Estimated 4.9 million people are living with HIV in the Asia and the Pacific region.

Drums beating to a thunderous applause marked the opening of a major regional AIDS congress in the Thai capital on Tuesday. But a new UN report said Asia and the Pacific was at ‘a pivotal juncture’ of HIV epidemic. The report's release marked the opening of the 11th International Congress on AIDS in Asia and the Pacific (ICAAP). It said some countries made progress, but many could not tackle new waves of infection. More than 3000 participants from 80 countries joined the four-day congress to work out strategies to achieve ‘three zeros’ –zero new infections, zero AIDS related deaths and zero discrimination. “Let us share and work together to achieve the common goal of fighting HIV/AIDS,” Chair of the Congress Local Organising Committee Wilas Lohitkul said in his opening remarks. Thai Prime Minister Yingluck Shinawatra in her message hoped that the congress would help in developing ‘innovative strategies’ on sustainable HIV/AIDS response. Estimated 4.9 million people are living with HIV in the Asia and the Pacific region. Number of new infections has fallen by 26 percent since 2001 with some countries like India, Myanmar and Nepal able to reduce it by as much as 50 percent. But according to the new report, in some countries the new infections increased sharply. It soared by 2.6 times in Indonesia, by 8 times in Pakistan and doubled in Philippines. The rise was also evident in Bangladesh, despite low prevalence. Like others, a high level Bangladesh delegation joined the conference led by health secretary MN Neazuddin. Lawmaker, academicians, UN representatives, officials of the Partners for Population and Development, singers, and NGO workers comprise the delegation, apart from the government officials. A group of Bangladeshi drummers joined the opening show with host Thailand, Indonesia, and Cambodia. The conference also put Thailand under spotlight. The kingdom has been internationally acclaimed as a global leader on HIV as major steps have been taken in the early 1990s to promote awareness of safer sexual practices. New HIV infections fell dramatically in Thailand to 9,000 last year from more than 140,000 per year in 1990. “We have remarkable successes and remarkable failures in the region. So if we keep doing what we are doing right now, we’ll not be getting zero,” Steve Kraus, director, UNAIDS Regional Support Team for Asia and the Pacific. He said “quick and easy” access to testing facilities and changing laws and policies to remove the barriers of being open can make the difference. “We have 800 days before 2015, unless drastic changes happen, we’ll fall well short of MDG target,” he said.

UN praise for Hijra recognition

“It recognises that transgender population exists,” Steve Kraus said at a press conference on the sidelines of an Asia- Pacific AIDS congress being held in the Thai capital Bangkok.

He spoke of Bangladesh’s successes in the fight against HIV/AIDS, particularly early interventions in the case of intra-vienous drug-users, helping the country to keep prevalence below 0.1 percent. “We are pleased to note that (recognising Hijra)”, he said, while criticising the stigma attached to homosexuality, drug-users, and sex workers, identified by the UN as barriers to HIV response. The government on Nov 11 officially recognised the 'hijra' or transgender people as the ‘third gender’ to bring the secretive group out in the social mainstream. Officially, they are about 10,000 of them, but activists claim the number is higher. The recognition is being seen as a landmark decision for a conservative Bangladesh, where sexual and reproductive health rarely talked about even by policymakers. The ‘third gender’ recognition will allow a 'hijra' to choose the option of being recognised as ‘she or he’, said ruling Awami League lawmaker Tarana Halim, who first raised the issue in Parliament over two years back. Talking to bdnews24.com on the sidelines of the Bangkok meet, she said many of the hijras in Bangladesh were biologically male but preferred to a female identity. Henceforth, their gender would be entered in passports or national ID cards, she said. The recognition will give them the right to property. “Now they will be able to choose their gender. If they are male, they will inherit more property than a female as per Bangladesh law." Even their families in Bangladesh do not acknowledge their hormonal or chromosomal abnormalities. They stay isolated and only mix with their peers and finally end up as a sex worker to manage their living. According to the Ministry of Health and Family Welfare, the hijra population accounted for 2.1 percent of last year’s 338 new HIV infections. “Now they are recognised. They will come forward and enjoy government facilities. It will increase their job opportunities also,” the MP said. Being unidentified, she said, they were stigmatised and vulnerable to abuse and exploitation that ultimately rose the risk of being HIV infections. The government allocated separate budget for their education and training for the first time in this fiscal year. Bangladesh's neighbours India, Nepal and Pakistan have already given them that recognition to end their discrimination in all spheres including education, health and housing.

