Volume 2, Number 18
April 24, 2002

In this edition:

• U.S. Pledges to Help Caribbean Fight HIV/AIDS
• United States' Initial $300 Million Gift to Global Fund to Be Sent Immediately
• Nearly One-third of South African Gold Mining Company Work Force is HIV-positive
• AIDS Expected to Kill 17 percent of Mozambican Teachers by 2012
• Number of HIV Cases Doubles in India
• Portugal has EU's Highest Rate of HIV
• Kenyan Youths Form Virginity Club to Fight HIV
• Hong Kong Teens Know Less About Sex than 10 Years Ago
• Tanzania Bans Condoms for Prison Inmates
• Drug Abuse Fueling Indonesia's HIV Epidemic
• Child Prostitution a Global Problem
• Hepatitis C Deaths in the U.K. Set to Overtake Those from HIV
• Scottish Police Chief Want Blood Tests of Those Who Assault Officers

U.S. Pledges to Help Caribbean Fight HIV/AIDS

The United States will send health experts to help Caribbean governments fight the regional spread of HIV/AIDS, Health Secretary Tommy Thompson said Saturday. "We are here today to extend to you and the Caribbean, the hand of partnership as we fight" against HIV/AIDS, Thompson told more than 20 Caribbean health ministers and other officials at a one-day conference. The meeting, sponsored by the United States, focused on patient treatment and care, training health personnel, and collaboration among donor countries to fund programs. Thompson said experts from the U.S. Centers for Disease Control would travel to the Caribbean to work with regional officials. The United States will help the Caribbean get funding from the non-governmental organization including the Global HIV/AIDS Fund, to which the United States has so far pledged $500 million and proposes to give $1.1 billion next year, Thompson said.

The U.S. Agency for International Development has already offered $20 million to the Pan Caribbean Partnership to combat HIV/AIDS infection, he said. "Most Caribbean countries are unable to provide adequate access to care and treatment," Denzil Douglas, prime minister of St. Kitts and Nevis said, citing a lack of money, skills and technology.

Though the infection rate in the United States has declined, it has increased in the Caribbean, Douglas said. People in the Caribbean have the world's second highest infection rate after sub-Saharan Africa. An estimated 2 percent of people, or 500,000, are HIV-positive, according to the Caribbean Task Force on HIV/AIDS. The statistics exclude Cuba, where extensive treatment and prevention have kept infection rates low.

[Association Press, 4/20/02]

United States' Initial $300 Million Gift to Global Fund to Be Sent Immediately

U.S. Health and Human Services Secretary Tommy Thompson, the U.S. representative to the Global Fund to Fight AIDS, Tuberculosis and Malaria, said this week that the United States' initial contribution of $300 million will be made available to the fund "by the end of the week" and noted that the contribution could grow to more than $500 million by the end of the year. The United States has already earmarked $300 million for the fund, and President Bush has asked for an additional $200 million in this year's budget. "At the end of this year we will have contributed at least $500 million, but Congress has the opportunity and usually increases the amount of money. So I would say it would probably be higher than $500 million by the time Congress gets through with it this fall," Thompson explained. The global fund was established last year after U.N. Secretary-General Kofi Annan said an annual "war chest" of $7 billion to $10 billion was needed to fight HIV/AIDS, TB and malaria in the developing world. The United States was the first, and remains the largest, donor to the fund.

However, the administration has been criticized for not allocating enough to the fund. At the fund's board meeting this week in New York City, Annan said that the fund must act "as an effective complement to other actors" involved in combating the three diseases, including governments, non-governmental agencies, international organizations and the private sector. According to Annan, the fund faces three major challenges: "moving quickly," ensuring that fund resources have a "maximum impact where they are most needed" and assisting in the mobilization of additional "commitment and resources." To meet these challenges, the board will have to "walk a tightrope-- balancing the need to work quickly with the need for careful consultation with a wide range of stakeholders," he said.

