Maldives identifies “first” child HIV infection

Senior health figures have called on the government, NGOs and members of the private sector to help step up attempts to promote AIDS prevention in the country after authorities discovered that a two year-old child had tested HIV positive earlier this year.

While accepting that HIV infection rates remained relatively low in the Maldives, Minister of State for Health Lubna Zahir Hussain said that efforts needed to be increased across all sectors of society to tackle attitudes towards high-risk behaviours that allow the virus to be transmitted.

Lubna heads the National Drug Agency (NDA). Her comments followed the hosting of a special NDA workshop on HIV prevention held on December 1 to commemorate World AIDS Day. The workshop was focused particularly on the HIV infection through drug abuse.

Though statistics indicate HIV infection rates have been limited in the Maldives over the space of the last two decades, health officials in the Maldives have begun to raise concerns about the risk of cases spreading across the country.

In October Minister of Health Dr Ahmed Jamsheed Mohamed claimed it was only through “incredible luck” that HIV had not spread across the Maldives, considering the prolific levels of unprotected sex and intravenous drug use.

Addressing concerns raised by Health Minister Jamsheed about the potential scope for HIV to spread beyond high-risk communities such as drug users, Lubna said greater effort was needed to address attitudes of the general public to the spread of the virus.

“I think what the health minister was saying is that it is not only people living bad lifestyles that are at risk [of HIV infection],” she said, reiterating concerns about the number of young people engaged in intravenous drug use and potentially dangerous sexual practices.

She spoke about a child who was suspected of having been infected from her mother at birth.

“We were first made aware of the case in April 2012 and as far as I know, this is the first case [of a child in the Maldives being born HIV positive],” she said. “However, I think it is important for the public to know the reality of the situation right now, whilst respecting [the child’s] privacy and well being.”

Lubna said she was ultimately encouraged by the work of the country’s health authorities in trying to address the HIV risk from national attitudes towards sex and drug use in the country, yet warned against complacency.

“This doesn’t mean that we continue to work at this pace to try and address attitudes towards AIDS and its spread,” she said.

Lubna called on civil society, the business community and government to speed up efforts to hold awareness and education events about the dangers posed through unprotected sex and intravenous drug use, and to promote preventative measures to reduce the national HIV risk.

Attempts have been made to work with local drug NGOs such as Male’-based Journey on running special outreach programs and blood tests to try and monitor and manage infection rates.

However Lubna said that drug use was not the only area of concern in trying to curb HIV infection.

“Prostitution is another area that needs to be looked into. Awareness work in this area needs to be seen immediately,” she said.

She said greater awareness was needed not just among the general public, but by government authorities and law enforcement agencies.

First Lady’s concerns

During the NDA workshop, First Lady Ilham Hussain stressed that growing numbers of the country’s youth were subjected to dangerous habits that could potentially lead to HIV infection.  She highlighted recreational drug use in particular as the leading cause of the virus spreading nationally.

“Incredible luck”

Speaking earlier this year on the issue of HIV infection rates, Health Minister Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

“What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire,” he said at the time.

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.

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“Worst fears over HIV coming true”: Health Minister

Minister of Health Dr Ahmed Jamsheed Mohamed has expressed concern about the risks of HIV spreading rapidly in the Maldives, stating that “our worst fears seem to be coming true.”

Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

At the press conference on Sunday, Jamsheed said: “What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire.”

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed further cautioned against assuming that the HIV virus would stay within the injecting drug user circle, pointing out that some drug users do so in secret, and that many are married to non-drug users who could just as easily be infected with the virus.

Minister of State for Health Lubna Zahir Hussain, who heads the National Drug Agency (NDA) and Centre for Community Health and Disease Control (CCHDC) Director Maimoona Abu Bakr said that both their departments were taking preventive measures against the spread of HIV.

Jamsheed, too, said the NDA’s efforts to help drug users out of their addiction is a preventive measure against HIV as drug users are most at risk.

Meanwhile, the CCHDC is working with civil society groups like Journey, Society for Women Against Drugs (SWAD) and regional NGOs to spread awareness about STIs and HIV, and to encourage the public to change their habits to ways that present less risk of contraction.

Practical action or the moral highground?

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

“This is an argument I do not accept,” he said. “I presume that those among us who are already infected are also Muslims, being Maldivians. Of course, there are certain protections that being in a Muslim community affords us. For example, all of us men have been circumcised, which is proven to provide protection against STIs. To put it short, we need to work on more practical forms to prevent the spread of HIV.”

Sexual promiscuity elevating risks

The minister further spoke of the risks of promiscuity in the society, referring to the 2010 case where police arrested an HIV positive prostitute. He stated that the same prostitute had been identified in the Maldives as being HIV positive in the year 2009 as well, emphasising the risks to the spreading of HIV that such events presented.

Prior to his appointment as Minister of Health, Jamsheed had written about his concerns regarding the spreading of HIV in his personal blog, speaking about the “sexually active” lifestyle of the Maldivian people, which created a higher risk of infection.

