"All Well at Gangtok - Final Update - Bit by bit account of the event"

Dr Avi Kumar Bansal

Dear All,

At the outset, my deep acknowledgements and thanks for all the blessings and wishes showered by all for our safety through the event.

I further thought I must share the nightmarish experience, bit by bit, that we went through.

This earthquake was of magnitude 6.9 with its epicenter 60 Kms north of Gangtok in North Sikkim. If we remember, the earthquake which had devastated Bhuj in Gujarat in 2001 was of the same magnitude. To make things worse it had been heavily raining in Sikkim which is unusual for this time in the year for this region, which was resulting in landslides at places.

The STO Sikkim Dr.Dorjee, Dr.Taufique and myself were in Manipal Medical College (MMC), located 10-14 kms from Gangtok and on another hilltop, the whole day on 18th September 2011. We were overseeing the near-perfect preparations for the Zonal Task Force Workshop done by Dr.Tewari (HOD and Prof, TB&Chest Deptt, MMC), Dr.Dorjee and Dr.Toufique the whole day. At around six p.m. after having ensured all preparations in place Dr.Dorjee, Dr.Toufique and myself started to depart for Gangtok as we had to come back to receive DDG and the rest of the CTD team at 10.00 p.m. who had started their journey from Bagdogra for Gangtok (an extremely wonderful 120 Km drive by the riverside of Teesta all through out).

As we boarded our vehicle (a Scorpio Jeep) and the driver had just started the engine, the vehicle all of a sudden, started swaying violently. It was felt that the vehicle was being tossed in the air, off from the ground by at least half a feet. On one side of the road was a steep fall off the hill and on the other side was the five-six storeyed building of the college. Everybody in the jeep thought that some severe problem had developed with the jeep and that the engine was going to explode. While the driver was being asked to switch off the engine, we realized that the vehicle could go down the slope and at the same moment Dr.Toufique recognized that the problem was not the jeep and screamed to get out of the vehicle and run for cover. At the same time all the lights went off. As we jumped from the jeep, I saw a sight which left me completely bewildered at the power of the forces of nature. The huge building of the college was swaying like____ (I don’t know) and a nearby hill (visible right in front) was shaking. Standing right underneath the building I started saying my prayers and was frozen for a moment, thinking I would run towards the other side from where the building would fall. Toufique had been shouting to follow him to an open space on the other side of the building. During all this panic while we could search for an open space the quake stopped. Panic had set in but fortunately no damage, to life or property, had happened in the college. Once we realized what had happened, our nerves had settled down and ensured that no damage had happened nearby, thoughts of safety of all the participants of the ZTF workshop travelling to Gangtok crossed our minds. But as happens usually, the emergency services get crippled first in an emergency, the mobiles were off, the electricity was gone and all contact systems had gone for a toss.  Battery power became a precious commodity.

I personally felt that the quake had occurred for more than a minute (as against 48 seconds reported on television). So many events happened in this short time.

The STO decided to move to Gangtok form where there could be some possibility of getting information on the event and whereabouts of the participants who were in all probability could have been trapped on the roads. The way back was also eerie with huge rocks having fallen on the road. In Gangtok the whole city had taken to the roads but again fortunately no damage had happened to lives and property except for buildings having developed huge cracks and some of them having tilted too. Reaching back some communication could be established and it was learnt that DDG and the whole CTD team alongwith the NE consultants were trapped between two landslides at a town Mahelli. I could get to speak to DDG only 4-5 hours after the quake. No whereabouts of a few participants were known. Some of them had started their journey back to Bagdogra.

The road from Gangtok to Bagdogra had closed due to landslides at various places. God was kind and did not let rains come for 4-5 hours post the quake which let people be on the streets and withstand the two aftershocks. The whole night Dr.Dorjee and Taufique spent ascertaining the whereabouts of other people, arranging for accommodation for the workshop participants as and where possible. DDG and others with him could be accommodated in Mahelli town by the efforts of the CMO of the district there. 

With rains returning at 11.00 p.m. the people had a hard time balancing between shelter and the aftershocks. The entire Gangtok spent two nights on the streets for the fear of the quake coming back. 

