Saturday, February 25, 2012

HIV-Hunger Cycle: Give them enough food to prevent AIDS

By Sugata M

‘Do you like to stop AIDS? Give them enough and enough food’

Let me tell you a story. This is a story of a woman who got HIV from her husband.

There are so many stories of poor women who were infected by the husband. What is sospecial about it?

From that aspect my story will sound a pretty ordinary one. But to me it is not onlyshocking but can give us a hard lesson of life.

Let’sgo into the story.

“Sandhya (name changed) was in her early thirties, living with her husband and twochildren in one of the medium sized cities in South India.Her husband was working in private sector and having a good income. They had a happy life.

Butthings were not the same. Sandhya’s husband suddenly fell ill and the ailments,in course of time got turned into a chronic one. The man who had a robust health previously underwent very rapid loss of weight, swollen glands in the body and not easily curable fever and loose motion. The physician finally got the HIV test done which came to be reactive.

Unfortunatelyhe died irrespective of attempts from the doctors and Sandhya with her two kidswere forced to shift to her in-laws house.

In the mean time Sandhya also had gone through HIV testing and found to be positive. And the things got worse. Her in-laws threw her and her two smallkids out of the house. They thought Sandhya is woman of immoral character andactually passed the virus to her husband to cause his premature death.

Sandhyawas literally came into the roads. She did neither find support from her parents,relatives nor find a job. Nobody likes to put a HIv infected into the job.

When hunger became intolerable with the two small innocent children to feed with Sandhya had taken the boldest decision of her life. She became a prostitute.”

So the crux of the story is, if you are hungry, your off springs are hungry but at  the same time denied all sources of food what best you can do to survive? Forget the so called ‘morality’ of life and jump into anything that can generate source of living for the survival.

I told the story to one of my good friends who is a strong feminist. Her reaction was, “I would have definitely committed suicide with my children before gettingmyself into such dehumanizing act.” I was simply surprised the way she responded.

But in reality how many hungry people kill themselves when humiliation goes beyond tolerance? Rather, most of them put all their attempts together to survive against all odds. After all, living is loving.

Sandhya did not do anything different. She tried to provide food to her children’s hungry mouth and dreamt of better future for them. Please don’t look at Sandhya’s story through the lens of morality.

My issue is not related to morality or sex work. It is insecurity of food that makes people vulnerable to HIV. Sandhya is one of such vulnerable women but throughout the globe there are millions of people who do not have enough food for them or their children. AIDS is constantly knocking at their doors.

Experts say there is enough food in the world to feed everyone. But where has all those food gone?

Morethan 800 million people on earth know what is like to go to bed hungry. Around 200 million children under 5 yrs are underweight only because there is notenough food for them. One child dies every five seconds from hunger and relatedcause. 35% of the total population is malnourished in several countries locatedin East, Central and Southern Africa. In India which produces enough food for its people there are still incidences of death from hunger, selling of children out of sheer poverty and food insecurity.

If you analyze carefully whole of the food insecurity business you will find ademoralizing picture existing all corners of the globe.

Food insecurity, most of the time is man made and inevitably leads to disruption of human integrity thus generating numerous marginalized, hard-to-reach populationallover the world, left with hunger and humiliation. Never-ending war of DR Congo, political violence of Haiti, socio-political instability in Somalia, Sudan, Uganda, civil conflict and illegal drug trade of Colombia, war that devastated health system of Ivory coast, restless Chechnya, war that tore apart Iraq and Afghanistan, power game and proxy war by the ‘World Powers’ – the listis long but number of people denied access to food through these unending pathological processes is countless. The human community is further fragmented by social and domestic violence, terrorism, communalism, racism, castism, gender inequity and troubled childhood thus enhancing pace of hunger. Hunger is the natural triggering mechanism of dehumanizing events like human trafficking, prostitution, crime, drugs, child labor and migration pushing millions ofhopeless people into vacuum of AIDS. On the other hand, those already infectedby HIV are constantly refrained from producing and utilizing food, being victimized by disability, denial and discrimination. And the cycle goes on incessantly to make the virus stronger and deadlier.

This is Hunger-HIV cycle gradually taking shape of ultimate destroyer and silently preparing ground to make final assault in the form of AIDS. No other disease has taken so much of resources, attention and concern because AIDS has jolted the root of humanity and exposed the darker side of human civilization. Hungry,vulnerable people also remain miles away from critical information vital for living. HIV can be easily renamed as ‘Hunger and Ignorance led Vulnerability’.

