played an important role in MSM and that male sex work is a significant part of South Asian culture. Male sex workers even provide cheaper services than their female counterparts, he said, adding that many have to entertain three to five clients a night, mostly with anal sex.

"There are no laws on male on male rape," said Khan, who added that the existing cultural construction of masculinity means these people who are penetrated are being socially excluded as less than human.

He cited several surveys supporting the facts, such as one that found that 15 per cent of 527 truck drivers interviewed said they have sex with other men.

A 2002 survey in Bangladesh found that 33 per cent of 124 random male respondents said they had been raped by friends, while 87 per cent said they had been sexually assaulted because they were effeminate.

The situation is similar in Africa and talk about the issue, not to mention leading a campaign for safe sex among MSM, is taboo, said Chukwuemeka Anyamele of the Research Triangle Institute in Nigeria. Anyamele said most African states regard homosexuality as illegal, complicating the fight against HIV/Aids.

Progress being made on HIV gel - July 16, 2004

Vaginal cream that kills or blocks the virus could be produced within 5-10 years: agency

Efforts to develop a vaginal cream that can kill or block the Aids virus, thus protecting women during intercourse, are at last making progress and a "safe and effective" product may emerge within five to 10 years, the world Aids forum heard yesterday.

Microbicidal gels have been one of the most overlooked but potentially beneficial fronts in the war against Aids, said Zeda Rosenberg, chief executive of a new agency, the International Partnership for Microbicides (IPM).

But, she said, candidate microbicides are now making their way through the research pipeline, where they are being tested for safety on human volunteers on progressively larger scales.

"There are 10 microbicides under active development for HIV in pre-clinical tests and 16 in clinical trials, six of which are in or moving into efficacy studies this year," Rosenberg said.

More than 20,000 women will be enrolled into the six studies over the next three years, she said.

"With an epidemic like HIV you have to focus on treatment for all, but historically treatment doesn't end an epidemic," Rosenberg said. "We must also have a combination of new preventive technologies."

And yet, while trials are currently being conducted on 30 vaccine candidates, a viable vaccine appears to be years away, Jose Esparza, director for HIV vaccines at the Bill and Melinda Gates Foundation, said.

This, however, should not prevent world leaders from investing in research and development since a vaccine is the only way to finally end the epidemic, Esparza added.

While microbicides and a vaccine are still in development, several other methods have already proven effective in preventing the spread of HIV/Aids.

Preventing mother to child transmission (PMTCT) programmes in which mothers are given drug treatments to protect their offspring from the virus have reduced transmissions in many countries including Thailand, said Siripon Kanchana from the Public Health Ministry.

Quarraisha Abdool Karim of Columbia University's Mailman School of Public Health also pointed out the continued importance of condom use, including the need to further produce, distribute and promote female condoms.

"The introduction of the female condom in many countries has substantially increased protected coital acts," Karim said. "One issue, though, is that female condoms do remain more expensive than male condoms."

In the end, all panellists agreed that a combined strategy is necessary to fight the spread of HIV/Aids.

"We shouldn't be talking about prevention versus treatment versus research on microbicides and vaccines," Allan Rosenfield, dean of the Mailman School, said. "Instead we should be talking about prevention plus treatment plus research."

'Leaders must focus on vaccine development' - July 16, 2004

Vaccine experts and activists at the 15th International Aids Conference have urged the world to collectively keep up pressure on leaders to focus on developing vaccines for Aids.

As work on treating the symptoms steams ahead, efforts to put an end to the epidemic are lagging behind, Stephen Lewis, the United Nations' special envoy for Aids in Africa, said at a session yesterday.

Dr Seth Berkley, the president of International Aids Vaccine Initiative, echoed those sentiments, saying the world is too focused on short-term solutions, even though the long-term goal is to develop an Aids vaccine to end the epidemic.

"The word 'Aids vaccine' was not even mentioned by any speakers at the conference here," he said.

The world is in dire need of more vaccine candidates, vaccines related to different strains of HIV, and more vaccine trials.

