Lessons for Karachi sex workers

Zeba Raman is a 28-year-old Pakistani sex worker. Born into the profession in Karachi’s red light district of Napier Road, she plies her trade all over the city.

I did not know that precautionary measures should be taken during sex Nadia, sex worker

She is celebrating the launch of an initiative to promote health awareness among sex workers.

“We are now revealed to society,” says Ms Rahman.

But prostitution remains illegal and anathema to many in Muslim-majority Pakistan. It is an ever-present fact of life, but never really acknowledged.

The last two decades, given the increasing Islamisation of Pakistani society, have further reinforced stereotypes about such women.

But the profession has only grown.

Karachi alone has at least 100,000 female sex workers, according to data gathered by local welfare organisations.

Lahore has 75,000 sex workers while the military garrison town of Rawalpindi has at least 25,000.

‘Spirit of openness’

Pakistan’s first workshop on health awareness among sex workers has contributed to a new spirit of openness in the profession.

“Earlier we were doing our jobs secretly, but now we can raise our voice for our rights,” Ms Raman says.

It was very difficult to gather sex workers under one roof. Many were simply afraid of being arrested Dr Ghulam Murtaza

The three-day event was recently held in Karachi by Gender & Reproductive Health Forum (GRHF) – a local social welfare organisation – in collaboration with the United Nations Fund for Population (UNFPA).

“I am very happy that a number of sex workers attended the workshop,” says Ms Raman.

“This has provided us an opportunity to gather and exchange views and experiences.”

She is not the only one to have benefited.

“I became a sex worker five years back,” says Nadia, 26.

Nadia said that she learned about safe sex measures at the workshop.

“I had heard about HIV/Aids, but I thought that it could only be transmitted through blood transfusions.

“I did not know that precautionary measures should be taken during sex as well,” she said.

Before the workshop, most of sex workers who attended did not know about measures for safe sex, Nadia added.

Dr Ghulam Murtaza is the head of the GRHF organisation and the man behind the workshop.

Ms Raman said she drew a lot of confidence from the workshop

The man behind the workshop, GRHF head Dr Ghulam Murtaza , said the organisation was working to create awareness of safe sex among female sex workers.

“It was very difficult to gather sex workers under one roof. Many were simply afraid of being arrested,” he said.

“We offered several incentives and assurances and paid them 1,000 rupees ($20) per day for their attendance,” he said.

“Finally, we succeeded in gathering almost 100 sex workers at the workshop held at a local hotel”.

Most of the sex workers who attended avoided the cameramen there., saying they were afraid of being exposed to their families.

Many said their husbands or family members did not know they were sex workers. They told their families that they work for private firms.

Despite these barriers, Dr Murtaza said the workshop had been successful.

“We have trained some female sex workers. They will now go to their community to create awareness among their co-workers.”

‘Reinvigorated’

The international participants at the workshop were of the view that Pakistan was still relatively safe as far as HIV/Aids was concerned.

I can now continue with my profession with more confidence Zeba Raman

The UNFPA representative, Dr Safdar Kamal Pasha, said at least 100 HIV- positive sex workers had been found in central Punjab. But the number of HIV-positive women was not high among female sex workers in Pakistan.

“It can be controlled by creating awareness about the disease among sex workers and about usage of precautionary measures,” he said.

The workshop was widely considered to be a success and Dr Pasha said they were considering organising a national convention for sex workers next year.

The sex workers themselves were moved by the workshop.

“Having attended the workshop, I feel reinvigorated,” Zeba Raman declares.

“I can now continue with my profession with more confidence.”

Alarming Africa male gay HIV rate

The reports said more education was needed to combat HIV among gay men

HIV rates among gay men in some African countries are 10 times higher than among the general male population, says research in medical journal the Lancet.

The report said prejudice towards gay people was leading to isolation and harassment, which in turn led to risky sexual practices among gay communities.

But the risks are not limited to gay men, as many of the infected also have female sexual partners.

The report called for greater education and resources in the fight against HIV.

The Oxford University researchers found that the prevalence of HIV/Aids among gay men in sub-Saharan African has been “driven by cultural, religious and political unwillingness to accept [gay men] as equal members of society”.

Lead researcher Adrian Smith told the EXPRESS there was “profound stigma and social hostility at every level of society concerning either same-sex behaviours amongst men, or homosexuality”.

“This has the consequence that this group becomes extremely hard to reach,” he said.

Mr Smith said that gay male sex had always been acknowledged as being particularly dangerous in terms of contracting HIV/Aids.

But gay men were also more likely to be involved in other high-risk behaviours, including sex work, having multiple partners and being in contact with intravenous drug use, he said.

