Hello All,
This is to draw your attention on the launch yesterday [Dec 10, 2008] by
the World Health Organization of the World Report on Child Injury
Prevention:

More than 2000 children die every day as a result of unintentional or accidental injuries. Every year tens of millions more worldwide are taken to hospitals with injuries that often leave them with lifelong disabilities, according to
a new report by WHO and UNICEF.

The World report on child injury prevention provides the first
comprehensive global assessment of unintentional childhood injuries and
prescribes measures to prevent them. It concludes that if proven
prevention measures were adopted everywhere at least 1000 children's
lives could be saved every day.

"Child injuries are an important public health and development issue. In
addition to the 830 000 deaths every year, millions of children suffer
non-fatal injuries that often require long-term hospitalization and
rehabilitation," said WHO Director-General Dr Margaret Chan. "The costs
of such treatment can throw an entire family into poverty. Children in
poorer families and communities are at increased risk of injury because
they are less likely to benefit from prevention programmes and high
quality health services."

"This report is the result of a collaboration of more than 180 experts
from all regions of the world," said UNICEF Executive Director Ann M.
Veneman. "It shows that unintentional injuries are the leading cause of
childhood death after the age of nine years and that 95% of these child
injuries occur in developing countries. More must be done to prevent
such harm to children."

Africa has the highest rate overall for unintentional injury deaths. The
report finds the rate is 10 times higher in Africa than in high-income
countries in Europe and the Western Pacific such as Australia, the
Netherlands, New Zealand, Sweden and the United Kingdom, which have the
lowest rates of child injury.

However, the report finds that although many high-income countries have
been able to reduce their child injury deaths by up to 50% over the past
30 years, the issue remains a problem for them, with unintentional
injuries accounting for 40% of all child deaths in such countries.
The report finds that the top five causes of injury deaths are:
* Road crashes: They kill 260 000 children a year and injure about
10 million. They are the leading cause of death among 10-19 year olds
and a leading cause of child disability.
* Drowning: It kills more than 175 000 children a year. Every
year, up to 3 million children survive a drowning incident. Due to brain
damage in some survivors, non-fatal drowning has the highest average
lifetime health and economic impact of any injury type.
* Burns: Fire-related burns kill nearly 96 000 children a year and
the death rate is 11 times higher in low- and middle-income countries
than in high-income countries.
* Falls: Nearly 47 000 children fall to their deaths every year,
but hundreds of thousands more sustain less serious injuries from a
fall.
* Poisoning: More than 45 000 children die each year from
unintended poisoning.

"Improvements can be made in all countries," said Dr Etienne Krug,
Director of WHO's Department of Violence and Injury Prevention and
Disability. "When a child is left disfigured by a burn, paralysed by a
fall, brain damaged by a near drowning or emotionally traumatized by any
such serious incident, the effects can reverberate through the child's
life. Each such tragedy is unnecessary. We have enough evidence about
what works. A known set of prevention programmes should be implemented
in all countries."

The report outlines the impact that proven prevention measures can have.
These measures include:
* laws on child-appropriate seatbelts and helmets;
* hot tap water temperature regulations;
* child-resistant closures on medicine bottles, lighters and
household product containers; separate traffic lanes for motorcycles or
bicycles;
* draining unnecessary water from baths and buckets;
* redesigning nursery furniture, toys and playground equipment;
* strengthening emergency medical care and rehabilitation
services.
It also identifies approaches that either should be avoided or are not
backed by sufficient evidence to recommend them. For example, it
concludes
* that blister packaging for tablets may not be child resistant;
* that airbags in the front seat of a car could be harmful to
children under 13 years;
* that butter, sugar, oil and other traditional remedies should
not be used on burns;
* that public education campaigns on their own don't reduce rates
of drowning.

The full report is freely accessible on the WHO web site at
http://www.who.int/violence_injury_prevention/child/injury/world_report/
en/index.html
Hard copies can be purchased, with a discounted price for developing
countries, through our online bookshop at www.who.int/bookorders where
other ordering channels are also described.

Some papers ultimately achieve significance beyond their relatively small and specialized initial audiences. This is particularly the case when it comes to methodologic insights. It is for this reason that the study by Delbaere et al cited above merits greater recognition.

