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ladystylestores · 4 years

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A transport ban in Uganda means women are trapped at home with their abusers

The night before, the 25-year-old mother-of-five was busy buying medication for her children in Moroto, a town in northeast Uganda. When Veronica (whose surname we’re not using to protect her identity) returned home, her husband picked up a sharp object and stabbed her in the right eye. He then beat her, and when she blacked out, he fled, she said.

Two legal volunteers from the Association of Women Lawyers (FIDA-U), an organization that provides legal aid and access to essential services for women, were already working on the ground in the community. They heard Veronica’s screams and decided to investigate. After finding her lying unconscious on the floor, they called their colleague Jacob Lokuda, a front-line legal clerk who responds rapidly to violent incidents, and who recounted what happened.

The three men carried her to Moroto hospital, roughly four miles away. By car, the journey is a 20-minute drive; by foot, it took over one hour. Veronica drifted in and out of consciousness, mumbling that she thought she was already dead.

On May 4, Ugandan President Yoweri Museveni began to loosen the country’s strict anti-coronavirus restrictions after more than six weeks in lockdown. While businesses including hardware shops and wholesale stores have now reopened, the existing ban on all public and private transport remains intact.

This means, critics say, that many women will continue not only to be trapped at home with a potential perpetrator, but they remain unable to travel to seek medical treatment, refuge or help.

The country currently has 160 confirmed Covid-19 cases and no fatalities, according to Johns Hopkins University.

Many women, like Veronica, have found themselves forced to spend more time with partners who were already abusive. Economic worry is an added tension. More than 80% of Ugandans work in the informal sector and many have lost their jobs due to the Covid-19 restrictions.

“We stopped a lot to catch our breath,” says Lokuda, who had already jogged 40 minutes to Veronica’s village from his own home. “We didn’t have any protective gear, such as gloves, but she needed medical attention,” he adds.

“He had gone beyond reason,” Veronica said over the phone.

In late March, Museveni indicated that domestic violence is not life threatening and should not be considered so during the Covid-19 pandemic.

“We’re just dealing with a few things [that are] life-threatening. Childbirth, snakebite, heart attack — finish. What else is there? We’re not dealing with all problems. Somebody is drunk and has beaten his wife? No, no, no,” he said.

He has since addressed the issue and said he is devising a “comprehensive plan” on how best to handle the situation.

While ambulances have been given travel permits, the number of vehicles is low and many citizens live in villages with a patchy phone signal.

Those working in essential services such as health care are allowed on the roads, yet legal aid providers were not deemed essential until last week. Now, 30 lawyers working for the Uganda Law Society are permitted to provide urgent legal services.

“This is a positive step,” says Irene Ekonga, FIDA-U’s director of programs, “but it’s a drop in the ocean.”

Movement is an issue, agrees Rose Nalubega, acting commissioner for the national police’s Sexual and Children Offences department in Kampala, the bustling Ugandan capital.

“Response is our greatest challenge,” she said in an interview. “We’re operating in the normal way but [Covid-19] has escalated the problem. We were not prepared, but we try.”

Ugandans can apply for a special travel permit from the resident district commissioner, but locals have complained their offices are often empty. For organizations like FIDA-U, time is of the essence — and applying for a permit waiver can take hours.

“In these emergency situations, the first response is what really counts,” says Lokuda. “I put everything down because we have to move fast, but there are lots of delays.”

Those found driving without permission can be arrested or have their vehicle impounded.

Several weeks ago, Lokuda received an 8 a.m. call about an alleged rape. As it was still early, and the young woman’s village was a little further out, he decided to seek permission for transport. After negotiations, he didn’t arrive until 2 p.m.

“It was too late,” he sighs. “The perpetrator had already run away but at least we managed to bring her for a medical examination.”

Police were called and they took her to a station before Lokuda brought her to the hospital in the car he’d been given approval to travel in.

“Violence against women is accepted here”

Josephine Aparo, Senior Coordinator at International Justice Mission

In one month, police noted a surge in gender-based violence cases, with an estimated 3,280 recorded between March 30 and April 28, according to Frank Tumwebaze, the Minister of Gender, Labour and Social Development.

