Your daily Selection of IRIN Africa PlusNews reports, 12/5/2006

December 5, 2006

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - MALAWI: Each migrating nurse costs country up to US$26 million

2 - PAKISTAN: First association of people living with HIV/AIDS launched

3 - SWAZILAND: Has Swaziland turned the corner in the fight against AIDS?

1 - MALAWI: Each migrating nurse costs country up to US$26 million

JOHANNESBURG, 5 December (PLUSNEWS) - Malawi, one of the world's poorest

countries, is losing up to US$26 million for every nurse who leaves the country

in search of greener pastures, according to a new research paper.

" Better salaries and good working conditions are among the contributing factors

for these nurses' migration, " said Fresier Maseko, one of the authors of 'The

financial losses from the migration of nurses from Malawi'.

The paper by researchers from the College of Medicine at the University of

Malawi and the US-based University of North Carolina, attempts to quantify the

financial loss to the country, besides the obvious impact on its health

services.

" For each enrolled nurse-midwife that migrates out of Malawi, the country loses

between $71,081.76 and $7.5 million ... For a ... nurse-midwife [with a degree],

the lost investment ranges from $241,508 to $25.6 million, " the document

claimed.

The researchers calculated the amount by taking into account the expense to the

government of training a nurse or a midwife, at interest rates ranging from 7

percent to 25 percent, over a period of 30 years - the time the migrating worker

is expected to spend outside the country.

Students at nursing schools are not required to pay tuition or boarding fees, as

these costs are paid to the institution by the government. The cost of primary

and secondary education was also included.

The shortage of medical personnel has hit crisis point in Malawi, where there is

one doctor per 60,000 people instead of the required ratio of one physician per

5,000. According to government sources, 64 percent of nursing posts in Malawi

are unfilled and there are just 100 doctors in public hospitals serving a

population of 12 million. Anyone requiring the attention of a specialist has to

travel outside the country.

" In Malawi, the high maternal mortality ratio - estimated at about 1,120 deaths

per 100,000 live births - has been partly blamed on the unavailability of

trained midwives to deliver satisfactory quality ... care, " the paper said.

The researchers also voiced concern that the rapid scaling-up of antiretroviral

(ARV) therapy, aimed at reaching about 170,000 Malawians, would be constrained

by the unavailability of adequately trained nurses, clinical officers and

doctors. A five-year government plan to scale up ARV therapy means an additional

40,000 patients will begin receiving treatment in 2007, and another 45,000 in

each of the following three years.

Maseko commented that if the government improved the working conditions of

nurses, many of whom look after 60 to 80 patients per shift, provided better

wages and motivated personnel it could help reduce migration.

Pubic healthcare workers received a 52 percent wage top-up in 2005 and a

campaign funded by Britain's international development agency (DFID) was mounted

to entice nurses back from the private sector. Money from the Global Fund to

Fight AIDS, Tuberculosis and Malaria is also being used to expand the capacity

of Malawi's training institutions and provide extra incentives for health

workers in remote, rural areas.

Until these efforts yield results, some of the countries that have lured health

workers from Malawi are lending doctors to fill the gap. About 25 percent to 30

percent of Malawi's doctors come from overseas: some are United Nations

volunteers; others come with Britain's Voluntary Services International or

through agreements with European governments.

jk/he/oa

[ENDS]

2 - PAKISTAN: First association of people living with HIV/AIDS launched

ISLAMABAD, 5 December (PLUSNEWS) - The United Nations Joint Programme on

HIV/AIDS (UNAIDS) has launched Pakistan's first association of people living

with HIV/AIDS.

" So far only a few individual NGOs with limited capacity were providing support

to people living with HIV/AIDS, but there was no association in Pakistan,

whereas most of the countries in the region have established their associations

a while ago, " said Fawad Haider, a UNAIDS programme officer.

The overall objective of the association is to provide a platform for the

Association of People Living With HIV/AIDS (PLWHA) to voice their concerns and

to build their capacities to fight against the stigma and discrimination through

knowledge of the virus.

The South Asian nation is currently classified as in the 'concentrated epidemic'

stage by the World Health Organization (WHO) and UNAIDS, where the number of new

cases of HIV infection continues to rise.

According to Pakistan's National AIDS Control Programme (NACP), a total of some

3,393 HIV/AIDS cases have been reported, including 346 cases of full-blown AIDS.

However, estimates of the number of those infected are as high as 85,000,

according to WHO and UNAIDS.