[Kaiser Daily HIV/AIDS Report, 4/24/02; Associated Press, 4/23/02]

Nearly One-third of South African Gold Mining Company Work Force is HIV-positive

Gold mining giant AngloGold estimated Wednesday that between 25 and 30 percent of its South African work force was HIV positive and called for a coherent national strategy to combat the AIDS epidemic. One of the world's largest gold producers, AngloGold has about 44,000 South African employees, while another 6,000 work at its mines in Argentina, Australia, Brazil, Mali and Namibia. Its HIV prevalence estimate was based on tests done last year on more than 1,800 employees. The results were in line with previous research done by the company, said Dr. Petra Kruger, a manager of AngloGold's HIV/AIDS program. While dated research indicated that 98 percent of miners were aware of AIDS and how it was spread, there was no recent data available to indicate whether there had been a change in their behavior, she said. AngloGold estimates that at its peak, the epidemic will cause its gold production costs to rise by between $4 and $6 an ounce. The company said if were to do nothing to manage the epidemic, this cost would rise to $9 an ounce.

"AngloGold has a comprehensive response to HIV/AIDS, from preventative management programs to the provision of assistance to and treatment of those who are affected," Bobby Godsell, the company's chief executive officer, said in a statement. "This strategy will ensure that the company... continues to function profitably."

The government estimated last year that about 4.7 million South Africans - one in nine - are HIV positive, and has been widely criticized for not doing enough to combat the epidemic and provide access to treatment. A study carried out by the independent Medical Research Council found up to 7 million people could die of AIDS by 2010, unless there was more active intervention.

[Associated Press Worldstream, 4/24/02]

AIDS Expected to Kill 17 percent of Mozambican Teachers by 2012

At least 17 percent of Mozambique's teachers will die of HIV/AIDS during the next 10 years, according to a new study released on Wednesday by the education ministry. "The picture is somber, with the disease taking a serious toll amongst our teachers," deputy education minister Telmira Pereira told state radio. AIDS is already the leading cause of death among teachers at all levels of education.

Pereira did not say how many teachers were currently infected with HIV or how many had died. Schools in the impoverished southern African country are already suffering a serious shortage of teachers that has left millions of children without classes.

HIV is most prevalent among young people, particularly in urban areas and along the key transport routes linking Mozambique with Zimbabwe, Zambia and South Africa-- nations that have some of the highest infection rates in the world. Most of Mozambique's teachers are young and the rate of infection among them is higher than among the general population. Official statistics show 12 percent of Mozambique's 17 million people are infected with HIV, while a further 700 people are infected every day. AIDS orphans in the country number about 300,000 and the United Nations Children's Fund estimates that number will top one million in the next five years.

[Agence France Presse, 4/24/02]

Number of HIV Cases Doubles in India

The number of HIV cases increased in India by 2.8 percent to 3.97 million last year, reports citing government figures said Wednesday. The figure stood at 3.86 million in the year 2000, Minister of State for Health A. Raja told parliament. Some 765 people died of AIDS last year, compared to 378 in 2000, Raja said. But observers said the figures of AIDS deaths and HIV cases is much higher since the government's figures are based on cases registered with the official National AIDS Control Organization and a large number of cases go unreported.

[Deutsche Presse-Agentur, 4/24/02]

Portugal has EU's Highest Rate of HIV

Portugal has the highest rate of HIV in the European Union, and is the only nation in the 15-member bloc where rates of infection are rising, the National Statistics Institute said on Wednesday. The institute said there were 104.2 cases of the AIDS virus for every one million residents in Portugal in 2000, compared with 88.3 cases in 1999. The EU average is just under 25 cases of HIV per million residents. Portugal recorded its first case of AIDS in 1983 and the number of new cases has continued to rise in each subsequent year.

"I believe HIV infection rates may be stagnating, but are not yet declining," said the national coordinator of the fight against AIDS, Fernando Ventura, at an AIDS conference earlier this month. Health authorities say drug injection is the main source of HIV infection in Portugal. Some 4,600 people have died of AIDS in Portugal since 1983, according to the National Commission Against AIDS.

