Women account for the majority of pupils that have HIV/AIDS in Nigeria

Introduction

Being a citizen of Nigeria, it is paramount to talk about the issue and rise of HIV/AIDS in the country, Nigeria. The Federal republic of Nigeria is a federal constitutional republic consisting of 36 States and its Federal Capital Territory, Abuja. It also has the third-highest number of people living with HIV/AIDS. This epidemic varies depending on region and social class. In some states, the epidemic is more concentrated and driven by high-risk behaviors, while other states have more generalized epidemics that are sustained primarily by multiple sexual partnerships in the general population. 

The acronym “AIDS” brings fear in many communities in Nigeria as the disease that ravages developing countries in Africa, Asia, and South America. But how much do people know about this terrible disease? This research will provide information for people with little or no knowledge about HIV/AIDS. It is intended to show that there is not enough awareness on how to prevent getting the disease. The disease, HIV/Aids, was first diagnosed in Los Angeles, USA, in 1981. HIV stands for Human Immuno Deficiency Virus, which is a lentivirus slowly replicating retrovirus that causes Acquired Immuno Deficiency Syndrome (AIDS). The human body has a natural in-built immune system (the body’s defense mechanism) that attacks and kills germs and viruses; therefore, without the human immune system as a means of protection, humans could very easily be killed. However, HIV infects vital cells in the human immune system, which makes the cell mediated immunity lost and the body progressively more susceptible to opportunistic infections. (Prince A. Efere, 2010.) 

Africa has 11.6 million AIDS orphans. At the end of 2007, women were accounted for 59% of all adults living with HIV in subsaharan Africa. The population of people living with HIV/AIDS was drawn from the south south zone of Nigeria. This zone was chosen because it has the median HIV zero prevalence rate of 5.2 percent, the 2nd highest in Nigeria (National AIDS/STD control programme/FMOH, 1999). The main goal is reaching 80% of sexually active adults and 80% of most-at-risk populations with voluntary HIV counseling and testing (VCT) by 2015.  Many risk factors contribute to the spread of HIV/AIDS but the youths are yet unaware of these factors. These factors include prostitution, rape and sexually transmitted diseases (STDs), shared needles or any sharp object(s) and irregular blood screening. With a population of 166, 629, 000 (world bank, 2011) Nigeria still retains a high level of poverty with 63% of the population living below the poverty line ($1 daily). 

Research Question

HIV/AIDS is chronically common among vulnerable people, it is a community problem in Nigeria: how can this problem be addressed? How should we decide what to translate and what factors affect the teachers willingness to communicate about HIV/AIDS in institutions and rural community setting? Do attitude functions (Traditional predictors) affect the teachers willingness to communicate HIV/AIDS in institutions and community settings? And lastly How can we encourage interdisciplinary research? Why does Stigma & Discrimination have a significant effect on HIV/AIDS?

Public health information has to be presented in simple language (without jargon) for it to be meaningful and effective. A country like Nigeria has more than 250 ethnic groups, with varying languages, values, ideas and customs; creating a country of rich ethnic diversity. The largest ethnic groups are the Yoruba, Fulani/Hausa and Igbo’s, comprising 62% of population. As a fairly new “issue” research into HIV/AID’s have an impact on attainment in different ethnic diversity is limited and much of what exists predates current technologies and pedagogies. I have attempted to identify sources which have direct relevance to my task while maintaining contemporaneous relevance, also. I want to see how HIV/AIDS fits into the teaching of the three largest ethnic groups in Nigeria, generally and how it fits with other teaching initiatives, such as the Prevention of Mother-to-Child HIV/AIDS Transmission (PMTCT) Support, Antiretroviral Therapy (ART), TB/HIV integration. Whilst providing an understanding of how central government expects to increase awareness of HIV/AIDS in English; it offers no expectations to have an impact on attainment.

Prevention of Mother-to-Child HIV/AIDS Transmission (PMTCT) Support, this process of MTCT (Mother-to-Child HIV/AIDS Transmission) is when an HIV positive woman passes the virus to her baby either through labour, breastfeeding or delivery. Without treatment around 15-30% of babies born to HIV positive women are infected; 5-20% will be infected through breast feeding. In high income countries, MTCT has been virtually eliminated due to voluntary testing and counseling, safe delivery practices and widespread of available breast milk-substitutes. If this process were used in Nigeria, it could save lives of thousands of children each year (Children HIV and AIDS, 2008). Prevention of Mother-to-Child HIV/AIDS Transmission (PMTCT) Support could influence their teaching initiatives by teaching in simple language to ensure effective communication and prevent; unwanted pregnancies among HIV infected women, preventing the transmission from mother to their infant. 