The amount spent on developing an Aids vaccine should be doubled from the current US$650 million (Bt26.6 billion) a year, but the funds should not be diverted from other health resources, Berkley said. A mere 1 per cent of research and development on health products is spent on developing an Aids vaccine.

Long-term commitments from the global leadership and intercontinental collaboration are crucial, he said.

Former US president Bill Clinton, for example, had set a goal to develop an Aids vaccine by 2007 and the president of India had declared it as a national agenda. But so far, Berkley said he had seen no progress in the work.

"But the challenges are how do we turn those declarations of leadership into real leadership, real dollars and real priority to make it really happen?" he said. "And what to do is keep up the pressure."

To encourage societies around the world to act together, the importance of an Aids vaccine must be demystified first, said Zackie Achmat, a prominent Aids activist from South Africa.

Developed nations need to funnel more capital into developing a vaccine, while developing countries need help to build their capacities to carry out trials, said Laetitia Van Den Assum, HIV/Aids ambassador of the Netherlands.

She said she spoke on behalf of the entire European Union.

"A quest for a vaccine must lay at the heart of our collective response," said Lewis.

Mandatory HIV tests mulled for inmates - July 16, 2004

The Justice Ministry is pursuing a plan to have all inmates undergo mandatory blood tests for HIV as part of an effort to prevent the spread of the virus.

"We are going to discuss the plan with the Forensic Science Institute," said Kitti Limchaikij, the ministry's deputy permanent secretary. He promised yesterday that test results would be kept confidential and thus the test should not be regarded as a violation of a prisoner's human rights.

Mandatory blood tests would become a necessary measure in the future, said Charnchao Chaiyanukij, director-general of the Rights and Liberties Protection Department.

Aids has been spreading in prisons through sex between men and illegal intravenous drug use among inmates.

Nathee Chitsawang, the Corrections Department director-general, said the agency was seriously cracking down on drug abuse in correctional facilities, but at the same time it neither encouraged nor banned affairs.

"Our preventative measures are to educate inmates and to provide homosexual inmates with free condoms," he said.

He added that homosexual and/or good-looking prisoners were separated from other inmates in an effort to prevent sexual assaults.

Aids in prisons is relatively under control, and about 1,350 out of the country's 200,000 inmates are HIV-positive, he said. Only those with apparent symptoms are held in separate areas.

Justice Minister Pongthep Thepkanjana supports the availability of free condoms in prisons, saying it would reduce infection rates among inmates. His ministry yesterday received 100,000 free condoms from the Public Health Ministry to promote safe sex.

Meanwhile, the Aids Access Foundation has found that about 10 per cent of 7,000 inmates in Bangkok's Klong Prem Central Prison are living with HIV/Aids, said Nimit Thienudom, director of the foundation.

Lack of ID is the greatest health threat to hilltribes - july 16, 2004

Lack of citizenship documents is the single greatest threat to the health and welfare of hundreds of thousands of hilltribe residents, a forum on trafficking and HIV heard yesterday.

The failure to provide identification papers for hilltribe people - many of whom have lived in Thailand all their lives - violated international agreements the country has signed on the provision of care for women and children, Unesco's coordinator for trafficking and HIV/Aids projects Dr David Feingold said at a forum in Bangkok.

"These women are vulnerable to every form of exploitation," said Dr Feingold.

"They can't register their marriages or even work outside their district [because of restrictions on their movement]," he said.

"This has to be confronted."

The Physicians for Human Rights group echoed concerns raised by Feingold, an American anthropologist who has worked in Southeast Asia for more than 30 years.

Burmese and hilltribe women faced grave repercussions because of "corrupt and discriminatory law enforcement" by the Thai government, the group said in a statement.

"No Status" - a new report released by the group yesterday - documents how the lack of legal standing results in exploitation, a lack of personal security and an inability to access healthcare and other services.

It also elevates the chances of hilltribe people getting HIV/Aids, the group said.

At least half of Thailand's hill-tribe population - estimated at 600,000 to one million people - are not officially recognised as citizens, the group said

Closing speaker lives a life of hope - July 16, 2004

Violeta Ross wants to look as beautiful as possible today as she steps onto the podium to address the closing ceremony of the 15th International Aids Conference.