In 1951, Simpson was describing the general analysis of contingency tables when he introduced what has since come to be known eponymously as Simpsons Paradox. When discussed at all in introductory texts, it is usually categorized as an example of an 'extreme confounder', which it is. However, the paradox refers more specifically to the demonstration of one effect in aggregate data and the exact opposite effect in each stratum or subgroup that makes up that aggregate. It is less confusing perhaps with a 'toy' example comparing two treatments A and B:

Males Females
Treat A Treat B Treat A Treat B
Success 200 10 19 1000
Failure 1800 190 1 1000
2000 200 20 2000

http://www.mother-child.org/files/tableSimpson.png (click for formatted version of tabular data)

The above contingency table illustrates the paradox. Treatment A was given to 2020 people, and 219 were cured, for a success rate of 10.8%. In comparison, Drug B cured 1010 of the 2200, or 45.9%, and we would therefore select treatment B as superior. However, if we analyze the sex-specific subgroups, we have different results. Among males, the success rate was 10% for treatment A (200/2000) and 5% for the alternative (10/200). Similarly, among females, the success rate was 95% (19/20) for treatment A and 50% (1000/2000) for treatment B. In both cases, treatment A is preferable. As illustrated here, Simpsons paradox arises when there is a 'effect modifier', which is able to reverse the sign of the effect. In this case, the modifier (gender) is in fact an intermediate variable on the causal pathway between exposure (treatment) and outcome (success).

Less well appreciated is the fact that the same phenomenon arises with attempts to adjust more complicated analyses for a factor like birth weight that is also affected by prior exposure, which can introduce a selection bias with an equally dramatic impact on the sign of the observed effect. This bias may occur regardless of the adjustment method e.g. regression, stratification or z-score. As these authors explain clearly, the key ingredient is the attempt to stratify by some intermediate variable which is affected by the exposure or shares a common cause with the outcome.
To this extent, their specific results may be of only limited interest (they conclude that it is inappropriate to adjust for gestational age when assessing the effect of single vs. double embryo transfers on birth weight in the setting of assisted reproductive technologies). What is more important is the general strategy they propose to help illuminate the potential dangers involved in such adjustments. In brief, they advocate using directed acyclic graphs (DAGs or causal diagrams) summarizing the relationships between exposures, outcomes, confounders, and intermediate variables. With directed graphs, arrows between exposures and outcomes imply causal relationships, thus providing an intuitive, visual tool for developing and testing alternative causal models. In this specific context, adjustments should be avoided for factors that lie on the causal pathway between exposure and pregnancy outcome unless those factors share no common cause with the outcome of interest. The philosophy is elaborated in greater detail in the commentary by Wilcox, whose concluding remarks are worth consideration:

“ It is the mantra of observational studies that we can never rule out unobserved confounding. Perhaps we need a second mantra: Never adjust for covariates just because they are handy. Epidemiologists cannot depend on adjustments (or stratifications of any sort) to bring results closer to the truth. Indeed… baseless adjustments are easily worse than no adjustment at all”

It should probably be noted that theirs is not the only graphical method for understanding this artifact. Tu et al applied a vector geometric approach to multiple regression analysis to examine the so-called 'foetal origins of adult disease hypothesis', or the inverse association between birth weight and a range of diseases in later life. Just as the study by Delbaere does not invalidate standardization by z-scores in general, this work should not be regarded as a broad attack on this hypothesis. Nevertheless, they quite rightly point out that some of these studies have only been able to demonstrate a statistically significant association by adjusting for current size, a strategy that is susceptible to what they call the 'reversal paradox' and which further reinforces the dangers of uncritical adjustment for potential covariates.

Atul Sharma MD, FRCP(C)
Montreal

Just last month, I was saddened to read several news reports describing how illegal overfishing by foreign fleets has severely depleted fish stocks within the national waters of Sierra Leone and Namibia. Apparently, declining harvests there have meant that once prosperous local communities are starving and fisherman can no longer feed their own families. According to some estimates, even fisher-families have had to cut back from three protein meals per day to one, with predictable consequences for nutrition status, general health and susceptibility to the usual gamut of childhood illnesses.

