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UK: HIV—future of social care
1308
period of detention in these secret houses. Dr Tariq blindfolded, beaten, threatened with execution, and forced to stand in a flooded toilet for 3 days with 4 other detainees. Dr Hamouda el Rahman, president of the White Nile Doctors Union, was suspended by the ankles for 2 days. Even the teaching of science is justification for torture if it
initial
UK: HIV—future of social
care
was
conflicts with the views of the Islamic fundamentalists. During one of the interrogations of Prof Farouk Ibrahim, professor of biology at Khartoum University, the interrogator, Lieut Bakri Hassan Suleh, justified his treatment because the regime objected to the content of some of his teachings on biology. After this period, detainees are then usually transferred to Koba prison in Khartoum, where conditions are slightly better. Dr Tariq was released after 2 months’ detention. Those who are going to be detained for longer are usually then transferred to prisons in the provinces. Professor Attiya, Dr Hamouda, and Professor Ibrahim have been taken to one of the worst, Shala prison, near el Fashir in West Sudan. Others detained here include Dr Ngieb Nagim el Din, general secretary of the Sudanese Doctors Union, and Dr Omar el Nagieb, an orthopaedic surgeon who was taken off a flight to the UK. This prison is in the middle of the desert, infested with insects; the food and water are contaminated and sometimes unavailable. The detainees’ families are unable to provide support because el Fashir is 5 days’ journey from Khartoum in an area over which the government has no control; it is controlled by bandits and racked in the conflicts that are part of the war in nearby Chad. Professor Attiya started a hunger strike on Oct 1,1990, in protest against his detention and the conditions at Shala prison. His fate is unknown. The junior doctors at Soba University Hospital have an annual picnic for the new medical staff which is financially supported by the hospital. Dr Nadir Khogali and other organisers of this year’s picnic were arrested the following day. Dr Nadir has not been released, and other participants in the picnic have been summoned to the main building of the Sudan Security Police in Khartoum for interrogation. This violation of human rights is part of the general catastrophe in Sudan. Atrocities in the civil war against the Sudanese People’s Liberation Army are common. The physiotherapy department of the leprosy clinic in Omdurman is treating civilians from Kordofan with peripheral nerve injuries after being suspended by the arms tied behind the body and then whipped. Aid organisations estimate that between 1 -5 and 5 million people are at risk of starvation. There are large groups of famine refugees moving towards Khartoum from the drought affected area of Western Sudan. The military governors of the three cities that comprise greater Khartoum have plans to stop the refugees by force from reaching Khartoum. This will inevitably cause many deaths. In Khartoum inflation is 160% per annum, all essential foods are severely rationed, and there is a general shortage of all goods in the markets. There has been a night curfew in Khartoum for the past year. The last harvest is rumoured to have been exchanged with Iraq for guns, when twelve Iraqi military transport planes arrived at Khartoum airport during the first week of the invasion of Kuwait. No-one I spoke with in Khartoum supported the Islamic fundamentalists, and the doctors are hopeful of change in the near future. Until then all political, trade union, and even social activity exposes doctors to grave risks. A
correspondent
The recent publication of the quarterly AIDS figures by the UK Department of Health, which showed a 95% increase over the previous year in cases of AIDS acquired by heterosexual intercourse and a 72% increase in cases in women, has added impetus to Government initiatives to translate national media campaigns into local preventive and community care programmes. In August, 1989, a scheme for the appointment of district HIV-prevention coordinators (DHPC) was begun, and this week saw the first national seminar for these new appointees. 80% of DHPC posts have now been filled and the meeting explored the key issues in prevention strategies and how to establish networks for coordinators to share their skills and experience. Despite the UK being below the European average for cases of HIV infection (20-59 cases/million of population compared with over 140 cases/million in France), Sir Donald Acheson, Chief Medical Officer, suggested that the UK figures probably represented only a third of the total. Clusters of disease place especial strain on certain local authorities-eg, in England, 70% of cases of AIDS and 60% of cases of HIV are located in the four Thames regions; in Edinburgh, 1 in 250 pregnant women are known to be infected. Data from Department of Health anonymous screening surveys will be reported in 1991 and should give invaluable information for appropriate resource allocation. An audit of current social and community care services (completed in 1989-90) has highlighted some of the organisational inadequacies of currently available facilities.’ Although motivation was reported to be high among social services, the planning of resource allocation was often hampered by the concern of carers and voluntary organisations that provision of case details may breach confidentiality. There is a need for a reliable but confidential database to allow effective targeting of funds (Lancet, Nov 3, p 1123). Cooperation between health authorities and voluntary organisations was often poor-links need to be strengthened and resources pooled, not duplicated. Furthermore, it is important to establish programmes for HIV disease prevention and care within the mainstream of community health services, with account being taken of the diversity of those affected. The rapid evolution of these support services will demand a continued funding commitment from the Department of Health. The Government has pledged to earmark money for such programmes at a similar amount to that for this year: in total, over C 140 million in 1991. Money to local authorities will be increased from 9-8 million to over £ 10 million and voluntary sector funding will rise from 1-8 million to £19 million. However, anxiety was expressed at the DHPC seminar about the Government’s commitment to increase funding in line with inflation. The Minister, Mrs Virginia Bottomley, was unable to give such an assurance and claimed that a flexible response to funding with no predetermined limits was important. The fact that, in the copy of Mrs Bottomley’s speech made available to the press, the words "in line with inflation" were deleted from the announcement of further funding to local authorities does add justifiable uncertainty over the promises given by central government.