Sandhya’story is a perfect example of Hunger-HIV cycle.



Breaking Hunger-HIV cycle is probably the toughest challenge in front of us. I strongly believe that it is neither condom, ARV drugs, microbicide nor vaccine butuninterrupted supply of food with sufficient quantity to the needy and hungrypeople of the world that can really make the true difference in reversing the pandemic of AIDS and many other communicable diseases.

Are our powerful global leaders sufficiently prepared and equipped to bring necessary changes in the food production, distribution and utilization processes and patterns? It needs concrete political commitment atinternational, national, state, district and sub district levels.

When billions of dollars are being spent for space research, weapon technology, nuclear plants and sophisticated biological inventions countless hopeless people are dying simply because of lack of accessibility, availability andaffordability to food – the basic vital source of human existence. Do our respected leaders feel the contrast?

The world has basically two groups of people: One who earns more and the other who earns less or does not earn. The first groups sometimes make money in trillions and billions. The second group, many a times can not even earn in terms of at wo digit number. Can the leaders of the world make a balance between the two absolutely polarized money earning patterns?

Iam not politician. I am not a public leader. I am just a physician who is practicing public health and epidemiology. Whatever I have documented so far is my deliberation from the perspective of public health and, over and above from the point of humanity.

(Published in Concern Worldwide 2009 Writing Competition)

Friday, February 24, 2012

Self-regulatory boards (SRBs) – an innovative and effective anti-trafficking initiative of DMSC, sex workers organization of West Bengal, India




D. Chowdhury, B. Dey, S. Jana, S. Mukhopadhyay, R. Steen

Issues: Involving community and development partners - in combating trafficking and enabling survivors of trafficking to lead a healthy life - is an ideal approach but to translate it into action is a challenge. Durbar Mahila Samanwaya Committee (DMSC), a sex workers’ organization, from Kolkata, India, made this possible by ensuring participatory democracy in practice.
Description: DMSC to formalize its fight against trafficking launched Self Regulatory Board (SRB) in 1997 - as an innovative anti trafficking approach in sex work. The primary objective of SRB is to regulate new entry into sex work. 60% of the SRB members are from sex workers community and 40% representative from Social Welfare Department of Government of West Bengal, doctors, lawyers administrators and members of civil society organizations. Any new entrants to the sex work set ups are brought before SRBs who clarify their age, motives and process of entry. Girls below 18 yrs and unwilling entries identified through medical examination and counseling and not allowed to join sex work and are sent back home or rehabilitation centers.
Lessons learned: There are 33 SRBs operating presently. Eight are in Kolkata and 25 in other districts. 558 girls (84% below 18 yrs) were rescued during 1996-2007 and 497 sent back homes and 61 to rehabilitation centers. Number of minors in sex work decreased from 25% to 0.7% and mean age of sex workers increased from 22 yrs to 28 yrs in Sonagachi as compared between 1992 and 2001.
Next steps: Durbar’s SRB program of community-led anti-trafficking approach should be adopted and integrated with TI programs in sex work set ups in line with community based and community centric approaches of the third phase of National AIDS control Program of India.

AIDS 2008 - XVII International AIDS Conference (selected for poster presentation), Abstract no. THPE1084

