OTI Cafe

Welcome to our Cafe at On The Issues Online Magazine.

We're deepening the conversations by continually adding the insights of progressive writers, thinkers and artists on the topics we address. Check back frequently for new commentary.

If you wish to contribute to the Cafe, email cafe@ontheissuesmagazine.com.

Once the silence has been broken by Mehret Mandefro
Women with AIDS : Off the Radar Screen by Janine Avril
Media Missteps + Misogyny = Death for Women by Mary Lou Greenberg
The Down Low Effect by Natalie Bell
Time to Rethink Global HIV/AIDS Care by Nicole Itano
Global Gag Rule Poses Moral Challenge for U.S. HIV/AIDS Funding by Marjorie Signer
ART STILL VITAL TO AIDS ACTIVISM by Larry Schulte
Not Enough Women Use Web Resource by Cindy Cooper
African Woman With Aids Rebuffed For Life-Saving Care by Lisa Vives
High Rates of HIV and STIs Show the U.S. Is Flouting Teens' Human Rights by Cynthia Soohoo and Katrina Anderson
Talking Shop in the Medical Field: The Unfolding of A Strange New Disease by Mahin Hassibi
Having Children When You Have HIV – Still a Problem? by Dr. Ann Boyer


Once the silence has been broken
By Mehret Mandefro

Silence is a universal metaphor that explains marginalized human experience. With HIV, the silence that cloaks sexism, the silence that cloaks racism, the silence that cloaks homophobia, the silence that cloaks poverty, is the same silence that fuels the epidemic.

I learned this while caring for HIV positive patients, as their physician, in some of the most silenced communities in the African Diaspora. The women in these settings also taught me these silences are inseparable and that using gender equity as the lens to analyze HIV requires a larger discussion of human rights and health.

I co-founded a non-profit called TruthAIDS out of the experience of women physicians working to prevent and treat HIV in the South Bronx. In that setting, conversations about HIV prevention had to start with love, trust, identity, abuse and support in order to make safe sex a reality for women. This dialogue was missing from traditional teaching and discussions about risk.

Once you ask a woman to break her silence, it is evident that discussions of risk also must move past personal responsibility to environmental factors beyond individual control, such as violence and the destruction of neighborhoods. Too often, whether it is the South Bronx or Ethiopia, there is an experience of trauma, one that starts with the woman, but quickly moves to the people around her and the places they inhabit.

If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life. (R. Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848).

The extremely common acts of violence against women are a "mass disturbance" that is fueling the HIV epidemic across race, class and ethnicity. Ending gender-based violence is a critical human rights issue that must inform HIV prevention for women. This violence is perpetuated by misogyny, and in this hierarchical system, social order determines health status for all.

The nonviolence movement has a long legacy that has much to offer in thinking through these next steps of HIV prevention in women, as does the civil rights movement and the women's movement. TruthAIDS hopes to connect these discourses across silos, across generations, and across continents through creative partnerships that teach how to move beyond the silence. These partnerships can make the world change.

Women 's rights are human rights. Community-based groups around the world are innovating HIV prevention programs that tackle violence, as well as social and economic rights. Their vision of health and human rights is the key to ending all silence.


Dr. Mehret Mandefro is a social medicine physician and Founding Director of TruthAIDS, a preventive health education non-profit. Her primary research interests are the connections between human rights and health, HIV prevention program development and translation efforts targeting marginalized communities. She is currently a Robert Wood Johnson Health and Society Scholar at the University of Pennsylvania where she is advancing film as a method to teach and communicate about societal determinants of health.

Also see: AIDS and Listening to Women by Sharon Walton in this edition of On The Issues Magazine
The Poet's Eye, Conversations With Love poems by Gale Jackson in this edition of On The Issues Magazine

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Women with AIDS: Off the Radar Screen
By Janine Avril

I feel for all women with AIDS, but my heart goes out to women like my mother who have lived, suffered and died with it secretly, perhaps without even naming it AIDS to themselves. Sixteen years after my mother's death, there is a huge and unfulfilling gap between my own questions and the answers that she could give me to help me to best understand the painful experiences that she endured in the wake of the AIDS crisis.

