From HIV to trafficking: shifting frames for sex work in India

Hijras in a train in Rajasthan in 2012. Giannis Papanikos/Demotix.

Hijras in a train in Rajasthan in 2012. Giannis Papanikos/Demotix.

The conflation of trafficking and prostitution in anti trafficking discourses not only frames all sex workers as victims in need of rescue, but elides the reasons many include sex work as part of their complex livelihood strategies.

NGOs focusing specifically on ‘sex work’ and ‘trafficking’ (where ‘trafficking’ is conflated with prostitution) in India have only been around since the mid and late 1990s. There has been a steep rise in their numbers in the last decade. Previously, if organizations addressed the needs of sex workers, they did so within the rubric of HIV/AIDS. Indian HIV/AIDS organizations were spurred into existence by the flow of international aid dollars that increasingly became available to organisations working in Asia, Africa, and Latin America during the first decade of the AIDS pandemic (1985-1995). Funds for HIV-related work in India came from the European Union, Sweden, Norway, and Canada into then relatively new entities like India’s National AIDS Control Organization (NACO). This money provided the infrastructural support for both governmental and nongovernmental efforts to surveil, control, and eventually treat HIV and AIDS. Local organisations also emerged as a result of this new funding to provide HIV-related services to sex workers, men who have sex with men, andhijras (people assigned male sex at birth who live as a ‘third sex’ in the feminine range of the gender spectrum).

By the late 1990s, thanks to feminist debates on pornography and prostitution, an antitrafficking framework—composed of laws, policies, and theories that used prostitution as an allegory for women’s oppression by men—was taking hold within some national governments and segments of the international policy-making community as a primary lens for understanding sexual commerce. This framework now largely dominates the discussion, having become the ‘common sense’ of sexual commerce and even, to a degree, migration among poor and working class people. This is despite the fact that the trafficking framework has been repeatedly criticised for conflating human trafficking with prostitution, and for failing to provide clear parameters for tracking the phenomena it aims to describe. It remains, for the moment, a significant but contested lens on sexual commerce for international policy, especially with respect to interventions crafted for countries in the Global South.

The rise in the explanatory power of the anti trafficking framework for understanding phenomena like migration and the exchange of sex and money in the Global South paralleled an increase in the significance of prostitution in the global image and imaginary of India, usually as the dark foil of India’s buoyant economic growth rates. By 2007, ‘prostitution in India’ had become a categorical focus for charitable organizations, an object of study for filmmakers, a worthy cause for politicians and celebrities, and a Wikipedia entry. This was not due to the discourse on HIV per se, nor was it due to an increase in the proliferation of HIV in India (the national rate of new infections decreased by half between 2000 and 2009). Rather, the increased significance of prostitution to the idea of India itself was linked with the increased global significance of the anti trafficking framework.

While this framework is far from being unequivocally dominant in managing and understanding prostitution, its increased significance in the halls of international policy formulation has helped position prostitution as particularly important to understandings of women in the Global South. This conflation of trafficking and prostitution is contextualised by a number of historical trends, including the ways in which discourses of venereal disease have figured female sex workers as infectious vectors since the nineteenth century. It is also contextualized by the altered conditions for labour migration brought about in the late 1980s and early 1990s due to the adoption of neoliberal economic policies in many parts of the world; the well-rehearsed histories of feminist pornography debates in the United States; and the confluence of interests between governments and some segments of women’s movements in seeking to eliminate illegal and undocumented cross-border migration. While migrancy has changed dramatically in the era of neoliberalism, such that economic migrants are vulnerable to wage theft, debt bondage, exploitation, and abuse in new and unprecedented ways, we may ask whether the frame of ‘trafficking’ accurately tracks and addresses these vulnerabilities, or whether it is more effective in protecting states’ interests in securing and monitoring borders?

At worst, the rise in the explanatory power of ‘trafficking’ for prostitution consists of an elision of political economy within discourses of sexuality, contributing to the reproduction of the idea that sexual freedom, autonomy, expression, and even sexual subjectivity are all luxury goods, available only to those whose access to food and shelter is secure. This form of depoliticisation within sexuality politics in the United States and elsewhere has attracted much scholarly and activist attention, as well as criticism from both the mainstream left and the LGBTQ left. In my view, a sustained scholarly engagement with sexual commerce in the Global South would not only offer a way to critique prostitution per se. It would also demonstrate the kind of discussion of sexuality, politics, and power that is possible when sexuality is not primarily or exclusively understood as a form of individuated, innate human expression.

The result of this depoliticisation in understandings of sexual commerce has been the subjection of women and girls selling sexual services to a discourse in which prostitution is a state of being from which they must simply be rescued. In this discursive trajectory, sexual commerce is never figured as a livelihood strategy that is part of a complex set of negotiations for daily survival that include, but cannot be reduced to, violence and precarity. Just as identitarianism marginalises questions of political economy with respect to LGBTQ politics, the conflation of selling sexual services with human trafficking deprioritises and, in some spaces, erases the question of survival with respect to sexual commerce. This individuated frame reinforces and reifies the idea of origins, on the moment in which an individual subject knew, came out, was forced, was called into being, within a fixed subjective matrix.