The 27-year-old Bolivian anthropologist will tell her story of a life living with HIV/Aids, and how she has moved from fearing death to living with hope and an important message to deliver to billions of people - especially those who remain uninfected.

Ross plans to wear her bright red shawl to match a Bolivian-style beige skirt embroidered with colourful flowers. She is a keen Latin dancer, but does not plan to perform today as she wants to spend the limited time given to her on stage for her speech.

"My story is not so sad," she said in an interview with The Nation. "I don't look weak and frail as people may expect people with HIV to look. I am still healthy and happy. In fact I'm even healthier than before I got the virus because I now do a better job of taking care of my body."

The story of Ross is the one of a well-educated, middle-class woman who might have received HIV from unprotected sex. She lost her partner to the disease last year. But the virus could have also been contracted from two strangers who raped her on the street in 1996.

It was not until 2000 that she got tested after being infected by insect bites while she was doing fieldwork on a coffee plantation.

"Of course, I was devastated," she said, recalling when the test confirmed she was HIV-positive. "I went in for the test because I thought I might have malaria or some other tropical disease," she said. "I was naive. I thought, how on earth could I get HIV? I'm not a sex worker or an injecting drug user. I thought those were the only two ways to get infected.

"I did not believe the result and asked to have another test. It turned out the same."

She almost took her own life.

Strong support from her family helped her fight. Today she is a frontline anti-Aids advocate who travels around the world to tell her story, the story of a woman who did not let the disease turn her into a poor victim. She is also pursuing her master's degree and plans her to write her dissertation on HIV/Aids and women.

"I got infected because I had very little knowledge about HIV. And I don't want my mistake to be repeated," she added.

^{Gender is key, say UN bodies - July 16, 2004}

World leaders must take immediate action to end gender discrimination if they hope to stem the spread of HIV/Aids, according to a report by three UN agencies.

"HIV/Aids is not just a health crisis. It is a long-term development, human rights and human security problem," said Noeleen Heyzer, executive director of Unifem.

"If we don't stop it now by addressing its gender dimensions it will destroy all of our development gains."

In the last two decades, the proportion of women infected with the virus has grown tremendously - from 35 per cent of infected adults in 1985 to 48 per cent today.

These numbers are a direct result of gender discrimination, violence against women and the "feminisation" of poverty, according to the report released by the Joint United Nations Programme on HIV/Aids (UNAids), the United Nations Development Fund for Women (Unifem) and the United Nations Population Fund (UNFPA).

"The spread of HIV/Aids among women, especially young women, represents the intersection of many hierarchies of social and economic power that subordinate women to men," Heyzer said. "The message here is, gender inequality kills."

Thoraya Obaid, executive director of UNFPA, said the ABC prevention strategy - Abstain, Be faithful and use a Condom - is not sufficient for preventing women from becoming infected with HIV.

Throughout the world women are subject to sexual violence, rape and child marriages, situations in which negotiating the use of a condom is nearly impossible.

Even marriage often fails to protect women since women have little control over whether or not their partners are monogamous, Thoraya said.

AIDS conference ends with calls for cash and commitment -16/07/2004

BANGKOK, The leaders of the world's fight against AIDS called for renewed political and financial impetus to counter its inexorable march on Friday as they expressed their shame that 38 million people were still living with HIV.

In a blunt appraisal of work so far, a coalition of leaders at the closing ceremony of the world AIDS forum said failure and inaction had contributed to the 20 million AIDS deaths since the early 1980s and vowed to step up the fight against the disease.

"We are ashamed that in 2004 some 38 million people are living with HIV/AIDS and fighting the same battles after two decades," said the Bangkok Leadership statement at the end of the six-day conference in the Thai capital.

"Despite all that we have learned about what works in prevention and treatment, the epidemic is on the rise in every region.

"We recognise that we have not done enough to protect people from new infections. We have not done enough to provide access to affordable treatment and care to all those who need it."

The communique was drafted under the patronage of Graca Machel, the wife of former South African president Nelson Mandela, in the name of health ministers and representatives from churches, youth groups, women's organisations and armed forces who took part in the conference.

