Agenda

NIEUWS VAN U N I T E D N A T I O N S
Office for the Coordination of Humanitarian Affairs
Integrated Regional Information Network (IRIN) –

ZAMBIA : Bridging the gap between traditional and western medicine

LUSAKA , 28 August (IRIN) - Zambia 's HIV/AIDS pandemic is helping to bridge the divide between traditional healers and practitioners of western medicine.

Earlier this year the government commissioned the first clinical trials of remedies dispensed by traditional healers who claimed to have found an AIDS cure, fostering closer relations between the two groups of practitioners. About one in five sexually active Zambian adults is infected with HIV/AIDS.

National AIDS Council spokesperson Justine Mwiinga told IRIN that the results would be published soon. "The three herbs passed all the tests and we have just concluded the six-month clinical observation period, after having successfully administered the same herbs to 30 people living with HIV/AIDS."

Clinical tests conducted by medical doctors determined the composition and properties of the traditional healers' remedies, while monitoring the patients' CD4 count (which measures the strength of the immune system), viral load (which measures the amount of HIV in the blood) and appetite.

"Initial indications show that each of the three formulae has its own unique healing properties ... Some increase the patients' CD4 count while others reduce the viral load, or simply treat a number of opportunistic infections like coughing, rashes and tuberculosis - but we are not saying Zambia has found a cure for HIV/AIDS," said Mwiinga.

Rodwell Vongo, president of the 40,000-strong Traditional Health Practitioners Association of Zambia, said the membership included herbalists, spiritualists, diviners and traditional birth attendants.

"People have a lot of faith in us because we are constantly in touch with them. Even when they are diagnosed HIV positive and put on TB drugs, they still come to seek our opinion," he said. "Therefore, if we allow the divide between healers and medical doctors to continue, healers may become counterproductive because we surely have the authority to command any patient to discontinue the medical doctor's prescribed medicine."

Vongo said both his organisation and western-trained medical doctors worked for the "patient's wellbeing and, by working together, we shall cushion government's depleted resources and save many lives."

About 1.6 million of Zambia 's 10 million people are infected with HIV/AIDS, but only 60,000 have access to antiretroviral (ARV) medication.

Zambia 's health sector has been depleted by medical staff seeking higher salaries and better working conditions in other countries.

The World Health Organisation's (WHO) 2006 report, Working Together For Health, cited the shortage of trained health professionals as one of the main problems in low-income countries struggling against the HIV/AIDS pandemic.

Zambia has about 600 registered doctors in the public and private health sectors. The doctor-to-patient ratio in the UK is about one to 50; in Zambia it is about one to 14,000.

WHO acknowledged traditional health practitioners as a key resource in HIV/AIDS prevention and care, and stressed that an effective response to the pandemic would require collaboration between traditional and medical health providers.

nm/go/he

De Verenigde Naties benadrukken dat de definitieve resultaten van de lopende onderzoeken essentieel zullen zijn om de doeltreffendheid van besnijdenis te bepalen voor de preventie van hiv-besmetting bij de man.

In juni 2006 kondigden de Amerikaanse NHI aan dat de twee studies in Oeganda en Kenya omtrent het verband tussen besnijdenis en hiv-besmetting bij de man, moesten worden voortgezet. Die studies lopen af in juli en september 2007. De resultaten ervan zijn belangrijk, want ze moeten de uitkomst bevestigen van een studie in juli 2005 in Orange Farm (Zuid-Afrika). Daaruit bleek dat besneden mannen maar liefst 60% minder risico lopen op besmetting met hiv.

De voorlopige resultaten van de studies in Oeganda en Kenya werden in juni 2006 bestudeerd door de Raad voor controle van gegevens en veiligheid, die aanraadde om de studies voort te zetten omdat er nog niet voldoende gegevens zijn om definitieve besluiten te trekken. Er werd verder voorgesteld om een nieuwe tussentijdse analyse te maken in de loop van volgend jaar.

"In afwachting van die belangrijke resultaten pogen de partners van de Verenigde Naties en anderen hun raad en bijstand aan de landen te coördineren zodat ze de omstandigheden waarin besnijdenis wordt uitgevoerd, kunnen verbeteren", zegt Dr. Kevin De Cock, WGO-directeur van de afdeling hiv/aids.

Een andere studie over de impact van besnijdenis op het risico voor hiv-overdracht naar de vrouw, uitgevoerd door onderzoekers van de Johns Hopkins universiteit, is aan de gang in Oeganda. De resultaten worden verwacht tegen eind 2007. Men bestudeerde ook het effect van besnijdenis op het risico voor hiv-besmetting tussen homoseksuele mannen, maar daarover werd nog geen studie gevoerd.
De WGO, het UNFPA, Unicef en het secretariaat van Unaids benadrukken dat ze hun huidige standpunt niet wijzigen en dat ze besnijdenis nog steeds niet aanraden als preventiemiddel tegen hiv. Toch zijn de VN er zich van bewust dat het belangrijk is om zich voor te bereiden op een eventuele stijgende vraag als de lopende studies wijzen op een beschermend effect van besnijdenis. Uitgaande van een daling met 60% van het risico op besmetting bij besneden mannen, zou het aantal besmettingen en overlijdens in subsaharisch Afrika in een 20-tal jaar aanzienlijk kunnen afnemen, als de bescherming bevestigd wordt en als besnijdenis algemeen wordt toegepast.
Uiteraard is besnijdenis maar een onderdeel van een geheel aan maatregelen ter preventie van hiv, zoals correct en regelmatig gebruik van condooms; minder seksuele partners; uitstellen van het eerste seksuele contact; vrijwillige en vertrouwelijke opsporing van hiv.

M.V. (naar een persbericht van de WGO)

U N I T E D N A T I O N S
Office for the Coordination of Humanitarian Affairs
Integrated Regional Information Network (IRIN) -

LUSAKA, 6 September (IRIN) - Maria Banda, just five years old, and her
grandmother, Aineli, spend every day breaking stones into gravel in
quarries a few kilometres from the heart of Zambia's capital, Lusaka.
Hundreds of others are doing the same.

Maria produces two to three tins each day, her grandmother as many as
nine, which they sell for US$0.50 a tin. Roadside stalls sell the chipped
stones to construction companies, but the demand is oversupplied. This
backbreaking work pays for their US$15 monthly rent; the rest provides a
meagre living.