A few weeks later, we were all greeted with the story of the Sirius Star being hijacked off the horn of Africa. These two stories are not as disparate as might first appear to be the case.

Make no mistake, piracy in the Gulf of Aden is a criminal conspiracy involving corrupt politicians, lawless warlords and heavily armed militia. Nevertheless, it would be a mistake to overlook its historical origins. It is easy to forget how unscrupulous European and Far Eastern governments allowed their commercial fishing fleets to essentially invade Somali waters, counting on the failure of its central government and the absence of effective policing, coast guard, or military resistance. When Somali fisherman cried foul, they were met with indifference from the international community. As noted above, recent reports indicate that precisely the same scenario is now unfolding in other locales, with consequences beyond just the question of national sovereignty.

Canadians, in particular, can therefore appreciate what prompted some Somali fisherman to borrow a page from our own playbook and seize European trawlers, imposing 'fines' in the form of ransom for their release. Lured by easy money, it was not long before their example attracted the attention of the warlords and their political cronies, who continued to cultivate the romantic myth of modern-day Robin Hoods. Before we scoff, we would do well to recall that our own history and popular culture continue to glorify shameless pirates (in recent fare, Clive Owen's Sir Walter Raleigh comes to mind :). The perception of hypocrisy is further reinforced when you consider that the story was barely newsworthy - despite 95 confirmed attacks in the Gulf of Aden in 2008 alone - until the Sirius Star dramatically revealed it as a threat to western oil supplies and commerce.

As long as wealthy western nations are perceived as hypocrites, the pirates will enjoy the protection of their local hosts, and there will be no practical military solution. And even if brute force were to pacify the Suez Canal zone and the Gulf of Aden, failure to achieve some form of global consensus on control of predatory commercial fishing fleets and the rescue of failed states will ensure no lasting solution to the problem, merely shifting the theater from Somalia to, say, Sierra Leone or the South China Sea.

Given our own history and status as a maritime nation, I would be delighted if Canada stood up to demonstrate global leadership on the issue. At the very least, we must resist the temptation to reduce the story to a mindless caricature of ‘cops and robbers’, as none of us can say how we might also react if forced to watch our children starve and our livelihoods vanish as the result of illegal predation. More to the point, the consequences of unrestrained overfishing on the health and well-being of local communities has important policy implications, where solutions are only possible through international cooperation and policing of commercial fleets. Though others may disagree, I am convinced that this will not happen unless we first identify the problem honestly and recognize the nature of the relationships between seemingly unrelated questions.

Atul Sharma MD, FRCP(C)
Montreal

The “Health for All” target has not yet been met but the news is not as bad as you might think. The effectiveness of multidisciplinary primary care models has been established in many settings. Total global child mortality has declined from 15 to 9.2 million, still an unacceptable number. As acute infections and malnutrition are being tackled, application of primary health care systems is extending to chronic conditions both communicable and non-communicable. Experience gained in low-income country settings suggests that primary health care works best if it is tailored to suit local circumstances and if its bureaucracy is minimized.

This local, low-bureaucracy focus is appealing provided mechanisms are in place to foster critical discussion, sharing of experiences and research between local programs. To assist in advancing the application and quality of primary health care models, at least those directed to children and mothers, this website has at least 2 important resources to contribute to the cause.

1.Communication capacity
Our website is easily accessed, free, interactive and flexible. As primary care initiatives develop in communities around the world, there is a need for workers and policy makers to share and compare experiences, to present their successes and learn from their failures. Given that most such programs are quite local, active steps should be taken to avoid a pattern in which a silo mentality prevails. As The Lancet shows so well, there will always be a place for publications but rapid, less formal interactions, comparable to corridor chats are needed..

2.Personnel
Health professionals in the west will be keen to participate, to learn from the experiences in low-income settings, and to share their own experiences. Since well before Alma-Ata, western pediatricians have worked in multidisciplinary primary care models usually directed to chronic diseases such as cystic fibrosis and inflammatory bowel disease.

I urge you to read the inspiring material in this recent issue of The Lancet 37(942) September 13-16, 2009

What do you think?

Can our network contribute to the development of effective primary health care initiatives around the world? If the answer is “yes” or even “maybe” how should we go about it?