In 2019, an average of 1,137 domestic violence cases were reported monthly.

FIDA-U say they witnessed a 522% increase in the number of cases reported by phone (from nine on average to 56 calls per week) since the lockdown was first introduced, though they believe many more domestic violence cases are going unrecorded.

Violence against children has also soared: the Uganda Child Helpline dealt with 881 cases since the lockdown began in late March (the average is 248).

The surge in domestic abuse is set against a backdrop of already high levels in the country. Forty-six percent of ever-married women say they are afraid of their current or most recent spouse or partner compared to 23% of ever-married men, according to figures published by the Uganda Bureau of Statistics in 2016.

“Violence against women is accepted here,” says Josephine Aparo, Senior Coordinator at International Justice Mission (IJM) Uganda, who work with police and prosecutors to bring perpetrators to court.

After a 14-day period, the President will announce the next phase of reopening on 19 May. Yet experts are concerned the existing problems will continue.

“[Once the transport ban lifts], women in close proximity with abusive partners might be able to report and seek refuge elsewhere,” says Ekonga.

“Issues like economic difficulties are still likely to persist, as well as dependence on male partners for financial support. Cases might drop slightly but by and large, I think they will remain higher than the rates before the lockdown.”

Veronica had been with her husband for 12 years before this assault, which she reported to police in a local station. She had previously reported him some years ago because, she says, he wasn’t taking care of the children properly. He didn’t have a job, and Veronica’s work as a street vendor selling meat dried up due to Covid-19 restrictions. They had little money for food or rent.

While her case is being followed up by the Ugandan police, several rights organizations say the police have been unable to adequately respond to incidents or make arrests.

“The police are usually under-resourced,” explains Tina Musuya, executive director of the Center for Domestic Violence Prevention. “During an emergency like this? Violence against women is a forgotten territory.”

Amid the pandemic, police vehicles were reallocated to the Covid-19 response, which left a shortage elsewhere. Several organizations who supported law enforcement with cars before the transport ban have since been given permission to do so again. IJM, for example, is providing cars to assist police investigations into gender-based violence crimes.

Many women and children flee their abusers with nowhere to go: all domestic violence shelters have closed across the country, bar one, though this may change as the lockdown gradually lifts. The police have recently opened a new temporary shelter in Kampala, and launched a toll-free line in a bid to handle the increasing number of cases.

“It’s astonishing,” says Asia Russell of Health GAP, a HIV advocacy organization with staff in Uganda. “The mode of implementation of the Covid-19 response has killed people,” she adds, referring to vulnerable groups such as women experiencing violence, with chronic illnesses and those who are pregnant.

“Where is the infrastructure for communities who are experiencing increased terror? Don’t they matter?” Russell says.

Weeks after Veronica was released from hospital, her eye is still painful.

She and her husband haven’t spoken since that “fateful night,” she says, before adding firmly: “I’m not going to have contact with him again.”

She still has difficulty sleeping, but she feels safe and, for now, that will do.

Louise Donovan is a Nairobi-based correspondent with The Fuller Project, a journalism nonprofit reporting on global issues impacting women.

Top image: Shutterstock/CNN Photo Illustration by Gabrielle Smith

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ellenlucasonlinedatingblog · 5 years

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A Future Without HIV: Are We There Yet?

Jennifer Waugh

The findings of a major eight-year-long HIV study known as the PARTNER2 study have shown that so long as HIV+ partners are being fully treated, there is no chance of passing on HIV to a sexual partner, even with unprotected sex. What does that mean, and where do we stand now that we know this?

Last weekend was huge for HIV research. Literally epic.

The Guardian, CNN and other major news sources reported on the findings of a major eight-year-long HIV study known as the PARTNER2 study. This landmark study followed 1000 male couples where one partner was HIV positive and on antiretroviral (ARV) medication, and one partner was negative for the disease, across fourteen different countries in the United Kingdom.

The study findings showed that when men were adherent to their ARVs (when they took their meds daily and as directed), they became virally suppressed, and had no chance of passing on HIV to their sexual partner, even with unprotected sex. These couples reported engaging in unprotected sex more than 77,000 times collectively without any transmission of the virus.