"We eat nshima [maizemeal] once, before going to bed, because I don't have
enough money to buy food to eat twice. If something remains after we have
eaten, then Maria has to finish it in the morning before we go for work,
otherwise I will have to buy her some fritters around 12:00 [noon] if she
didn't eat anything in the morning," Aineli, aged about 70, told IRIN.

Small but agile, Maria's left hand sweeps away the gravel from the stone
she has just crushed and swiftly puts another one against a larger pebble.
Her right hand brings down a big hammer to pound it. "I was hurting myself
when I started doing this work but now I know how to avoid the hammer,"
she says.

Maria has been living with her grandmother since her parents died from a
suspected AIDS-related illness a year ago. Barefoot and dusty, her
struggle to survive is a snapshot of the growing number of children drawn
into the labour market here.
More than 600,000 children in Zambia are believed to be working on farms,
in construction and other business sectors, and in the sex industry.

Anne Kamwendo, project officer for the protection of children at the
United Nations International Children's Fund (Unicef), said children were
forced to work to supplement low household incomes.

"Poverty and HIV/AIDS are the major causes of child labour, after creating
an army of orphans and vulnerable children who are now being left in the
care of aged grandparents or extended family members. When times are hard,
these guardians tell the children to begin contributing to their own
welfare by doing some form of work for money."

Although Zambia is signatory to the conventions of the International
Labour Organisation (ILO), and although its laws do not allow children
below the age of 15 to work for a living, for many of the country's
million or more HIV/AIDS orphans and vulnerable children, there is little
alternative.

Grade six pupil Mervis Mulenga, 11, is one of nine children. She works in
the stone quarry because her mother told her they needed to pay for
schooling and clothing.

"I am forcing myself to crush at least five tins in one day because I
really want to become a nurse when I finish school. I start crushing my
stones around seven [in the morning] after cleaning the house, and I go to
school at eleven," she said. When school finishes, she either goes back to
the quarries or helps her mother at home.

By early evening, with only candles for light, sleep takes often
precedence over homework.

A hacking cough is often the telltale sign of a child working long days in
the dust-laden air of the quarry said Godfridah Sumaili, president of the
Jesus Cares Ministry. "When they first come to our centres, most of the
children from stone crushing have physical symptoms of their neglect, such
as stunted growth and bodily injuries. They look harassed, afflicted,
hopeless and lifeless," said Sumaili.

"They appear withdrawn and reserved. They have not known to look at
themselves as children, but as adults, and some of them actually head
families. Therefore, parents and guardians also refuse to let go of such
children, who are perceived as economic pillars."

With assistance from the ILO and Unicef, the ministry has managed to
withdraw 5,000 children from various types of labour, including 3,000
previously involved in stone crushing. Some have been reintegrated into
the formal primary school system, while others are attending the
organisation's community schools throughout the country.

5) Tropisch Instituut van België ism Centrum Tropische Geneeskunde van Zambia

Dr. J-P Van Geertruyden en zijn collega’s van het Tropisch Instituut te Antwerpen, in samenwerking met het Centrum voor Tropische Geneeskunde van Zambia, publiceren een interessant artikel in de Journal of Infectious Diseases. Zij tonen aan dat VIH+ patiënten met een gering aantal CD4 lymfocyten een hoger risico van falen hebben van therapie tegen malaria dan HIV-- en HIV+-patiënten met normale CD4. Dit betekent dat de behandeling van patiënten die slecht antwoorden op de nieuwe behandelingen het risico doet toenemen van resistentie van Plasmodium ertegen. Overigens kunnen anti-malariamiddelen en middelen tegen AIDS interacties vertonen en hun efficiëntie beiderzijds reduceren. Het risico van therapeutisch falen en resistentie neemt ook toe.

He said the institution still needed 12 more doctors to have the required 24 doctors.

Zambiase bisschop Mpundu: Evangelisatie grootste uitdaging , Missionarissen blijven nodig .

Geplaatst door Theo Borgermans op
wo 25 okt '06 om 11:25u (Bron: Cisa )

LUSAKA (RKnieuws.net) - “De belangrijkste uitdaging voor de katholieke Kerk in Zambia is een effectieve evangelisatie, tegen de achtergrond van de arm oede en de jonge democratie : dat zegt Mgr. George Telesphore Mpundu, aartsbisschop coadjutor van Lusaka.

Volgens de bisschop vormen de politieke, sociale en economische omstandigheden momenteel de belangrijkste hinderpalen voor de evangelisatie.

De visie van de katholieke kerk op evangelisatie in zijn land is gebaseerd op een integrale visie op de menselijke persoon. De kerk heeft wel eigen priesters, maar heeft nog nood aan missionarissen. Ik denk dat we als leden van de universele kerk moeten delen wat we hebben. Alle christenen van de eerste, de tweede of de derde wereld hebben iets te geven en iets te ontvangen. In Afrika is het ons doel op eigen benen te kunnen staan. Dat impliceert dat men zowel in de eigen materiële als spirituele middelen kan voorzien. Al betekent dat echter niet dat missionarissen niet langer nodig zijn.

Mgr. Mpundu voegt er nog aan toe dat de strijd tegen aids en de hulp aan de vele aidswezen tot de integrale missie van de katholieke kerk behoren. (tb )

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8) ZAMBIA: Cold reception for China's president

U N I T E D N A T I O N S
Office for the Coordination of Humanitarian Affairs
Integrated Regional Information Network (IRIN) -

LUSAKA , 5 February (IRIN) - China's pledge to pour US$800 million into
Zambia over the next three years has been given a frosty reception on the
ground, as many locals believe the investment will hold little benefit for
the people, two-thirds of whom live on one dollar or less a day.

Chinese president Hu Jintao made the multi-million dollar announcement on
Sunday, when he also wrote off $11 million worth of debt, promised to
build schools, and provide agricultural training and loans for
road-construction equipment. A trip to Copperbelt Province to lay the
foundation stone for a national stadium was cancelled at the last minute,
apparently over fears that he would be embarrassed by a protest over poor
working conditions planned by mine workers.