The morning thereafter DDG and others could take a route to Bagdogra via Darjeeling and reach safely. Whereabouts of all participants were ascertained by Dr.Dorjee and advised/helped suitably. Dr.Behera, Dr.S.K.Sharma and Dr. Sinha (Asstt. Prof. AIIMS), who were in Gangtok since Saturday, were met in the morning and advised to leave on the next day, once the roads were properly cleared.

The whole event was indeed terrible but I left the place with my Belief in GOD only further higher, since clearly the damage that had occurred was definitely much-much lesser looking at the magnitude of the quake.

But above all what moved me were a few acts of great character, which perhaps help us to tide over such periods of crises. It is rightly said that the character is truly revealed during adversities. 

The first I would say was the whole citizenry of Gangtok which were astonishingly calm and composed during the crisis. Not a single case of stampede, theft or any mis-adventure was reported anywhere. The people were helping themselves and also others, whether they were people caught in traffic or their older citizens, the women and the children. 

The second was the administration, local and central, which swung into action immediately. Electricity was restored in 6-8 hours, the roads were opened by afternoon the next day, relief was dispatched within 1-2 hours and the law & order being completely maintained.

The third was the STO Sikkim who had completely abandoned his family (very much in distress) to be with us the whole night and arranging and ascertaining for the security of the workshop participants. The anger was visible in his daughter’s eyes when we could meet her the next day. But she can be proud of her father who left his self aside to help others in this moment of crisis. 

And the fourth was none other than our Dr.Toufique who inspite of all nervousness and distress decided not to leave the place till all the workshop participants had reached safely and further to stay back in Gangtok in case there is a recurrence of the quake and be there for the people of Sikkim. Dr. Toufique left only once the situation had returned to normal in Gangtok.

Thanking one and all, once again and sincerely praying for all those who have been affected by the quake.   

With Regards

Dr Avi Kumar Bansal is one of the National level Consultants of the Revised National Tuberculosis Control Program (RNTCP) of India. Recently he visited Gangtok to participate in a regional event of RNTCP and eye witnessed the devastating earthquake while traveling on the hilly roads. He expressed his feeling in a language that came from the bottom of his heart and shared with his colleagues in RNTCP. Dr Avi has given permission to Universal Health to post his write-up in the blog that describes the dreadful natural calamity  second by second exactly the way we watch in a movie.

Thank you Doctor for your great contribution.

ANN A VICTIM OF SEXUAL ABUSE

Uchenna Anozie, Nigeria

 Nigeria an oil rich country in Africa, once regarded as the giant of Africa has been experiencing political instability, corruption, inadequate infrastructure and poor macroeconomic management. They country has suffered from decades of military rule and failures in constant economic reforms. Lots of people live below one dollar per day.

I noticed that there are so many female sex workers in the country, brothel based, non brothel based and unidentified sex workers.

Aside from sex workers in the country, I realized that sexual exploitation of young girls has been a very common practice in the country and the most surprising issue is that these girls are not aware of safe sex practices.

I took my time to talk with about 40 young girls exploited sexually and their ages ranged from 12, 15 to 18 years in my state Anambra state, Nigeria and I came up with lots of stories and events.

However one fact remains that parents do not loud the incidence of such sexual exploitation because they always want to protect the images of their daughters, they generally believe that if such cases are mentioned, it might lead to stigmatization of the girl in her community which might make it difficult for her to get married much later in future. Marriage in eastern part of Nigeria is prestigious and most times women that are unmarried and are of age are disregarded in the society, this has ended up leading to numerous hidden and unmentioned child sexual abuses in the province.

I personally realized that most young girls are forced into child labour to help carry the economic burden of their families, these practices often takes place in form of road side hawking and trading of snacks, sachet water, bread and numerous items on the road sides, motor parks and bus stops.

The suffering under the scotching sun can be unbearable for adults talk less of young females, men then seize the opportunity of their suffering to give them little money or gifts to entice them for sex exploitation and due to the economic situation of the country many parents do not really care how their daughters make extra money from the little items they sell. These girls are most often engaged in unsafe sex practices, sexual abuses and violence of several degrees.