Antiretroviral Therapy (ART), consists of the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease (WHO, 2013) but this does not stop HIV/AIDS infected individuals from facing termination of appointment, hostility, denial of gainful employment, forced resignation or retirement. Leading to the crucial role of Stigma & Discrimination, experienced within the health sector represents one of the most inimical forms of institutional stigma. Discriminative acts among healthcare workers include, delivery of poor quality treatment and counseling services, early discharge from hospital, segregation of hospital wards, isolation, the marking or labeling of patients beds, files and ward, selective application of “universal” precautions and lack of confidentiality.

The background to educating people in Nigeria has led certain type of people to be stigmatized and discriminated upon (Emmanuel Monjok, Andrea Smesny and E. James Essien, 2009). They make some important observations on how the contextualization of use (situated learning) is having an impact learning. Stigma and discrimination are major obstacles to effective HIV/AIDS prevention and care, globally, in HIV/AIDS context it is unique when compared to other infectious and communicable diseases. It tends to create a “hidden epidemic” of the disease based on socially-shared ignorance, fear, misinformation, and denial. This is particularly more intense in sub-Saharan Africa, including Nigeria, where a combination of weak health systems is entangled with poor legal and ethical framework. Significant and relevant research studies are needed to thoroughly understand the consequences of stigmatized and discriminated at the three levels and its effect on HIV/AIDS prevention, treatment and care as it is directly related in the different socio-cultural settings in Nigeria.

According to Emmanuel Monjok, Andrea Smesny and E. James Essien, (2009). The argument of trying to measure the impact of HIV/AIDS on attainment is, on its own, a flawed approach. I agree with their idea that identifying successful techniques for contextual HIV/AIDS tools and developing its obvious disadvantages as a motivator and a tool for rebalancing pupils’ and conceptual misunderstandings. However, I would argue that accepting attitudes towards those living with HIV/AIDS should indicate better knowledge and understanding of HIV/AIDS rather than Stigma and Discrimination.

Written by Bolanle Adekunle

Women and HIV

It is a well-known fact that change is possible, and with change comes improvement. HIV infected women in America; particularly African American women were given something to rejoice for on May 22, 2013. The Center for Disease Control and Prevention announced that the number of HIV infected African American women have decreased for the first time in two decades.

Although the amount of women affected by HIV remained stable throughout 2008 and 2010 it is important to understand why the decrease in infected numbers is momentous for the African American woman. African Americans make up 12% of the population, but they make up more than 40% of the infected HIV population here in America. African American women make up the fourth largest group of infected individuals after White males, African American males, and Latino Males. Did you notice that African American women were the only group of women in the top four infected groups, because I did?

Announcing that the percentage of infected African American women has dropped gives African American women hope. Hope, when given to people with nothing left to believe in may just be the thing that they need to hold on to, to fight for their lives. The percentage drop shows that there is an improvement within this particular group to stop the spread of the disease. “It's probably a little too early to declare victory,” said Donna Hubbard McCree, associate director for Health Equity in the CDC's Division of HIV/AIDS Prevention. “But are we evolving as the epidemic evolves? Are we cautiously optimistic? I'd have to say

Written by Gurwin Sandhu

References:
Center for Disease Control and Prevention
http://www.cdc.gov/hiv/statistics/surveillance/incidence/
The Root
http://www.theroot.com/views/black-women-and-hiv-rates-reprieve

An HIV-AIDS Project in East Africa

                         

Today, I would like to introduce you to my good friend and colleague, Dr Connie Chung, who graduated with a doctorate and two master's degrees in Human Development and Psychology  from Harvard University, USA. In the year 2009, Connie won the Harvard Committee on African Studies project that funded her study on gender and HIV in East Africa and this brought her into close contact with the small town of Iringa, in Tanzania, Africa. She met with Anthropologist Joseph Lugalla, who was part of the Iringa Development of Youth, Development and Children Care and after a thorough research of Iringa and the project’s objectives, began working with the project. I had a conversation recently with Dr Connie Chung regarding her experiences in Iringa and regarding her opinion about women and HIV-AIDS in East Africa. Connie provided me with a keleidoscope of myriad experiences coupled with her inferences from the project and her views. The following is an excerpt of my chat with her………

AB: It is really wonderful chatting with you regarding your experience with the gender and HIV-AIDS project in East Africa. I have been thinking about it and the first thought that comes to my mind is ‘this is such enriching and rewarding experience’. What drew you to this project, Connie?
CC: I was drawn to gender since I had previously worked with young girls who were forced or pressured into prostitution and had volunteered with Aids Project Los Angeles. Some of the girls that I had worked with had contracted STDs during their sex work, and females are more likely to contract HIV through heterosexual intercourse than males.