You heard that right: so long as the HIV+ partners were being fully treated, it was found that there was no chance - zero — of passing on HIV to their sexual partner, even with unprotected sex.

The findings of this study were published in 2018, but the CDC recognized the fact that undetectable viral loads lead to zero HIV transmission in 2017, showing support of the Prevention Access Campaign’s “Undetectable = Untransmittable,” or “U=U." More than eight hundred organizations across one hundred countries have now joined together in support of the U=U campaign. HIV/AIDS has claimed the lives of millions since it was first discovered in 1983, but it seems things may finally be looking up.

This is obviously amazing news. This is also a lot to unpack, though, so let’s talk basics, filling in gaps you might have about HIV or AIDS, treatment, and their history, then let's take a look at the view from here.

What are HIV and AIDS, anyway?

HIV (Human Immunodeficiency Virus) is a disease that attacks the immune system, and which makes anyone who has it more susceptible to other infections that can then cause AIDS (Acquired Immune Deficiency Syndrome). A person living with HIV is considered to have AIDS when their CD4 count — the amount of white blood cells in the body — drops below 200 (the normal range is 500-1,500), and they have been diagnosed with what's called an opportunistic infection. Some of the most common opportunistic infections are recurrent pneumonia, toxoplasmosis, hepatitis B and C, and candidiasis (yeast infections or thrush) - though there are many. Basically, because HIV attacks the immune system, which makes it easier to fall seriously ill by another serious infection, and greatly inhibits the body’s ability to fight back. Good CD4 cells are destroyed, and HIV begins creating new copies of the virus.

One big misconception that still exists, thanks in part to stigma and lack of accurate education, is that HIV = AIDS, or even that HIV always leads to AIDS. That’s not true. With advances in research and treatment options, many people with HIV in developed nations now never experience AIDS.

HIV was initially found in 1981 and first called GRID -- Gay-Related Immunodeficiency -- because it was first seen in gay men. This framing unfortunately perpetuated stigma (negative, oftentimes shameful, perception) that still surrounds both gay men and HIV to this day. HIV isn’t just about gay men. It can be transmitted (passed from one person to another) through bodily fluids including blood, semen, vaginal fluids, and breastmilk. Though the virus passes most easily during anal sex (due to the ease with which anal tissue tears, making the act more “risky” for the receptive, or bottom, partner) HIV does not discriminate based on sexuality, gender, or skin color. Contrary to historical stereotypes, statistics show that globally heterosexual women are who experience the highest rates of HIV infection.

In the 1980s and 1990s when treatments were not yet readily available or affordable, hundreds of thousands of gay men had died from AIDS, largely due to homophobia. In the USA alone, "By 1995, one gay man in nine had been diagnosed with AIDS, one in fifteen had died, and 10% of the 1,600,000 men aged 25-44 who identified as gay had died." Gay men have accounted for more than half (55 percent) of all AIDS deaths since the epidemic’s beginning.

Sensationalized news articles and headlines across the world played a great part in this by demonizing gay men, using terms like “gay plague,” “gay cancer,” and displayed images of tombstones and the Grim Reaper. Heartlessly, HIV and AIDS were viewed by many as a punishment for what they or others considered “amoral behavior,” like sex between men, IV drug use, or sex work. This, combined with existing intense bias against these groups, led to a mass amount of fear, and tremendous silence surrounding the disease. At the height of the AIDS epidemic in the US and beyond, gay men led activist movements criticizing the government’s blind eye and lack of action at such a crucial time, fighting for the Reagan administration to pay attention and to fund research and treatment. It wasn’t until 1986 that President Reagan even mentioned the word AIDS publicly. During this time, HIV was still considered by many to be a death sentence, as affected populations continued to be further marginalized.

Ian Green, Chief Executive of Terrence Higgins Trust, a British charity that provides services relating to sexual health and HIV, was diagnosed with HIV 23 years ago. In a recent interview, Ian, now undetectable, disclosed fears he had when he was diagnosed that many still have today when they test positive for HIV. “The most significant [emotion] at that point in time was how long did I have to live. The other thing that really concerned me for a very long time is am I a risk to other people?” I can only imagine the immense relief that might now be felt by a person living with HIV to learn they are unable to pass it on to anyone else – to not feel as though they are any sort of danger to other people, so contrary to perceptions and experiences of the past.