This ugly situation has given rise to the increase of unwanted pregnancies and very high rate illegal abortions in the region and entire country Nigeria. Most of the abortion which has not been taken seriously by the Government of the country is administered by quark practitioners. This has led to many untimely and unfortunate deaths of poor young girls. Money demanded by these abortionist ranges from 3000 naira to 10,000 naira. To worsen the matter health workers have been aiding this dirty act in the country without being penalized. There are also traditional health practitioners that administer herbs that lead to abortion of unwanted pregnancies and often lead to other health complications or even fatality.

I further found out that lots of girls ranging from the ages of 10 to 18 years were maids  and lived with alien families that they served either to generate money for their families or to merely survive. More than 70% of these young girls are not been sent to schools irrespective of the fact that primary school education is free in the country and state government secondary schools in the province has been made affordable, their guardians or newly found parents that they serve preferred not sending them to school rather they stay at home and carry out all sorts of domestic works in their homes, these set of girls generally called maids face various human right abuses such as brutality, rape, lack of good food, stigmatization of all sorts, open humiliation and intimidation of various degrees.

Ann a girl of 16 narrated her ordeal to me, of how she was constantly sexually abused by the man of the family she served and his 2 grown sons in the universities. She narrated her ordeals with tears rolling down her chicks of how she was maltreated by the madam of the house. She never knew what a sanitary pad looked like, she was made to understand that toilet roll and unkempt cloths were meant to be used during her menstrual periods, she was practically denied education and was promised that sometime in future she will be sent to a vocational school where she will learn tailoring.

I asked Ann what she wanted to be and she said she has ever aspired to becoming a doctor or a nurse. Ann’s future was totally jeopardized but I tried telling her that life goes on and nothing is too late to achieve.

Ann further told me of how she was always given an unnamed pills to take after being sexually abused by one of the boys in the house, I asked Ann why she did not report all her ordeals to the madam of the house and she told me that the madam will kill her or send her packing and going back to her village will be worse for her because her dad was late and the mother had 11 children and as a poor rural farmer, she cannot sustain her family.

I further investigated to know how she was brought to the family and she confirmed to me that a Revered sister of the roman Catholic Church came and convinced her mother to take her to a good God fearing family that will assist her achieve her dreams in life and make her a better person. Without any prejudice lots of young children mainly girls are been taken away from their homes by missionaries and contractors whom convince their parents in the village that their daughters are being taken to better homes where they will be ensures quality education and all sorts of beautiful promises. These girls then end up in forced labour, sex machines and punching bags.

Ann has presently gone home to stay in the village with her poor family and take her fate as it goes. She cannot forget her ordeals in the hands of her foster family in the city and still upholds her dream of becoming a great health worker in her community someday, sometime in future.

Ann is a girl I cannot easily forget in my life she is presently enrolled in a rural government primary school and she greatly believes in her inspirations.

LESSONS

·         Slavery still exists in Nigeria in the name of maids.

·          Child right is poor in Anambra state and abused on daily bases in Nigeria.

·         Missionaries and many contractors pose to mean good for parents and children and turn out to be child traffickers

·         Sexual abuse remains an untold constant event in the province and all parts of Nigeria without apprehension because of social and cultural factors bonding females.

·         These young girls are vulnerable to STI/HIV/AIDS, they lack knowledge of safe sex practice and are being exposed to sexual abuses.

·         These young girls end up in the streets frustrated and they turn out to become female sex workers, drug users and even join in high criminal activities which are common in the country.

·         The psychological torture experienced by these vulnerable young girls is simply unimaginable and only those that are lucky turn out to become responsible people in life.

·         This type of practice has given rise to many unwanted pregnancies and street children that lack parental love and care.

·         The government of Nigeria has little or no concern for children and the poor. They just give political statements that end up not improving the quality of lives of poor children and her citizens.

·         Serious attention is not given to health workers and quarks that conduct illegal abortions in the country which has led to the painful and untimely deaths of many girls.

Ann is just one in a million young girls that has and are still currently suffering from untold and unrevealed forced labour, sex exploitation, brutality, forced illiteracy and other social vices.

 I urge human right activists, religious organisations, health workers and all members of  civil society to say no to child abuse and sexual exploitation of young girls. Children remain our future hope and strength.