Thursday, February 23, 2012

THE PLIGHT OF THE FEMALE KENYAN DOCTOR

Auma Bonyo, Nairobi, Kenya


As doctors prepare for mass action on 5th December to protest their incredibly low pay and unacceptable work conditions, a lot has been highlighted about the plight of doctors in Kenya. Enough can never been said, and I therefore sought to highlight our plight as female medics.
Medicine has always been one of those prestigious careers that many if not all have aspired at some point in time to be a part of. Also termed as a ‘noble profession’, it is a career that has brought many a tear of joy to a parent that watched their child being crowned after having achieved the fete. But it has also brought tears of anguish to one a parent whose child committed suicide after having been frustrated going through medical school to please the parent. 
I don’t know what it is about being a doctor that is so attractive. Whether it is the sheer power and mystery that surrounds it or simply the thrill of putting on the white coat or the prospect of a padded wallet, I will never know. What I am sure of is that it is neither the sleepless nights nor the continuous rummaging through thick books nor the constant insults from seniors that attracts people to it. Or could the heroism of going through the hurdles and emerging a victor be akin to a native 'Maasai moran' literally breaking the jaw of a lion with his bare hands?  
For a female doctor, it is even a greater attainment to go through and succeed in a once male dominated field. People celebrate your newly acquired status but oblivious of the struggles that come with it. Even as a student, when you perform better than the men, they attribute your success to your pretty face or curvy hips but when you fail it is something to be expected. As such, you end up struggling more to prove yourself. Once in the job market, your title loses its meaning because you are constantly reduced to ‘aunty, sister or siste’ and the male nurse or attendant gets all the glory and admiration as the ‘daktari’ or doctor. Or you wake up enthusiastically to go to work despite your meagre pay only to reach the patient’s bedside and the patient demands to see the doctor! This is because as a woman, you cannot be the doctor!  
Once you earn your coveted title, society assumes that you have been pushed into another league where you earn more than any other professional in the country. In fact when having a social chat, you refrain from mentioning the word doctor because immediately it is mentioned, the men shy from telling you what they do or they begin to use phrases such as ‘I am a mere lawyer..’ thereby elevating you to this ‘god-like’ status because of an empty title. In essence, medicine kills your social life; people either avoid you or relate with you but with pre-conceived ideas. They look at your clothes and assume them to be high end fashion and they get dumbfounded when you tell them that you bought it from a second hand seller at ‘Toi’ market. In fact, a Kenyan man who ventures to date a doctor always has to think of how much dowry he will have to part with; or if he will spend the rest of his life breaking his back to pay ‘instalments’ for this female doctor who is so out his league.


When your friends or relatives see you going on foot, they label you as ‘stingy’, they simply do not understand that you cannot afford a car because your earnings are too mediocre and you have to save your earnings to go for further education in the hope of getting something better. When your patient meets you in a public vehicle, they comment, ‘Hata wewe daktari uko hapa?’ I was once labelled as being so ‘humble’ that I took ‘matatu’ rides despite the fact that I could afford a decent ride and avoid mingling the lesser commons.
As soon as you decide to further your studies, guns are drawn out ready to shoot. The specialities are male dominated and you are asked at entrance level if you intend to get married, have children as if these are the greatest crimes one can commit. I don’t even know why they interview women-they might as well have big signs on the doorposts written ‘No procreating, emotional species with anything less than a six pack allowed in here!’ These are just a few illustrations of what doctors and especially female doctors experience.
 So even as doctors go about picketing on the 5th and beyond, it will just be the beginning for female doctors who will still have even more to fight for. A positive achievement on the 5th is that when people see female doctors picketing, they will realise that female doctors exist and in large numbers. Wait a moment; or will they get confused and imagine that those are nurses standing in solidarity with their doctors?
About the author: Young medical doctor; a general practitioner..absolutely humanitarian..love fun and laughter and friends. Life is what you make it! A christian-God is my first love...

Wednesday, February 22, 2012

Partner notification (PN) in a targeted STI control program – best practices of Sonagachi project, Kolkata, India


S. Jana, D. Chowdhury, A. Singh, P.L. Chan, S. Mukhopadhyay, R. Steen
Issues: PN is an important component of STI/HIV interventions in sex work settings. Systemic implementation of PN can enhance control of STIs in high transmission networks where partner turnover is high. The Sonagachi Project, Kolkata, India is a recognized model STI/HIV intervention reaching more than 7000 sex workers. It has successfully established core public health interventions within a community empowerment model where sex workers are mobilized to handle their problems and participate actively in STI/HIV programs.
Description: Four categories of sexual partners of FSWs have been identified in Sonagachi - regular clients, flying (once-off) clients, Babus (cohabiting partners) & spouses.
PN was facilitated by the following approaches:
1) Introduction of ‘Babus’ as male peers for mobilizing visiting clients for STI screening and promoting safe sex,
2) Establishment of evening clinic hours exclusively for clients,
3) Coordination with health clinics outside brothels for notification of spouses of both sex workers and clients
4) Regular sensitization of local private practitioners for treating partners with index cases following National guidelines
5) Tracking regular and flying clients by highly motivated and trained peers from sex worker community
6) Motivational counseling for sex workers visiting STI clinics for concurrent PN
7) Mobilizing members of the sex workers’ community in management of the STI clinics and monitoring of the STI services (the basis of the empowerment approach).
Lessons learned: The community empowerment model implemented in Sonagachi since 1992 has demonstrated multiple success in HIV prevention. Consistent condom use is up to 85% and HIV prevalence among sex workers has remained stable below 10%. Sonagachi has also established innovative methods of PN with high rates of partner treatment, up from 40% in 2002 to 46% in 2007 (13 STI clinics).
Next steps: Sonagachi’s experience of implementing PN is being adapted for use in other sex work settings across India.
Selected for poster presentation in AIDS 2008 - XVII International AIDS Conference
(Abstract no. THPE0303)