AB: And what research prep did you do before you left for Africa? What were your expectations?
CC: I wrote a proposal that I sent to my advisor, the Harvard Committee on African Studies, a draft which was sent to an anthropologist who focuses on HIV in Africa and also spoke to an Anthropologist who worked with street youth. I did an extensive literature review prior to coming to Africa.
I was expecting to see a profound level of poverty, given that I was focusing on street children and AIDS orphans. I also expected to have difficulty adjusting to the living conditions and culture.

AB: And did you ? Was it how you thought it would be? How difficult was it?
CC: ……I would say that there are layers to the experience, sometimes painful and at other times joyous.  I had difficulty with the physical conditions of my experience, but over time I grew accustomed to it.  

My exposure to Africa prior to my arrival was very much based on Western media-and sometimes in a way that blended paternalism, sympathy, and/or condescension.  Prior to going to Africa, all I heard about Africans was civil unrest, hunger, apartheid, and memories of commercials showing a destitute or forlorn African child.  These snapshots of Africa are actually very myopic, and often streamed to the West en masse without sufficient education of the complexities of African geopolitics and their culture.  Instead, we lump Africa as some foreign, exotic other,without recognizing its significant internal diversity and the complexities of economic development in the aftermath of colonial rule.  I wouldn't say my experience was as difficult with respect to adjusting to the cultural shock and difference, but I did have individual experiences that were very hard. I was robbed in Kenya, and I remember crying because I woke up in a bed covered with lizards.  The latter story is not typical of what it is like to live in East Africa, but I ended up staying in one house that had a problem with lizard infestation.  I still vividly remember the lizards, and crying because I had never been surrounded by lizards before and thought they would attack me.  Being robbed was an emotional experience too.  I had to grow a thicker skin, and recognize that I was very fortunate to have regular access to basic resources. Over time, I adjusted to the rhythm of meeting my practical needs.  You can be robbed anywhere, so this isn't a statement that if you come to Africa, you'll get robbed.  I know plenty of foreigners who lived in Africa for years on end and have never been robbed.  But those two memories were very difficult for me.

The people were very kind to me.  Many people went out of their way to welcome me to their home, sharing whatever resources they had.  There was a warmth and kindness that permeated my social networks, and I also welcomed the different pace of life and how in tune I felt with my core values.  I did a lot of soul searching in Africa, and I think it offered me a breath of healing. I grew up in Los Angeles, a concrete jungle ripe with the entertainment industry.  Then I moved to Boston, a city with a high proportion of academics who are intensely ambitious and/or competitive.  In East Africa, I lived in a house with chickens, boiled water to sanitize it regularly, bathed in a plastic tub, and sometimes didn't have a toilet, running water, electricity, or a shower.  I passed chickens on the way to work, and sometimes saw monkeys cross my path.  My mom grew up in a similar way, having been raised on a farm.  But I wasn’t.  I loved my new life.  

AB: It sounds like a bittersweet experience in some ways Connie. But considering that you were for a project, let us talk about the project a little. Tell me about the condition of women in general and those afflicted with HIV in Africa. How did the project identify those requiring help? Who were you focussing on?
CC: Tanzania, Africa is a complicated place. I specialized in Iringa, Tanzania which is a major travelling center for migrant workers going to Zambia and other countries. There was a high proportion of men migrating for seasonal labor and contracting HIV and then spreading it along migratory transit routes where sex work was common. Tanzania, Africa also allows polygamy so a man could infect multiple wives at a time. So, the magnitude of the problem is colossal. Education and socio-economic status were big barriers. Most of the cohort lived on less than a dollar a day and condoms were very expensive. Cultural beliefs were sometimes at odds with utilizing condoms and there was still a lot of cultural stigma about HIV and a very high prevalence. HIV/AIDS afflicts a high percentage of various regions in Africa, an anecdotal figure of 16% of Iringa residents has HIV.
From what I understand, the organization had social workers who found street-based children (female and males) who were living in destitute conditions outdoors. Many of whom had been orphaned by AIDS, and sometimes contracted HIV on the streets or from birth. In terms of adult women, we often worked with Masaai women who were semi-nomad tribal women. However, I am unclear as to their HIV status: this was more in the context of  microfinance aspects of the organization with business development models.