[Agence France Presse, 4/24/02]

Kenyan Youths Form Virginity Club to Fight HIV

In a move aimed at containing the rapid spread of HIV/AIDS in Nakuru in Kenya's Rift Valley province, the town's youths have formed a Virgins' Club open to boys and girls as members. Club chairman Patrick Kinyanjui, a member of the Active Peer Counselling Catholic Youths in Nakuru, said that the club was necessary as a vehicle to encourage abstinence of both sexes prior to marriage. Kinyanjui also extolled the virtues of virginity as a means to guard the dignity of the club's members before God and society. Virginity was also a virtue worthy living for especially at this era of the HIV/AIDS pandemic, he added. He appealed to fellow youths in the country to engage themselves in meaningful activities to enable them to contribute to the national development. He also challenged the youth to practice abstinence if they wanted to be free from other sexually transmitted diseases, which contributed to the contraction of the pandemic, said to be claiming 700 people in the country daily.

[Panafrican News Agency (PANA) Daily Newswire, 4/23/02]

Hong Kong Teens Know Less About Sex than 10 Years Ago

Teenagers in Hong Kong know less about sex today than they did 10 years ago despite being more sexually active, a survey published Wednesday claims. Many of those questioned failed to answers basic questions about sex and showed a decreasing knowledge in their awareness of important issues such as AIDS and sexually transmitted diseases.

The Youth Sexuality Study 2001 carried out by the Family Planning Association interviewed 6,000 young people aged 12 to 27 last year. It found that almost 9 percent of boys and 5 percent of girls aged 14 to 18 have had sexual experiences compared to only 1.2 percent of boys and 0.2 percent of girls 10 years ago. The 18 to 27-year-olds are also more sexually active today with 40 percent of men and 30 percent of women saying they had had sex before marriage, compared to 27 and 19 percent of their counterparts 15 years ago.

Around 30 percent of boys and 20 percent of girls aged 14 to 17 did not know that having more sexual partners increased the risk of getting HIV. Twenty-three percent of boys and 16 percent of girls thought AIDS could only be contracted through homosexual sex-- a higher level of ignorance than 10 years ago when 12 percent of boys and 14 percent of girls believed it so. However, the pregnancy rate among women aged 18-27 was 14 percent-- the first decrease in 20 years.

[Deutsche Presse-Agentur, 4/24/02]

Tanzania Bans Condoms for Prison Inmates

The Tanzanian government has refused to supply inmates with condoms as a way to control the spread of communicable diseases including HIV in its congested prisons, local media reported Sunday. Minister for Justice and Constitutional Affairs Bakari Mwapachu explained over the weekend at the House which is in session in the central town of Dodoma that the law bars people of the same sex to engage in sexual intercourse. According to media reports, bisexual relationship among prisoners is practiced in high level, which in one way or another increases HIV infection to prisoners.

The minister was responding to a supplementary question by a parliament member who raised concern over what he termed "increasing diseases" among prison inmates including HIV. Mwapachu said that convicts were classified before being locked in according to age, nature of offense, sex and overall behavior. All preventive measure were taken to control the spread of communicable diseases in prisons. However, he admitted that Tanzania has failed to implement the United Nations Standard Rules for the treatment of prisoners as the rise in crime had resulted in overcrowding in the jails and the government could not mobilize enough money to build more prisons. Mwapachu said that Tanzanian prisons have a total capacity of catering for 21,188 prisoners, but there are now 45,000, more than twice the combined prisons' capacity.

[Xinhua News Agency, 4/21/02]

Drug Abuse Fueling Indonesia's HIV Epidemic

Activists say that Indonesian prison authorities have long been aware that the country's prisons were plagued by rampant drug use and drug dealing, but corruption stopped them from doing much about it. Now that drug abuse is being singled out as one of the major reasons for a rise in the number of HIV/AIDS among Indonesian inmates, activists say jail authorities must move to address the problem.

"Drugs are readily available in the country's prisons because of some corrupt authorities," says AIDS activist Baby Jim Aditya. "And in the country's prisons, the drug dealers and drug users are together, making it difficult to control the use of illegal drugs." Indeed, the drug deals in the Cipinang prison in East Jakarta alone was reported to have amounted to at least $2,100 last year. According to the National Narcotics Agency (BNN), the use of illegal drugs among inmates is prevalent, making them prone to HIV infection, because the virus can spread through the sharing of dirty needles, as well as 'unsafe' sex. Experts point out that the latter is more likely to happen if at least one of the partners is under the influence of drugs.