'HIV in invisible gays big worry'

Chris Beyrer, a guest editor of last year’s ‘The Lancet’ series on MSMs (men who have sex with men) told bdnews24.com in an interview that these ‘sexual minorities’ are ‘hidden’ in South Asia, “but carry 10 times more HIV infection risk than others”.

“They are not so much in public dialogue and discussions. But the fact is that everywhere we look we see there are substantial MSM populations. “It does not vary much between countries and cultures. It’s roughly the same,” he said on the sidelines of the ongoing International Congress on AIDS of Asia and the Pacific. More than 3,000 participants have joined the Congress from 80 countries in the Thai capital. Beyrer described the MSMs as the ‘key’ population for HIV response for two reasons – higher risk of HIV and lower access to services. “We have to lower their HIV rates and provide services. We have to deal with their human rights to provide them access to the healthcare in a setting that is safe and where they don't lose out on dignity and where they can disclose their actual behaviour and talk about their partners. “The country that fails to do that, will face an ongoing epidemic,” he said. ‘Who are MSMs?’ “It’s (MSMs) a behavioural term,” Beyrer, who is the director of the John Hopkins Centre for Public Health and Human Rights, said. “It does not describe about how people feel whether they are truly gay, whether they are married to women, whether they are attracted to both men and women. “This is a broad category that include all men who behaviourally have sex with other men, including men sex workers who may be heterosexual, homosexual or bisexual.” But he said, commonly they share “higher risk of HIV infections and the stigma and discrimination and the limits of access to healthcare”. ‘Hard-to-reach’ Being invisible, there is no official statistics about the number of gays and bisexual men in Bangladesh. But different surveys put the figure at more than 1.5million. They are criminalised in Bangladesh, according to the UNAIDS latest report that also showed that they are less likely to use condoms than any other high risk groups like sex workers and intravenous drug users. The condom use rate was only 26 percent, despite the fact that anal unprotected sex is ‘very efficient route’ of transmitting HIV. Beyrer said HIV rate among general population in the region was very low, but higher in men who have sex with men. In the Asia Pacific region it varies from country to country in Bhutan and Bangladesh it is much lower than the average 15 percent while in Thailand it is over 20 percent. “The challenge for prevention is that they are hard-to-reach. They are more hidden,” he said stressing on specific efforts like promoting condom, HIV testing and treatment of other diseases focusing them. But it can be changed if a government has political will. “They are ready to assist. They are already engaged. They just need a safe environment where they are free from political harassment or other kinds of harassment and then they can be a real partner in the efforts to stop HIV,” he said citing a South Indian ‘Abahan’ programme where they could reach out to the gays and bisexual men rather effectively. ‘Next generation change-maker’ Beyrer is optimistic. “The next generation is much more open about these issues. They are more willing to explore and discuss. They are more tolerant,” he said. Because of internet “the next generation of gay and lesbian are connected globally in a way that the previous generations never were”. “So everybody is sharing their experience more and standing up wanting to be a part of the society, wanting to express their love, their relationships, to have dignity and to be accepted,” he said. So nobody gets to decide who is not entitled to human rights. Sexual and gender minority people are also entitled to human rights and citizenship rights including in Bangladesh. That is our goal,” Beyrer said. He said it was policymakers ‘responsibility’ to provide services and ensure that “nobody is excluded and health services provide appropriate services to the men who have sex with men and transgender populations. “This is the part of responsibility of the government towards HIV control and also human rights. They are very much interrelated and they are not separate things."