Education crucial

George Kanuma, a gay rights activist in Burundi, told the EXPRESS many men “hide their sexual orientation” to get married and have children, but continue to have sex with men.

“Most of them know that you can contract HIV/Aids or any infection when you are making sex with women, but not when you are having sex with another man,” he said.

Mr Smith said there was “a desperate need for delivering a basic package of prevention for HIV”, including ensuring supplies of condoms.

“There is also a need to sensitise, educate and train those involved in HIV, the interface with men who have sex with men, to educate those involved in care and prevention activities,” he said.

The United Nations Aids agency estimates that 33 million people in the world have HIV, of whom two-thirds live in sub-Saharan Africa.

Gay sex ‘not criminal’ in India

Rights groups have long campaigned for a repeal of the law

A court in the Indian capital, Delhi, has ruled that homosexual intercourse between consenting adults is not a criminal act.

The ruling overturns a 148-year-old colonial law which describes a same-sex relationship as an “unnatural offence”.

Homosexual acts were punishable by a 10-year prison sentence.

Many people in India regard same-sex relationships as illegitimate. Rights groups have long argued that the law contravened human rights.

Delhi’s High Court ruled that the law outlawing homosexual acts was discriminatory and a “violation of fundamental rights”.

The court said that a statute in Section 377 of the Indian Penal Code, which defines homosexual acts as “carnal intercourse against the order of nature” and made them illegal, was an “antithesis of the right to equality”.

‘India’s Stonewall’

The ruling is historic in a country where homosexuals face discrimination and persecution on a daily basis but it is likely to be challenged, says the BBC’s Soutik Biswas in Delhi.

It also promises to change the discourse on sexuality in a largely conservative country, where even talking about sex is largely taboo, our correspondent says.

Gay rights activists all over the country welcomed the ruling and said it was “India’s Stonewall”.

New York’s Stonewall riot in 1969 is credited with launching the gay rights movement.

“It [the ruling] is India’s Stonewall. We are elated. I think what now happens is that a lot of our fundamental rights and civic rights which were denied to us can now be reclaimed by us,” activist and lawyer Aditya Bandopadhyay told the BBC.

Homosexuals face discrimination in India

“It is a fabulously written judgement, and it restores our faith in the judiciary,” he said.

Leading gay rights activist and the editor of India’s first gay magazine Ashok Row Kavi welcomed the judgement but said the stigma against homosexuals will persist.

“The social stigma will remain. It is [still] a long struggle. But the ruling will help in HIV prevention. Gay men can now visit doctors and talk about their problems. It will help in preventing harassment at police stations,” Mr Kavi told the news.

But the decision was greeted with unease by other groups.

Father Dominic Emanuel of India’s Catholic Bishop Council said the church did not “approve” of homosexual behaviour.

“Our stand has always been very clear. The church has no serious objection to decriminalising homosexuality between consenting adults, the church has never considered homosexuals as criminals,” said Father Emanuel.

“But the church does not approve of this behaviour. It doesn’t consider it natural, ethical, or moral,” he said.

In 2004, the Indian government opposed a legal petition that sought to legalise homosexuality – a petition the high court in Delhi dismissed.

But rights groups and the Indian government’s HIV/Aids control body have demanded that homosexuality be legalised.

The National Aids Control Organisation (Naco) has said that infected people were being driven underground and efforts to curb the virus were being hampered.

According to one estimate, more than 8% of homosexual men in India were infected with HIV, compared to fewer than 1% in the general population.

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Are you in India? What is your reaction to the court ruling? How will it change life for homosexuals in India?

India drug firm turns to Giuliani

Mr Giuliani’s firm will advise on compliance

Indian drug firm Ranbaxy has hired ex-New York City Mayor Rudolph Giuliani as an adviser, the company says.

The move comes a day after the US Food and Drug Administration (FDA) banned the import of more than 30 generic drugs made by the drug firm.

The FDA said it imposed the ban after it found manufacturing quality problems at two Ranbaxy factories in India.

Ranbaxy said Mr Giuliani’s consulting and investment firm will advise it and look into compliance issues.

Ranbaxy has said it is “very disappointed” with the decision of US drug authorities.

The import ban affects some popular generic versions of antibiotics and cholesterol medicines.

Key documents

In July, US prosecutors had alleged that Ranbaxy, India’s largest pharmaceutical company, deliberately lied about the quality of its low-cost drugs, including those for HIV.

The US Department of Justice wanted the firm to hand over key documents relating to drug testing procedures.

The firm was paid millions of dollars by the US government to provide low-cost HIV drugs for President Bush’s emergency plan for Aids relief, which was set up to help Aids patients in 120 countries around the globe.

Defending the reliability of its drugs, Ranbaxy had said the US Food and Drugs Administration had tested over 200 random samples of its products and found them “complying with all the specifications”.