Police also sealed off all access roads to the University of Zambia's
campus on Saturday, the day Hu arrived, after widespread rumours that
students were going to demonstrate against his visit.

Muweme Muweme, social conditions research project officer at the Jesuit
Centre for Theological Reflections, a faith-based human rights watchdog,
told IRIN: "The problem with such foreign direct investment as the
Chinese, is that it always comes with vested interest, which is profit.
Many of these investments coming into the country are actually not helping
in building the capacity of the local people so that they can contribute
to their own economic growth.

"It is time that our government stopped favouring foreigners through
incentives because Zambia offers raw materials. Government should be more
cautious with these investment pledges," he said.

A $200 million copper smelter is the centrepiece of an Economic and Trade
Co-operation Zone in Copperbelt Province, the first of five such zones to
be established in Africa with Chinese investment and the co-operation of
host governments. The Zambian zone is expected to create 50,000 new jobs
by 2010, adding to the 10,000 jobs already created by China's
investments - a high number of employment opportunities, given that only
about 400,000 formal jobs exist in a country of about 10 million people.

Hu's 2004 policy of strengthening ties with the mineral- and energy-rich
continent coincided with the adoption of free market polices by President
Levy Mwanawasa's administration. China's exports to Africa rose by 36
percent to $13.82-billion in 2004, while imports, mostly natural
resources, rose 81 percent to $15.65-billion. In 2006, total trade between
Africa and China reached US$55.5-billion, and China now sources one-third
of its crude oil imports from Africa.

Zambia's investor-friendly approach offers generous investment terms to
lure foreign mining companies, such as 20-year tax holidays, a low 0.6
percent mineral royalty tax - the global norm is 3 percent - and no duty
imposed on imports of equipment and machinery.

According to the Zambia-China Business Forum, bilateral trade between the
two countries grew by 11.8 percent in 2006 to $316 million. Hu's two-day
stopover in Zambia is an indication of its importance to China, as the
seven other African countries he is visiting to promote trade are only
being given a day each. His tour takes him to Cameroon, Liberia, Sudan,
Namibia, South Africa, Mozambique and the Seychelles.

Chinese investment became a divisive campaign issue in the run-up to
Zambia's 2006 general election, during which the main opposition leader,
Michael Sata, of the Patriotic Front, promised to chase away the Chinese
if he won the election. Voters in the capital, Lusaka, and the country's
economic heartland, the Copperbelt Province, favoured Sata, giving him all
the parliamentary seats in these areas.

Although Mwanawasa was returned to power for a second and final term of
office, the election period saw Ambassador Li Baodong seemingly break
diplomatic protocol when he told local media that Chinese investors had
put "on hold further investments until the uncertainty surrounding our
bilateral relations with Zambia is cleared." His remarks were seen as
interfering in Sata's election campaign and caused widespread anger.

Justin Chilufya, a street vendor in Lusaka, said more Chinese investment
in Zambia would lead to a further deterioration of living standards
because "these Chinese investors just come here to make money and take
away from us even the simple businesses like selling groceries in markets.
Honestly, is this the kind of foreign investment we can be celebrating
about?

"Today, we are forced to trade on the streets simply because the Chinese
have taken over selling in our newly constructed shopping complexes at
Kamwala [Lusaka's main trading area] and at town centre. We don't see any
need for Chinese investment if they are not going to put up their own
structures, which can remain here after they leave."

Emily Sikazwe, executive director of Women for Change, a local gender and
human rights advocacy organisation, said Chinese investment was
counter-productive. "This move will promote massive externalisation of the
few resources that Zambia has, because our country will be used as a
provider of cheap raw resources and a market for poor-quality goods. We
expect China to make their investment in our country more meaningful by
observing human rights, especially the right to livelihood and dignity."

As China's investment increases, so do the number of Chinese people
residing in Zambia, which is becoming another hotly disputed issue. Deputy
minister of Home Affairs Chrispin Musosha recently told parliament that
within six months the number of Chinese people working and living in
Zambia would double from the current figure of 2,300.

According to an official at Zambia's immigration service, who declined to
be identified, "there could be well over 50,000 Chinese residents in
Zambia, as we don't count the women and all the dependants whenever we
give out work permits to foreigners. In 2006 alone, we gave out over 5,000
permits to Chinese investors."

Guy Scott, secretary-general of the Patriotic Front, claims there are
80,000 Chinese people currently residing in Zambia. "People are very angry
with China's investment in Zambia: they are paid poor salaries, they work
under risky conditions - in some cases without protective clothes - and
this is why no one seems to be supporting them."

Two years ago, 49 miners were killed in an accident at the Chinese-owned
Chambishi Mine in Copperbelt, and last year five miners were shot dead by
police during violent protests over working conditions at the same mine.

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9) ZAMBIA : Kabwe, Africa 's most toxic city .

KABWE, 9 November (IRIN) - Kabwe, home to 300,000 people, is Africa 's most polluted city and has gained the dubious distinction of being ranked as the world's fourth most polluted site, according to a survey published by the Blacksmith Institute, a New York-based organisation monitoring pollution in the developing world.

In this toxic environment, Christine Mupika, barefooted and without any protective clothing, is just one of many scavenging Kabwe's open quarries and old dump sites near the city centre every day for metals, coal and zinc to sell by the roadside. Her high-risk occupation earns her about US$0.25 for 25kg of zinc and around $1.25 for the same quantity of coal; income derived from scrap metal sales depends on her bargaining abilities.

"If I don't work here, then I won't feed my five children at home," said Mupika, 52, whose husband died in 1995. "Much of my income comes from coal - sometimes I can sell two bags in one day, but zinc takes a bit longer to find a customer and it is not even profitable."

Kabwe , Zambia 's second largest city, grew up around the 1902 discovery of lead deposits about 150km north of the capital, Lusaka , and became Africa 's largest lead mine. Veins of lead ore, with concentrations as high as 20 percent, were mined deep into the ground; smelting operations were established nearby and ran almost continuously until 1994.

Chernobyl in the Ukraine , which suffered the world's worst nuclear accident in 1986, topped the list of most polluted sites, followed by the Russian city of Dzerzhinsk , where chemical weapons were produced during the Cold War. Third on the list is the Dominican Republic town of Haina , where emissions from an old car battery smelter have caused almost the entire population of 85,000 to suffer from lead poisoning. Kabwe is ranked fourth.