_Street Corner Secrets _takes up this critique by asking what an analysis of sexual commerce would be if it were to use a framework other than trafficking, one that focuses instead, for example, on the relationship between sexuality and livelihood? How would such an analysis account for violence, without conflating the exchange of sex and money with violence? The book does this by emphasizing the idiosyncratic and extremely local ways in which laws and criminality are interpreted and enforced as part of a larger focus on migration and daily economic survival. This emphasis is able to account for the relationship between sexual commerce and the profoundly uneven and inadequate access to water and land among poor migrants living in Mumbai. Here, the difference between living in a brothel and a slum is, among another things, the relatively higher access to municipal services like water and government-run schools among brothel-based sex workers, compared with those eking out a living in the slums at the edge of the city.

The emphasis in the book on livelihood, economic informality, housing and the liminal legal zones migrants must navigate in the city opens up a number of questions that are subsumed, or unasked, when abolitionism imbricated with trafficking serves as the primary interpretive frame for sexual commerce. What, for example, could a critical examination of sexual commerce reveal about the politics of day wage labour? What would it show about the exercise of state power on the urban street? What could it reveal about economic survival, in the Indian context, or in any other? Addressing these questions brings us closer to discursively repositioning violence, such that we may account for violence as it is meted out in myriad forms by police, housing authorities, and clients against people selling sexual services, while also explaining why sexual commerce endures as a livelihood strategy among people who are extracting survival from an shrinking field of economic options.

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HIV sweeps across eastern Europe amid economic crisis

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Rallying Bucharest to raise awareness for World AIDS day: Romania has seen a surge in HIV among drug users (Photo: Petrut Calinescu)

 

HIV is spreading at a dangerous rate in nations around the Black Sea, passing a record 100,000 new cases yearly.

Hotspots for the HIV rise are Ukraine and Russia – two countries facing economic crisis and armed conflict, factors which could provoke a further surge in the virus.

Smaller countries in the region are also recording rises in the numbers, with decade-highs registered in Bulgaria, Armenia, Belarus and Turkey.

Meanwhile Georgia, Azerbaijan, Moldova, Romania and Ukraine have maintained a record post-Soviet rate for the past four years.

None of these nations is experiencing a decreasing trend in new cases.

“We are all concerned about the rise of HIV/AIDS in the region, perhaps the region where HIV is growing fastest,” says the World Bank’s Global AIDS Programme Director David Wilson. “Russia faces a large and potentially growing epidemic.”

Due to the low uptake of HIV testing in the region, up to 60 percent of viral carriers are unaware of their infection, according to the World Health Organisation (WHO).

The true figure of new cases per year could be 300,000 per year with over three million people now living with HIV.

HIV rates can be halted by giving drug users access to sterile syringes, to stop them sharing needles containing blood infected with the virus.

Allowing heroin users to switch to taking a substitution drug, methadone, also slows the viral spread.

Medicine readily available to treat carriers of HIV on a regular basis also reduces the chances of further contagion.

“Unfortunately, political opposition and laws in Russia doom all of these approaches,” adds Robert Heimer, professor of epidemiology and pharmacology, Yale School of Medicine.

Drugs: Russia seeing record surge

Injecting drug use is the key reason for the rise of HIV in Russia. HIV spreads among this group due to their practice of sharing dirty needles.

However the Russian state will not finance health workers to exchange dirty for clean needles, arguing that this would encourage drug use.

Last year, 58 percent of new HIV cases were due to drug users using infected syringes to inject heroin and its codeine-based home-made alternative Krokodil. This figure is on the rise.

Russia is the centre point of HIV in the region. Its new HIV numbers rose from 58,000 new cases in 2010 to 78,000 in 2013 – accounting for three quarters of cases of the nations under our analysis.

The total number of people living with HIV in November 2014 in Russia was 864,394, although under the WHO’s “iceberg principle” that reported cases are a fraction of reality, this figure could be 2.4 million.

Russia’s method of dealing with the spread of HIV is based on an ultimatum ideology to drug users: give up first, then receive care.

The country bans the medical prescription of methadone, which allows users to extract themselves from drug communities, re-enter civil society and regulate their lives.

In neighbouring Ukraine, the situation is different. NGOs are financed in the millions by foreign donors and there are 8,000 patients on such opioid substitution treatment (OST) as methadone, the largest number in Eurasia.

Half of these patients are HIV positive and Ukrainian experts argue this has been a crucial policy to curb the viral spread.

But Russia prefers to combat HIV by encouraging abstinence and healthy living, with an emphasis on sports and exercise.

“Based on international practice and guidance, the three interventions needle exchange, substitution therapy and treatment for people with HIV would help to check Russia’s epidemic,” says Wilson.

Romania

Romania also witnessed a boom in new cases of HIV among drug users from 2010 to 2011 – when its 20,000-strong injecting drug community was almost free of new cases of the virus.