In the United States, specifically, the population most affected by HIV is still men who have sex with men, accounting for 26,000 new infections each year. Worldwide, though, women represent the majority — 52% — of all adults living with HIV. Though we know anal sex poses the greatest risk of transmission, penis-vaginal intercourse is also a leading cause of transmission worldwide. Similar to the anus, it's easy for the vaginal wall to experience small (usually unnoticeable) tears during intercourse, providing a route for HIV transmission. Vaginal tissue is highly susceptible to any type of infection. Beyond basic physiology, women (including those who don't have vaginas) also remain disproportionately affected by the virus due to vulnerabilities created by social, economic, and cultural status. Gender inequality, as well as intimate partner violence, reinforce harmful power dynamics, both on a personal and systemic scale. In many countries, women face significant barriers to education and healthcare, contributing to a known lack of understanding around pregnancy and HIV.

What about treatment?

HIV treatment medications (ARVs) became available in the late 1980s, starting with the first licensed drug, AZT (of the drug class Nucleoside Analogs), which was initially highly toxic.

Fast forward to the 1990s and a new era of ARVs. Researchers began to realize that one class of drugs was not enough to control CD4 counts, and eventually introduced HAARTs – highly active antiretroviral therapies – made up of combinations of Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors, Fusion Inhibitors, CCR5 Antagonists, and Integrase Inhibitors. Not only were these treatments (called “cocktails” in early years) numerous - sometimes 20 or more pills a day - but many doctors refused to even treat people living with HIV. Then there’s the fact that even seeing a doctor and paying for these incredibly costly meds meant having health insurance (something many, many people didn’t have), and a plan that would potentially pay thousands upon thousands monthly for treatment.

Through years of advocacy and research, ARVs became more effective in treating the virus, and HIV resource agencies began growing around the world, making it easier for more people to access these medications. Drug trials continued, and researchers found the right combination of these different classes of drugs.

Today, people living with HIV who are connected to treatment can now take as little as one single pill per day as their full treatment. (That one pill contains at least three types of medications, though.) By finding these effective combinations, remaining adherent to one’s ARVs has become much easier than not only remembering to take, but having to swallow, handfuls of pills per day.

This brings us back to the results of the PARTNER2 study and what life looks like for people who receive HIV treatment today.

UNAIDS data from 2018 reported that 21.7 million of the 36.9 million people living with HIV worldwide were receiving treatment in 2017. Their current initiative and goal is 90/90/90: that 90% of people living with HIV will know their status, 90% of those people will be on treatment, and 90% will be virally suppressed. Adherence to treatment is key to suppression of the virus.

Current standards of treatment include taking daily medication and having lab work done every six months prior to checking up with a healthcare provider. Today there are many ARV medications, and doctors choose the best regimen for each individual patient. Typically, after a few months of taking medication (and depending on how long they have been living with the disease untreated), people diagnosed with HIV will have such a small amount of copies of HIV in their blood that they are considered “undetectable.” People achieve viral suppression (a controlled, lowered amount of the virus) when the copies of HIV are less than 200 per milliliter (mL) of blood. This doesn’t mean that a person with an undetectable viral load will test negative for HIV, but during routine labs (which check the CD4 – the level of good white blood cells, and the amount of HIV copies in the blood) their amount is so small that it will not show up on that particular test.

It’s important to note that just because a person achieves undetectable status does not mean they can stop taking medication. If a person begins missing more than 3-4 doses of their ARV per month regularly, their viral load can climb to a detectable value, and they may need to switch medications to get that number back under control.

So, what does this news mean for everyone?

Obviously, the fact that HIV treatment has now been proven to prevent transmission when taken properly is incredible news, and is potentially momentous both for people living with HIV and those of us who have worked or are currently working to prevent it. Researchers have been working hard for decades on the science behind HIV and developing and administering effective treatment.