"This smelting process [in Kabwe] was unregulated ... and these smelters released heavy metals in dust particles, which settled on the ground in the surrounding area. The mine and smelter are no longer operating, but have left a city poisoned from debilitating concentrations of lead in the soil and water from slag heaps that were left as reminders of the smelting and mining era. In one study, the dispersal of lead, cadmium, copper and zinc in soil extended over a 20km circumference from the smelting and mining processes. The soil contamination levels of all four metals are higher than those recommended by the World Health Organisation," the institute said in its survey.

Richard Fuller, director of the Blacksmith Institute, said environmental problems caused up to 20 percent of deaths in developing countries, but "the worst problem is the damage they do to children's development, and that damages the future of the countries."

Lead is one of the most potent neurotoxins and is particularly harmful to children and infants. It leads to attention deficit disorders and hearing impairment, and affects a child's mental development; in pregnant women it can cross the placenta and put an unborn baby at risk.

According to The Lancet, one of the world's leading medical journals, "Almost all children born in industrialised countries between 1960 and 1980 were exposed to substantial amounts of lead from petrol that could have reduced the number of children with far above-average intelligence [IQ scores above 130 points] by more than 50 percent, and might likewise have increased the number with IQ scores below 70."

Medical experts say the lead levels in children should not exceed 15 microgrammes per decilitre, but lead concentrations of up to 300 microgrammes per decilitre have been recorded for children in Kabwe, with average levels in the blood ranging from between 60 and 120 microgrammes per decilitre.

Matildah Muyunda, who cares for her two grandchildren, told IRIN: "My two children last month developed a terrible skin rash and blisters which looked like chicken pox. They could not eat for two days and when I took them to the hospital, I was told it was something to do with lead poisoning, but they were not given any medication until they [rash and blisters] disappeared on their own after some two weeks."

Soil testing in Kabwe revealed that lead levels around the closed smelter were as high as 245,000 microgrammes per decilitre [24.5 percent] while samples taken from residential backyards and surrounding areas have up to 38,000 microgrammes per decilitre [3.8 percent] lead content. The recommended safety limit for an industrial site is a maximum of 2,000 microgrammes per decilitre [0.2 percent].

In Kabwe, the main cause of lead poisoning is believed to be inhalation or ingestion of airborne particles, dust from gardens and general play areas, food grown in contaminated soils, and dust created as people search the mine dumps for scrap metals.

"On three occasions I have been diagnosed with lumps in my chest, which doctors say are due to lead poisoning, and they always advise me to stop working here, but no one has ever given me any money to do something else," said Mupika. "How do they honestly expect me to survive if I stop mining? I do this because I have no other means."

Justine Mukosa of the Environmental Council of Zambia, a government watchdog, told IRIN, "We are having to deal with a lot of pollution cases at the moment - not just in Kabwe but also across the Copperbelt Province because when most of these mines were opened, there were no stringent laws targeted at protecting the environment."

Environmental impact and assessment legislation compelling all mining companies in Zambia to adhere to environmental safeguards was introduced in 1997 - three years after the Kabwe mine closed.

"Somehow, the Kabwe lead pollution provided some insight into the extent of damage that mining activities were having on the environment, and it played a major role in the formation of the Act. But it is very difficult to work out a lasting solution to the problem because of its historic nature, unless it is for the new mines that are just coming up," Mukosa said.

Kabwe's lead mine was run without pollution controls by the government-owned Zambia Consolidated Copper Mines (ZCCM) for most of its life before it became financially unviable and the smelter closed down.

An open canal that used to carry toxic waste from the lead mine pits and smelter when the mine was in operation passes through the three sprawling townships of Chowa, Kasanda and Katondo.

During the 2002 rainy season the canal flooded, spilling "several years" of toxic waste, silt and rubbish into the neighbouring communities. The vegetation, dusty soils and waterways are severely contaminated with heavy metals.

Yet scores of barefooted children play in the dusty soil of the three most affected communities. "It is hard to change attitudes - we tell people not to allow children to play in the soil or, better still, to start greening their surroundings, but we are not seeing positive results as yet," said Mujinga Kamoto, an assistant manager at the Katondo information centre run by ZCCM Investment Holdings to increase awareness of lead poisoning in the area.

Abel Kabalo, director of health in Kabwe district, declined to comment.

A medical doctor at the government-run Kabwe Mine Hospital , who preferred to remain anonymous, said all the health institutions in the area were ill-equipped to handle lead poisoning cases.

"Lead poisoning is a very serious problem here but it has not been given due attention. For example, even if almost on a daily basis we receive cases of severe anaemia, vomiting, kidney damage and brain damage, which are all linked to lead poisoning, none of us has undergone any specialised training in this field, and all government hospitals here don't have a single testing machine for lead poisoning. We borrow from a private clinic which has one, in times of emergencies."

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10) Beschermende werking van besnijdenis bij jongens

Het verwijderen van de voorhuid van de penis halveert bij mannen de kans op besmetting met het aids-virus. Dat blijkt uit twee grote onderzoeken die zijn gedaan in Kenia en Ouganda. Dat meldt de Washington Post. De resultaten bevestigen een vergelijkbaar onderzoek dat eerder in Zuid-Afrika was gedaan. Alledrie de onderzoeken zijn voortijdig afgebroken omdat de onderzoekers het ethisch onverantwoord vonden de onbesneden mannen geen besnijdenis aan te bieden. Net als bij Joden en Moslims is het besnijden van jongens in gote delen van Afrika een oud gebruik dat echter in onbruik raakte. Uit onderzoek blijkt dat in de landen waar aids het hardste toeslaat in Afrika, met name Zuidelijk Afrika, besnijdenis het minste voorkomt. Daarentegen komt aids het minste voor in overwegend islamitische gebieden. Het beschikbaar maken van medisch veilige besnijdenis kan op termijn miljoenen levens redden.

Ter bevestiging hier twee wetenschappelijke artikels uit de PUBMED.

Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa : A Review.

Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, MC 923, Chicago, IL, 60612, USA, rcbailey@uic.edu.