AB: What did the project hope to achieve ? And was this feasible?
CC: I think this project was excellent at providing support for AIDS orphans through housing, educational supports and also provided microfinance/business loans and small business developmental training to impoverished women and youth. Once you contract HIV, consistency and availability of ARVs is critical. Some of these people seemed to be able to access ARVS but were not always consistent in taking their prescriptions. However, I personally believe that enriching people's lives by poverty reduction efforts, educational outreach, and social support, the project was able to provide some degree of support and help to the women and children afflicted with HIV-AIDS.

AB: Was anything done at all in terms of medical aid to these women and children? How were the resources and facilities medically? Did these women have access to them?
CC: In terms of medical care, IDYDC provided care and support to HIV positive people across age and gender groups. It partners with Family health International, Football for Hope movements, USAID, Engender Health-CHAMPION project, International Youth Foundation, GrassrootSoccer, and FHI-Tunajali project for more resources that are health-specific.

AB:  What is the understanding of the people and particularly the women afflicted with HIV-AIDS and their knowledge about HIV?
CC: I think that when you are dealing with functionally illiterate women who may be highly intelligent but didn't have the resources to attend school, understanding Western conceptualizations about medical diseases can be very foreign and different. Also, these women are dealing with life stressors that are so intense: 5 or 6 children, living in severe poverty, without clean water, etc. that more information that does not align with their indigenous beliefs can be difficult to adopt or practically enact

AB: Did they volunteer for the HIV test? Did the project offer incentives for these tests?
CC: I do not know.I am not sure if there were incentives for taking HIV tests through this organization. I think testing centers are prolific, but many people are reticent to actually get tested and know their status. There is still much cultural stigma related to HIV status, and sometimes people claim to have malaria instead.

AB: How do you think gender inequality affects a woman with HIV status in Africa?
CC: I think gender inequality affects women's access to health care, education, social support, and making empowered decisions about their sexual health. Encouraging condom use actually
assumes that women have egalitarian stakes and choice in the elective use of a condom.
Sometimes men may forgo or refuse condoms on the basis that it numbs their pleasure, and some women who do not have the resources to survive on their own may simply go along with what their partner says. 80% of HIV infections in Tanzania are via heterosexual sex.
Saying no to sex, using condoms, or limiting sexual partner exposure (such as a man who sleeps with multiple women, or accumulating one's own partners) are contingent on other variables related to power, access, status, and gendered ways of being where women are often in a position of less power yet the irony is that women are more likely to be infected with HIV from heterosexual penetration than men. But sexual decision making is undergirded by so many cultural ways of relating and understanding gendered norms that women may sometimes be put at a disadvantage and then subsequently have less resources once they contract the disease ,even if contracted in a situation of oppression or forced assault.

Gender inequality isn't so always so concrete, or black and white.  The preceding example of not being in a position of reciprocal power in negotiating sexual health precautions, such as condom use should not be exaggerated that African men are mysogynistic or that African women are just victims of gendered and other forms of structural/personal oppression.  That would be an over-reduction of a complex issue, and not the case in many relationships between partners.  However, there are still some deep seated cultural norms about gendered roles, gendered separation of labor, and ways of negotiating relationships-particularly for such a delicate topic as sexual intimacy-that I myself am not privy to, or do not fully understand.  I never dated an African man, and many cultural ways of family/gendered life are still very alien to me.  However, some ways of relating that I did observe, as a cultural outsider, not from a rigorous form of study or investigative research-is that many of the women that I dealt with (which does not represent all Africans, of course)-and who are predominantly very poor and have low education/literacy levels, is that they were often highly reliant on men for basic survival, and sometimes that changes the tenor of how sexual and other personal decisions are negotiated in a way where the women were less advantaged, or in a position of elevated risk for HIV.  