Bangladesh’s ‘paradoxical’ health outcomes: Lancet

In its first ever series on Bangladesh after similar studies on China, India, Pakistan and Africa, the journal says the mobilisation of communities, gender equity, and a commitment to universal healthcare are some of the lessons that others can learn from Bangladesh to make a difference. But authors warned against complacency as diseases are changing their patterns, and malnutrition remained all pervasive along with poverty. “We still face the dual burden of infectious and chronic diseases. So we have to learn. Lancet shows we have done well in the past,” series co-leader Prof Abbas Bhuiya of the International Centre for Diarrhoeal Disease and Research (ICDDR,B) in Dhaka, told bdnews24.com. The six part series takes a comprehensive look at one of the “great mysteries of global health” and takes note of the successes. It points out the challenges involved in achieving universal health coverage, making sure people will not slip into poverty due to healthcare costs. It lists successes such as reducing maternal and child deaths, increasing immunisation coverage as well as life expectancy, and controlling tuberculosis. However, a second wave of innovation would be needed to progress to a universal health coverage. Bangladesh’s President Md Abdul Hamid has launched the series in Dhaka on Thursday. The journal said outstripping neighbour India, and Pakistan from which it won independence, Bangladesh cut maternal deaths by 75 percent since 1980 and halved infant deaths since 1990. Life expectancy has increased to 68.3 years. Series co-leader Prof Mushtaque Chowdhury, also vice-chairperson of the world’s largest NGO, BRAC, said Bangladesh’s success ‘convincingly’ defied the expert opinion that reducing poverty and increasing health resources were the ‘key drivers’ of improving health. According to the Series, what set Bangladesh apart was its ‘pluralistic’ health system in which many stakeholders including the private sector and NGOs were “encouraged to thrive and experiment”. This led to rapid improvements in accessing essential services such as diarrhoea treatment, family planning, vitamin A supplementation, and vaccination coverage. The report noted that research paid back in Bangladesh, despite the fact that at the national level the government could not develop a research institute. The Lancet credited the ICDDR,B for its groundbreaking researches and innovations. Research- driven knowledge helped in strengthening the health-system, the journal said, an eye-opener for the Bangladesh government which is traditionally known for paying little attention to researches. Bangladesh was seen as a ‘pioneer’ in scaling up community-based approaches to take key health interventions to the household level. For instance, the tuberculosis cure rate rose to more than 90 percent, among the highest in the world, from less than 50 percent when community health workers were engaged by NGOs. Female health workers' door-to-door services helped raise the use of contraceptives to 62 percent, with a rapid fall in total fertility rate to 2.3 in 2010 from 6.3 after independence in 1971 – a rate that Lancet says was ‘unparalleled’ in countries with similar levels of development. Other factors that made a big impact included a strong focus on reducing gender inequality through pro-poor and pro-women development programmes like education and microfinance, and improvements in natural disaster preparedness and response. But with nearly half of its under-5 children underweight and pregnant mothers anaemic, malnutrition still remained a big challenge for Bangladesh, along with access to primary care. “The stark reality is that the prevalence of malnutrition in Bangladesh is among the highest in the world. Nearly half of the children suffer from chronic malnutrition,” said a series leader, Prof Lincoln C Chen, President of the China Medical Board in Cambridge. “Moreover, over a third the population –more than 47 million— live below the poverty line, and income equality is widening”. Despite free services to the poor, Lancet suggested the strengthening of poorly equipped public health sector, with a reported shortage of 800,000 doctors and nurses.

While the urban population grew to 28 percent from about 5 percent over last 40 years, urbanisation was also seen as a challenge. If current trends continued, by 2050 roughly 100 million people will be urbanised putting tremendous pressure on already inadequate water, sanitation, and primary health-care services. The last paper of the series suggested reforms involving “a multipronged strategic approach that assures affordable, equitable and high-quality care in the context of the current pluralistic health system”. As much of Bangladesh’s success has centred on progress towards the MDGs, the Editor-in-Chief Richard Horton commented: “The future looms heavily in a small country with such a huge population, amid continuing deep poverty and inequality. “An obesity epidemic is emerging among the urban middle class. The proliferation of unregulated, low-quality, and high-cost private practitioners is also a cause for present concern." As national elections approach in January, the Editor-in-Chief writes, “The country’s vulnerability to climate change, rapid urbanisation, persistence of poverty and inequality, and low quality of life and income levels will be major political challenges. "Bangladeshis have shown enormous creativity, resilience, and energy in the past. They will need to continue to do so again in the future,” he concluded.