Monday, February 20, 2012

Gaining acceptance of the target community – a real challenge for a doctor working in sex workers project


 


Sugata Mukhopadhyay, Smarajit. Jana
Issues: Remodeling role of healthcare provider in enhancing efficacy of the Sex Workers HIV prevention program.
Description: While working in Sonagachi (a brothel consisting of 7000 FSWs) SW project in Kolkata, India as a doctor I recognized that only technical skill is not enough in getting acceptance of the community. I discovered there are four determining factors. First, the doctor must consciously challenge his/her “moral values” towards the community to remove barriers between service providers and sex workers. Secondly, s/he should be in the position of identifying multiple socioeconomic needs of the SWs directly and indirectly linked with their sexual health problems. Thirdly, the structural and livelihood issues closely associated with high risk behavior of SWs should be firmly addressed through the intervention program where doctor’s involvement makes a big difference. Finally, physicians have role to play in capacity building of the SWs, providing support in building their self esteem, confidence and facilitating strategic advocacy with an objective to protect their right ensuring safe sex practices. The very approach can help community to attain citizenship triggering positive lifestyle. Therefore, healthcare provider, more specifically has to play duel role as doctor as well as “community associate” to make changes.
Lessons learned: This very realization and strategic actions made me highly accepted and recognized by SWs and helped to run sexual health intervention program smoothly with full community participation and ownership to make significant impact on HIV prevention (since the inception of the program during ’92 till date it has succeeded in stabilizing HIV prevalence level between 3% - 5%).
Recommendations: Doctors recruited to work in SW projects must go through well designed orientation programs to augment their prompt acceptance by the community for bigger interest of the project. Such programs compulsorily include attitudinal change in addition to socio-economic and structural issues that impinges safe sex practices.
AIDS 2006 - XVI International AIDS Conference
Abstract no. WEPE0854 (selected for poster presentation)

Saturday, February 11, 2012

GMP inspections from Health Authorities of developing countries

María Inés Guaia, Argentina

Getting positive reports of GMP inspections of manufacturing facilities have always been a very important step in the process of registration of a new drug product in a country. Traditionally, developing countries would rely on GMP certificates issued by high-surveillance health authorities, such as those the members of the International Conference on Harmonisation, ICH: USA, Japan and European countries.

But, as economies in development start to be heavy targets for the pharmaceutical business, the landscape tends to change. Although Certificates of Pharmaceutical Product, documents that prove that a drug product is approved or marketed in a country, issued by developed countries are still widely required by regulatory agencies of the rest of the world, most of these agencies now started requiring further information and documentation from pharmaceutical companies to review and, in many cases, began inspecting manufacturing facilities themselves.

Such is the case of Turkey, which in 2010 issued a new regulation according to which GMP inspections by the Turkish Ministry of Health had to be performed and approved for all new imported pharmaceutical products. Other Arabic countries, as well Brazil, Mexico and Taiwan to mention a few, reserve the rights to inspect facilities, and sometimes create and update their own GMP guidelines, frequenlty based on those enforced by EMA or FDA or written by WHO.

Another trend in the international GMP matter, is that of collaboration and mutual recognition agreements among developing countries. This could mean, authorities of two or more countries carry out joint inspections, or groups of countries either recognize each other's GMP certificates or formalize unions with own power to conduct inspections, which results will be valid for all the participants. As examples we have Brazil, accepting GMP certificates issued by the rest of the MERCOSUR countries Argentina, Paraguay and Uruguay; in the middle East, the Cooperation Council for the Arab States of the Gulf, grouping Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates, through its GCC Council of Health Ministers, performs inspections and issues certificates, accepted by all the GCC members plus Yemen.