In 2010, the capital of Bucharest was hit by the spread of legal highs – stimulants which could be bought over the counter as ‘bath salts’ or ‘doll-cleaning powders’, but which contained a spin on the chemical formula for amphetamine.

Users switched from heroin to injecting these cheaper substances, but experienced episodes of paranoia, schizophrenia and paralysis.

To get a faster, quicker high, they also increased the regularity of injections, to up to 15 times per day.

At the same time, the Global Fund ended financing for programmes in Romania which combat HIV, such as vans which travel to drug hotspots to provide users with clean needles.

This double blow allowed the number of cases of HIV among drug users to rise by 200 per cent year-on-year in 2011.

HIV plagues drug users, especially poor communities, many of who belong to the Roma minority, who inject in squats, sewers and crowded flats.

“Users come to these place to shoot up in groups,” says Alina Dumitriu, executive director of Bucharest HIV NGO Sens Positiv.

This makes needle exchange a key factor in limiting the viral spread.

Since then Romania’s Government criminalised the sale of “legal highs”, but powders are still available on the street. And heroin is returning with a vengeance to Bucharest.

Economic collapse: virus spread in the balance

Russia’s currency has been in freefall with the deputy Governor of the central bank Sergey Shvetsov last year calling the situation more serious than his “worst nightmares”.

Meanwhile Ukraine suffers with inflation of 25 percent and an economy propped up by the International Monetary Fund and cash from the west hoping to consolidate Kiev’s western-facing ambitions.

There is strong debate over whether this could lead to a rise in HIV cases, particularly among drug users.

“Much of the drug use that contributes to HIV has its origins in the earlier economic crisis [in the region] following the end of communism and recent data from Greece and Romania shows a sharp spike in HIV infections after the economic crisis in Europe [in 2008],” says the World Bank’s David Wilson.

“There are reasons to believe the economic crisis might make things worse by contributing to transgressions and reducing the capacity to respond.”

However the picture may be more nuanced.

“The timing of the 1998 financial crisis in Russia and the beginning of the first wave of HIV among drug injectors is hard to explain as anything more than a coincidence,” argues Robert Heimer. “The expansion of drug markets and the replacement of marijuana by heroin in many major Russian cities seems to be at the heart of that HIV epidemic.”

Vadim Pokrovskiy, director of Russia’s Federal AIDS Centre, also says that so far he has “no evidence” of economic hardship causing a rise in HIV among drug users.

“We have found more HIV cases in regions with better economic situation,” he says. “Such regions have been more attractive for drug dealers.”

Sex: Taking over as cause of HIV in Ukraine and Moldova

A rise in HIV numbers through sex has overtaken drugs as the main route for new cases in Moldova and Ukraine.

By January 2014 there were 139,573 Ukrainians living with HIV – and estimates assess that AIDS-related complications claim 17,000 lives each year in a country of 45 million people.

An integrated network of associations, funded by money from abroad, has helped stabilise the numbers of new infections to around 21,000 each year.

In 2001, around two-thirds were infected with the virus through sharing dirty syringes and almost one-third through sex.

However by 2013 this was reversed, with two-thirds infected through sex and one-third through needle-sharing.

“Since 2008, the HIV epidemic changed from the route of injecting drug users to sex,” says Pavel Skala, associate director: policy & partnership, Alliance Ukraine. “But injecting drug users are still the major source, through sex, including sex workers.”

Now half of Ukraine’s 310,000 injecting users have access to services, such as clean needles. Around one fifth of them have HIV. This has brought down risky behavior in the last five years.

“The more clients to whom we provide service, the less HIV transmission – in Russia this is another story,” says Skala.

A similar pattern has occurred in Moldova. The ex-Soviet nation saw an HIV boom in the late 1990s due to a surge in the injection of home-grown poppy concoction shirka and heroin. Needles were scarce and sharing was commonplace.

Since then, international funds have pumped millions into promoting harm reduction services – and the number of new cases is stabilising at around 700 per year, of which 92 percent come from sex.

“People believed HIV was due to drugs,” says Roman, a consultant at Chisinau’s Regional Social Centre providing services for people living with HIV. “Now we are more democratic and more libertine. Through the Internet, we can find a partner much faster for sex for two or three days. Sex plays a very large role.”

Both Ukraine and Moldova also see growing numbers of men having sex with men as a cause of HIV.

At present the viral number is around 5.9 percent of the estimated 176,000 male-on-male sexual partners in Ukraine.

“They are not so accessible for prevention services,” says Pavel Skala, “and this is a huge group.”

Money: Fall in funding risks viral spike

Prevention, treatment and care of HIV in the region depends on western financing, mostly from the Washington-based Global Fund to Fight AIDS, Malaria and TB.

“The Global Fund programmes in east Europe were more effective in the region than other [programmes],” argues Russian Federal AIDS Centre’s Vadim Pokrovskiy.

But the World Health Organisation says this funding route is “unsustainable” in the long-term.