TB and Injecting Drug Users

Part 1: Are IDUs the most potential candidates for MDR-TB and HIV co-infection?

Sugata M 

Conversion of latent TB infection into TB disease is accelerated by the influence of HIV. The people living with HIV and AIDS have 60-70% more chances to be affected by TB in their life time. TB remains as the major killer of the people living with HIV and AIDS worldwide.

MDR TB (Multi Drug Resistant TB) is caused by Mycobacterium Tuberculosis strain which is resistant to two of the key anti-TB drugs – Rifampicin and Isoniazid. It is a gradually increasing problem which is evolving in many countries and raising steeper challenge in the TB control initiatives of the countries. Chronic dug defaulters, poor airborne infection control in the healthcare set ups and irrational usage of antibiotics by the healthcare providers are key reasons that give rise to MDR-TB. The treatment of MDR TB is 100 times costlier than treatment of normal TB and needs prolong treatment (daily therapy for 24 – 27 months).   XDR-TB is the severe form of DR resistant TB where person affected by MDR TB shows resistance to several drugs used to treat a MDR-TB patient including valuable injectable medicines.

HIV transmission is highly enhanced among the drug users who inject drugs into their bodies and  share needles and syringes. Sharing of injecting tools is actually the culture of the drug users, especially those who are poor, illiterate and belong to the low socio-economic strata of the society. The culture is attached with a strong recreational value that is still existing in many parts of the world and helping rapid transmission of HIV. Though evolvement of the harm reduction strategies like NSE (needle syringe exchange), OST (oral substitution therapy) are becoming popular and gradually accepted and adopted in the country’s HIV/AIDS policy, rapidly increasing HIV transmission, especially among IDUs in the countries of Central Asia and Eastern Europe is a source of major concern. Political unrest, drug trafficking, high level stigma and social intolerance towards drug users and inadequate policies and strategies to tackle the HIV epidemic among the criminalized high risk population groups chiefly IDUs and sex workers are flaring up the problem. There are increasing evidences of overlapping of sex work and injecting drugs in many places of this region. Selling sex for buying drugs and sharing injecting tools with IDU partners – sex workers are being affected in both ways.

Recently, to add fuel to the spreading fire, association between MDR-TB and HIV has been established in countries like Latvia, Estonia and Moldova indicating HIV infected individuals are at higher risk to harbour DR TB strains. This survey concurs with the earlier reported survey conducted in Ukraine in 2006. Furthermore, in Lithuania – where drug resistance data could not be disaggregated by HIV-negative and unknown HIV status – HIV-positive TB patients had a 8.4 (95% CI: 2.7–28.2) times higher odds of harbouring MDR-TB strains than TB patients for whom HIV status was unknown, indicating a possible association of the two epidemics. 2 studies in Thailand showed such association where many IDUs were there in the study group.

Let’s have a look at the HIV situation of these countries of Eastern Europe.

Estonia has already demonstrated the highest rate of HIV transmission and highest adult national HIV prevalence in Western and Central Europe. As per the current statistics of the country 6444HIV infected cases has been registered in the country though as per WHO data one as for one hundred adult Estonians is infected by HIV. The transmission of HIV in this country has been chiefly occurring through sharing of contaminated needles and syringes among the IDUs and HIV prevalence among IDUs has been estimated as high as 72%.

In Latvia, HIV prevalence has double the European Union average rate but remains below Estonia and a few other European countries. 3981 cases have been registered as of 2007 and 63.2 % of the infected population is IDUs.

Lithuania has the lowest HIV prevalence among the Baltic states, out of 1300 registered cases as of 2007 (as per the official data of the country’s AIDS centre), 75% is IDU.

Ukraine is the first country to reach estimated HIV prevalence of 1.5% among the age group 0f 15 – 49 years and a majority of them are IDUs. HIV prevalence among the IDUs is estimated to be between 39 – 50%.

In Moldova, despite the apparent changes of transmission patterns, the HIV epidemic is largely concentrated among the IDUs.