My father, a chef, restaurateur and émigré from France who had been embraced by my mother's New York family, approached the family in 1986 to share that he was HIV positive. My mother's shock and fear upon hearing the words which changed her life irrevocably prompted her to decide never to be tested for HIV. She felt she couldn't live with the knowing, so she continued her life with hope and prayers; I'm sure there was not a day that she lived without fear, without shadows lurking in her mind of when AIDS could hit her and take her away from her two young children. Nonetheless, she kept the secret of my father's diagnosis from her best friends, from the community members of the insular nouveau riche Long Island community where I grew up, and moreover from her doctors. Even when my mother came down with a rare, inexplicable soft tissue cell sarcoma, she didn't utter the word AIDS, and no one picked up on her HIV status. A white, heterosexual Jewish suburban woman was simply not on the radar screen for testing back then. She underwent treatment for "cancer" and died shortly after.

I'd lived out my childhood and grew into my late twenties before I even learned that my mother had been exposed to HIV and before I drew the logical conclusion that her death was not some random and cruel strike of nature but had rhyme and reason. I know my mother was one among countless women/mothers in the 1980's to discover that her husband was HIV positive, to decide against testing, and to die a statistic never taken...I know there are women living with HIV today who won't tell a soul if they suspect infection and who therefore will suffer privately. This saddens me since I feel that there should be no shame attached to the disease; women exposed should all feel free to seek testing, support, and the love they all deserve to help them through the uniquely traumatic experience of HIV/AIDS.

My father did not infect my mother intentionally; I know that even though he was promiscuous, he wouldn't have wished to hurt her. When I reflect on his view of women which was rooted in his own upbringing, I feel that he dichotomized women into Madonnas and whores. His misogyny unfortunately had cataclysmic effects on my family. My mother was his loyal wife who lived at home and expected his faithfulness; the women (and men) he slept with on the side were his playthings. Because of the way that he dichotomized the role of his wife and the role of his lovers, my mother contracted AIDS. I feel the deepest sympathy for the loyal wives and mothers out there who expect fidelity and instead receive chronic illnesses or death sentences. It's unfortunate that the punishment for infidelity can be far worse than the crime. The way that men might conceptualize women at a core level needs adjustment. If sexism and misogyny are examined and challenged, it will translate to women's lives saved. Women cope with husbands who devalue them; they balance this hardship with being primary caretakers. They are often selfless and many keep their demons private.


Janine Avril is a writer and educator in New York. She is the author of Nightlight: A Memoir.

Also see The Down Low Effect by Natalie Bell in this edition of On The Issues Magazine.

AIDS and Listening to Women by Sharon Walton in this edition of On The Issues Magazine.

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Media Missteps + Misogyny = Death for Women
By Mary Lou Greenberg

Gender-blind spots in assessing the HIV/AIDS epidemic today are key factors in today's deadly ignorance about the fastest growing segment of the HIV/AIDS population -- women.

The media adds to the misogyny at the risk of women's health. Reporting in June from New York and Britain are but the latest examples.

British publication says no problem

A June 8, 2008 article in the British newspaper, The Independent announced in its headline that the "threat of world AIDs pandemic among heterosexuals is over."

But the growing feminization of the HIV/AIDS pandemic caused overwhelimingly by heterosexual transmission, as described in the series of articles, BLOWBACK HITS WOMEN HARD, in this edition of On The Issues Magazine Online is largely missing.Women are invisible in the Independent reporting. The publication quotes, with little probing,Kevin de Cock, the head of the WHO's department of HIV/AIDS as saying that "it is very unlikely there will be a heterosexual epidemic in other countries [outside of Africa]." (As if Africa doesn't count!)

On the Issues Magazine edition on HIV-AIDS reported that in the U.S. HIV/AIDS is the leading cause of death among black women ages 25 to 34, that women represent 27 percent of new cases (a threefold increase since the disease was first identified), and that more than four-fifths of new HIV infections in women result from sex with a husband or primary partner.