The Global Fund – which has 14.82 billion USD at its disposal for three years – changed its funding model in 2014 to focus on more countries affected by the diseases, mainly in the southern hemisphere.

It also introduced a new mechanism in which Ukraine was called, confusingly, an “Upper Lower-Middle Income country”.

“The fund considers us a middle income country and we are on the same list as some countries from Latin America and Asia – but this does not take into account the recent crisis in Crimea or the conflict in eastern Ukraine,” says Pavel Skala.

While funding remains constant at 51 million USD per year for Ukraine between 2014 and 2015, NGOs argue that a greater proportion is now going to combating TB, while around 39 percent less is earmarked for HIV elimination.

The Global Fund says there is no breakdown for how this money is differentiated between the diseases.

As countries reach a higher income status, the Global Fund expects to exit their financing to allow local health authorities to take over.

A visit to the Alliance Ukraine offices in Kyiv in November showed the network was in the process of cutting staff.

“It is coming at the worst time, as we have never had such huge decrease in budget with such a huge crisis in government financing, it might be really disastrous,” says Skala.

In 2017, Ukraine is likely to see a halving of its annual financing from the Global Fund from 57 million USD to 27 million USD.

“We are increasing funding in every region, yet we understand that people affected by HIV and TB and malaria in many countries are arguing that they need more. They are right,” says Seth Faison, head of communications at the Global Fund.

In Romania, when the Global Fund stopped financing HIV/AIDS prevention programmes in 2010, the local government did not support the continuity of services such as paying staff to facilitate needle exchange to drug users.

As a result, the number of injecting drug users with HIV boomed. This was in the hundreds in Romania, but in Ukraine a similar pattern could be in the thousands.

Skala says the Romanian lesson taught him “we don’t want same picture in Ukraine”.

The state is usually willing to fund treatment for HIV/AIDS carriers. But countries are less open to financing prevention, which is a cheaper and more effective method of curbing HIV.

However this can mean the government giving money to NGOs on the ground – a structure alien to many post-communist states.

“In many cases, when [external financiers] fund NGOs directly, when donors leave, the governments don’t have the tradition, the experience, the confidence or competence to start financing civil society directly,” says the World Bank’s David Wilson.

War: Ukraine conflict sees risky behavior up

Conflict in Ukraine’s east and the annexation by Russia of Crimea is causing unemployment, displacement and economic hardship across the country – factors likely to spur the rise of HIV.

NGO Alliance Ukraine has been operating on a national scale for over 14 years, but its services are now under threat in Donetsk and Luhansk, while its operations in Crimea have ended.

The Alliance still has harm reduction projects in Luhansk and Donetsk, a hotbed of HIV in the region. Here users have increased their number of visits to get clean needles and support.

“There is definitely an increase in risky behavior,” says Pavel Skala. “It’s sometimes dangerous for drug users to walk on the street and go to exchange needles – so some users are really stigmatised.”

Users themselves are marginalised by the rebel authorities in the occupied regions, who reportedly enlist drug users as “slaves” to dig trenches for their soldiers.

According to official figures and state services, the level of HIV has started to rise because of dangerous practices in these areas.

“Infections with syphilis, TB and HIV will increase,” says Skala.

A growing number of ‘drug refugees’ from Crimea, Donetsk and Luhansk, who no longer have access to substitution drugs such as methadone, are moving to cities such as Kharkov and Kiev.

These supplies are due to run out in east Ukraine at the beginning of 2015.

Skala believes once the patients run out of methadone, they will be forced to migrate or could regress to taking illegal drugs.

Following the Russian annexation of Crimea, users were left without their regular fix of methadone or buprenorphine.

Many fled to mainland Ukraine for treatment, some detoxed and others returned to injecting illegal drugs.

Unknowns: No certainties on Turkey’s recent HIV peak

While countries in the Caucuses and Bulgaria have been witnessing a moderate rise in the numbers of HIV, Turkey, which has never suffered from an HIV epidemic, is witnessing alarming figures.

Turkey has seen a sharp increase in HIV numbers to over 1,000 for the first time in 2012 and with 1,313 cases in 2013, according to the Turkish Ministry of Health.

The official body claims that the source of 52 per cent of cases are “unknown” and that 33 per cent come from heterosexual sex and 14 percent from homosexual sex, and near-zero from injecting drug users.

Experts believe a higher number may be coming from men having sex with men, which is a difficult issue to confront in a country of mostly conservative family values.

While this is still a low prevalence for a major country, Turkey has no harm reduction services for drug users or widespread awareness campaigns, nor are international groups such as UNAIDS present in the country, which is sure to face further scrutiny.

Yet a concerted effort now could head off any potential epidemic.

“My sense is with a bit of international collaboration Turkey has the resources to manage what is likely to be a relatively small epidemic,” says David Wilson, who has worked in the nation.