In Georgia, in 2009-10, MDR among new TB cases, previously treated TB cases and TB/HIV co-infected cases were 6%, 27.4% and 23.8% respectively, denoting strong suspicion towards association of MDR-TB and HIV. Georgia is a low-prevalence country with widespread of IDUs. According to the UNODC report Georgia has the highest rate of opiate abuse (.6% of adult population) of the Caucasus countries.

It is evident that 50 – 70% of the HIV infected population of these countries belong to groups of IDUs.

If these countries have also established association between MDR-TB and HIV, doesn’t it also indicate that the IDUs are actually the first and foremost victims of the deadliest co-infection?

Unfortunately, it is not possible to come to such conclusion now because of lack of global data, especially related to IDUs who have been affected by TB or TB/HIV.

                                                          (Sugata with IDUs of Nepal in 2008)

What obligation do developed countries have to the third world in times of economic struggle?

Uchenna Onyekwere, Nigeria

With an impending $300 billion dollars in tax cuts and other spending cutbacks in President Obama’s jobs plan it is logical to wonder if global health projects will be eclipsed by more important domestic initiatives in the US. The same thought could be applied internationally since it can be shown that globally, economies are suffering. Dr. J Steven Morrison, Senior Vice President at the Center for Strategic and International Studies mentioned in a blog post about the impending budget cuts that the US will cut funding directed to global health by 9% and foreign aid by 18% overall.  One reason for this is that unemployment is  still very high, and not only in the US. Unemployment is at 9.7%, 9.1%, 8% in France, the US, and Brittain respectively. Despite any amount of global health advocacy by any group or individual, each nation is expected to ameliorate domestic issues first before attempting to save the world.
So this begs the question: What is the extent of the responsibility of developed nations to the 3rd world when it comes to healthcare? The simple answer to this in my opinion is that there are no responsibilities especially in times of economic hardship. At this point, everyone has been affected in some way. It is inconceivable that a sovereign nation will be bound by obligation to another without the colonization or absorption of the sovereignty of said nation. The role that the US and other developed countries have played in the development of healthcare in third world countries is driven strictly by the advocacy of individual groups and private companies with an interest in those nations, and also politicians with an interest in re-election. For example, USAID has a Global Health Initiatives program which distributes funding to individual interests groups that specifically request funding for specific projects. It appears that that global health interests are less vital for re-election than domestic ones. In an effort to evade annual budget cuts , Rajiv Shah, an administrator for USAID, appealed to republican House Rep. Charlie Dent that the proposed $120 million dollar cuts to USAID could result in the death of 70,000 children across the globe. What was the response? “Can I just quickly change subjects?” Video of the appeal and response below.

Video: http://bit.ly/nNaD4B
Third world nations will need to find a way to exercise a lot more self-sufficiency in terms of funding and implementing their health initiatives, especially under economic times such as what we are currently experiencing. Global health funding from developed nations is no longer guaranteed in duration or amount. However, it seems that for many 3rd world countries, self-sufficiency is the direction many are headed towards. For example, the Philipines is exploring public health practices in reproductive health with the introduction of a Reproductive Health bill currently in debate while in Nigeria there is heated discourse about the direction of the countries public health programs and emergency response protocol in light of the recent attack on the UN building in Abuja. Hopefully, by the time full economic recovery has been established globally, third world nations will no longer require first-world assistance.

Uchenna Onyekwere is a medical student of Nigeria, currently studying medicine in B.S. Biological Sciences, University of Maryland Baltimore County.

THE FATE OF PRISIONERS IN NIGERIA

Uchenna Anozie, Nigeria

Nigerian Prisons

Presently, there are a total of 145 convict prisons, 83 satellite prison camps in Nigeria.
According to the Nigerian Prisons Service, the conventional convict prisons are designed as remand for both the convicted and awaiting trial inmates.  There are two major types of convict prisons operational in Nigeria today namely: The maximum and the medium security prisons.  The maximum security prisons take into custody all classes of prisoners including condemned convicts; lifers, long term prisoners etcetera.

Prison Population

 In 1989, the staff strength of the service was 18,000, a decrease from the 23,000 in 1983. By 1976, the average daily prison population was 26,000, a 25 per cent increase from 1975.
 In 1989, Nigeria’s prison population was about 54,000. Lagos State was said to have accounted for the largest number then 6,400. Anambra, Kaduna and Borno had 4,000 each while Ondo, Kwara and Ondo had less than 1000 each.  By 1989, the prison population had reached 58,000.