AB: From what you have just mentioned, it sounds like these women have very few choices with regards to their life. Did you have the opportunity to speak to any of these women personally?
CC: Yes I spoke to them personally when I was there. I think that choice and opportunity are not only personal, but structural in nature.  So I do want to underscore that many hard working, highly intelligent African men also confronted significant limitation in their occupational or educational trajectory.  In the areas I visited, the levels of poverty could be very severe.  Poverty is a compounding risk factor-it permeates everything from health care, to education, to literacy, to risk for HIV, to family dynamics, sexuality and gendered norms, family dynamics, and engagement with civil society.  So the range of choices that many (not all) of these women confronted may be very limited in comparison to an African of better economic resources and education, and extremely limited in comparison to many middle class Westerners-however, they still aren't victims.  They still exercise choice, even if these choices are made in extreme challenge, hardship, or duress.  

AB: Do you think you were making any difference to them particularly if they were HIV affected?
CC: Population movement among young men in Tanzania is extraordinarily high and this is also a barrier to health care, medication compliance, and maintaining care. My own feeling is that the biggest difference is when you empower people to empower themselves on a grassroots level. IDYDC staff are primarily composed of local Tanzanians or people who permanently relocated to Tanzania to help out. So any effort that I put in should ultimately be about facilitating indigenous populations to access resources, and thereby build their own networks that heighten social capital to help their own people. If anything, they made a greater difference in my life. They changed my perspective about life and love, what poverty looks like, and how resilient the human vessel is when faced with horrific poverty and abuse

AB: Do you feel considering the multitude of problems we have just discussed, the project was a success? What would you call a success ?

CC: The aim of the organisation is to decreased incidence rate of new cases of HIV infection over a 5-10 year span and to create a greater awareness of HIV/AIDS, destigmatization of the illness and people who are infected and strengthening social support and quality of life for HIV-infected persons. ARVs have changed the quality of life for people with HIV. Encouraging patient compliance, targeting dimensions of health, education and poverty reduction, all strong protective factors for HIV are important goals. If you live without access to clean water, you're functionally illiterate living on less than a dollar a day, if you live on one meal a day, then you have to address success as a whole person-their socio-emotional needs,  improving the health care access and consistency of client use of available medical care in already infected persons, nutrition, clean water, essentials for good health when immune functioning is already suppressed from the virus, and educational needs.

Me: Would you like to share what you learnt from this experience and how it changed you to be a better person?
CC: I learned many personal and spiritual lessons from this experience. I learned the power of human resilience in the face of atrocious adversity. Many of these girls/women still laughed, had families, had friends, tried to do the best with what little resources they had: fighting for a bit of food with whatever skills they could muster. I also learned that by virtue of being born in the United States, I was shielded from many assaults such as starvation that afflict many persons in developing nations.I learnt that I was lucky to have clean water, access to a doctor and was fortunate to be able to read and have an education. Hope takes many disparate forms
and tenacity is often built in the mires of deep and insufferable anguish. In terms of what I learned about women, I will say that I learned that gender inequality is reified and reproduced in a culture of silence and shaming.  When women don't have access to clean water, regular access to food, proper health care, who cannot read, and who are sometimes reliant on sex work to survive-it may be difficult for them to fully embrace, or practically institute changes, that reflect Western medical notions about health care and safer sexual health practices.  I really believe in the power of communities advocating for themselves on a grassroots level-African women advocating for African women, Africans advocating for Africans, and this should be done in a climate where basic resources and sheer physical survival are not the most pressing concerns of the day.Then as women grow economically, they can charter a different course in how they conduct themselves in sexual/romantic relationships, and how they negotiate sexual decision making.
and make choices about their bodies, their health, their voice, their opinions, and decide on their fundamental core values in a climate of safety, respect, and understanding. I am not claiming that African culture is anti-women, or that I understand the sophisticated, complex and subtle dynamics that subsume gender relations but that gender and how women empower themselves are still issues that need to be debated, voiced, and loudly heard. It is then that HIV/AIDS, poverty, rape, sex trafficking, abuse, (all of these conditions which also affect boys and men) will have less of a chance to thrive in such an environment of openness, destigamatization, and personal empowerment.

Thank you Dr Connie Chung. We thank you for sharing your experience and wish you all the best for future endeavours.


Dr Anusmita Baruah

The impact of gender inequality on women afflicted by HIV- what are we doing about it?

Entrenched gender inequality burdens and tearingly debilitates girls and women when afflicted by HIV and AIDS, particularly in the lower socio-economic strata,  restricting their access to social and economic resources and even the necessary support services. It has implications on a girl’s education. It has implications on her economic opportunities and it implies stigma and discrimination.  The stigma and discrimination is definitely greater for women than men. 