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Tough austerity measures in Greece leave nearly a million people with no access to healthcare, leading to soaring infant mortality, HIV infection and suicide

A woman walks a closed branch Greek state health fund EOPYY in an Athens suburb

A woman walks a closed branch Greek state health fund EOPYY in an Athens suburb

Austerity measures imposed by the Greek government since the economic crisis have inflicted “shocking” harm on the health of the population, leaving nearly a million people without access to healthcare, experts have said.

In a damning report on the impact of spending cuts on the Greek health system, academics found evidence of rising infant mortality rates, soaring levels of HIV infection among drug users, the return of malaria, and a spike in the suicide count.

Greece’s public hospital budget was cut by 25 per cent between 2009 and 2011 and public spending on pharmaceuticals has more than halved, leading to some medicine  becoming unobtainable, experts from Oxford, Cambridge and the London School of Hygiene and Tropical Medicine (LSHTM) said.

Rising unemployment in a country where health insurance is linked to work status has led to an estimated 800,000 people lacking either state welfare or access to health services and in some areas international humanitarian organisations such as Médecins du Monde have stepped in to provide healthcare and medicines to vulnerable people.

The report, which is published today in the medical journal The Lancet, accuses the Greek government and the international community – which demanded swingeing cuts as a condition of bailing out the Greek economy during the debt crisis between 2010 and 2012 – of being “in denial” about the scale of hardship inflicted on the Greek people.

Health employees demonstrate outside the Health Ministry in Athens

Health employees demonstrate outside the Health Ministry in Athens (Getty Images)

Health employees demonstrate outside the Health Ministry in Athens (Getty Images)“The cost of austerity is being borne mainly by ordinary Greek citizens, who have been affected by the largest cutbacks to the health sector seen across Europe in modern times,” said senior author Dr David Stuckler, of Oxford University. “We hope this research will help the Greek government mount an urgently needed response to these escalating human crises.”

Greece was forced to make massive cutbacks to meet the terms of twin bailout packages, totalling €240 billion, offered by the European Commission, the European Central Bank and the International Monetary Fund, known as the Troika. Health spending was capped at six per cent of GDP.

Analysis of figures from the EU Statistics on Income and Living Conditions survey revealed a leap in the number of people with unmet health needs, the authors said. The cost of healthcare has been significantly shifted away from the state and towards patients, with new fees for prescriptions introduced and charges for out-patient visits to hospital raised from €3 to €5 .

Government disease prevention schemes have also been rolled back leading to the resurgence and revival of once rare infectious diseases – including malaria, which has returned to Greece for the first time in 40 years.

“There are a whole series of infectious diseases which have been kept at bay over the past 50 or 60 years by strengthened public health efforts,” Martin McKee, professor of European public health at LSHTM and one of the report’s co-authors, told TheIndependent. “If you lift up your guard, as the Greek example shows, they can very easily exploit those changes.

“The experience of Greece demonstrates the necessity of assessing the health impact of all policies carried out by national governments and by the European Union.”

People stand outside the

People stand outside the “Polyklikini”, one of the hospitals affected by overhaul of the health sector (Getty Images)

People stand outside the “Polyklikini”, one of the hospitals affected by overhaul of the health sector (Getty Images)Prevention and treatment programmes for illicit drug users faced major cuts, with a third of street work programmes halted in 2009-10, the first year of austerity. Reductions in the numbers of syringes and condoms distributed to known drug users has led directly to a spike in the rate of HIV infections in this community, the report said – from just 15 in 2009 to 484 in 2012.

Although reliable data on the health impact on the wider population will take several years to emerge, the Greek National School of Public Health reported a 21 per cent rise in stillbirths between 2008 and 2011, which was attributed to reduced access to prenatal services, and infant mortality also rose by 43 per cent between 2008 and 2010.

The suicide rate has gone up from around 400 in 2008 to nearly 500 in 2011.

Alexander Kentikelenis, researcher in sociology at the University of Cambridge and the report’s lead author, said that the Greek welfare state had “failed to protect people at the time they needed support the most.”

“What’s happening to vulnerable groups in Greece is quite shocking,” he told The Independent. “It’s quite straightforward to measure what has happened, it’s much harder to quantify the long-term health implications for the long-term unemployed and uninsured…Leaving health problems to get out of hand ends up costing a state much more in the long run.”

The Greek Ministry of Health and Social Solidarity did not respond to a request for comment.

Case study

The Metropolitan Community Clinic at Helliniko in Athens was founded in December 2011. It is run by volunteer doctors and provides free healthcare to people without medical insurance

Co-founder Christos Sideris told The Independent: “The healthcare situation in Greece is, unfortunately, dramatic. We have helped more than 4,400 patients, with more than 20,300 appointments in 26 months of operation. We look after more than 300 children below the age of three, and have helped 126 cancer patients to receive chemotherapy, in collaboration with a public hospital. This is not done in an official capacity, but by the people working there, every Wednesday after working hours, with donated medicines.

We have three basic rules: we accept no money from anyone, we have no party politics, and we do not advertise anyone for the help they are offering us. We only accept money from our own volunteers – there are 250 of them at the moment. These volunteers do fundraisers and give money to the clinic. The local municipality also helps us. Our medicines are all donated. There are more than 40 community clinics and pharmacies like us across Greece. They cannot solve the problem – we’re only here because there is a need for us to exist. We cannot substitute a public health system and we do not want to.”