But what about the people who don’t have access to these medications? In developing nations, poor economy contributes to a lack of healthcare, and the availability of medication to fight HIV. UNAIDS estimates that more than $26.2 billion will be required to combat HIV/AIDS in the year 2020. Treatment is expensive.

Stigma plays — as it always has — another huge role in the ability to receive treatment. Even just being tested for HIV is scary because of fear of judgment and discrimination. In terms of HIV, however, ignorance is not bliss. It is crucial to know one’s status so that treatment can be initiated, and more people will not come in contact with the virus. 73 countries worldwide still consider homosexuality to be a prosecutable offense, sometimes punishable by death: these attitudes and policies obviously keep many people from even getting tested. A key proponent to HIV prevention is education and counseling, but for many, the idea still exists that HIV = gay, and it can be dangerous to discuss either.

There are many other barriers that exist that prevent people from receiving HIV treatment. People of color and those who are low-income are incredibly underserved. Many people do not have access to health insurance or appropriate healthcare. ARVs cost upwards of $3,000 per month without insurance. Even with insurance, lack of education often leads to the inability to understand a diagnosis and other parts of health, and makes it difficult for many marginalized people to communicate their needs with a doctor. What about transportation? Just getting to a doctor’s office or pharmacy is often a task on its own, especially in rural areas or healthcare deserts (areas with no clinics or hospitals). Additionally, housing and food security play their own roles in creating barriers to optimal HIV health. Without a safe place to live, many people lack a safe place to store their medications even if they can get them. Most ARVs need to be taken with food to be absorbed properly: not knowing where your next meal will come from adds another layer to the struggle with adherence.

Luckily, there are many HIV resource agencies to assist people with some of these barriers and help to make access to HIV healthcare easier. In the United States, the AIDS Drug Assistance Program (ADAP - though the name varies by state; for example, this resource is called MIDAP in Michigan) provides free HIV healthcare and HIV medications for people enrolled in the program. This organization even covers undocumented citizens. HIV resource agencies often provide testing, education, counseling, and HIV health management services (including social work, and food, housing, and insurance assistance) for people who are lucky enough to have an organization in their area.

There are also other recent HIV advancements to be excited about. Pre-Exposure Prophylaxis (PrEP) was initially approved by the FDA as a preventative medication from MeetPositives SM Feed 4 http://bit.ly/30bb2qr via IFTTT

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integrativeaddiction · 5 years

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Crystal Meth Rehab Success Rates

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Crystal meth rehab

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Clinic attend group therapy) brendan

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alamante · 6 years

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Image copyright AFP

Zimbabwe’s President Robert Mugabe resigned last year after almost four decades in power. Now, the country is approaching its first post-Mugabe election, with his successor Emmerson Mnangagwa and MDC Alliance candidate Nelson Chamisa the two front-runners in a field of 23 candidates.

Here are 10 numbers that will help you understand how the country got to where it is now.

2 = the tally of leaders in the last 38 years

Robert Mugabe, who led the country’s liberation movement, was in power from independence in 1980 until he was ousted in November last year at the age of 93. His years in office, first as prime minister until the switch to a presidential system in 1987, were marked by economic turmoil and the crushing of dissent.

Image copyright AFP/Reuters

Image caption Both Robert Mugabe (L) and Emmerson Mnangagwa (R) are from the ruling Zanu-PF party

Emmerson Mnangagwa is his successor – nicknamed the “crocodile” because of political cunning. Once a Mugabe loyalist, he promises to revive the shattered economy and hopes to win elections on 30 July to legitimise his presidency.

231 million % = inflation in July 2008

Zimbabwe’s economy has struggled since a controversial land reform programme was introduced in 2000.

The programme that saw white-owned farms redistributed to landless black Zimbabweans – and those with good political connections – led to sharp falls in production.

As the country’s central bank printed money to try to get out of the crisis, rampant inflation took hold.

Although the World Bank does not have figures for 2008 and 2009, numbers from Zimbabwe’s central bank showed annual inflation reached 231 million % in July 2008. Officials gave up reporting monthly statistics when it peaked at just under 80 billion % in mid-November 2008.

The country was forced to abandon its own currency a year later at a rate of Z$35 quadrillion to US$1.