There are several studies that conclude how poverty compels women to exchange money for sex and goods thereby placing them at a high risk for contracting HIV-AIDS. All over the world, governments have focussed on policies to raise awareness and particularly address and mitigate concerns that spill beyond the health sector. And yet, the magnitude of the problem continues and the burden is borne most heavily by the female gender.

I would like to now narrate a story of how recently I met a woman who had tested positive for HIV. Perhaps because I was not known to her and perhaps because she did not feel much threatened by me, she opened up to me. She lives in self imposed isolation, in fear and only one or two people know about this. I was appalled and shocked by her ‘resignation to her fate’ and how in this day and age she appeared worried about trivia like stigma and discrimination.  She said to me ‘ It is hard being a woman. Whatever the times and however modern and progressive we are.’  She said there were a multitude of things she needed to think of and she did not want to restrict her access to any of the social and economic opportunities that she currently has. To this I exclaimed that she needed support and help and isolating herself and pretending normalcy would not help. She replied ‘ Learn to live in society, Learn to be pragmatic. You are not going to make a difference. And particularly because you are a woman.’ My mind was in a turmoil for long after this. I compared her with a friend of mine who recently died of cancer and thought how vast the difference was! My friend had friends and family to support her all throughout.  It made me think life was not fair and that things do not need to be this way. It made me think, does a woman from a much poorer background stand a chance at all then? While we talk big. Here was a woman from a more affluent strata very much living in fear and particularly mentioning about the burden of being a woman. So what chance of education, support and acceptance by society does a woman with a poorer background have?  

When are we going to open our eyes and make life worth living for everyone? What are we doing to remove such entrenched gender inequality which does not appear to spare her even when she is ill?

By Anusmita Baruah

[headlines] USA: Police practices fuel HIV epidemic

Sex Workers at Risk From Condom Policy
July 19, 2012 -- Police in New York, Los Angeles, Washington, DC, and San Francisco are confiscating condoms from sex workers and transgender women, undermining health department campaigns to reduce HIV, Human Rights Watch said in a report released today.

The 112-page report, “Sex Workers at Risk: Condoms as Evidence of Prostitution in Four US Cities,” documented in each city how police and prosecutors use condoms to support prostitution charges. The practice makes sex workers and transgender women reluctant to carry condoms for fear of arrest, causes them to engage in sex without protection, and puts them at risk of HIV and other sexually transmitted diseases. The report was released prior to the 19th International AIDS Conference, in Washington, DC, starting on July 22, 2012. The US response to the epidemic will be in the spotlight before 20,000 delegates gathered from around the world. The four cities investigated are among the hardest-hit in the US, with over 200,000 people living with HIV among them.

“Sex workers in each city asked us how many condoms it was legal to carry,” said Megan McLemore, senior health researcher at Human Rights Watch. “One woman in Los Angeles told us she was afraid to carry condoms with her and sometimes had to use a plastic bag instead of a condom with clients to try to protect herself from HIV.”


Human Rights Watch interviewed more than 300 people for the report, including 200 current and former sex workers as well as outreach workers, advocates, prosecutors, public defenders, police, and health department officials.

The report includes testimony from sex workers and transgender women who said that police harass, threaten, and arrest them for carrying condoms. In New York, Los Angeles, and San Francisco, prosecutors introduce condoms into evidence at trial, asking courts to consider them indicators of criminal activity. For immigrants, arrest for prostitution can mean detention or removal from the United States. Some women told Human Rights Watch that they continued to carry condoms despite the potentially harsh consequences, but many did not.
One sex worker in Washington, DC, said, “Police always ask ‘why do you have so many condoms?’ No one walks around with a lot of condoms because of it.”

New York, Los Angeles, Washington, DC, and San Francisco have reported high rates of HIV among sex workers and transgender women, and targeted HIV prevention among these groups as an urgent priority. The US government provides millions of dollars to each of these cities to prevent HIV among groups at high risk, including sex workers and transgender women. Yetsex workers told Human Rights Watch that they turned down offers of condoms from outreach workers.

“These cities gave out 50 million condoms last year,” McLemore said. “But the police are taking them out of the hands of those who need them the most.” Police and prosecutors defended the use of condoms as evidence, saying that the practice was necessary to enforce anti-prostitution laws and that condoms are one tool that helps obtain convictions against prostitutes, their clients, and those involved in sex trafficking.
But law enforcement efforts should not interfere with the right of anyone, including sex workers, to protect their health, Human Rights Watch said. State or city governments should ban the use of condoms as evidence of prostitution. A bill proposing this ban recently failed to pass in the New York State legislature.