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Next Volunteer Induction Meeting with HIV & Hepatitis Update Training afterwards

Volunteering

Our next Volunteer meeting will be on 29th January 2015 and consists in two parts.  To begin with, we’ll ensure all new volunteers have an induction to LASS and our services where we’ll talk about our aims and objectives, an overview of our teams, confidentiality/policies, and checking paperwork like applications and CRB checks (if necessary).

LASS can be a busy place at times, and these monthly meetings are ideal to stay updated with our work and engage with us while socialising and staying active with new and interesting projects.

Once these basics are covered, we’ll explain HIV basics and talk about volunteer involvement and plan for our current and future projects.  Previously we’ve shared our collective knowledge about volunteering within a health and social care environment, provided details of free training courses ranging from HIV information, to mentoring, to computer skills (some of these award certificates or qualifications).

We have a very interesting year ahead, we work across the whole range of communities in Leicester and Leicestershire, tackling wider health, poverty and inequalities that impact on individuals living with HIV.

We request all new volunteers to attend at least one meeting so we can ensure new people are familiar with our service, and for everyone else, we hope you’ll become a regular so we can plan ahead and really make an impact like we have been doing over the past 26 years.

HIV & Hepatitis Update

Celia---HIV-Basics

Celia Fisher (@LASSCelia) delivering HIV training at LASS.

 

Following out Volunteer meeting, we’re delivering a HIV & Hepatitis update between 13:00 – 15:00hrs, facilitated & developed by LASS’s Celia Fisher.

The aim of this session is to provide an update of the recent advances and information about HIV & Hepatitis – including transmission, risks, treatment and statistics. It is beneficial to consider these blood borne viruses in one session and to explore the wider determinants of these viruses.

The session will be of interest and benefit to people who deliver health, HIV, Hepatitis or other support services such as housing, job advice, those who work with people living with / affected by or more at risk of HIV and/or Hepatitis. The session will benefit individuals who want to be up to date with their knowledge.

We hope you’ll join us this Thursday, 29th January at 11:00am at 11:00am at The Michael Wood Centre, we’d love to hear from you.

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Greece’s 200% increase in HIV shows how disastrous austerity can be for public health

Austerity measures in Greece are raising red flags, and red ribbons. (AP Photo/Nikolas Giakoumidis)

Austerity measures in Greece are raising red flags, and red ribbons. (AP Photo/Nikolas Giakoumidis)

One day in late March 2013, European finance and health ministry officials met at the OECD’s Paris office to discuss how healthcare systems are faring in times of austerity.

On the second day of the two-day conference, Greek finance ministry official Evdoxia Andrianopoulou read from a series of brown-colored PowerPoint slides riddled with details of attrition and savings. Greece’s cuts were deep, of the sort commonly seen in a corporate turnaround – but rarely on a government’s balance sheet, and almost never to healthcare expenses.

The takeaway from the meeting – according to two people who attended it – was that Greek officials knew that these huge cuts would result in the curtailing of essential services for their people. But the officials were working under the stress of having to meet a financial target set by their tri-party group of creditors: the European Commission, the International Monetary Fund, and the European Central Bank. And so they delivered.

According to an Austrian finance ministry official who attended the meeting, participants in the room “were in a state of shock” after Andrianopoulou concluded her talk. Another attendee who asked that he not be quoted said “a pin-drop silence” filled the room.

Meanwhile, across the Channel in London, academics were preparing to release a study in “The Lancet” on the healthcare crisis that has followed deep budget cuts in Southern Europe.

One of that work’s principal researchers, David Stuckler of Oxford University, warned that not just Greece, but also Spain and Portugal, faced a potential healthcare disaster due to their own steep budget cuts.

Yet of the three crisis-stricken countries, Greece seems to have suffered the most.

“Greece is an example of perhaps the worst case of austerity leading to public health disasters,” Mr. Stuckler explained in a telephone interview.

“After mosquito spraying programs were cut, we’ve seen a return of malaria, which the country has kept under control for the past four decades. New HIV infections have jumped more than 200 percent,” he noted.

Malaria returned because municipal governments lacked the funds to spray against mosquitoes. HIV spiked because government needle exchange programs ran out of clean syringes for heroin addicts. By Stuckler’s estimate, the average Greek junkie requires 200 clean needles in a given year.

“But now they’re only getting three a year each,” Stuckler said.

Athenian drug addicts sharing needles or malaria-carrying mosquitoes biting Spartans have put Greece in the media spotlight over the past few months. But a decidedly less headline-grabbing fact is this: cuts taken over the last two years could look even worse a few years from now.

“The thing about healthcare systems,” the OECD’s Ankit Kumar explained in a telephone interview, “Is you cut the money today, and start to see the cuts’ impact at least three to four years from now. You know that people aren’t getting their medications. But it takes a couple of years before this manifests itself in high levers of sickness, fewer people being able to work, and more people facing shorter lives. Given the consequences of what has happened in Greece, these outcomes are just going to get worse and worse.”