These changes and transitions could be not always smooth and inicially satisfying, but should be encouraged and supported by the international comunity because, positively, along with their population and GDP, developing countries are growing their involvement and responsibility on the quality of the drug products for use of their people

(About the author: My name is María Inés Guaia, and I am a 24-year-old, advanced Pharmacy student from Buenos Aires, Argentina. I am very interested in topics of public health, international health, neglected diseases, tropical medicine, regulatory affairs, intelectual property, etc)

Thursday, February 9, 2012

NEW HIV INFECTION ON THE RISE AND KNOWLEGDE, ATTITUDE, PRACTISE TOWARDS HIV/AIDS IN AFRICA.

Uchenna Anozie
Nigeria


HIV new infection rate has been a long lasting fight for more than two decades globally but unfortunately in sub Saharan Africa the incidence of new HIV infection rate has been prominent and a thing of concern.
Irrespective of the fact that figures given by different ministries of health of various African countries in Africa show a decrease of HIV prevalence rate, the truth remains that our record keeping and data management is nothing to write home about.
Fake figures are always given and method of data collection is dependent on sentinel method, for instance, in Nigeria Pregnant women that go for antenatal check are mandated to go for HIV screening and that serves as a source of data collection for HIV infection.
The fact remains that many pregnant women are still left out in the screening process especially those that are in the rural areas, those that are attended by traditional birth attendants, and even those that go to private hospitals where there are no data collection for HIV positive patients.
From my working experiences in Senegal, Gambia, Burkina Faso and Nigeria, there is gross lagging in keeping health data and unfortunately HIV new infection tends to be on the high side. In countries like Senegal females within the ages of 17 to 30 are mostly infected and males ranging from 35 to 50 are mostly infected, in Nigeria females within the ages of 25 to 35 are mostly infected while males ranging from 25 to 45 are mostly infected. This shows that those that are still in their productive age are mostly infected and these are people that are mostly sexually active.
I have also asked myself several questions like: why is HIV thriving tremendously in Africa? Why is it that mostly married people are infected? Why is HIV new infection rate high? Why are we Africans mostly discriminating against the people living with HIV/AIDS and yet we are not cautious over sex issues?
I had to carefully interview my clients that came for voluntary HIV testing and counselling and for the past six years I found out that Africans have the knowledge of HIV/AIDS transmission and risks, they equally have the skills to protect themselves but attitude towards HIV/AIDS/STI/RH/FP remains a problem.
Amongst these problems I mentioned above the most worrisome is consistent and correct use of condoms. Most Africans are not interested in condom message; many are against the use of condom, some don’t trust the use of condom as a protective measure, some ladies see it as disrespect and that condoms are used for prostitutes not for regular sexual partners.
Promiscuity has been since the days of Adam, it is as old as the bible, and it is not surprising to learn that in Africa both men are women are promiscuous especially amongst the married.
It is interesting to note that women remains the most infected population due to their vulnerable nature of their genital organs, financial limitations and lack of education and empowerment.  Unfortunately women suffer more than men when infected because people discriminate and stigmatize women that live with HIV/AIDS than men.
Men are considered promiscuous in Africa and women are considered to be prostitutes if they test HIV positive, cases are worst if their husbands test HIV negative.
People in Africa rarely believe that there are other ways of getting HIV infected other than through sexual intercourse. This has led to many frustrated women living with HIV/AIDS, majority are even divorcees as a result of their HIV status and we still have lots of ladies that are widowed by this pandemic.
Irrespective of the fact that we hear, see and read articles, posters, policies that condemn the stigmatization and discrimination of people living with HIV/AIDS, the act of discrimination and stigmatization remains very pronounced. It is most unfortunate that health workers champion these ugly acts, they are the ones that break the law of confidentiality and they go ahead to tell people in the community about people’s HIV status triggering open stigmatization and discrimination of people living with HIV/AIDS. The manner of approach exhibited by health workers in the health facilities towards patients are unimaginable and this discourages patients to keep to thier medical appointments and strict adherence to HAART (highly active antiretroviral therapy).
In Senegal I found out the health workers were kind and respectful towards people living with HIV /AIDS, talking with lots of patients in CTA Dakar, Senegal, they were very encouraged and confidentiality was maintained, patients were truly encouraged to continue treatment and keep to medical appointments. They were even given food and transport money for medical checks. Efforts were made to make the patients feel at home at the health facilities and a sense of love and concern was showered on them.