Based on epidemiological, clinical and experimental evidence, male circumcision (MC) could have a significant impact on the HIV epidemic in selected areas. We reviewed studies of the acceptability of MC in sub-Saharan Africa to assess factors that will influence uptake of circumcision in traditionally non-circumcising populations. Thirteen studies from nine countries were identified. Across studies, the median proportion of uncircumcised men willing to become circumcised was 65% (range 29-87%). Sixty nine percent (47-79%) of women favored circumcision for their partners, and 71% (50-90%) of men and 81% (70-90%) of women were willing to circumcise their sons. Because the level of acceptability across the nine countries was quite consistent, additional acceptability studies that pose hypothetical questions to participants are unnecessary. We recommend pilot interventions making safe circumcision services available in conjunction with current HIV prevention strategies and evaluating the safety and acceptability of circumcision.

PMID: 17053855 [PubMed - as supplied by publisher]

Male circumcision and risk of HIV infection in sub-Saharan Africa : a systematic review and meta-analysis.

Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine , UK .

OBJECTIVE: To systematically review studies of male circumcision and the risk of HIV-1 infection in men in sub-Saharan Africa , and to summarize the findings in a meta-analysis. DESIGN: A meta-analysis of observational studies. METHODS: A systematic literature review was carried out of studies published up to April 1999 that included circumcision as a risk factor for HIV-1 infection among men in sub-Saharan Africa . A random effects meta-analysis was used to calculate a pooled relative risk (RR) and 95% confidence interval (CI) for all studies combined, and stratified by type of study population. Further analyses were conducted among those studies that adjusted for potential confounding factors. RESULTS: Twenty-seven studies were included. Of these, 21 showed a reduced risk of HIV among circumcised men, being approximately half that in uncircumcised men (crude RR = 0.52, CI 0.40-0.68). In 15 studies that adjusted for potential confounding factors, the association was even stronger (adjusted RR = 0.42, CI 0.34-0.54). The association was stronger among men at high risk of HIV (crude RR = 0.27; adjusted RR = 0.29, CI 0.20-0.41) than among men in general populations (crude RR = 0.93; adjusted RR = 0.56, CI 0.44-0.70). CONCLUSION: Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa , particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.

PMID: 11089625 [PubMed - indexed for MEDLINE]

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11) Condoms not the answer for Zambian pandemic, AIDS-fighting nun Maria Crusis says
(We met sister Maria Crusis several times while visiting her Hospice)

9-February-2007 -- Catholic News Agency

Konigstein, Feb 8, 2007 (CNA).- Preaching chastity and fidelity are “the only way” to tackle an AIDS pandemic sweeping Zambia, according to a nun who has set up a hospice for people infected by HIV. Sister Maria Crucis Beards recently spelled out the ineffectiveness of condoms and how the devices actually encourage promiscuity.

In an interview with Aid to the Church in Need (ACN), she said most Zambians wrongly believed that condoms provided a guarantee against the spread of HIV. “I believe telling people about the importance of chastity and fidelity is the only way to tackle the crisis. Condoms have been freely available for 10 years or more and yet there’s been no obvious change in HIV levels. Clearly, condoms don’t work,” she said.

Sr. Crucis stressed the need for action against HIV, saying that up to 200,000 Zambians are in urgent need of HIV treatment with anti-retroviral therapy and about half of all general hospital admissions involve people infected with the illness.

Source: Catholic News Agency

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12) AFRICA: Armed forces find HIV a tough opponent

KIGALI, 19 June 2007(IRIN) - When young men sign up to join the army, they have
to undergo a series of tests to determine their eligibility. Increasingly,
in Africa, an HIV test is one of them and, if you are positive, a potential
career can come to an abrupt halt.

If you are HIV-positive you could be facing "career death", and unlikely to
be deployed on peacekeeping missions or sent on training courses abroad,
activists have argued.

Combat effectiveness versus the rights of soldiers is an issue many of
Africa's armed forces are grappling with.

The impact of the epidemic on the military is well recognised: in two
decades of war with the rebel Lord's Resistance Army, Uganda's defence force
lost more soldiers to AIDS than to fighting; in Zimbabwe, AIDS-related
illnesses are estimated to have killed more military personnel since 1983
than all its military operations combined, including the bloody independence
struggle.

Rwanda, which has been excluding HIV-positive recruits since the early
1990s, views the high uptake of voluntary counselling and testing (VCT)
services as a major achievement in its military AIDS programme.

Seventy percent of the country's armed forces have been tested for HIV, and
prevalence currently stands at 4.5 percent, according to Dr Charles Murego,
director of medical services in the ministry of defence. More than 1,000
HIV-positive personnel and their families are enrolled in the military's
care and treatment programme.

But only 17 percent of Zambia's military personnel have come forward to be
tested voluntarily. "VCT is not working in our military set-up; let's look
at mandatory or routine testing," suggested Zambian Brig-Gen Joseph Banda at
a conference on scaling up AIDS services, held in Kigali, Rwanda, this week.

Mandatory testing being considered

Banda told delegates at the gathering, organised by the US President's
Emergency Plan for AIDS Relief (PEPFAR), that mandatory testing ahead of
peacekeeping missions, or before troops were sent on foreign training
courses when the host country demanded an HIV test, was a fact of life in
the Zambian military.

Mandatory testing was also carried at the discretion of the service command,
when considering promotion or assigning special duties. "Perhaps mandatory
testing is not the right word ... It's too strong, maybe we should use the
words routine testing, because it is more polite and more inviting, and
soldiers can accept it," Banda told IRIN/PlusNews.

The Zambian Defence Force is in the process of drafting a new AIDS policy,
which could include compulsory testing during the annual medical checkup.

"We can pick up on these people immediately, and then admit them quickly to
management systems before they deteriorate; but if we just depend on VCT,
very few people will come forward, they will only come forward when ill,
when we can't even deploy them, therefore compromising the combat readiness
of the defence force."

Combat readiness at all costs?

Combat readiness was a phrase Banda used often, and in his view was the
bottom line when discussing the screening of HIV-positive recruits. "We just
won't be combat ready if we compromise."

Analysts have argued that the policy of rejecting HIV-positive recruits has
not been thoroughly considered by African militaries.

Martin Rupiya, of the defence sector programme at South Africa's Institute
of Security Studies, noted in a recent study that the increasingly common
policy was a "rough and ready practice" with serious shortcomings.