Barring the use of specific types of evidence in criminal proceedings is not uncommon where there are competing public interests. For example, in each city addressed in the report, clean needles are available for drug users to reduce HIV and hepatitis C infection, and municipal law enforcement and public health officers collaborate to ensure programs can reach those most at risk. In all 50 states, “rape shield” laws forbid the use of a victim’s sexual history in court, even if it has probative value in a given case, because the harm generally in admitting such evidence is simply too great.

“In legal systems everywhere, evidence is excluded because it is judged to do more harm than good,” McLemore said. “Eliminating HIV infections is a national priority and ensuring the availability of condoms among those at highest risk is critical.”

Human Rights Watch found that police stops and searches for condoms are often a result of profiling, targeting suspected offenders for the way they look, what they are wearing, and where they are standing, rather than on the basis of any observed illegal activity.

In New York, Washington, DC, and Los Angeles, many people, particularly members of the transgender community, told Human Rights Watch they had been stopped and searched for condoms while walking home from school, going to the grocery store, or waiting for the bus. Broad loitering laws in these cities invite profiling and discrimination and should be reformed or repealed, Human Rights Watch said.

Sex workers in New York, Washington, DC, and Los Angeles also described abusive and unlawful police behavior. Police sometimes subjected transgender women to vulgar insults, mockery, and disrespect. Transgender women described being “defaced” by police who removed their wigs and other clothing, in one case throwing it to the ground and stepping on it. In New York and Los Angeles, women reported that some police had demanded sex in exchange for dropping charges.

Few of these women filed complaints, both for fear of further abuse and because they had no faith that police would respond with fairness and integrity. The US Department of Justice should investigate police treatment of sex workers and transgender people in New York, Los Angeles, and Washington, DC, Human Rights Watch said.

The report also called for local, state, and federal leadership to stop the use of condoms as evidence of prostitution. The Obama administration has highlighted the need to reduce HIV among women and girls, a goal that remains out of reach for many sex workers and transgender women.

“The AIDS Conference is a perfect opportunity for Washington, DC, and the other cities to announce their intention to end the use of condoms as evidence of prostitution,” McLemore said. “Criminalizing HIV prevention undermines human rights and endangers the public health.”
Human Rights Watch Press release

HIV/AIDS - CASH PAYMENTS HELP CUT HIV INFECTION RATE IN YOUNG WOMEN - STUDY

Research in Malawi finds girls who receive regular payments are able to resist attentions of older men and avoid infection.

Sarah Boseley, Health Editor, The Guardian – 15 February 2012

The randomised controlled trial was carried out in one of the poorest parts ofMalawi. Photograph: Martin Godwin

Regular small cash payments to girls and young women can enable them to resist the attentions of older men and avoid HIV infection, according to a new study.

Girls and young women are at the greatest risk of HIV infection in endemic countries. In sub-SaharanAfrica, between a quarter and a third have the virus by the time they reach their early 20s.

But educating girls about risks and promoting condom use has had little impact in countries where they are struggling with poor education, low status and poverty, and where older men with money offer one of the few ways out of financial difficulties.

A team of researchers from the World Bank, University of California at San Diego and GeorgeWashington University in the US carried out a randomised controlled trial in Malawi to find out whether monthly payments to schoolgirls and their families would help change the girls' behaviour and safeguard their health.

They recruited nearly 1,300 young women, aged from 13 to 22, who were enrolled in school in the Zomba district of southern Malawi – an area of poverty, low school enrolment and high HIV prevalence.

The young women were randomly assigned, according to where they lived, either to receive between $1 and £5 a month, with their families given between $4 and $10 a month, or to get nothing. At the end of 18 months, the girls were tested for HIV and herpes infection.

The study, published online by the Lancet, found that girls who had received money were less than half as likely to have HIV as those who had not been paid – 1.25% (seven out of 490 women) compared with 3% in the control group (17 out of 796).

While the numbers who contracted HIV were relatively small, the researchers believe it shows a significant trend and would make a substantial difference across the population. There was a reduction of three-quarters in the risk of herpes, another sexually-transmitted infection.

Half of those who were given money got it only if they attended school, but there was no difference in the infection rate between those and the others who were paid regardless. Nor did the amount they and their families received make a difference.

Girls in the groups receiving payments were more likely to be in school than the others. Condom use did not go up, but the girls were less likely to be having sex frequently and less likely to have a partner over the age of 25.