“Maldivians have always been a sexually very active and promiscuous community. We have a very high divorce and remarriage rate, which increases the number of sexual partners any individual has over their lifetime. It is also a known fact that despite being a Muslim community, a lot of Maldivians have multiple extramarital relationships,” he had written then.

CCHDC’s Maimoona Abu Bakr also highlighted that “undesired sexual acts”, prostitution, injecting drug users and homosexuality proved to be some of the greatest challenges to preventing the spread of HIV.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.

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Male’ festival aims to clear HIV “misconceptions” among migrant population

A “HIV Awareness Festival” being held this weekend in Male’ aims to provide free advice and medical examinations, alongside activities for those interested in learning about HIV/AIDS in a friendly environment, organisers have said.

According to the United Nations Development Programme (UNDP), the main organiser of the festival, the aim for the event is to promote HIV/AIDS awareness amongst a rapidly growing migrant population in the Maldives – identified as one of the most vulnerable groups to contract the deadly virus.

It is an opportunity to connect migrant workers to the available HIV preventive and curative services in the Maldives as well.

“The festival will create a platform for migrant workers to obtain information on prevention of HIV/AIDS and clear misconceptions through activity-based interaction in their native languages,” a press statement about the event read.

The festival will begin at 4:00pm in Sultan Park and throughout the event, stalls will be providing basic healthcare checks, for dental and eye health, voluntary counselling and testing for HIV/AIDS – all free of charge.

A jumble sale will also take place, while snacks and music will reflect the different food and cultures of migrant populations.

According to the organiser, the stall activities are supported by various foreign embassies and civil society organisations.

HIV situation in Maldives

Compared to many countries in the region, the Maldives had been found to have a low prevalence of HIV.

As of December 2011, state figures reveal a total of 15 HIV cases were detected among Maldivians, while 289 were identified among the expatriate migrant labour force.

However, the challenge remains to maintain the low prevalence rates amid widespread high risk behaviours.

Heath Minster Dr Ahmed Jamsheed has contended that these high risk behaviours – including unsafe injecting, unprotected sex with multiple partners, serial monogamy, group sex, gang rape, commercial sex, and unprotected male-to-male sex – have put Maldives at the brink of an HIV/AIDs explosion.

Recent studies suggest that migrant construction workers, injecting drug users, female sex workers, men who have sex with men, seafarers, resort workers and young people are the seven groups at the most risk for contracting deadly virus.

An unknown number of 80,000 to 110,000 foreign workers – almost one-third of the total local population – is estimated to be working in Maldives – primarily in the construction and service sectors.

Thousands of them are undocumented workers who have entered the country illegally, possibly escaping the mandatory HIV screening process.

Through the Global Fund Supported Programme in the Maldives, health authorities and UN agencies are working to run outreach programmes on HIV, targeting the groups most vulnerable to contracting HIV and strengthening national HIV preventive mechanisms.

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Comment: Intravenous drug use raises AIDS spectre in Maldives

Thirty years since the first reported cases of acquired immunodeficiency syndrome (AIDS) in 1981, the response to the HIV/AIDS epidemic has been unprecedented, especially in terms of global and national initiatives.

Substantial progress has been made, such as a 31 percent reduction in the number of new infections between 2001 and 2009 in South-East Asia. A revolutionary new approach to treatment endorsed by UNAIDS and WHO, which includes improved, lower-cost drugs, simplified HIV diagnostic technologies, improved delivery systems, and innovations  in prevention of HIV infection, give hope for achieving universal access to prevention, care and treatment of HIV/AIDS, even in resource-constrained settings.

Yet, the challenge is far from over. HIV still remains a formidable foe, affecting 33.3 million people globally, including 2.5 million children. Despite years of concerted global efforts and investments, there is still neither a cure nor an effective vaccine for the disease.

However, over time, the profile of the HIV epidemic is evolving from a life threatening to a chronic disease, thanks to availability of more effective drugs and efficacious service delivery models involving communities and people living with HIV/AIDS. With changing realities, it is time, then, to reflect and re-strategize in the long-drawn war against HIV/AIDS. Fundamental to success is acknowledging that HIV/AIDS is a social and developmental issue as much as a health one.

The impact on women and children is devastating. An estimated 1.3 million women aged 15 and above currently live with HIV in the WHO’s South-East Asia Region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste).

The estimated number of children living with HIV has increased by 46 percent during 2001 – 2009. Of the 448 million cases of sexually transmitted infections that occur globally, 71 million are in South-East Asia. Due to low coverage of the prevention of mother-to-child transmission (PMTCT) programme in the South-East Asia Region, a large number of babies born to HIV-positive mothers acquire HIV infection in the womb.

Despite considerable diversity in the HIV epidemic among the countries of the Region, unsafe sex and injecting drug use are the main drivers. Five countries -India, Indonesia, Myanmar, Nepal and Thailand – account for a majority of the disease burden. Sexual transmission accounts for the majority of cases in Bhutan, India, Myanmar, Sri Lanka, Thailand and Timor-Leste.  The HIV epidemic among people who inject drugs is significant in Indonesia, Myanmar, Nepal, Thailand, and some regions of India.