He argued that an HIV test could not be regarded as conclusive, as some
potential members could be in the 'window period', while HIV-positive
recruits could be deemed medically fit if their CD4 count - which measures
the strength of the immune system - did not fall below 200.

A recruit would need to be tested repeatedly over a period of 180 days, and
have a CD4 count of below 200, as well as viral load of over 100,000, before
they could be deemed unable to serve in the armed forces, he pointed out.

However, Rupiya found that very few African security institutions "have the
means, time and technical know-how to carry out such comprehensive tests".

"The scientific evidence on determining the HIV status of potential recruits
makes nonsense of the current position adopted by states and institutions,"
he wrote.

But scientific evidence does not always make good business sense to a
cash-strapped military like Zambia's.

"When you take on a [HIV-positive] recruit, right from the beginning you
have to start looking after that recruit; you have to put systems in place
for that recruit, you have to start testing them for CD4 counts at regular
intervals; you have to start providing them with ARVs [antiretrovirals] when
the time comes; you have to look at their diet, nutritional supplements, and
also areas of deployment; you can't just deploy them anywhere," said Banda.

"So why inherit a problem when you can avoid that problem?"

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13) ZAMBIA: AIDS drug recall creates panic

LUSAKA, 19 June (IRIN) - Contamination of the AIDS drug, Viracept, has
created panic among HIV-positive Zambians on antiretroviral therapy, who
fear other AIDS drugs may not be safe.

Purity Mwamba, an HIV-positive housewife in the capital, Lusaka, told
IRIN/PlusNews: "I may not be on Viracept, but I am deeply concerned as a
person living with HIV and on ARVs [antiretroviral drugs]. If Viracept could
be contaminated, other ARVs could be. We are therefore demanding an
explanation from the government."

Roche, the Swiss company that manufactures the drug, announced that some
batches of Viracept had been accidentally contaminated with mesylate
(methane sulfonic acid ethylester), prompting a recall of the product from
European Union markets.

The contaminant can cause cancerous tumours and genetic mutation that could
harm unborn children if used during pregnancy. Roche found the contamination
while investigating reports from patients that the Viracept tablets they
were taking had an unusual smell.

Zambia's health minister, Brian Chituwo, last week announced the immediate
discontinuation of the drug, mainly used in second-line treatment, and
ordered health workers to explain the incident to affected people.

About 1.6 million of Zambia's 11.7 million people are infected with HIV, but
only 100,000 are currently receiving treatment at state health facilities.

The government estimates that fewer than 1,000 of the people on ARVs - about
one percent - are taking Viracept, but independent analysts say the number
could be much higher.

According to Nkandu Luo, a former health minister, now an HIV/AIDS
consultant, "There could be more people affected by this because some of
them take Viracept as part of a combination therapy. Government should be
speaking to Roche because the damage has been done. Roche should take
responsibility for distributing contaminated drugs."

Roche introduced Viracept in 1998 as one of a class of ARV drugs called
protease inhibitors, which prevent newly reproduced viruses from infecting
other cells, thus slowing the spread of the HI virus in the body.

Samuel Mpuka, executive director of the Churches Health Association of
Zambia, an umbrella organisation for church administered health
institutions, said the contamination was scandalous and communities should
be made more aware and be better informed of drug-related issues.

"Government should strengthen quality assurance mechanisms in this country -
maybe there are many drugs that we are taking without actually ensuring
their quality. People should know what they are taking," Mpuka said.

Minister Chituwo said all HIV-positive patients on Viracept would be checked
by healthcare providers before being switched to other drugs. "Patients
should not unilaterally decide to change drugs on their own, as the effects
may be fatal," he cautioned.

There are fears that some patients will stop taking Viracept before health
workers determine the best replacement drug, and interruptions in treatment
can lead to the development of drug resistance.

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14) IRIN Africa English reports, 10/26/2007

CONTENTS:

- ZAMBIA-ZIMBABWE: Zimbabwe's sex workers look to their neighbour for
business

LUSAKA, 26 October (IRIN) - An influx of Zimbabwean sex workers into the
Zambian capital, Lusaka, is testing the government's patience with its
neighbour.

Although there are no official figures for the number of Zimbabweans
resident in Lusaka, unofficial estimates have put the figure at 10,000 or
more, and many are said to be engaged in activities the government frowns
upon.

"We have had numerous reports and concerns over Zimbabweans engaging in
commercial or illicit sex," Mulako Mbangweta, a spokesperson for the
immigration department, told IRIN.

"Surely we can't allow such a situation to go unattended to in this era of
HIV/AIDS. Some of them have documents which say they are in Zambia for a
visit, just a mere visit, but they are ending up doing businesses or taking
up prostitution and, therefore, are not qualified to be mere visitors."

Zimbabwe is in its seventh year of an economic recession that has seen
inflation reach more than 6,000 percent - the highest in the world - and
unemployment levels of above 80 percent. It has been estimated that as many
as 3 million Zimbabweans have left the country for neighbouring states, such
as Zambia, Botswana and South Africa, or have gone further afield to England
and the United States.

According to international donor organisations, more than a third of
Zimbabwe's population, or 4.1 million people, require emergency food
assistance.

Although the size of its economy makes South Africa the most favoured
destination for Zimbabwe's economic migrants, there are no visa requirements
for Zimbabweans travelling to Zambia and many simply stay on after their
visitor's permit has expired.

"We are very much concerned about the large numbers of Zimbabweans who are
entering and staying in Zambia without any proper or valid documentation. We
are therefore sending them back and, at the same time, we are also blocking
others from entering our country because we simply do not have the capacity
to keep them here - the numbers are just too large," Mbangweta said.

The Zimbabweans often survive by street vending, begging and working in the
sex industry, but earlier this year the Zambian government clamped down on
street vending in Lusaka, leaving sex work as the only option available to
many women.

Zambia's immigration department recently raided a guesthouse in the capital
where all the rooms had been rented by 51 Zimbabwean sex workers. All were
immediately deported to Zimbabwe by bus. Since July, 300 Zimbabweans have
been prevented from entering the country through the Southern Province
border posts of Chirundu, Kazungula and Kariba.