Admission of inmates increased to 130,000 in 1980 and 206,000 in 1984 and subsequent years.

The Nigerian Prison system was supposed to exist with the full complement of legal, vocational, educational, religious and social services but the situation has remained pathetic. There is the absence of classification of prisoners as in young and old, pre-trial detainees, first time offenders and suspects who committed minor offences as they shared the prison facilities with dangerous criminals or second time offenders 

Recently, the Comptroller-General of Nigerian Prisons Service, Olusola Ogundipe, said some of the 47, 682 prison inmates across the nation’s prisons had spent 17 years in detention without trial.
Speaking at a one-day quarterly roundtable on prison reform, Ogundipe stated that as at July 31, 2010, the total prisoners’ population was 47, 628. Out of the number, only 13,000 or 23 per cent were convicted persons while 34,328 or 77 per cent are awaiting trial. “It may interest you to know that up to 50 per cent of these ATPs have been on remand for between 5 and 17 years without their cases being concluded.“Ikoyi prison has an original capacity for 800 persons. Today, the population is 1,900. Out of this number, only 24 prisoners are convicts. Port Harcourt Prison has an installed capacity for 804 persons. Today, the prison locks up 2, 924 persons out of which only 117 persons are convicts.

According to him, Awka Prisons with an installed capacity for 238 persons presently accommodates 486 inmates out of which 21 are convicts.

                                                            

Hard facts on HIVAIDS/STI situation in Nigerian prisons

1.                   Prison populations are predominantly male and most prisons are male-only institutions, including the prison staff. In such a gender exclusive environment, male-to-male sexual activity (prisoner-to-prisoner and guard-to-prisoner) is frequent. The actual frequency reported to deaf authorities of instances is likely to be much higher than what is reported mainly due to continual denial, fear of being exposed or the criminalization of sodomy and homosexuality.

2.                   While much of the sex among men in prisons is consensual, rape and sexual abuse are often used to exercise dominance in the culture of violence that is typical of prison life. Inmate rape, including male rape, is considered one of the most ignored crimes. Sexual and physical abuse in custody remains a tremendous human rights problem.

3.                   The sero prevalence of Human Immunodefiency Virus [HIV] infection among male inmates in Kuje prison, Abuja- Nigeria was determined. Two hundred sera specimens from the prison inmates were tested using 3 different test kits. Of 200 samples tested 12 [6%] had HIV-1 antibodies. The highest prevalence of HIV antibodies was found in the age group of 10-20 years [7.1%]. This was followed by the age group of 21-30 years [6.8%] while the least [4.0%] was observed among those aged 41-50 years. HIV among inmates particularly the young was high. This research was done by Muhammad Tauwal Usman, Dr. Baba and Thilza.

4.                   In 2010 Lawrence N. Chigbu¹ and Christian U. Iroegbu conducted a study to determine transmission of Mycobacterium tuberculosis within the prison environment. In total, 168 Aba Federal prison inmates in Nigeria were evaluated for tuberculosis (TB) by sputum-smear microscopy and sputum culture, simultaneously, and for HIV status by serology. They were subsequently followed up for one year for fresh Mycobacterium-associated infection by tuberculin skin testing or for development of TB and for HIV infection or AIDS. Ninety-one (54.2%) of the 168 prison inmates had infection due to Mycobacterium, and three (3.3%) of them were sputum-smear- and culture-positive while 41 (24.4%), including one (2.4%) with concomitant TB, were HIV-infected. In a one-year follow-up study, 11 (19.3%) of 57 tuberculin skin test (TST) and HIV-negative inmates became TST-positive and one (1.8%) HIV-positive, eight (13.8%) of the 58 TST-positive but HIV-negative inmates developed TB, and one (1.7%) became HIV-infected: six (24.0%) of 25 TST- and HIV-positive inmates developed TB while five (33.3%) of 15 TST-negative but HIV-positive inmates became TST-positive, and one (6.7%) progressed to AIDS. The duration of imprisonment did not influence the rates of infection, and the transmission of Mycobacterium tuberculosis did not necessarily require sharing a cell with a TB case.