In June the Japanese pharmaceutical company Daiichi Sankyo agreed to pay more than $4bn (£2bn) for a controlling stake in the firm.

The US government has been investigating Ranbaxy since February 2006 when the FDA issued a warning letter over what it said were manufacturing violations found at a Ranbaxy factory in India.

Since then Ranbaxy has been trying to resolve the issue with US regulators.

Last year, US officials seized documents from Ranbaxy’s US headquarters in New Jersey.

In July, Justice Department prosecutors alleged that the company had systematically lied about the makeup of its generic drugs, which include a cheaper version of US drug maker Merck’s cholesterol pill Zocor.

Ranbaxy has denied any wrongdoing, saying the allegations were baseless.

The FDA will only approve cheaper generic drugs if they can be shown to be equivalent to the original drug.

US investigators had also alleged that Ranbaxy has used unapproved ingredients in its drugs.

Swaziland king celebrates in style

One of the world’s last remaining absolute monarchs, King Mswati III of Swaziland, has held lavish celebrations to mark his 40th birthday and 40 years of independence from Britain, reports.

King Mswati III was flanked by dignitaries as he delivered his speech

Mswati III arrived in the stadium framed by mountains in the capital Mbabane in a brand new BMW – one of 20 bought just for the occasion.

The king, dressed in traditional clothing and wearing a beaded necklace, was welcomed by cheering, flag-waving supporters.

“We all trust him,” said a young man with a front-row seat, also in traditional dress.

“He’s a good man. He believes in his country. He loves everybody. We are all like the royal family.”

The king has a taste for the finer things in life – something he shares with his 13 wives.

Some of them arrived for the so-called “40-40” celebrations fresh from a shopping trip to Dubai.

With marching bands and dancing troupes, and a garden party to follow, it was a party fit for a king.

But can his impoverished kingdom afford it?

Contempt

The official budget is $2.5m (£1.4m) but some estimates claim the real cost could be five times that.

Critics say that it is money that could have been better spent elsewhere – on education, on health, and on saving lives.

Cheering crowds turned out to welcome the king to the stadium

With the world’s highest rate of HIV (adult prevalence of 26.1%), many believe there is nothing to celebrate.

For two days this week trade unions and civic groups took to the streets in protest calling for change and for multi-party democracy.

“We condemn this party with the contempt it deserves,” said Swazi Trade Union leader Jan Sithole, as he marched in the capital.

“People feel so strongly because this is a plundering of the country’s resources in the height of grinding poverty for most of the Swazi masses.

“People feel their money is being wasted, with arrogance.”

Powerlessness

Take a drive into the bush, and poverty is written all over the landscape – dirt roads, rundown homes, and hungry children.

A collection of African heads of state made the trip to Mbabane

Sibusiso Mamba is one of them. His name means blessing. Sibusiso is an Aids orphan, who is HIV positive himself. Now aged 14, he looks more like a seven-year-old.

For the past two months he has been on anti-retro viral drugs (ARVs).

They brought him back from death’s door, according to his grandmother, Ntsambose, who is caring for him at a remote homestead – 80km (49.7 miles) from the nearest hospital.

Now, as the king is having a banquet, she has run out of food.

“I feel bad when I see that he’s hungry,” she said. “It hurts me. He’s better because of the medicine. But the problem of hunger will make him sick again.”

Ntsambose knew nothing of the celebrations in the capital, or of the money being spent.

“Who am I to say anything?” she asked. “There’s nothing I can say about what is done by the king.”

Zimbabwe President Robert Mugabe was among those present

Many feel powerless to speak up against the monarch – criticism of Mswati is still frowned upon here.

Ntsambose can hardly see, so she relies on her grandson to gather firewood.

It takes all his strength to carry a few sticks. He dreams of being well enough for school next year, and of growing up to be a policemen. But he may not live to his next birthday.

Aids campaigners Tengetile Hlope, whose has been helping Sibusiso and his grandmother, believes this is no time for parties.

“HIV is killing the country. When you think of the budget that is being used for the 40-40 celebrations, you just feel like crying,” she said.

“There are people here who don’t have water, food or transport to a clinic.

“They are just out in the rural areas on their own. The people who are organising and celebrating the 40-40, they don’t even know about this place.”

’40 years of poverty’

The government denies that the birthday party is extravagant, and insists it’s a fitting way to mark a milestone.

“I think the nation can celebrate the achievements of the past 40 years,” said Percy Simelane, a government spokesman.

After the celebrations, many of those who attended waited in line for food

“The country has changed tremendously. At independence we used to get teachers, doctors and nurses from other countries. Now we export them. ARVs are provided free.