A joint release from UNAIDS and WHO after the Independent article appeared criticized the paper for "seriously misleading statements that have led to inferences and conclusions that bear no relation to the highly complex realities of the HIV epidemic." (An understatement, to say the least.) The correction stated that "worldwide, HIV is still largely driven by heterosexual transmission" and that "heterosexual transmission continues to drive the epidemic among sex workers, their clients, and their clients' partners, and pointed out that in sub-Saharan Africa almost 60 percent of adults living with HIV were women, 48 percent in the Caribbean."

The Independent reported the WHO release as the result of "a backlash" for the organization but ignored the criticisms of its reporting. Other media outlets played up the original Independent article, didn't read the WHO report and ignored the correction altogether.

Even the response by WHO did not go nearly far enough in calling attention to the rapid increase of female infections in the U.S. and other countries, matters that desperately need headlines.

As Dazon Dixon of SisterLove said in the article, In The U.S. AIDS Spreads Rapid-Fire and Crosses the Gender Divide by Molly Ginty in On The Issues Magazine many heterosexual women "don't take steps to protect themselves because they don't even know they're at high risk," thinking they're in monogamous heterosexual relationships. Less than a third of U.S. women discuss HIV with their spouse or partner, according to the American Foundation for AIDS Research.

New York Magazine Erases Women

Media reports like the article in the June 16 New York Magazine are part of the problem.With a headline "Who Still Dies of AIDS, And Why," the article by Gary Taubes describes how the HAART cocktail can prolong life so that patients with HIV/AIDS can "live a normal life expectancy," but that many are still dying.

Unfortunately, New York Magazine also gives scant mention to women - and the biological, political and social inequalities that make women especially vulnerable to heterosexual transmission and more likely to die from AIDS because of late testing and other factors.The article noted only that "women account for almost one in three of total AIDS deaths." And that was it! Although the stories of some people with HIV-AIDS are included, not a single woman is mentioned.

By all-but-erasing women from the picture, such articles promote dangerous misconceptions about the prevalence of heterosexual transmission.Such erasure contributes to the deaths of thousands of women each year from a preventable and treatable disease.

In today's world, Silence = Women's Death. Let me add that media silence due to gender bias and misogyny is intolerable.


Mary Lou Greenberg is associate editor of On The Issues Magazine.

See also:
What Is a Woman Worth? by Marcy Bloom in this edition of On the Issues Magazine.

Break the Silence, End the Stigma in this edition of On the Issues Magazine.

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The Down Low Effect
By Natalie Bell

There is another side to the stories that occasionally break out into the public, such as with former New Jersey governor Jim McGreevey, but more typically only get whispered about among trusted friends or family.

McGreevey, married with two children, admitted having an extramarital affair with a man in 2004, announced he was gay and resigned. Much has been said about men who have sexual relationships with women, while at the same time carrying on a subversive life of sex with men. But what say the women in these triangular affairs?

First of all, African American and Hispanic males are more likely than their white counterparts to engage in the lifestyle dubbed "on the down low" -- the term they prefer to gay or bisexual -- by author J.L. King in his 2004 expose of the same name. .

The black and Hispanic women with whom they have sex are less likely than white women in similar situations to know that their partners have sex with both men and women, studies by the Centers for Disease Control have shown. This "down low" culture has been cited as a contributing factor in the rise of HIV cases among minorities, particularly heterosexual women. In 2006, while African Americans comprised just 13-percent of the U.S. population, half of all persons newly diagnosed with HIV/AIDS cases were black.

The risk of infection underscores the danger of the "down low" culture. But what women caught in the middle would say is that it goes much deeper than that. I know, having been married for ten years to a down low man without knowing it.

For the woman betrayed, actress Julianne Moore blows the siren loud and clear in her credible performance in Far From Heaven. The 2002 film written and directed by Todd Haynes won several Academy Award nominations, including Best Actress for Moore, and Best Cinematography for Edward Lachman's technicolor artistry.

Moore and Dennis Quaid play a married couple, in suburban 1950s Connecticut, whose relationship becomes strained when he realizes that he's in love with another man.

Moore's character turns to her gardener (Dennis Haysbert) for emotional support, but fights back a desire to be comforted in his arms. He is an African American man and she the wife of a successful television executive in a conservative, middle class community, a tale replete in its social mores and sexual repression.