The six-day forum has been marked by rows over funding and the commitment of key world leaders in combating the epidemic that now threatens Asia and Eastern Europe with a similar disaster that has hit sub-Saharan Africa.

In a colourful closing ceremony in the Thai capital, Mandela and India's ruling Congress Party leader Sonia Gandhi headed a cast of high-ranking politicians and activists calling for unity, and hard cash, to tackle the epidemic.

"I cannot rest until I am certain that the global response is sufficient to turn the tide of the epidemic," said Mandela, who announced this year that he was stepping out of the public limelight.

"Allow me to enjoy my retirement by showing that you can rise to the challenge," he said before receiving a standing ovation from delegates.

The United Nations said the world had to change its approach and develop a long-term strategy to confront the growing problem, which last year saw nearly five million new cases of HIV, the virus that leads to AIDS.

A quarter of those were in Asia. India, China and Indonesia, home to some 40 percent of the world's population, are viewed as some of the key battlegrounds in the next three years.

The UN said Africa's crippling debt problems -- amounting to 15 billion dollars a year -- needed to be relieved and investment had to be accelerated into the search for vaccines and better treatment.

However, activists said Friday that the conference -- attended by nearly 20,000 people including a record 500-strong official contingent from China -- had helped to awaken Asia to the threat of a looming AIDS crisis.

"It's about mobilising Asia to not go down the route South Africa has gone and to understand that there are populations that are vulnerable," said South African activist Zackie Achmat.

However, frictions remained, particularly over the US's decision to fund projects through individual deals with nations instead of joining in the world-wide response.

The United States has pledged the greatest sums to tackle the disease -- 15 billion dollars over five years -- but activists said the sum was still too small and criticised President George W. Bush's abstinence first policy approach to tackling the spread of AIDS.

French President Jacques Chirac and the European Union also criticised the US trading policy saying it favoured wealthy Western pharmaceutical giants and made it harder for poor countries to get cheap anti-HIV drugs.

The 16th International Conference is scheduled to be held in Toronto in Canada in 2006.

"People's Global Fund" launched in Bangkok  - July 16, 2004

BANGKOK, -It was born in a blaze of publicity at the International AIDS Conference on Friday, given the grandest name with which to start life -- but, for the moment, has just a cardboard box to call home.

The newborn is the People's Global Fund, which aims to encourage all six billion of us to contribute at least one dollar to fighting AIDS.

The scheme was launched at the closing day of the global AIDS forum in Bangkok by Thai Senator Mechai Viravaidya.

At the conference's last plenary session, he held up a cardboard box and dropped a banknote into it, and invited other delegates to follow suit.

An hour later, it was quickly filling with Thai baht, US dollars, euros, yen and other currencies.

"The plan is for everyone in the world to give a dollar," Mechai told journalists. "This is not to go to governments, but to community organisations" fighting AIDS.

Likely beneficiaries would be groups out in the field working with young people and women, the most vulnerable targets for HIV infection, he said.

Mechai said the initiative aimed at stimulating individual commitment to the fight against AIDS.

"Sometimes we expect too much from our politicians. Leadership can also come from the community," he said.

There already exists a Global Fund to Fight AIDS, Malaria and Tuberculosis, which channels money via national governments towards some of the biggest fronts in the AIDS war.

These include the provision of antiretroviral drugs to HIV-ravaged poor countries, training of doctors, nurses and health workers and prevention campaigns.

But Mechai said there was room, too, for more local and personalised initiatives.

After the conference, the money will be put in an interest-bearing account at a Thai cooperative bank, Mechai said.

As more contributions come in, a small but flexible governing board will be named set up to decide how to administer the money.

The European Union (EU) has pledged to pay administrative costs so that contributions are not drained by bureaucracy, Mechai said.

Mechai is a famously colourful figure in the history of the AIDS campaign.

He worked tirelessly in the 1990s to encourage safe sex in Thailand, a role that earned him the nickname of "Mr. Condom" and which is credited with saving hundreds of thousands from infection.