Bone marrow transplant centre to open Sunday

10 patients have been selected for the inaugural transplants. Doctors have already started collecting bone marrow from six of them

Bangladesh is going to open its first bone marrow transplant facility on Sunday at Dhaka Medical College and Hospital. Health minister AFM Ruhal Haque will inaugurate the facility that comes as a great news for thousands of cancer patients who needed to travel abroad for this very expensive and sophisticated transplant. Haematologist Prof MA Khan, in-charge of the unit, told bdnews24.com they would offer the crucial life-saving procedure at less than one-third of what it costs outside. Doctors replace damaged or destroyed bone marrow – the soft and spongy tissue inside bones – with healthy bone marrow stem cells by this procedure to treat different types of blood cancer, certain genetic blood and immunity disorders like thalassemia, and severe aplastic anaemia. There are no official data about people needing bone marrow transplants in Bangladesh but doctors say many go abroad for this replacement. Against this backdrop, the Ministry of Health and Family Welfare had tied up with the Massachusetts General Hospital (MGH), the teaching hospital of the Harvard Medical School, and a biomedical research centre in Boston last year to make the treatment affordable at home. The health minister first set the deadline to open it in June, but later said more time was needed to set up this ‘very sophisticated and technology-dependent’ unit. MGH trained up nurses and doctors while the government bought equipment for the centre which is housed at the ninth floor of the DMCH newly inaugurated building. The floor has been remodelled to suit its special needs. Prof Khan said they had selected 10 patients for the inaugural transplants and already started collecting bone marrow from six of them. “We hope to start first transplant on October 26,” he said, adding that they would start with autologous bone marrow transplant in which one’s own bone marrow is used. After six months, he wished to introduce more critical allogeneic bone marrow transplant in which the marrow of siblings or donors is used after proper matching. “It (allogeneic) needs greater expertise,” he said and that “every new centre starts with autologus bone marrow transplant and allows the skills to grow”. For autologous procedure the hospital will charge between Tk 0.5 million and 0.6 million while for the allogeneic it would be between Tk 1 million and 1.5 million depending on patients. Prof Khan said they had selected those who were fit for transplant for the inaugural phase. “We received many referred patients. Then we examined who is fit and whether their condition is under control for the transplant”. The ten patients are suffering from two types of cancer patients –multiple myeloma and lymphoma, he said. He said they would appeal to affluent people to donate for the centre so that the facility can help maintain standards. “Like many other countries we will form a Patient Support Group so that rich can donate for the poor’s help”.

Bone marrow transplant centre to open Sunday

10 patients have been selected for the inaugural transplants. Doctors have already started collecting bone marrow from six of them

Bangladesh is going to open its first bone marrow transplant facility on Sunday at Dhaka Medical College and Hospital. Health minister AFM Ruhal Haque will inaugurate the facility that comes as a great news for thousands of cancer patients who needed to travel abroad for this very expensive and sophisticated transplant. Haematologist Prof MA Khan, in-charge of the unit, told bdnews24.com they would offer the crucial life-saving procedure at less than one-third of what it costs outside. Doctors replace damaged or destroyed bone marrow – the soft and spongy tissue inside bones – with healthy bone marrow stem cells by this procedure to treat different types of blood cancer, certain genetic blood and immunity disorders like thalassemia, and severe aplastic anaemia. There are no official data about people needing bone marrow transplants in Bangladesh but doctors say many go abroad for this replacement. Against this backdrop, the Ministry of Health and Family Welfare had tied up with the Massachusetts General Hospital (MGH), the teaching hospital of the Harvard Medical School, and a biomedical research centre in Boston last year to make the treatment affordable at home. The health minister first set the deadline to open it in June, but later said more time was needed to set up this ‘very sophisticated and technology-dependent’ unit. MGH trained up nurses and doctors while the government bought equipment for the centre which is housed at the ninth floor of the DMCH newly inaugurated building. The floor has been remodelled to suit its special needs. Prof Khan said they had selected 10 patients for the inaugural transplants and already started collecting bone marrow from six of them. “We hope to start first transplant on October 26,” he said, adding that they would start with autologous bone marrow transplant in which one’s own bone marrow is used. After six months, he wished to introduce more critical allogeneic bone marrow transplant in which the marrow of siblings or donors is used after proper matching. “It (allogeneic) needs greater expertise,” he said and that “every new centre starts with autologus bone marrow transplant and allows the skills to grow”. For autologous procedure the hospital will charge between Tk 0.5 million and 0.6 million while for the allogeneic it would be between Tk 1 million and 1.5 million depending on patients. Prof Khan said they had selected those who were fit for transplant for the inaugural phase. “We received many referred patients. Then we examined who is fit and whether their condition is under control for the transplant”. The ten patients are suffering from two types of cancer patients –multiple myeloma and lymphoma, he said. He said they would appeal to affluent people to donate for the centre so that the facility can help maintain standards. “Like many other countries we will form a Patient Support Group so that rich can donate for the poor’s help”.