All of this, a far cry from the public life she has led, the envy of every woman in her community, with the perfect house, and if there is such a thing as a perfect marriage, it's definitely hers. Then one day - poof - she discovers that she doesn't really know her husband at all.

Fortunately for Moore's character, her husband comes to her with the truth. But most women in this situation may never know. Even if they suspect it, they may never get their partner to admit as much.

One may wonder, how can a woman be married to a man, have children with him, and not be able to tell that he likes or prefers sex with men. Weren't there signs? After all, you live in the same house and sleep in the same bed.

The answer is that often these women are deceived in the worst way by men for whom it is absolutely vital to keep up an image of the happily heterosexual male for his own self esteem.

The down low man hates that part of himself that is attracted to men, so therefore he goes to great lengths to hide it, to overcompensate in the opposite direction. His need to protect his true identity becomes superior to everything and everyone in his life. If he takes a wife, she becomes his trophy and he makes it his business to keep her.

There's no question that this is the kind of person that our largely homophobic society produces. Read: this is not an attack on gay men or women.

Down low men may be confused about their sexuality, or understandably reluctant to come out; still, they make a concerted choice to perpetuate a fraud that puts women at risk of HIV.

The effect of their behavior can be deadly.

The fastest-growing group affected by HIV is black women, who in 2008 represent 66-percent of women living with HIV or AIDS in the U.S., while among other groups, 17-percent are Caucasian and 16-percent Hispanic.


Natalie Bell is a writer living in New York.

Also see Continental Bridges and Stage Firsts to "'In The Continuum"' Tells Women?s Missing HIV Stories" by Alexis Greene in this edition of On The Issues Magazine.

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Time to Rethink Global HIV/AIDS Care
By Nicole Itano

After 13 years at the head of the UN’s AIDS organization, Dr. Peter Piot is stepping down. His departure offers an opportunity; a chance for a new generation of leaders to shake up the hidebound world of AIDS advocacy and international aid.

A Belgian microbiologist who contributed to some of the first studies of AIDS in Africa in the early 1980s, Piot has been around since the beginning of the fight. He deserves credit for helping to bring the African epidemic to international attention, for marshalling billions of dollars of international aid and for overseeing the rollout of treatment for millions of people who would otherwise have been condemned to a slow and painful death.

But more than a quarter of a century into the epidemic, we’re desperately in need of new ideas. The AIDS world has been trapped in an outmoded paradigm, defined by a set of decades-old assumptions forged in the first-world and imposed on the developing world.

Despite all our efforts, we’re still losing the fight. By the UN’s own estimates, there were 2.5 million new infections last year. Part of the reason the virus keeps spreading is that we keep using the same old techniques, even when we know they don’t work. AIDS is a complex and multi-faceted epidemic, yet we’ve responded with one-size-fits-all solutions.

We need to start questioning some of our basic assumptions about the epidemic: that testing can never be compelled, that a person’s HIV-status is a private affair, that stigma is the dominant social experience of the infected, and that condoms are the best protection against the virus.

On the frontlines of the epidemic, especially among Africans themselves, many of these unassailable truths have been slowly crumbling. Across the continent, I encountered deep frustration on the part of medical professionals and local activists who felt the global dialogue about AIDS was out of step with the realities of their own communities. They felt constrained from taking innovative action by the rules of the AIDS world, even when they felt those rules were entirely culturally inappropriate.

Many African doctors, for example, believe the western emphasis on privacy in relation to AIDS has actually increased, rather than reduced, stigma by making AIDS more frightening than other diseases. Yet most AIDS testing still takes place in special clinics, separate from general health care. Most of the women I met had little faith in condoms; they wanted their men to stay faithful. Yet the vast majority of prevention programs still focus on condoms. These messages aren’t filtering up to the top, where AIDS agendas are being set.

This changing of the guard offers a chance for fresh thinking and, hopefully, radical new action.


Nicole Itano is the author of “No Place Left to Bury the Dead: Denial, Despair, and Hope in the Africa AIDS Pandemic,” published by Atria Books and reviewed by Eleanor Bader in this edition of On The Issues Magazine .

Also see: What Is A Woman Worth: Global Story is the Feminization of A Pandemic by Marcy Bloom in this edition of On The Issues Magazine.