Endang, head of the contagious disease department of the Jakarta Health Agency, confirms that "the spread of HIV in prison cells is mainly due to the sharing of syringes among drug users and unsafe sex."

In the Salemba penitentiary in Central Jakarta alone, results of random blood tests conducted from November to December last year showed that at least 22 percent of 200 prisoners who were tested for HIV came up positive. Random blood testing in the Salemba correctional center, where all the inmates are male, started in 1997. It had its first cases of HIV in 1998, when at least 19 or 3.8 percent of 509 blood samples tested positive for the virus. In 2000, about 44 or 17.5 percent of 250 blood samples were detected with HIV.

"All correctional and detention centers in Jakarta have cases of HIV/AIDS and the virus is spreading very rapidly," says Jakarta Health Agency chief A. Chalik Masulili.

Sigit Priohutomo, chief of guidance and evaluation section of AIDS and STD Control Program of the Ministry of Health, notes: "The increasing number of HIV/AIDS cases in Indonesia's prisons is related to the rising number of IDUs (injecting drug users) in the country. "The number of IDUs in the country is increasing very rapidly and the risk to contract HIV/AIDS is also increasing very much," he says. Data from the Ministry of Health showed that more than 50 percent of drug users in the country are IDUs. To make matters worse, authorities now say that Indonesia has become a producer of illegal drugs as well.

The health ministry also says that the number of people with HIV in the country reached 1,904 in 2001, up from 1,172 in 2000. The cumulative total of recorded AIDS cases stood at 671 by the end of last year, up from 452 by end-2000. Experts say the real number of Indonesians with HIV/AIDS could be much higher. Health Minister Achmad Sujudi himself says that the actual number of people with HIV could range between 80,000 and 120,000.

For all this, earnest efforts to limit if not stop drug use among prisoners seem to have begun only recently. Some jail personnel have been among the culprits in the spread of drug use behind bars. On March 22, a guard in Cipinang penitentiary in East Jakarta was caught conducting drug transaction with an inmate in the high-security prison building. Authorities, however, admit that this was hardly the first case involving prison personnel, since a number of security guards have been caught selling drugs in the penitentiaries over the past years.

In the meantime, no one, including non-government organizations (NGOs), has yet begun any anti-HIV program specifically for the country's prisons. But some say this is not surprising given the government's lack of commitment to addressing HIV/AIDS issues. Jakarta-based AIDS activist Chris Green says part of the reason why NGOs have been slow to come up with anti-HIV/AIDS campaigns for the prisons is that "like the government, we have limited resources and funding."

[Inter Press Service, 4/19/02]

Child Prostitution a Global Problem

An estimated one million children around the world are forced into prostitution every year, and the total number of prostituted children could be as high as 10 million, according to a report published in the April 20th issue of the Lancet (2002;359:1417-1421). "Child prostitution, like other forms of child sexual abuse, is not only a cause of death and high morbidity in millions of children, but also a gross violation of their rights and dignity," wrote co-authors Brian M. Willis, of the CDC, and Dr. Barry S. Levy of Tufts University.

Boys as well as girls are being prostituted and, according to the report, some of the children are as young as ten years old. "Most of these children are exploited by local men, although some are also exploited by pedophiles and foreign tourists," the authors wrote. They estimate the number of children exploited by prostitution is highest in India (400,000 to 575,000); Brazil is second (100,000 to 500,000); the United States is third (300,000); and in fourth place are Thailand and China (200,000 each).

Willis and Levy report that, worldwide, millions of children are infected with STDs, have abortions, attempt suicide and are raped each year. They note that in parts of Southeast Asia, 50 percent to 90 percent of children rescued from brothels are infected with HIV.