- Richard Hamilton

Who is working on these problems and where? If those working on producing sources of safe water and those involved in measuring its health impact post weblogs briefly describing their work, a productive dialogue might be generated on this website. If you are not directly involved in this field, spread the word to colleagues who are.

We hope to hear from you.

Richard Hamilton

Background link: http://en.wikipedia.org/wiki/Advance_market_commitments

I am genuinely hopeful that the forum provided by the mother-child.org web site will become a useful vehicle for those of us who labor in the trenches of pediatric, reproductive, and mother-child health worldwide. By making it easier to share our results, ideas, and frustrations, I hope it allows us to support each other in a mutually beneficial way and to better co-ordinate our widely dispersed efforts to improve the lot of those entrusted to our care. While I am not a fan of new technologies for their own sake, I am optimistic that new information and communication technologies will allow us to do things that we couldn’t even contemplate under the old paradigms. For this reason, I would really like to see this forum become more than just a talking shop, as useful as that can be. Inspired by the speed with which communication and reaction can be organized electronically, I wonder whether it might someday become a vehicle for canvassing mother-child health workers in a formal way and --- more importantly --- for bringing our opinions to the very policy makers and politicians that control the resources we need to do our jobs. It seems to me that the membership of this list represents a considerable mass of pooled expertise and experience, and that through vigorous on-line discussion and debate, our forums could easily brings a valuable perspective to any discussion of how to best deploy health resources and dollars. In addition to providing an opportunity to forge consensus among ourselves, it might also allow us to respond in a timely and effective way to proposed public-health initiatives before they are written in stone, to lobby for more useful priorities and resource allocations, and to focus attention on looming failures before they attain crisis proportions.

Let me give an example where I think we ought to have an opinion and make it known, vigorously. The thorny question of how we transform scientific advances into concrete progress has always troubled me, particularly since it tends to be ignored in academic research circles in the developed world. Yet billions of dollars get consumed in white-elephant policy initiatives, often with foreseeable and disastrous consequences. I was reminded of this recently by an article I stumbled across on the subject of the Advanced Market Commitment, announced with much fanfare by G8 finance ministers, such as Gordon Brown (UK), Paul Martin (Canada), and Tommaso Padoa-Schioppa (Italy). Since I am unlikely to do it justice here, I refer anyone interested in background to the nice review cited above.

As many of you will already know, this first AMC is intended to serve as a model for future efforts at technology transfer, and its implementation should therefore be a matter of genuine concern to many of us on this list. In conjunction with the Gates Foundation, five countries (Canada, Italy, Norway, Russia, and the United Kingdom) committed US$1.5 billion to speed the development and availability of a new conjugated pneumococcal vaccine. With pneumococcal deaths claiming 1.6 million lives a year, the program was trumpeted as the key to saving the lives of 5.4 million children by 2030, by specifically targeting pneumococcal strains prevalent in developing countries and assuring vaccine developers of stable, long-term, guaranteed markets underwritten by the donor countries. In announcing his nations commitment, the Italian finance minister described it thus: “The AMCs are an absolutely innovative approach which combines market-based financing tools with public intervention. This innovative instrument opens a new frontier in the financing of the fight against poverty and endemic diseases.” The role of private industry was further emphasized by World Bank president (the controversial Washington appointee Paul Wolfowicz), who characterized the effort as one where “we can save lives, and we will do it with the investment and expertise of industry”. From the beginning, the AMC was intended to accelerate the development of affordable vaccines by covering the cost of manufacture and making a “modest contribution to profits”, a guaranteed market to engage a for-profit industry that otherwise could not envision a global market for a vaccine that originally sold for $232 per dose in the US market. The idea itself has a long and curious pedigree, but gained real traction in the public eye only after being embraced by Bill Gates at Davos, subsequently finding support among finance ministers from several countires (with Mr. Brown and Mr. Martin continuing to promote the effort after becoming Prime Ministers).