5.                   On the 27th July 2011, it was announced that six inmates of Federal Prisons, Owerri, have reportedly died of the dreaded HIV/AIDS pandemic, while 12 others have been confirmed to be carrying the virus. The prison’s Nursing Officer, Mr. Mike Anyanwu, a superintendent of prisons, said this when the Chief Judge of Imo State, Hon. Justice Benjamin Ahanonu Njemanze, carried out a jail delivery session in the establishment. “We have recorded six deaths arising from HIV/AIDS in Owerri Prisons. Twelve other inmates have been confirmed as carriers of the dreaded virus,” Anyanwu said. He said more inmates might be infected and pointed out that there were no anti-retroviral drugs for such patients in the prison. Addressing the court in the case involving Chinaenye Onyeneho, who is suffering from a terminal disease, the Attorney-General and Commissioner for Justice, Chief Soronnadi Njoku, urged the court to order that the inmate be transferred to the Federal Medical Centre, Owerri, for treatment.

RECOOMENDATIONS

1.                   There is need to provide access to HIV prevention, care, treatment and support in prison settings in Nigeria. The first step to the development of adequate HIV prevention, treatment, and care programmes in prisons is to build, better knowledge of the situation, better knowledge of the extent of the problem, and identification of needs to address these problems.  

2.                   There is a need for a combination of sero-prevalence (surveillance surveys) and behavioral studies (knowledge, attitude, behavior and practice studies) to gather data on: (a) HIV prevalence in prison communities, (b) the patterns and nature of sexual behavior in Nigerian prisons, and (c) perceptions and attitudes towards HIV of prison populations, prison staff, and partners/families of the incarcerated. These baseline assessments should be collaborative efforts, conceivably involving UNAIDS, ILO, WHO, UNFPA, UNICEF, the World Bank, other interested multilateral and bilateral donors, Nigerian prison administrations, and international and local nongovernmental organizations (NGOs).

3.                   National HIV/AIDS guidelines and those on prison management should be reviewed to determine if and how they can realistically address the issue of HIV in prison populations. HIV prevention, care, and treatment in prisons should be part of the National AIDS Strategic Plan.

4.                   Networks should be developed to engage those who know how and those who can do better (e.g. by establishing a network of prison management across the country); promote dialogue and collaboration with national AIDS committees and local and international NGOs working on HIV issues; and promote the activities of human rights and advocacy groups, and civil society at large.

5.                   Legal reforms should be promoted, including those related to the penal codes of individual to develop alternatives to imprisonment as well as to deal with the access to health care in prison in general, and to evidence based HIV prevention and treatment in particular.

6.                   Peer-based education on condom use and reduction of violence (i.e. conflict prevention tools) among prisoners and prison staff.

7.                   Prisoners should have access to confidential voluntary counselling and testing.  No prisoner should be discriminated or segregated on the basis of his or her HIV sero-prevalence.

 

DOTS (TB) Treatment in AIDS Patients

By Dr Diwakar Tejaswi

Worldwide HIV infection – Total 33.3 Million
TB- Estimated prevalence 11 Million among HIV infected (1/3rd of HIV infected)
Our Primary Data- Estimates as high as 60%
1.1 Million developed TB Annually Worldwide.
3,80,000 people with HIV died from TB (4700 deaths a day);
There was a genuine concern at UN- “Living with HIV dying of TB” due to Underdiagnosis.

DOTS and AIDS:
Intermittent treatment during initial intensive phase was associated with significant higher rates of failure and relapse.Based on the findings:

WHO Recommendation March 2010 (Treatment of Tuberculosis Guidelines)

Recommendation 4.1- TB Patients with known HIV + status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during intensive phase.
Recommendation 4.2- For the continuation phase, the optimal dosing freq is also daily for these patients.

Central TB Division, MoH India should consider the facts and urged to make an appropriate ammendement accordingly

Dr Diwakar Tejaswi is the Medical Director at Public Awareness for Healthful Approach for Living (PAHAL) and based at Patna, Bihar, India.