"A coordinated international campaign is needed to prevent child prostitution, provide services to children who are prostituted until they can be removed from prostitution, and implement effective recovery and reintegration programs," Willis and Levy note. "For [such a] campaign to be successful, it will require global coordination, implementation at national, regional and community levels, and the leadership of many health professionals."

[Reuters Health, 4/19/02]

Hepatitis C Deaths in the U.K. Set to Overtake Those from HIV

There is a potentially fatal viral infection that is eight times more common than HIV. It poses the largest public health threat since HIV and both the medical community and the government have known about it for 12 years. But unlike the government's response to the HIV crisis in 1983, there is no national policy for dealing with this new virus and changes to the National Health Service management structure are likely to make matters worse. The virus is hepatitis C and until last month, when the actress Pamela Anderson admitted she had contracted the disease from her ex-husband, most people had probably never even heard of it.

About 300,000 people in the UK are infected with hepatitis C, according to conservative estimates from the Department of Health. Only 35,000 have been diagnosed; the others are unaware of their condition. Some may have had the disease for as long as 20 years but attribute their symptoms-- tiredness or aches-- to flu or exhaustion, rather than to a viral infection that could lead to cirrhosis, liver cancer or even liver failure.

People who inject drugs have one of the highest infection rates for hepatitis C but, as the virus is spread through blood-to-blood contact, there are other routes of transmission. Cases of infection have been reported through tattoos or body piercing, shared razors and toothbrushes and shared "straws" for cocaine snorting. Some people who received a blood transfusion before 1991, when screening for the virus was introduced, also became infected. The virus has also been linked to sexual intercourse.

Treatments are available and can be highly effective. In its 2000 review of hepatitis C treatments, the National Institute of Clinical Effectiveness suggested 7,000 patients should be treated in three years. But few regions implemented this guidance. In the UK only about 0.4 percent of the infected population (1,300 cases) has received treatment.

If predictions are right, UK will face a 500 percent rise in the need for liver transplants in the next five years, with the number of hepatitis C deaths overtaking those from HIV. The cost to the NHS is difficult to calculate. But liver transplants alone, which cost Pounds 4.4 million a year in the five years to 2000, could rise to Pounds 22 million a year.

[Financial Times (London), 4/23/02]

Scottish Police Chief Want Blood Tests of Those Who Assault Officers

Police chiefs are urging the Scottish Parliament to introduce laws which would force people who assault officers to undergo compulsory blood tests. The Scottish Police Federation (SPF) said its members faced an "increasing risk" from criminals and drug addicts infected with blood-borne diseases such as HIV and hepatitis B and C. In a petition to the parliament, the SPF said tests would reduce the "mental and psychological trauma" suffered by officers following an attack. The association, which represents 98 percent of police officers, said more than 150 officers a year were potentially exposed to infection. In a submission to the Public Petitions Committee, SPF general secretary Douglas Keil said an officer who had been infected also posed a risk to the public.

Mr. Keil said accused persons were often asked to submit voluntarily to a blood test but most of them refused. He said: "Even negative tests on accused persons will be of great value in reducing the mental and psychological trauma to which officers are subjected. The results of such tests would also be of evidential value in determining whether accused persons had knowledge of their condition when deliberately biting or spitting at police officers or any other victim."

The petition said compulsory tests should apply to those who have "exposed or potentially exposed" officers to risk of infection. And it called for the Data Protection Act 1998 to be amended to allow the information to be retained on the Police National Computer. A spokeswoman for the Scottish Executive said it gave "the highest importance" to the safety of police.

Councilor Lesley Hinds, convenor of Lothian and Borders Police Board, said she would have concerns about any new law covering assaults on police officers and not health service workers.

[Evening News (Edinburgh), 4/23/02]

The HIV Update International is a weekly report of articles, studies and other information related to HIV/AIDS, sexually transmitted diseases and related risk behaviors from around the world compiled from various news sources by the Children's AIDS Fund.

The Children's AIDS Fund is a non-profit, non-partisan organization dedicated to helping limit the suffering of HIV-impacted children through direct assistance and resources, as well as through technical assistance for their parents and care-givers. For additional information call (703) 471-7350.

www.childrensaidsfund.org