So is this a good way to transfer technologies to poor countries? Or is it --- as its critics contend --- simply a way to enrich western pharmaceutical interests out of the public purse while patting ourselves on the back for our humanitarian selflessness? The 7-10 year pilot project is now sufficiently far along to be judged in terms of concrete results, and worrisome concerns are being expressed. For instance, despite advanced manufacturing facilities in areas of the globe specifically targeted by the initiative (e.g. Asia and Africa), critics claim that most of the money has in fact gone to two western manufacturers, GlaxoSmithKline and Wyeth. The director of the Indian Serum Institute has charged that the current rules ensure ‘there is no provision for AMC money for developing-world manufacturers’, this despite world-class vaccine production facilities in India, China, Cuba, Brazil, etc. Others, including the vocal US critic Donald Light of Princeton University have described the profit provisions of the AMC as “morally indefensible” given the $1.7 billion sales generated annually from just two such vaccines in the developed world. Professor Light in fact states rather unambiguously that the donor countries “have donated taxpayers money and that money is going in profits and not to save children’s lives”, arguing that the profits should be re-invested to provide more vaccine doses. Moreover, and this troubles me a great deal given the source of the funding, it is impossible to seriously examine claims that the vaccines remain overpriced, since details of costs and profit margins are kept secret, with no requirement for full and transparent disclosure despite the public financing, a practice which has been criticized sharply by Médecins Sans Frontières and others. Now I'm certainly no econonomist, but I'm reliably told that in allowing a duopoly, we have accepted all the inefficiencies and shortcomings of the monopoly scenario, while failing to insist on the oversight and transparency that would normally be required of a public utility subsidized by taxpayer largesse.

In defense of the current structure, proponents will argue that without incentives, industry will not produce vaccines fast enough or in sufficient quantity, arguing that the goals of the project are worthy even “at the risk of not saving every penny”*, a case made by both pro-industry think tanks and child health workers in endemic areas, who argue that millions of children under the age of two are dying in rural villages even as we argue about details. And despite its shortcomings, they still believe that the availability of new conjugated pneumococcal vaccines will have been accelerated by 10-20 years as a result of this initiative, with important consequences for future efforts tackling HIV/ influenza/ and other pandemics.

Certainly, this is an important subject for members of this list. There are billions of dollars at stake, and few of us are indifferent to the scarcity of resources and the question of their optimal use. Surely, an informed consensus opinion can be developed through discussion and debate here, and perhaps communicated decisively to the national and international policy makers seeking to address the health needs of women and children at highest risk, even if we don’t always agree with their motives and priorities. For the developers of mother-child.org, I can hardly imagine a more fitting use of the platform and the community they seek to create. But then again, perhaps you will tell me I’m dreaming unrealistically. Either way, I look forward to your response(s), since the really marvelous thing about ‘discussion, debate and consensus’ is that the outcome will never be a foregone conclusion.

Sincerely,

Atul Sharma MD,FRCP(C)
Department of Pediatrics,
McGill University, Montreal, QC

As it turns out, our city (Montreal) recently figured prominently in the successful prosecution of the largest price-fixing scandal in history, one which saw the Competition Bureau of Canada levy fines of over $90 million – the largest criminal fines in Canada, ever – against pharmaceutical companies charged with fixing the prices of vitamin supplements used as food additives, in what the our national broadcaster, the Canadian Broadcasting Corporation, described as “the largest price fixing scam in the world”, a cartel whose predatory scheme “went on for more than 10 years” and totaled more than $100 million in illegal profits on sales of over $700 million in Canada alone. The compelling spy-thriller plot even included lamp-shade camera evidence recorded by the FBI,whose video tapes show corporate executives meeting in hotel rooms around the world, secretly dividing up the global market for vitamin supplements, fixing prices, and punctuating their group hugs with some rather sinister comments (at one point, the FBI transcripts include this pithy dialog right out of the Sopranos – missing only Tonyʼs trademark “Fahgeddaboutit” - with normally tight-buttoned executives remonstrating against their consumer “enemy”: “Thank God , we gotta have 'em, but they are not my friends. You're my friend. … 'Cause you can help me make money”). In the end, industry stalwarts including Hoffman LaRoche, Rhone Poulenc, Bayer, Eisai Chemical, and Dalchai Pharmaceuticals had little choice but to plead guilty. A number of smaller industry players have also been charged and fined, with the Competition Bureau web site listing penalties ranging from $1 million (Merck) to $48 million (Hoffman LaRoche) for what Bureau prosecutors described as “ the most egregious offence there is under the Competition Act".