"The findings suggest that financially empowering school-age girls and their families can have substantial effects on their sexual and reproductive health," write the authors.

In a commentary also published by the journal, Dr Nancy Padian, from the School of Public Health,University of California, Berkeley, and colleagues, say the findings "add to the increasing evidence suggesting that economic development and anti-poverty programmes can alter the context of sexual decision-making and, thus, HIV infection risk".

At a cost per case of HIV averted of $5000-$12,500 (£3,167-£7,918), paying individuals to stay healthy might seem expensive, they say, but it is still probably cost-effective and cheaper than putting people on antiretroviral drugs, which has been shown to reduce the risk of HIV infection.

DO NOT LOVE ME TO DEATH!!!

Based on a true story

The definition of love is as old as mankind and each is based on variety of perspectives. Some define love as caring and wanting the best of the person even if it means putting behind one’s own individual needs. Love is to see the best in a person despite their flaws, believing in them even when they don’t believe in themselves, notice and appreciate every good trait about them, think about all the time and so on.  

So you decide to spend the rest of your life with the person you love to make a home and raise kids together.
My name is Zainab. I was born and raised in Northern Nigeria. I went to an Islamic school and not the western type. My father is a strict and loving Muslim cleric.  Of course with my father inclusive, we are a family of twenty five consisting of four mothers and nineteen siblings. I am the sixth girl among eleven and four are married. When I decided to get married I wanted to do it because I was in love and not to foster family ties or get married into a wealthy family, as some of my sisters did.

I found my mate in Musa, who was handsome, caring, a devoted Muslim and rich man. Yes, I was ready to be his wife, to the envy of other girls in my community. And so we got married, of course with my father’s consent. 

I felt fulfilled. I had my own home in which I was comfortable, and a husband who cared for my every need and one whom I loved unreservedly.

This story was supposed to be happily ever after, or so I thought. 

A year later, there I was, in the market when my brothers came to tell me that my father needed to speak with me urgently. With my heart in my mouth I asked “what is happening? Is Mama sick? Please do not look clueless” I pleaded.  But I got no response. The instruction was to bring me to my father without delay.
My father smiled as I entered. “Sit down Zainab”, he said. “Is there anything you should have told me about Musa before you got married?”

I looked puzzled at my father, “No Baba, I told you all that I know about him, I would never lie to you” I answered.

“You are going not back to your husband’s house, Zainab,” “I have sent your uncles to investigate the report I got from your aunt, Hajara. And I expect the confirmation in the evening today”.

This discussion was going nowhere. I was becoming infuriated. I know he is my father, but what right did he have to tell me not to go back to my husband’s house. I did not elope to get married; I received consent from the man sitting across from me. Yes, my father.

“Zainab” Baba called. “Musa is HIV positive”.

‘He has been HIV positive for over a year and has been going to the General Hospital where your aunt Hajara works to get his Antiretroviral drugs.”Baba softly told me, looking into my eyes.
I sat dazed, as my father narrated the events that led to my aunt finding out about Musa’s status. 

Aunt Hajara is a senior nurse at Tudun Wada General Hospital. She met Musa on our wedding day, but I now remember she had asked if they had met somewhere prior to the wedding day because he looked familiar. She had seen him at the hospital severally after we got married, and became curious when he went into the same office at every visit. After enquiries, my aunt found out from a colleague that Musa was a registered HIV patient who receives his medication from the hospital. 

Aunt Hajara was bewildered. This is my niece’s husband, who has been married for a year, is Zainab also HIV positive and did not tell her parents?
My heart palpitated as I keenly listened to my father. My husband,Musa?
“How could he have done this to me”? I cried.
“We loved each other so much but not to ruin and slowly end the others’ life”. I screamed, with tears uncontrollably running down my cheeks.

All this happened two years ago. I am now the proud mother of a baby boy, Aminu.
I never went back to the home I had with Musa. My father took me for series of HIV tests which all came back negative! I waited agonizingly six months after and the tests were still negative. It is not an experience I would ever want anyone to pass through in life.
My aunt Hajara, counseled me on the importance of HIV testing before marriage and even when pregnant so as to avoid passing it on to the unborn baby.
I had to put my life together, with the help of my family. A year later, I met Jibril with whom I am now married and we have a child together.
And we were both tested before we got married and also when I became pregnant.
So how would you define love?  To live with your spouse,  no matter what, till death do you part?



By Hadiza C. Danlami.