In Nigeria the reverse was the case, patients in various parts of the country were massively shown hostility by the health workers, most times government hospitals where HAART were administered to patients freely failed to provide these drugs dues to multiple industrial actions taken by health workers over salary increment and agitation for better working conditions.
National action committee for AIDS Nigeria has failed to monitor HIV/AIDS programmes in the country, there were times we experienced lack of HIV test kits in open and free HIV screening centres just because of the laxity of the ministry of health in Anambra State Nigeria.
Many non government organisations are not monitored and are totally misappropriating funds set for  the fight against HIV/AIDS. Lots of NGOs, CBOs and other concerned organisations are camouflaging in the name of working for people living with HIV/AIDS but are actually not doing so, rather embezzlement of funds remains their priority, they carry out expensive ineffective and inefficient campaigns, health promotion and education against HIV/AIDS.
Some NGOs like family health international, society for family health, institute of human virology, catholic relief service, jphego, aidscap and several other organisations in Africa are working tirelessly to fight against HIV/AIDS in Africa but programme and project sustainability remains a problem in Africa, until we Africans stop depending foreign aid and learn to take over certain projects ourselves we can never achieve much in control of HIV/AIDS especially in Nigeria my country. We virtually rely on foreign donors for condoms, lubricants, anti retroviral drugs, HIV test kits, funds for sensitization activities. This is definitely not a way forward, donors will not be with us forever especially with the way European and American economy are going these days. Africans need to invest in the fight against HIV/AIDS, Africans need to take active part in active research on HIV/AIDS prevention. We don’t need to rely on donations to carry out massive campaigns and health promotion on HIV/AIDS. We need to train and retrain our health workers constantly to manage people living with HIV/AIDS properly.
I was opportune to work in a standard laboratory in Senegal where we carried out various diagnosis ranging from full blood count, CD4,CD3,CD8,liver function test, kidney function test, viral load test and all these things were properly put in place to monitor the efficiency and effectiveness of the anti retroviral drugs administered to patients. During my work exposure, I noticed that lots of patients from far areas of the countries were solely dependent on this facility. I occasionally found out that patients took the pains of travelling from neighbouring countries like Guinea, Bissau etc for HIV medical services due to poor facilities or breakdown of machines in health facilities in other countries. We have to take into consideration the transport fare to travel to the facility in Senegal from other countries, it was not cheap and easy; most patients could not make it and were left to their fate until things were put in place in their home country.
In Nigeria we have lots of facilities spread across the country for HIV/AIDS treatment and other services but there are still lots of limiting factors and challenges that patients face. The attitude of health workers towards patients, constant industrial actions that lead to closure of health facilities, some facilities are over stocked with patients and very few health workers to attend to them, thereby leading to health workers being over laboured, stressed and in turn show hostility to patients instead of care delivery.
Treatments of other STIs are not free of charge in most African countries, ranging from screening to medication and we are all aware that STIs increases the risk of HIV infection. In Senegal, nutrition for people living with HIV/AIDS are taken seriously but unfortunately in many countries including Nigeria we do not pay attention to nutrition for people living with HIV/AIDS.
In conclusion I would like to say that knowledge, attitude and practise on HIV/AIDS management in Africa are all in place but attitude and practise remains a major challenge and need to be improved. Africans should stop relying totally on foreign donors to fight against HIV/AIDS. Health workers need to work on their attitude and encourage patients instead of discouraging them. Africans should stick to consistent and correct use of condoms. We have to come out more openly and discuss sex and safe sex practise. From my findings lots of people that live in Africa do not know about HIV/AIDS management and still see HIV/AIDS as death sentence, this does not only discourage patients but also leads to fear and anxiety in patients. Facts on HIV/AIDS management need to be related to people massively, we need to know the real transmission route and transmission risks and know how to protect ourselves. Sero-discordant couples should be encouraged and guided on how to practise safe sex and manage their sexual practises to reduce chances of cross infection. Africans need more information about HIV/AIDS this will encourage voluntary testing and counselling, encourage acceptance of people living with HIV/AIDS and discourage discrimination and stigmatization in our society at large.