Smokers' skin may age faster

Judges who didn't know which twin smoked said the smoker looked older 57 percent of the time. That pattern held when both twins were smokers but one had smoked for many years longer than the other. "Smoking makes you look old. That's all there is to it," Dr. Elizabeth Tanzi said. "Besides lung cancer, heart attacks and strokes, just one more good reason to stop smoking is that it's definitely making you look a lot older," she told Reuters Health. Tanzi is a dermatologist at the Washington Institute of Dermatologic Laser Surgery and George Washington University Medical Center. She was not involved in the new study but said it confirms what she and others see in practice. The findings are based on standardized photos of 79 pairs of identical twins taken at the Twins Days Festival in Twinsburg, Ohio. Dr. Bahman Guyuron from Case Western Reserve University and University Hospitals of Cleveland and his colleagues showed the photos to three trained judges, then asked them to grade each person's wrinkles and age-related facial features. The twins were in their late 40s, on average. About three-quarters of them were women. Forty-five sets of twins included one smoker and one non-smoker. Smokers tended to have more wrinkles and other signs of face aging. But the differences were often small. For instance, on a 0-to-3 scale, where 0 means no wrinkles and 3 is severe wrinkles, upper eyelids were rated at 1.56 among smokers and 1.51 among non-smokers. Jowls were rated at 1.0 among smokers and 0.93 among non-smokers, on average. There was no difference in assessments of crow's feet or forehead wrinkles based on smoking. Other factors related to skin aging like sunscreen use, alcohol drinking and stress at work were similar among smoking and non-smoking twins, the researchers noted. Of the remaining 34 twin pairs, one twin had smoked for an average of 13 years longer than the other. Twins who had smoked for more years had more pronounced bags under their eyes and more wrinkles around their lower lips, according to findings published in Plastic and Reconstructive Surgery. "It really just kind of confirms a lot of stuff that most people believed," said Dr. Alan Boyd. He is a dermatologist at Vanderbilt University Medical Center in Nashville, Tennessee, and wasn't part of the study team. "I can usually spot a smoker from across the room because of some of their facial skin changes," Boyd told Reuters Health. Still, he said the study adds another layer of evidence by putting numbers on the effect of smoking on different parts of the face. The researchers didn't take into account how many cigarettes people smoked each day. And although weight was similar between smokers and non-smokers, they didn't know if differences in fat distribution affected facial appearance. Tanzi said toxins from smoking can speed up the breakdown of collagen, protein fibers that support skin and help it stick together. Smoking also reduces the amount of oxygen going to the skin, she said. In addition, having a regular source of heat close to the face may play a role in skin aging, according to Boyd. "The effects are cumulative. So you can benefit from stopping smoking at any time," Tanzi added. But, "You want to be careful, because some of those changes may be permanent." Facial creams and plastic surgery are options for people whose skin has been damaged by smoking, Guyuron told Reuters Health. But he said the goal of releasing the findings was to give people another reason never to start. "We are hoping that by again emphasizing the harms that come from smoking we can dissuade individuals from smoking … knowing how much it may damage their skin," he said.