Some experts have suggested that Greece’s budgetary ax fell unduly hard on its healthcare sector, which was slated to grow at around 4 percent annually, but which has instead been jolted by a series of wage freezes, firings, and drug rationing programs. Economists around the world warned of the cuts’ consequences – but it was the Greeks themselves who opted for deep gashes to their healthcare system.

“IMF doesn’t say ‘you have to cut 10 percent of your economy, but you can’t close hospitals or schools.’ Where the cuts are made remains a country’s sovereign right,” Kumar explained.

This spring has been an important time for healthcare research in Europe because data now confirm – as if there was any doubt – that in healthcare, too, the gulf between Europe’s north and its south has continued to widen.

Last year, while Greece went about adjusting to its new slimmed-down healthcare reality, German’s ministry of health contacted the OECD for its help in studying the exact opposite problem. German healthcare costs were ballooning, but only a third of the growth could be linked to Germans becoming sicker or aging.

The OECD’s research on Germany was published this spring, at nearly the same time that the full picture of Greece’s healthcare tragedy came into form.

OECD researchers compared Germany to its peers, and came to a simple conclusion: German doctors seem to be prescribing treatments, operations, and hospital stays more often than might be medically necessary. That this is occurring while Germany’s neighbors just a two-hour plane ride away in Athens face the worse healthcare and societal crisis in their history only underscores the much publicized idea that Europe is growing apart.

One statistic was especially telling: the OECD average for hospital beds per 1,000 patients sits at 4.9; in the case of Germany, it’s 8.3. France has 6.4, while the U.S. has 3.1.

“The difference in the medical science between the United States, Germany, and France is not so great that it can justify 70 percent higher numbers in Germany than the OECD average,” Kumar said.

Kumar and his co-author, Michael Schoenstein, theorized that because Germany has more hospitals than it needs, doctors and hospitals appear to be steering patients towards more expensive in-patient procedures and then tacking on multiple night hospital stays in order to fill hospital beds and submit payments to Germany’s essentially unlimited system of insurance reimbursements.

“These are big institutions that want to be busy,” Kumar said. “After investing millions, and in some cases billions of dollars, into the infrastructure, no one wants to have these institutions running at 60 percent. They know that if hospitals aren’t full, someone’s going to point the finger and say ‘hold on a second, you’re running at 60 percent capacity regularly, why do you have all of these empty beds, we need to get rid of that.’”

***

The OECD lacks clear data on how many Greeks have been denied medical care during the country’s economic crisis. But anecdotal reports have shown that people are being deprived care.

The New York Times reported that “breast cancer patients often have to wait three months now to have tumors removed” and that at least 2,000 patients in need of bypass surgery haven’t been scheduled for procedures.

Could the solution to Greeks’ healthcare crisis be to send patients north to Germany’s hospitals? With Europe’s common market, citizens’ freedom of movement, couldn’t Greeks just fly north for treatment?

“Yes, EU citizens can travel to other EU countries for treatment,” OECD’s Michael Schoenstein explained, “But for planned treatments like cancer treatments, they need prior approval from their healthcare insurers at home. It’s theoretically possible, but practically very difficult.”

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Timothy Ray Brown: World’s only person cured of HIV speaks about stem cell transplant experience

TRB

The only person in the world to have been cured of HIV has spoken out about his experience for the first time.

Timothy Ray Brown was cured of HIV in 2007 after living with the infection for 12 years. For a long time he was known only as the “Berlin Patient”.

Doctors conducted a bold experiment using a stem cell donor who was naturally resistant to HIV infection. The stem cells were transplanted into Brown and he was able to immediately stop all antiretroviral treatment – the HIV virus has never returned.

Published in the journal AIDS Research and Human Retroviruses, his story – I Am the Berlin Patient: A Personal Reflection – tells about his life with HIV, the treatment and his recovery.

“My name is Timothy Ray Brown and I am the first person in the world to be cured of HIV. While attending university in Berlin in 1995, I received a positive HIV diagnosis … I, like many HIV-infected people at the time, lived a rather normal life and had a nearly normal life expectancy. That continued for the next 10 years.”

He says that after returning from a wedding he started feeling tired all the time and found out he had anaemia. He then discovered he had acute myeloid leukaemia.

“The next day I went to the hospital and was put on chemotherapy after having tubes put into my neck that extended into my heart. The doctors told me that I would need four rounds of chemotherapy treatments, each taking a week, with breaks of several weeks in between.”

During his third round of treatment, he got an infection and was put into a medically induced coma. Before resuming treatment, his doctor sent a sample of his blood to the stem cell donor bank with the German Red Cross to look for matches in case he needed a stem cell transplant.

“This confused me because I thought this ordeal would end with the chemotherapy treatments.