In addition to a compelling plot, this storyʼs local angle saw a Montreal consumer protection group (Options Consammateur) and class-action lawyer Eric David lead the charge in seeking compensation on behalf of all Canadians who were unknowingly exploited through the prices charged for vitamin-enriched food staples. Moreover, in handing down their record-breaking $132 million judgment in 2005, superior courts in Quebec, Ontario and BC showed great collective wisdom in my mind, concluding that while every Canadian man, woman and child was owed $5 by way of compensation,justice would not be well served by sending us all a cheque. Instead, they ear-marked $22 million of the settlement to be divided among Canadian universities with doctoral programs in nutrition and veternary medicine, the latter to compensate farmers gouged on the price of lifestock feed. Additional funds were disbursed to support nutritional education and community groups promoting nutritional awareness. As I understand it, their intention was to use the settlement to directly support nutritional research and progress in the use of the very vitamin supplements at the heart of the scandal. Personally, I think cudos are due our magistrates, who exercised precisely the judgement and discretion one would hope for from the bench. Although the settlement dates to 2005, the disbursal of of funds from the class-action settlement was realised just last month and had yet another local dimension, in that the McGill School of Human Nutrition was among its beneficiaries.

For many reasons, this is an important story. The pharmaceutical industry is wealthy and politically powerful, particularly in Quebec. The products involved are ubiquitous and touch our lives intimately. The local dimension reminds us that national and global issues can sometimes touch very close to home, and the Solomonic wisdom of our courts recalls the very best of what they bring to such thorny questions. All said, the thing that troubles me most is why a search of local newspaper archives reveals so few column inches devoted to this story. In light of their editorial glee, one has to wonder just why this should be so. Is it perhaps that some price fixing is ʻmore badʼ than others? Or is it just that the petroleum industry makes an easier, more popular target for editorializing? Given the millions at stake, not to mention the principles involved, I was curious whether the story was commanding front page attention elsewhere.

Atul Sharma MD, FRCP(C)
Pediatric Nephrologist,
Montreal, QC

Anirudha Alam

Spread of HIV/AIDS results in risk of losing forms of social and economic protection. There is no doubt that onslaught of HIV/AIDS is closely associated with gender inequality and poor respect for the rights of women. So to mitigate the multiple impacts of epidemic, gender mainstreaming should be significantly integrated into HIV/AIDS prevention programs. Eventually, HIV prevention and impact mitigation policy will be able to make the realization of gender equality one of the most important strategies.

Gender mainstreaming for HIV/AIDS is to ensure gender equality in all policies, programs and activities that it would be possible to keep the epidemic in bay. It is the most efficient and equitable means for using existing resources with a view to combating HIV/AIDS internalizing need based approach. At a rough estimate since the beginning of the epidemic, over 10 million women have died from HIV/AIDS-resulted illness. 48 per cent of adults newly affected by HIV/AIDS in 2001 were certainly women. The fact that lack of gender mainstreaming along with domination of social stigma and discrimination creates a tremendous barrier to women making them unable to adopt HIV risk-reducing behavior.

Social stigma and gender discrimination engulf series of possibilities to reduce vulnerability to HIV/AIDS successively. The enhanced poverty and developmental decline nourished by gender inequality may make women and girls engaged in risky sexual behavior in lieu of getting money, food and other facilities. Having lack of enough access to quality treatment and care, then they fall into enormous vulnerability to sexually transmitted diseases (STIs) one after another.

As per the finding of Rainbow Nari O Shishu Kallyan Foundation, 95 per cent adolescent girls of Bangladesh are drastically vulnerable to HIV/AIDS because of their paltry access to necessary information for protecting their reproductive health. Due to their poverty at the levels of awareness, skill, knowledge, attitude and practice all along, they are being more vulnerable consecutively. When they are enough adult they are not able to ensure their role as potential manpower in planning, implementing, monitoring and evaluating pro-gender programs and projects.

