For Online E-newspaper
The East African : November 18th 2013
32 The EastAfrican OUTLOOK NOVEMBER 16-22,2013 S CI E N C E BILL CREATES TENSION Activists protest against Uganda’s HIV law, cite increase in violence, stigma Health wo≥ke≥s will be expected to testify against thei≥ patients By NAMARA RWOMUSHANA Special Correspondent numbers of HIV/Aids, as activists question a proposed law to control the epidemic. “You blink, it kills you,” says U Dr Stephen Watiti, an HIV activist. Dr Watiti was responding to a question on why Uganda’s success in bringing down the number of people being infected with HIV from 30 per cent in the early 1990s to 6.4 per cent by 2004, has started to be reversed. According to the 2011 Na- tional HIV Indicator Survey, the prevalence rate among Ugandans stands at 7.3 per cent and is even higher among women, at 8.3 per cent. The number of new infections had risen to 160,000 between 2010 and 2011, falling slightly in the most recent survey to 140,000 between 2011 and 2012. The reduction is among babies born to mothers with HIV, but new infections are still high among married couples. In response to increasing infections, government drafted the HIV and Aids Prevention and Control Bill 2010, intended to be the first legislation on HIV. The basis of the Bill is that the current laws are inadequate in controlling and managing HIV/ Aids in Uganda. Dora Kiconco, the executive director of Uganda Network on Law Ethics and HIV/Aids (Uganet), contends that this law could be double-edged. “It can ganda is at a crossroads in its fight against the rising INFECTION RATE The 2011 National HIV Indicator Survey shows that the prevalence rates among Ugandans stands at 7.3 per cent and is even higher among women, at 8.3 per cent. The number of new infections rose to 160,000 between 2010 and 2011, falling slightly in the most recent survey to 140,000 between 2011 and 2012. This drop is mainly in the prevention of mother -to -child programme couple is carrying the same strain or who got infected first. Without proof, the law will be hard to enforce, but may instead serve powerful members of society who will use it to accuse and harass weaker ones, who in most cases are women. Health workers will be man- One of the tents set up for voluntary counselling and testing for HIV in Kampala during events to celebrate World Aids day last year. Picture: Morgan Mbabazi They will say, if I do not know my HIV status, then I cannot be forced to disclose.” Dr Watiti be a constructive law if drafted in a way that supports service delivery and human rights, taking into consideration those that are most at risk. But it can be destructive in the sense that it is punitive, especially targeting those that are already vulnerable.” The draft Bill has progres- sive clauses on discrimination against people living with HIV, but it also has retrogressive clauses that seek to punish people for the transmission of HIV. Ms Kiconco points out that based on experience from Uganet’s work in providing legal aid to people living with and affected by HIV and Aids, dispensation of justice in Uganda is expensive, inequitable and in most cases inaccessible to the vulnerable. “One issue that stands out in our work is that discrimination on the basis of HIV status is so high. The cases we represent show us that a person living with HIV is unlikely to be treated fairly in a community.” Coupled with this, is the fact that Uganda does not have the capacity to carry out a phylogenetic analysis, which is a test that can distinguish between different strains of the HIV virus; it cannot determine if the dated to reveal results of an HIV test without seeking the consent of the one who has been tested, if a medical practitioner “reasonably believes that the HIV positive person poses a risk of transmission to his or her partner.” Forced disclosure would af- fect the delivery of health services and threaten the security of women where stigma and discrimination on the basis of HIV is still high at family and community level. Health workers will be expect- ed to testify against their patients. Not only does this break the code of ethics for health workers, but those intending to test for HIV will have to weigh the consequences of knowing their status, one of which is the possibility of a lawsuit. “They will say, if I do not know my HIV status, then I cannot be forced to disclose it, because there is no clause that says you must test,” says Dr. Watiti. Expectant mothers attending antenatal care are automatically tested for HIV. This is a good initiative that opens a window for treating the mother and to offer prevention of mother to child transmission (PMTCT). But it also means that a woman will be the first to find out her HIV status, and is thus compelled to disclose this to her partner. Uganda is a country with high levels of domestic violence. In spite of the existence of the Domestic Violence Act 2010, abuse of women is still rife. At 65 per cent, new infection rates are highest among married couples. Thus a woman who is forced to disclose her HIV status risks both physical and emotional abuse. There are also fears that law would entrench stigma. The Stigma Index Report 2013 among people living with HIV shows that high stigma and discrimination continue to affect people living with HIV. The report puts gossiping as the commonest form of stigma at 62 per cent, followed by verbal harassment, insults and threats at 37 per cent. Women would be put at risk if they are forced to disclose their HIV status first because they will be discriminated against. Uganet has rallied a coalition of 45 civil society organisation, some of which work in the area of human rights, people living with HIV and service providers. The coalition has engaged Members of Parliament on the Health and HIV/Aids committees, who are charged with the responsibility of scrutinising the Bill. “We are asking MPs to re- move the contentious provisions that will have a negative impact. We are asking them to broaden the mandate beyond prevention and control, and actually handle management of the epidemic,” says Ms Kiconco. The draft Bill has been toned down. The death penalty initially proposed as punishment for HIV transmission, has been revised to 10 years. Child≥en unde≥ 15 at huge ≥isk of aflatoxicosis in Kenya— study By CHRISTABEL LIGAMI Special Correspondent THERE IS a large population at risk of aflatoxicosis in Kenya, particularly in Eastern, Coastal, Central, and Nairobi Provinces, with children below 15 years of age being most at risk, a new survey by the International Food, Policy Research Institute shows. According to the researchers, an evidence-based strategy is urgently needed in Kenya to decrease aflatoxin exposure. Resources are also needed to quantify the burden of disease and associated health effects as well as to decrease aflatoxin exposure. “Due to widespread food move- ment across the East African region, a regional approach to containing aflatoxin exposure, such as the Partnership for Aflatoxin Control in Africa (PACA), should be the focus,” says the study. While there are growing concerns about aflatoxin issues in tropical environments, little is definitively known about their public health risks or about effective market and technology solutions. There is thus a continued need for a multidisciplinary and comprehensive research to inform policy and test potential solutions, the study says. “Such research can use the tools of risk analysis to better inform policymakers about the scope of public health risks,” says the study adding that given the nature of this food safety risk, solutions need to be evaluated within the context of the entire supply chain. For decades, research has shown that aflatoxin exposure causes liver 26,000 The number of Africans who die of liver cancer in sub Saharan Africa every year cancer in humans and a variety ofanimal species. The International Agency for Research on Cancer has classified “naturally occurring mixes of aflatoxins” as a Group 1 human carcinogen. Aflatoxin exposure has also been associated with childhood stunting — a condition in which the child’s height for his or her age is two standard deviations or more below a WHO growth reference. Taken together, these few studies indicate that aflatoxin exposure is associated with changes in markers of human immune systems. How these changes actually correlate to disease outcomes, howev- er, is less clear and was beyond the scope of the studies. Aflatoxins are estimated to con- taminate one-quarter of the global food supply, with over half the world’s population — 4.5 billion people — exposed to high, unmonitored levels, primarily in developing countries. An estimated 26,000 Africans in sub-Saharan Africa die annually of liver cancer associated with aflatoxin exposure. In 2010 Kenyan authorities re- ported that 2.3 million bags of corn harvested in that country had been contaminated with fungal poisons known as aflatoxins.
November 10th 2013
November 25th 2013