Pakistan is considered at 'high-risk' for the spread of HIV into the general

population due to multiple factors.

These include a large illiterate population, a high number of migrant workers,

limited safety standards for blood transfusions, an increasing number of

injecting drug users and a highly mobile refugee population.

In Pakistan, youth make up the major chunk of HIV/AIDS vulnerability, with 60

percent of the population aged below 25.

" Some 32 million within the age group of 10-19 are highly vulnerable, since

according to global trends, young people are becoming sexually active at a very

young age, " Dr Asma Bukhari, head of NACP, explained.

" The newly established association would promote and advocate for an improved

access to treatment, especially antiretroviral (ARVs) therapy and care and

support for PLWHA [people living with HIV/AIDS], " Haider said.

Pakistani health authorities have recently started providing AIDS treatment

services through eight care centres across the country. However, the scope of

coverage in the face of a concentrated HIV epidemic remains limited, analysts

say.

To boost HIV/AIDS awareness and educate young people to help them recognise

their personal vulnerability, NACP has recently started interactive theatre

programmes, including live street theatre. " We are also about to start youth

programmes on FM radios, " said Bukhari.

[ENDS]

3 - SWAZILAND: Has Swaziland turned the corner in the fight against AIDS?

MBABANE, 5 December (PLUSNEWS) - The Swazi government expressed cautious

optimism after a survey found that 39.2 percent of women visiting antenatal

clinics tested positive for HIV, indicating that the infection rate was

dropping.

Medical data from pregnant women is used as a barometer of HIV/AIDS prevalence

among the country's about one million people and although the figure was above

the 38.6 percent recorded in 2002, it was down from the 42.6 percent reached in

2004.

The Sero-Surveillance Survey, conducted every two years, has charted the rise of

the disease that now infects a third of the sexually active population aged

between 15 and 49. It began in 1992 and in its first year found HIV prevalence

of 4 percent among pregnant women.

Prime Minister Themba Dlamini presented the new figures on 1 December, World

AIDS Day, to the country that now records the highest percentage of infection in

the world, making the disease an uncomfortable international issue. Government

spokesman Percy Simelane has disputed the relevance of earlier antenatal

surveys, saying it was the government's position that because only sexually

active women were included in the survey, the results were not representative.

Countries worldwide use the Sero-Surveillance Survey as a statistical basis for

measuring the presence of HIV/AIDS, but Swaziland's health workers believe a

more accurate picture will be provided by a Demographic Health Study (DHS).

The study, now being conducted by UNAIDS and the National Emergency Response

Council on HIV/AIDS (NERCHA), uses a research base that randomly selects Swazi

households and then conducts face-to-face interviews and voluntary, anonymous

blood tests of household members.

" The true prevalence rate for the country will probably lie above the DHS but

below the Sero-Surveillance study of pregnant women, " said Patti Whitely, of

UNAIDS in Swaziland, which put the national HIV infection rate among those

between the ages of 15 and 49 at an estimated 33.4 percent in 2005.

Of the 2,467 pregnant women aged 15 to 49 who participated in the 2006

Sero-Surveillance Study, 966 tested positive for HIV.

The decline in HIV infections was recorded in urban and rural areas in all four

regions of Swaziland and in all age groups, with the sharpest reduction

occurring among those aged 25 to 29 years, from 56 percent in 2004 to 48 percent

in 2006.

People aged 15 to 24, considered one of the age brackets most vulnerable to new

infections, saw the prevalence rate fall from 39.4 percent in 2004 to 34.8

percent in 2006, a reduction the Ministry of Health described as significant.

" We are cautiously optimistic that this decline demonstrates that our prevention

strategies are beginning to take hold, " NERCHA director von Wissell said.

" We need to step up our fight against this disease and push even harder to

continue the prevalence rate decline. "

The survey found that pregnant girls in the age bracket from 15 to 19 years

experienced a drop in HIV infections from 29.3 percent to 26 percent between

2004 and 2006.

In his World AIDS Day statement the prime minister stressed caution in assuming

that the corner had been turned in the fight against new infections. " This is

not time to celebrate and relax. We must now renew our vigour and intensify our

efforts to bring this disease to an end in the country. "

However, a spokesperson for the Swaziland AIDS Support Organisation (SASO), the

country's first support group for people living with HIV and AIDS, disputed the

new figures. " We do not believe that HIV in this country has decreased because

the behaviour has not changed one bit. "

jh/go/he

[ENDS]

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December 5, 2006