Considering all the situations related to sexual behavior, social attitudes and praxis, financial empowerment and so on, there are in-depth differences between men’s and women’s access to information, prevention, treatment and care-giving supports. It is much more common in all cultures that commitments for guiding sexual behavior and sexual health are being threatened by gender discrimination. If women and girls have not qualitative reproductive health literacy HIV/AIDS will be turned into as the greatest social problem in developing countries. According to the findings of UNAIDS, as of December 2000, ninety five per cent of all AIDS cases have occurred in developing countries.

Through promoting, facilitating and supporting the implementation of gender mainstreaming, AIDS prevention should be brought about under the spotlight of women empowerment. Gender mainstreaming and women empowerment are obviously complementary strategies. So the strategy of gender mainstreaming within HIV/AIDS prevention should be outlined that women empowerment is ensured.

Anirudha Alam
Deputy Director
(Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.

Phone: 8801718342876, 88029889732, 88029889733 (office)
88028050514 (res.)

E-mail: anirudhaalam@yahoo.com
info@bees-bd.org, bees@worldnetbd.net
Website: http://anirudha-alam.blogspot.com

Ref: UNAIDS, World Bank, Commonwealth Secretariat, UNESCO

Anirudha Alam

Nowadays gender discrimination is the key challenge for sustainable development. It widens the likelihood of HIV/AIDS epidemic. So we have to alleviate all the discriminations as regards achieving ownership, leadership and dignity, enjoying freedom, controlling resources, accessing to information, establishing rights, making decision, grooming voices, taking responsibility as well as participating in development activities.

Women are being increasingly affected by HIV. So the reduction of gender-based discrimination has to be integral to the strategic response to HIV/AIDS. Otherwise there is a great scope that HIV/AIDS epidemic may be feminized. The aftermath of feminized endemic is very much enough for ruining overall development achievement. As per the UNAIDS report 2004, nowhere is the epidemic’s ‘feminization’ more perceptible than in sub-Saharan Africa, where fifty seven per cent of adults infected are women as well as seventy five per cent of young people infected are women and girls.

An essential fact is that lack of good governance is the ideal vehicle of deprivation and poverty. Concurrently spread of HIV/AIDS is closely associated with poverty and discrimination. All of these social issues intertwined with different byproducts like stigmatization, violence and sexual abuse affect the endeavors dedicated to establishing just society. People centered planning with a view to ensuring exclusive participation, accountability, commitment and transparency may promote good governance undoubtedly. Capitalizing on this pro-poor planning, HIV/AIDS prevention should be led by gender sensitized policy and strategy. Eventually, as a far-seeing impact it is possible to achieve sustainable development.

A socio-economic study in 2006 conducted by Rainbow Nari O Shishu Kallyan Foundation shows that lack of reproductive health literacy attributed by social stigma and poverty among adolescents at rural level in Bangladesh makes 98% young women practice risky behaviors. They are growing as unskilled manpower having minimal livelihood development. They are turning into vulnerable especially to STDs (sexually transmitted diseases)/HIV/AIDS on a great scale. Their vulnerabilities due to their too little life-skill are affecting the mainstream process of sustainable development extensively.

Being affected by the negative social and economic consequences of HIV/AIDS, women are compelled to experience various kinds of deceptions and deprivations cruelly. Therefore, a gender-inclusive approach to HIV/AIDS has to play a role to ensure women’s rights to productive resources comprising land, credit, agricultural technologies, and other facilities. In this regard, initiating outreach on HIV/AIDS to rural communities may help mitigate the negative impact of HIV/AIDS on sustainable development as a whole.

Without having gateway to health knowledge and protection comprehensively, women are very much susceptible to HIV infection. They, especially the young women, bear the vulnerability of the reproductive tract tissues to the virus. The stigma of STIs in women makes them hesitate to get proper treatment. They are supposed to bear the maximum burden of caring for sick family members. But often they have less care and support when they themselves are infected severely.

As the stepping stone to sustainable development, in the 1980s a new approach was evolved. This is the mainstreaming strategy which aims to make the goal of gender equality central to all development activities. If AIDS prevention is not en-gendered sustainable development might be endangered. So to en-gender all the development initiatives, especially HIV/AIDS prevention, it is necessary to involve a strategy for making women’s as well as men’s concerns and experiences an integral part of the design, implementation, monitoring and evaluation of policies and programs in all political, economic and social spheres. It results in that men and women will be benefited equally and inequality will be removed as a whole.