“Many patients do not have any matches; I had many matches, 267. This gave Dr. Huetter the idea of looking for a donor who had a mutation called CCR5 Delta 32 on the CD4 cells making them nearly immune to HIV. CCR5 is a protein on the surface of the CD4 cell that acts as doorway for the HIV virus to enter into the cell. Take away this entryway and CD4 cells will not be infected and the person will not get HIV. His team found a donor with this mutation on the 61st attempt. The donor agreed to donate should it be necessary.”

Initially, Brown did not want to be a “guinea pig” and refused the stem cell transplant – “the survival rate for stem cell transplants is not great; normally it is about 50/50,” he said.

After his leukaemia returned, he decided to try it, however. “I received the transplant on February 6, 2007, my new ‘birth date.’ With Dr. Huetter’s agreement, I stopped taking my HIV medication on the day of the transplant. (This is important because a continuation of antiretroviral therapy would have meant that no one would have known for a long time that I was cured of HIV.) After 3 months, HIV was no longer found in my blood.

“I thrived until the end of the year. I was able to go back to work and return to the gym. I began developing muscles that I had never had before because without HIV I no longer had the wasting syndrome.”

Brown’s leukaemia returned again, and he received a second stem cell transplant. His recovery was very slow, but after six years he is almost back to normal – HIV free. He said that he was not ready for the publicity his case would bring, but decided to waive his anonymity in 2010.

“I did not want to be the only person in the world cured of HIV; I wanted other HIV+ patients to join my club. I want to dedicate my life to supporting research to search for a cure or cures for HIV!”

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Hepatitis C drug delayed by NHS due to high cost

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. Photograph: Bsip/UIG via Getty Images

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. Photograph: Bsip/UIG via Getty Images

The NHS is to delay the introduction of a highly expensive drug that can save the lives of people infected with the hepatitis C virus. The move by NHS England is unprecedented, because the NHS rationing body, Nice (the National Institute for Health and Care Excellence) has approved the drug. Nice says sofosbuvir is cost-effective, because it is a cure for people who would otherwise run up huge NHS bills.

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. A liver transplant costs more than £50,000.

But NHS England appears to be balking at the bill for the drug, which would hit £1bn for every 20,000 people treated. Approximately 160,000 people in England alone are infected with hepatitis C, although fewer than half are aware of it.

Sofosbuvir has been hailed internationally as a breakthrough, but there is global concern over the very high cost of a drug that can save lives. Campaigners are pressing for lower prices, from the US – where it costs $1,000 a pill – to India, in a fight which they liken to that over drugs against another virus: HIV, which causes Aids. On Wednesday, they celebrated a decision by the Indian authorities not to allow a patent application for sofosbuvir by Gilead, the manufacturer, which means Indian companies may be able to make cheap copies for the developing world.

The price offered by Gilead in the UK is almost £35,000 for a 12-week course. Many patients will need a 24-week course, costing £70,000. In its final draft guidance on sofosbuvir, Nice said it was allowing NHS England to postpone implementation for four months, until the end of July instead the beginning of April. NHS England failed to comment.

Charles Gore, chief executive of the Hepatitis C Trust, said he was very concerned about the delay. Nice had allowed NHS England to make a decision based on affordability rather than cost-effectiveness. “It feels to me as if a whole new criterion has been invented by the backdoor,” he said. If the NHS could delay using a new drug by four months, it could also delay by six months or a year – or it could decide on the basis of its cash-strapped budget to use it one year but not the next.

“It is undoubtedly a high cost,” said Gore. “The unfortunate thing is there are an awful lot of people who need it. We’re talking about potentially hundreds of thousands of people. That becomes a massive budget-buster.”

NHS England has introduced a scheme to pay for the treatment of people who are very ill – many of them on liver transplant waiting lists. In April, it announced an £18.7m fund to pay for 500 patients with acute liver failure.

But Mark Thursz, professor of hepatology at Imperial College London and chair of the Hepatitis C Coalition, said there were others who needed treatment as soon as possible. “The delay is unprecedented,” he said. “What worries me about it is that if you have got advanced liver disease with hepatitis C, you could progress at any stage to the point where it is very difficult or impossible to reverse the situation or have any improvement. Opportunities are being missed by any delay.”

About 10,000 to 15,000 of people with hepatitis C infection in the UK have cirrhosis, he said. Around 5,000 have advanced disease and need treatment soon if they are not to suffer long-term damage.

Hepatitis C is spread by contact with infected blood. Some people live with it unknowingly for years having injected drugs in their youth, while some got it from blood transplants before screening for the virus was introduced. It is also thought to be spread by sharing razors or toothbrushes with those infected.

There are older drugs but the treatment lasts up to four years and has serious side-effects, including depression. Sofosbuvir is a once-daily pill, taken with one or two other drugs for 12 or 24 weeks

Stelios Karagiannoglou, Gilead’s general manager, UK and Ireland, said the company was pleased with the Nice decision. But he added: “We are disappointed that the majority of patients will not gain access to this important medicine until later this year.” He called on NHS England to commit to a scheme from April offering early treatment for people with cirrhosis.

Story via The Guardian

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