The Maldives has a growing threat of the HIV epidemic due to injecting drug use.

The evolution of the epidemic from life threatening to a chronic disease, with better drugs and better access to drugs, has resulted in prolonging survival and quality of care for people living with HIV/AIDS. This necessitates evolution of an HIV care model that is in line with chronic disease management, with primary care providers playing an important role.

The spectrum of HIV care needs to evolve into a comprehensive primary care model that has an integrated, patient-centered approach, and is linked to specialist care where and when needed. It also needs to address the various socio-cultural issues that take the response beyond the health sector into the families and communities.

Other key challenges include late diagnosis of HIV, stigma and discrimination faced by people with HIV and most-at-risk population; limited capacity of health systems; high prices of antiretroviral drugs especially the second line drugs, and lack of sustained finances.

The health sector can only overcome these challenges if it collaborates with other sectors in order to tackle the social, economic, cultural and environmental issues that shape the epidemic and access to health services.

WHO’s  Health Sector Strategy on HIV for South-East Asia has been endorsed by all the eleven Member States of the Region. It envisions “Zero new HIV infections, zero AIDS-related deaths and zero discrimination in a world where people living with HIV are able to live long, healthy lives.”

The four strategic directions to achieve the goal include: optimising HIV prevention, care and treatment outcomes; strengthening strategic information systems for HIV and research; strengthening health systems to ensure that the expanded response to HIV will build effective, efficient and comprehensive health systems in which HIV and other essential services are available, accessible and affordable; and fostering supportive environment to ensure equitable access to HIV services.

WHO continues to work with countries to achieve universal access to comprehensive HIV prevention, treatment and care and to contribute to health-related Millennium Development Goals (MDGs), particularly MDG 6 (combat HIV/AIDS, malaria and other diseases). Together, we hope to move closer to a world free of AIDS.

Dr. Samlee Plianbangchang is the Regional Director of the World Health Organisation for the South-East Asia Region.

<em>All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]</em>

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Authorities warn of looming AIDS pandemic

The Health Ministry has warned of the spread of AIDS in the Maldives after an expatriate prostitute tested positive for HIV.

At a press conference yesterday, Dr Ahmed Jamsheed Mohamed, senior medical officer at the centre for community health and disease control, said prostitutes from neighbouring countries were working in the Maldives on tourist visas.

“We have some evidence now that expatriate women who came to the Maldives without a work permit on a tourist visa are involved in prostitution,” he said. “We learned that one of them was HIV positive.”

While the authorities required  medical checkups for expatriates who apply for work permits, he said, foreigners on tourist visas were not tested.

246 foreigners on work permits have been sent out of the country after testing positive since 1995, an average of 15 a day.

He added the authorities discovered the expatriate prostitute was HIV positive when she applied for a work permit.

Jamsheed said it was likely that there were more prostitutes with HIV who work at massage parlours and appealed to the public to be aware of the risks of visiting local brothels.

Prostitutes from China and Russia working in Sri Lanka often come to the Maldives when their tourist visa expires, he continued, while prostitutes in the Maldives visit Sri Lanka to re-enter the country on a new tourist visa.

“There’s a rotating group between Ceylon and Maldives,” he said. “We believe there must be a lot of HIV positive people among them.”

If AIDS begins to spread in the country, he added, there was no reason to believe it could be controlled.

Jamsheed said HIV in the Maldives was like a ticking time bomb: “Everything necessary for the disease to spread exists among us.”

A recent survey on AIDS revealed all the behavioural risks contributing to the spread of HIV, such as promiscuity, prostitution, homosexuality, rape, child abuse and sharing needles, were “widespread” in the country.

Jamsheed said responsibility had to be taken at an individual, societal and government level to avoid the country “reaching that critical stage”.

Although the survey was based on a small sample of the population, since its release one Maldivian had been found HIV positive and it was likely that more would be discovered. There are over 30 Maldivians with HIV, according to estimates said Dr Jamsheed.

Of the 14 people with AIDS known to the authorities ten have passed away, three are undergoing treatment while the others’ condition had not deteriorated to require treatment.

Asked whether recommendations in the study, such promoting the use of condoms and making clean disposal syringes available to drug addicts could be implemented in the Maldives, Jamsheed said both strategies have been successfully deployed overseas.

“The question is whether they can be brought in to our society with our Islamic principles and values,” he said, adding that the National AIDS Council had to discuss the issues.

Dr Ali Nazeem, in charge of treating HIV patients, said more voluntary counselling and testing centres (VTCs) would be established in the near future, while testing was already available in regional hospitals.

Testing is currently available at ADK hospital and the police VTC.

He added the centres will maintain anonymity and the test results would be confidential.

Earlier this week, drugs NGO Journey opened a VTC with more than 20 volunteers to offer counselling.

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