Anirudha Alam
Deputy Director
(Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.

Phone: 8801718342876, 88029889732, 88029889733 (office)
88028050514 (res.)

E-mail: anirudhaalam@yahoo.com
info@bees-bd.org, bees@worldnetbd.net
Website: http://anirudha-alam.blogspot.com/

Ref: UNAIDS, World Bank, UNFPA, UNESCO

Anirudha Alam

The spread of HIV and STI is mounting in developing countries through gender inequality and taboos around sexuality. It results in discrimination and stigma associated with drastic poverty and marginalization. Leading to empowerment, happiness and well being, gender awareness can help to promote both rights to be free of violence and coercion around sexuality. Sexual rights, an inclusive framework, guide to have knowledge of the links between different sexuality issues thoroughly recognizing that campaign against sexual violence must continue.

The number of women living with HIV is mushrooming than the number of men through out the world. In 2004, the number of women (15+) living with HIV was 12.7 million in Sub-Saharan Africa. But the number was increased to 13.3 million in 2006. HIV epidemic is disproportionately affecting women of South Africa. Young women (15-24 years) are four times more likely to be infected by HIV than are young men in this region. Prevalence among young women was 17% compared with 4.4% among young men in 2005.

HIV/AIDS entrenches gender inequality, denial and as well as threats to basic human rights. The relationship between HIV, gender and sexuality may be intertwined as a vicious circle. Unfortunately this aftermath limits women’s access to reproductive health information, STI (Sexually Transmitted Infection) prevention technologies and treatment. There is no doubt that gender inequality makes women experience poverty and vulnerable to STIs gravely.

According to the findings of BEES (Bangladesh Extension Education Services), 95% of the rural adolescent girls in Bangladesh are vulnerable to STIs and ill health due to gender discrimination, sexual violence and lack of knowledge regarding reproductive health. They do not know how to protect themselves from HIV/AIDS. Rainbow Nari O Shishu Kallyan Foundation found that adolescent girls are two times more vulnerable to HIV and STD (Sexually Transmitted Disease) than the adolescent boys in urban areas of Bangladesh because of sexual harassment. In the name of so called gender equality, their reckless free mixing subculture is making them vulnerable significantly as well.

To curb the spread of HIV/AIDS, it is necessary to challenge the stigmatization and discrimination faced by women living with HIV/AIDS. Counting on collective action at all levels from community to national level, gender equality can strengthen the HIV and STI prevention through a coordinated action for establishing the right of safe sex. In 2005, half of the new HIV infections occurred due to unprotected sex in China. Moreover with HIV spreading successively from most-at-risk population to general population, the number of HIV infections among women is increasing fast.

In the developing countries, most of the women have very little or no knowledge about HIV transmission as well as risk before they are diagnosed HIV positive. Married women do not want to think that they may be at risk of infection. In Bangladesh, the women are induced by their family members to conceive. On the other hand, they feel under presser from healthcare workers to avoid conception. But in most cases, none of them provides necessary information clearly to help the vulnerable women conceive safely or to lessen risk of mother to child transmissions.

Involving women living with HIV, national social welfare organizations, community based organizations (CBOs), academies and policymakers, there may be a promising plan to develop advocacy strategies and extend counseling to women diagnosed in antenatal clinics. It will highlight the necessity to ameliorate the plight as for gendered response to the needs and desires of vulnerable women. Consequently it will be possible to build their life skills to enable them to work with field workers, researchers, monitors, evaluators, policymakers at all levels of program design and implementation, research, monitoring, evaluation and policymaking. Then it would be possible to keep HIV in bay effectively stamping out discrimination, stigmatization and sexual violence through gender awareness as a whole.

Anirudha Alam
Deputy Director
(Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Website:http://www.bees-bd.org, http://www.newsletter.com.bd/anirudha
Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)
E-mail: anirudhaalam@yahoo.com, info@bees-bd.org, bees@worldnetbd.net

Ref: UNDP, UNESCO, World Bank