South African AIDS task force comes under fire

MEDICINE AND HEALTH POLICY

Human Rights Watch highlights abuses in Bangladesh when the police stay at the hotel overnight . . . One year ago, when a policeman was about to rape me, I tried to get him to use a condom. The policeman said, ‘Why should I use a condom with you, you magi (whore)?’” she recalled. “The abuses against persons vulnerable to HIV are reflective of a nationwide crisis of law and order. Bangladesh needs to reform its law-enforcement system to curb its own abuses and to effectively protect citizens from abuses by mastans”, according to Maru. The report recommends prosecution of police and mastans committing human rights violations, government support for peer-driven HIV/AIDS prevention services among persons at high risk of HIV, and respect for the rights of people at risk of or living with HIV/AIDS. “The government must . . . recognise and support Bangladesh’s needleexchange programmes and ensure that needle- exchange outreach workers are not harassed or arrested by the

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he Washington-based group Human Rights Watch (HRW) has called for an end to abuses reportedly perpetrated by Bangladesh’s police and “powerful criminals” against commercial sex workers, men who have sex with men, and injecting drug users (IDUs). “Bangladesh has to stop these abuses—both because these are violations of basic rights and because these abuses could fuel an explosion of AIDS in the country”, Vivek Maru, an HRW researcher told The Lancet. “Violence against individuals at a higher risk of HIV infection drives them out of reach of HIV prevention services.” In its latest report entitled Ravaging the vulnerable: Abuses against persons at high risk of HIV infection in Bangladesh, HRW documents physical and sexual abuse by police and criminals known as mastans. A 26-year-old commercial sex worker interviewed by HRW said: [sex workers are] raped frequently by police, for example whenever the manager’s bribe is due, or

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Bangladeshi sex workers protest against police harassment

police”, it emphasised. Arifa Sharmeen of CARE Bangladesh, a nongovernmental organisation, said such abuses were more serious in urban than rural areas. And Sharaf Ali Shah, head of the HIV/AIDS control programme in Pakistan’s Sindh province believes the report should serve as a wakeup call for HIV/AIDS control managers in most south Asian countries. “These abuses are also common in Pakistan . . .

and it is our responsibility to stop these.” For example, in June police in Pakistan’s Larkana district detained more than 150 IDUs after media reports suggested some of the IDUs had been HIV-infected. Increased police presence or abuses, Shah said, is one of the reasons why so many people in Pakistan who start out smoking heroin turn to injecting drugs. Khabir Ahmad

South African AIDS task force comes under fire he composition of a national task team appointed to coordinate the drafting of an operational plan for an antiretroviral treatment programme in South Africa has been sharply criticised. Health Minister Manto Tshabalala-Msimang selected the team after the Cabinet, in a special meeting (Aug 8), asked the health department to urgently develop a detailed treatment programme by the end of September, 2003. Anthony D Mbewu, executive director for research at the Medical Research Council of South Africa, will chair the team. Nono Simelela, the cluster manager for HIV/AIDS, tuberculosis, and sexually transmitted infections in the health department, will continue to coordinate the plan’s activities. Tshabalala-Msimang said that the 16-member team comprises mainly senior officials from her department as well as experts in the health sector. But AIDS activists and experts have expressed dismay over the choice of the team members. They say that none of them except one, Ashraf Grimwood, who is a clinician and national AIDS treatment expert, have been publicly vocal about shortcomings of the government’s previous AIDS policies, or have hands-on experience with public-sector HIV/AIDS treatment programmes. The Treatment Action Campaign (TAC), the anti-AIDS

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lobby group, said in a statement it would work with the team but had reservations about it because most of the members have never been at the forefront of advocacy for antiretroviral treatment and a national treatment plan. Notably absent from the list are representatives from Médecins Sans Frontières, whose work in Khayelitsha, Cape Town, has been heralded by WHO as an outstanding example of how to run antiretroviral programmes in indigent areas. The TAC said there are no representatives of the Southern African HIV/AIDS clinicians society, a group with more than 4000 registered members. And yet, the TAC noted that the list included several people who provided affidavits supporting the government’s opposition to a national mother-to-child transmission prevention programme. The team has only one civil society representative and does not have a paediatrician experienced in providing antiretrovirals to children. Tshabalala-Msimang said that over the next 6 weeks, the team will work closely with provincial health authorities and will consult broadly with national and international experts and various South African stakeholders. Adele Baleta

THE LANCET • Vol 362 • August 30, 2003 • www.thelancet.com

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