A correspondent 1. Social Services Inspectorate.HIV and AIDS: progress and development in social service departments. London: Department of Health, 1990.
period of detention in these secret houses. Dr Tariq blindfolded, beaten, threatened with execution, and forced to stand in a flooded toilet for 3 days with 4 other detainees. Dr Hamouda el Rahman, president of the White Nile Doctors Union, was suspended by the ankles for 2 days. Even the teaching of science is justification for torture if it
initial
UK: HIV—future of social
care
was
conflicts with the views of the Islamic fundamentalists. During one of the interrogations of Prof Farouk Ibrahim, professor of biology at Khartoum University, the interrogator, Lieut Bakri Hassan Suleh, justified his treatment because the regime objected to the content of some of his teachings on biology. After this period, detainees are then usually transferred to Koba prison in Khartoum, where conditions are slightly better. Dr Tariq was released after 2 months’ detention. Those who are going to be detained for longer are usually then transferred to prisons in the provinces. Professor Attiya, Dr Hamouda, and Professor Ibrahim have been taken to one of the worst, Shala prison, near el Fashir in West Sudan. Others detained here include Dr Ngieb Nagim el Din, general secretary of the Sudanese Doctors Union, and Dr Omar el Nagieb, an orthopaedic surgeon who was taken off a flight to the UK. This prison is in the middle of the desert, infested with insects; the food and water are contaminated and sometimes unavailable. The detainees’ families are unable to provide support because el Fashir is 5 days’ journey from Khartoum in an area over which the government has no control; it is controlled by bandits and racked in the conflicts that are part of the war in nearby Chad. Professor Attiya started a hunger strike on Oct 1,1990, in protest against his detention and the conditions at Shala prison. His fate is unknown. The junior doctors at Soba University Hospital have an annual picnic for the new medical staff which is financially supported by the hospital. Dr Nadir Khogali and other organisers of this year’s picnic were arrested the following day. Dr Nadir has not been released, and other participants in the picnic have been summoned to the main building of the Sudan Security Police in Khartoum for interrogation. This violation of human rights is part of the general catastrophe in Sudan. Atrocities in the civil war against the Sudanese People’s Liberation Army are common. The physiotherapy department of the leprosy clinic in Omdurman is treating civilians from Kordofan with peripheral nerve injuries after being suspended by the arms tied behind the body and then whipped. Aid organisations estimate that between 1 -5 and 5 million people are at risk of starvation. There are large groups of famine refugees moving towards Khartoum from the drought affected area of Western Sudan. The military governors of the three cities that comprise greater Khartoum have plans to stop the refugees by force from reaching Khartoum. This will inevitably cause many deaths. In Khartoum inflation is 160% per annum, all essential foods are severely rationed, and there is a general shortage of all goods in the markets. There has been a night curfew in Khartoum for the past year. The last harvest is rumoured to have been exchanged with Iraq for guns, when twelve Iraqi military transport planes arrived at Khartoum airport during the first week of the invasion of Kuwait. No-one I spoke with in Khartoum supported the Islamic fundamentalists, and the doctors are hopeful of change in the near future. Until then all political, trade union, and even social activity exposes doctors to grave risks. A
correspondent
The recent publication of the quarterly AIDS figures by the UK Department of Health, which showed a 95% increase over the previous year in cases of AIDS acquired by heterosexual intercourse and a 72% increase in cases in women, has added impetus to Government initiatives to translate national media campaigns into local preventive and community care programmes. In August, 1989, a scheme for the appointment of district HIV-prevention coordinators (DHPC) was begun, and this week saw the first national seminar for these new appointees. 80% of DHPC posts have now been filled and the meeting explored the key issues in prevention strategies and how to establish networks for coordinators to share their skills and experience. Despite the UK being below the European average for cases of HIV infection (20-59 cases/million of population compared with over 140 cases/million in France), Sir Donald Acheson, Chief Medical Officer, suggested that the UK figures probably represented only a third of the total. Clusters of disease place especial strain on certain local authorities-eg, in England, 70% of cases of AIDS and 60% of cases of HIV are located in the four Thames regions; in Edinburgh, 1 in 250 pregnant women are known to be infected. Data from Department of Health anonymous screening surveys will be reported in 1991 and should give invaluable information for appropriate resource allocation. An audit of current social and community care services (completed in 1989-90) has highlighted some of the organisational inadequacies of currently available facilities.’ Although motivation was reported to be high among social services, the planning of resource allocation was often hampered by the concern of carers and voluntary organisations that provision of case details may breach confidentiality. There is a need for a reliable but confidential database to allow effective targeting of funds (Lancet, Nov 3, p 1123). Cooperation between health authorities and voluntary organisations was often poor-links need to be strengthened and resources pooled, not duplicated. Furthermore, it is important to establish programmes for HIV disease prevention and care within the mainstream of community health services, with account being taken of the diversity of those affected. The rapid evolution of these support services will demand a continued funding commitment from the Department of Health. The Government has pledged to earmark money for such programmes at a similar amount to that for this year: in total, over C 140 million in 1991. Money to local authorities will be increased from 9-8 million to over £ 10 million and voluntary sector funding will rise from 1-8 million to £19 million. However, anxiety was expressed at the DHPC seminar about the Government’s commitment to increase funding in line with inflation. The Minister, Mrs Virginia Bottomley, was unable to give such an assurance and claimed that a flexible response to funding with no predetermined limits was important. The fact that, in the copy of Mrs Bottomley’s speech made available to the press, the words "in line with inflation" were deleted from the announcement of further funding to local authorities does add justifiable uncertainty over the promises given by central government.
A correspondent 1. Social Services Inspectorate.HIV and AIDS: progress and development in social service departments. London: Department of Health, 1990.