“Aids orphans go to school free of charge, and the government pays for meals.”

But a short distance from Sibusiso’s homestead we found more evidence of the hardships many face, at a neighbourhood children’s centre.

About 60 children visit the centre every day – more than half of them are Aids orphans.

The volunteers who run the centre feed them when they can – that is about two days a month.

On the day of our visit, there were songs, games and informal education for the children, but nothing to eat.

Tengetile Hlope believes this is the reality of life for many in rural Swaziland, four decades on.

“I feel like I am just celebrating 40 years of poverty and hunger in this country,” she said.

Roman Empire ‘raised HIV threat’

The Romans spread their genes far and wide

The spread of the Roman Empire through Europe could help explain why those living in its former colonies are more vulnerable to HIV.

The claim, by French researchers, is that people once ruled by Rome are less likely to have a gene variant which protects against HIV.

This includes England, France, Greece and Spain, New Scientist reports.

Others argue the difference is linked to a far larger event, such as the spread of bubonic plague or smallpox.

We’re waiting for the big piece of evidence which will solve this Dr Susan Scott Liverpool University

The idea that something carried by the occupying Romans could have a widespread influence on the genes of modern Europeans comes from researchers at the University of Provence.

They say that the frequency of the variant corresponds closely with the shifting boundaries of the thousand-year empire.

In countries inside the borders of the empire for longer periods, such as Spain, Italy and Greece, the frequency of the CCR5-delta32 gene, which offers some protection against HIV, is between 0% and 6%.

Countries at the fringe of the empire, such as Germany, and modern England, the rate is between 8% and 11.8%, while in countries never conquered by Rome, the rate is greater than this.

Legionnaire’s disease

However, the researchers do not believe that the genetic difference is due to Roman soldiers or officials breeding within the local population – history suggests this was not particularly widespread, and that invading and occupying armies could have been drawn not just from Italy but from other parts of the empire.

Instead, they say that the Romans may have introduced a disease to which people with the CCR5-Delta32 variant were particularly susceptible. This tallies with some other theories of why some have the gene variant, and some do not.

Researchers at the University of Liverpool had suggested that the variant could have offered protection against pandemics such as the Black Death which swept Europe on a regular basis during and after the Roman era.

These, said the Liverpool researchers, were viral illnesses which were lethal to people without the gene variant, raising its frequency from one in 20,000 people to approximately 10% in Northern Europe.

Dr Susan Scott, one of the researchers, said that the idea of Roman occupation being the driving force behind this was another theory to be considered.

“We just don’t know. This is just another piece of the jigsaw, but we’re waiting for the big piece of evidence which will solve this.”

Clinton wants Aids funding boost

Former US President Bill Clinton has called for an increase in funding to keep down the cost of drugs for people with HIV.

Courtesy BBC

Mr Clinton told a world Aids conference in Mexico that a 50% rise was needed in the next two years just to keep pace with expanding drug programme.

Figures released ahead of the meeting show the number of people with HIV worldwide has decreased slightly.

However, infection rates are still rising in some countries.

Across the world 33 million people are affected by the syndrome.

“Aids is a very big dragon. The mythological dragon was slain by Saint George, the original knight in shining armour, but this dragon must be slain by millions and millions of foot soldiers,” Mr Clinton told the conference.

A crowd of demonstrators holding banners calling for housing for people with HIV walked in front of the podium during his speech.

Mr Clinton used the moment to talk about how rising oil, food prices and the mortgage crisis had made the lives of people with HIV even more difficult.

There was “no silver bullet” to rid the world of the disease, he said.

“We know there is so much yet to be done: to expand prevention, treatment and care, to strengthen undeveloped health systems,” he added.

Universal access

The six-day conference was preceded by an awareness march, a photo exhibition and other events.

About 20,000 scientists, government officials and campaigners are in Mexico City for the event.

Funding, access to treatment, improving prevention against HIV and social issues such as stigma and violence against women are all on the agenda.

However delegates are not expecting any breakthrough announcement concerning new drugs or the search for a preventative vaccine.

The UN General Assembly and the Group of Eight (G8) have set the goal of achieving universal access to treatment and therapy by 2010.

Since Aids first became widely known, a quarter of a century ago, 25 million people have died.

In one positive development, US President George W Bush recently won backing to triple US spending on combating the syndrome.

But in some countries like Russia and China, and even Germany and the UK, the rates of infection are rising, the BBC’s Duncan Kennedy reports from Mexico City.

In the US, better detection methods have just shown the figures there have been underestimated by about 30%.

And in Africa, home to 70% of cases, access to the right drugs is improving but there are not enough health care workers to administer them.

There are concerns too about the human rights of sufferers who are often too scared to seek treatment.