Marjory Kwenda, a Zimbabwean cross-border trader has had to engage in sex
work since the Zambian authorities enforced strict by-laws preventing
vendors from trading.

"In the past, I could bring in things like sweets, chocolates and nice
jewellery, which I easily sold on the streets: the market was massive and
the demand was high. Now I have to sell these things in the shanty compounds
[squatter camps] where few people are able to buy, and sometimes I can't
even sell anything in a day," Kwenda told IRIN.

"So I have been supplementing my income to sustain my stay. During the day I
sell my products in these shanty compounds; at night I go to taverns and
nightclubs to hook up a man or two. Zambian men are really nice because they
pay for the [sex] services promptly, they don't give me any problem."

When asked whether she understood the risks of engaging in commercial sex
work, Kwenda said: "I always insist on condom use, though some of them
refuse and force me to sleep with them without using a condom. It is one of
the hazards of this occupation, but there is nothing much one can do about
such circumstances."

Frederick Chintu, a Lusaka resident, told IRIN the sex trade was fast
becoming the mainstay of employment for Zimbabwean migrants in Lusaka and
Livingstone, the country's tourism capital, because "in most cases, they
literally take over the entire lodge or guest house, and rent a room each".

Chintu told IRIN: "If they rent the entire guesthouse, they start parading
themselves at the reception. Any client who walks in at any time can just
choose which woman he will sleep with for a short time, since their charges
in most cases are uniform.

"They are usually aged between 16 and 40 years, and so it's a question of
one's taste, whether to go for the young one or pick on the elderly and more
experienced, but they would all be there at the reception."

Both countries have high rates of HIV/AIDS: in Zimbabwe 20.1 percent of
people aged between 15 and 49 are HIV positive, while in Zambia the
infection rate for the same age-band is 17 percent.

Clementine Mumba, a spokesperson for the Treatment and Advocacy Literacy
Campaign, an HIV/AIDS prevention advocacy group, told IRIN: "This issue of
having Zimbabweans taking up prostitution here will have a very negative
impact on our country.

"These people are desperate for cash and can do anything, regardless of
whether they are infecting or getting reinfected. Some don't even know their
HIV status, for that matter. It's a very negative picture for our country."

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15) Hoopgevend nieuw malariavaccin (okt.2007)

Een nieuw vaccin tegen malaria vermindert de kans op besmetting met 65 procent. Dat melden onderzoekers op de website van het medische tijdschrift The Lancet.

Zij hebben het experimentele vaccin getest op 214 baby ’s in Afrika en het middel op basis van de eerste resultaten veilig en effectief bevonden.

Malaria is een van de meest dodelijke ziekten in de derde wereld. Iedere 30 seconden sterft er iemand aan deze ziekte, die wordt overgebracht door muggen. De meeste slachtoffers zijn kinderen onder de vijf jaar.

Het experimentele vaccin voorkomt dat de parasiet die malaria veroorzaakt vanuit de lever in het bloed terechtkomt. Voor het onderzoek werden jonge baby ’s van 10 tot 18 weken ingeënt, de meest kwetsbare groep. Na drie maanden bleken zij 65 procent minder kans op besmetting te hebben dan andere baby ’s.

Vanwege de succesvolle resultaten wordt het middel vanaf volgend jaar op 16.000 kinderen in 7 Afrikaanse landen getest. Als die grootschalige testfase ook goed verloopt, kan het vaccin tussen 2010 en 2012 op de markt komen. Volgens de medische wereld zou dit een enorme doorbraak zijn.

BRON: BBC / Reuters

16) Afrika dreigt strijd tegen Aids te verliezen (okt.2007)

Het United Nations children's agency waarschuwt dat Zuid-Afrika de strijd tegen HIV/Aids dreigt te verliezen.

De Zuid-Afrika-afgevaardigde van Unicef, Macharia Kamau, zegt dat de besmettingsgraad en de sterftecijfers sneller stijgen dan dat ze bestreden kunnen worden. Dit heeft een verpletterend effect op de kinderen van wie de ouders stierven aan Aids en stuurt een uiterst dringende boodschap de wereld in. Mr Kamau stelt dat als de huidige trend zich blijft voortzetten, dat er tegen 2015 meer dan 5 miljoen aids-wezen zullen zijn in Zuid-Afrika.

Groot risico

Zuid-Afrika is een van de 9 landen wereldwijd waar de kindersterfte stijgt - van 60 sterfgevallen op 1000 geboortes in 1990 naar 95/1000 in 2007. De voornaamste reden is HIV/Aids, stelt Unicef.

De gemiddelde besmettingsgraad bedraagt bijna 30% van de totale bevolking, met pieken tot 50% in sommige streken. De impact op de kinderen is immens en veel kinderen van wie de moeder stierf aan Aids lopen het risico om zelf aan de ziekte te sterven. Oudere kinderen die hun ouders verloren worden geconfronteerd met een strijd om te overleven en naar school te kunnen gaan.

In Zuid-Afrika zijn er momenteel 1,5 miljoen Aids-wezen. Als de lijn van 400.000 Aids-doden per jaar zich blijft voortzetten, zullen er tegen 2015 meer dan 5 miljoen Aids-wezen zijn in Zuid-Afrika.

Het aantal mensen dat besmet geraakt en sterft, overtreft constant het aantal mensen dat een behandeling krijgt in Zuid-Afrika. Kamau beschrijft dit als een dringende boodschap voor de toekomst. Ook al worden er 380.000 Zuid-Afrikanen behandeld met antiretrovirale medicijnen; er blijven er 1,2 miljoen die geen behandeling krijgen.

Zolang als het aantal nieuwe besmettingen en het aantal sterfgevallen hoger blijft liggen dan het aantal behandeldingen, dreigt Zuid-Afrika de strijd te verliezen tegen Aids, zegt Kamau.

Unicef roept op tot een onmiddellijke expansie van de behandeling, naast een meer open Aids-preventie campagne van de overheid om het stigma dat in Zuid-Afrika nog steeds rond de ziekte hangt, te doorbreken.

Bron: news.bbc.co.uk

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17) Persartikel in Gazet van Antwerpen Online ivm Bertram Project (feb.2009)

18) Persartikel in Het Nieuwsblad: Prinses Astrid bindt strijd aan met malaria (april 2008)

19) Persartikel : Zuid-Afrika wil malaria verbannen tegen 2015 (mei 2009)

20) IRIN Africa English reports, 18 May 2011

CONTENTS: ZAMBIA: The dangers of unsupervised school accommodation

MANSA, 18 May (IRIN) - An absence of boarding facilities for high school pupils in Zambia's northern province of Luapula is forcing children to share lodgings with their peers - unsupervised by adults - leading to teenage pregnancies and HIV/AIDS infections.

Many children live a long way from school and prefer to rent accommodation nearby. Grade 12 pupil Dorcas, 17, stopped attending the Mabumba High day school, about 20km east of provincial capital Mansa, after becoming pregnant.

"We were staying the three of us [girls], then we started sharing the house with three guys and that is how we paired ourselves. We just wanted some form of emotional support; life is really tough out there. So, the whole of last year we were living together with the guys and would have [unprotected] sex almost every night but everything was OK," she told IRIN.

"When I missed [my periods] early this year, I decided to go to Mansa General Hospital for a [pregnancy] test and the results were positive... I left school because everyone was laughing at me. They were saying 'this one is a married woman' after they knew [of my pregnancy]."

Mabumba High School enrols some of its 690 pupils from as far away as the capital Lusaka and about 500 of the children are responsible for their own accommodation arrangements.

"We couldn't find a place in a proper boarding school in Luapula. Everywhere we went, we were told 'the places are full', and that's how my mother decided to bring me here. She sends money every month for rentals, food and groceries," Margaret Chanda, 16, a Grade 12 pupil from Ndola in the Copperbelt and attending Mabumba High School, told IRIN.

She shares a two-room grass-thatched hut with her friend and pays US$5 a month.

Wamunyima Chingumbe, a Health Ministry director in Mansa District, said the absence of boarding facilities at day schools had led to teenage pregnancies and made pupils vulnerable to contracting sexually transmitted infections (STIs). After malaria, STIs were the most common ailments recorded at makeshift boarding high schools.

Higher STI rates

"In terms of HIV/AIDS and other STIs, quazi-boarding schools record higher numbers of pupils with STIs compared to schools with [official] boarding facilities," Chingumbe said.

"Mabumba High School once recorded 13 HIV-positive female cases and four HIV-positive male cases out of an enrolment population of about 600 pupils," Chingumbe said.

"On the other hand there are very few cases of HIV-positive/STI cases recorded [at official] boarding schools, and this could be attributed to the fact that pupils are confined in one place and dormitories are out of bounds for the opposite sex," he said.
Government investment in universal primary education has not been matched in the high school sector, and the 2008 scrapping of qualifying examinations for Grade 10 has put more pressure on school facilities, with more and more pupils continuing their education. The province has 23 high schools, six of which are day schools.

Elizabeth Mushili, coordinator of the Mansa District Women's Development Association, a gender-based advocacy group, wants the government to equip all schools with boarding facilities.

'Free-range lifestyles'

"These children adopt confused, free-range lifestyles. We are of the view that government should have been more considerate and constructed dormitories for both girls and boys at these high schools. Or better still, they [government] should have built more day high schools to cut down on the distances [between the schools].

"Early pregnancies are very common because of lack of parental care; no one is looking after these children and, hence, they can do anything," Mushili told IRIN.

"We have pupils, especially girls, who get abused by male adults for sexual exploitation; we have many children around 13, 14 years carrying their own children and dropping out of school in Mabumba and Chembe [another day high school in Mansa where children use makeshift accommodation]," she said.

Luapula is one of Zambia's poorest provinces: it has a poverty level of 75 percent, compared with the national average of 64 percent. According to UNAIDS the national HIV prevalence for sexually active adults aged 15-49 is 14.3 percent.

"Many of us end up sending our children to these weekly-boarding schools like Mabumba because we have no money to send them to boarding schools. We are poor," Joseph Mutale, a small farmer in Mansa, told IRIN.

"I give my son a tin of maize [for grinding into the staple maize meal] every month and 10,000 kwacha [US$2] to buy relish but he keeps on complaining about other things that I can't afford to give him," he said.

Pupils attending boarding high schools pay up to $300 for a three-month term, but day schools like Mabumba only charge $40 a term.

Defilement

Zambian law classifies sex with anyone under 16 as defilement, and is punishable by a prison term of up to 25 years.

"We have many children below 16 years who are very sexually active. It is defilement [of a minor] but she will not see it that way. There are many defilement cases going on here; they are contracting many diseases especially STIs; some are falling pregnant," a teacher at Mabumba High School, who preferred anonymity, told IRIN.

Luapula's provincial education officer Florence Kanchebele told IRIN the government had begun constructing boarding facilities at two day schools - in Ponde and Lukwesa, and acknowledged the problems associated with learners renting accommodation close to schools. She said some pupils engaged in "what may be termed as 'marriages of convenience' with other pupils and sometimes, community members due to economic reasons".

The school authorities were still responsible for their children outside school hours and landlords were "instructed to protect the pupils, report to the school any bad behaviour by such pupils, and sensitize the pupils on the dangers of HIV/AIDS, STIs and early pregnancies," she added.

Ruth Mwewa, a landlord for several pupils from Mabumba High School in the past, told IRIN: "No teacher has ever approached me to talk about these pupils' behaviour. Two of the girls I have kept here got pregnant and stopped school. The girls are especially a big problem because they are forever found with boys or married men who come with cars."

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Sfeerbeelden uitreiking HidroPLUS 2012

21) Bertram project valt in de prijzen tijdens HidroPlus 2012

De nood aan zuiver drinkwater en goede sanitaire voorzieningen blijft nog steeds hoog.
Elk jaar draagt Pidpa via HidroPLUS zijn steentje bij om dit probleem op te lossen.
Op zondag 25 maart 2012 werden de projecten bekendgemaakt die in 2012 een financiële bijdrage ontvangen.
Het zijn er 23 in totaal. 15 projecten uit Afrika, 6 uit Midden- en Zuid-Amerika en 2 uit Azië.
Eén hiervan is dus het Bertram Project in Zambia waardoor een cheque in ontvangst mocht genomen worden.

Nieuws/Nouvelles/News/Neues

>Artikels over de Bertram-P-Z-Foundation

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