Continental Bridges and Stage Firsts by Alexis Greene in this edition of On The Issues Magazine.

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Global Gag Rule Poses Moral Challenge for U.S. HIV/AIDS Funding
By Marjorie Signer

The pending reauthorization of the U.S. President's Emergency Plan for AIDS Relief, commonly called PEPFAR, is a clear challenge for our government to demonstrate its commitment to human dignity and life.

PEPFAR would be expanded dramatically by legislation, S 2731, now before the Senate and already passed by the U.S. House of Representatives (and with the long name of "The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, H.R. 5501").

Funding would be tripled to $50 billion over the next five years. While the increased funding is a tremendous step forward, the House version also contains ideological restrictions that will prevent the funds from most effectively containing the spread of HIV by blocking the participation of family planning programs.

The Religious Coalition for Reproductive Choice and our partners in the interfaith community are urging the Senate to hear the voices of people of faith on the issue of AIDS relief. These are people from diverse traditions who share common principles of justice and compassion and the belief thatwe have a moralresponsibility to help the vulnerable and the sick to the full extent of our ability.

Simply put, we want PEPFAR to be reauthorized and we welcome the increased funds -- but we want language restricting the participation of family planning organizations to be removed.

This language requires that organizations must comply with the global gag rule -- the requirement that foreign organizations receiving U.S. funding must not provide abortion counseling or services or conduct advocacy on abortion policy. We believe that an ethical policy will support the best and most flexible approaches possible to contain the spread of HIV. Experience shows that involving family planning organizations will ensure the greatest level of access to information and services for women and girls.

We also are concerned by an onerous reporting provision in the bill that would require Congress to be informed when countries with generalized epidemics fall below 50 percent of funds spent on abstinence and fidelity programs. Instead of promoting programs that allow for flexibility and are tailored to the needs of individual communities, the new reporting policy will restrict delivery of comprehensive and integrated information.

Those involved in our community response on PEPFAR include 26 Protestant, Catholic, Jewish, Unitarian Universalist, ecumenical and interfaith agencies and bodies. We are actively reaching out to our constituencies to underscore that this issue involves our faith commitments, including our commitment to action for social justice.

HIV and AIDS have had devastating consequences throughout the developing world - consequences that can be prevented by empowering the most vulnerable populations with proven prevention strategies.

The United States launched PEPFAR in 2003 as the largest investment ever made by any nation to combat a single disease. PEPFAR has successfully brought AIDS treatment, care and HIV prevention to millions of people who would not otherwise have had services. But constraints on prevention and care are contrary to the authentic moral concerns of the American public for those suffering from HIV/AIDS. The religious and religiously affiliated organizations opposing these constraints have pointed out that they directly affect women, youth, and socially marginalized groups - those who increasingly bear the greatest burden of this pandemic and who often receive medical care mainly or only from family planning organizations.

It is our moral duty to challenge our government to adopt the most effective, humane and just policy to contain the HIV/AIDS pandemic, without ideological restrictions and constraints.


Marjorie Signer is the director of communications for the Religious Coalition for Reproductive Choice (RCRC, headquartered in Washington, D.C.

Also see: What is a Woman Worth? The Global Story is the Feminization of a Pandemic by Marcy Bloom in this edition of On The Issues Magazine.

Book Review by Eleanor Bader: AIDS, Women and Africa in this edition of On The Issues Magazine

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ART STILL VITAL TO AIDS ACTIVISM
By Larry Schulte

The AIDS/ART/WORK conference in New York earlier this summer brought together a distinguished group of professionals from the art world, queer world and AIDS activist/prevention world.

The first session presented an historical overview of AIDS, including art that was made in response to the AIDS crisis. As one who lived in NYC in the ‘80s, the history was not only thoroughly presented, but was also a moving remembrance of those years.

The second session dealt with art and activism in the age of AIDS ranging from militant art to art that expresses grief. And, it covered the early years up to current AIDS art. (Ed. Note: See a photo, The AIDS Quilt, by Mark Phillips in this edition of On The Issues Magazine.)

The third session dealt with collaborations and the futures. How do we effectively continue the fight to prevent AIDS on both a local and a global level?

These sessions were followed by a roundtable discussion. One of the participants, Marilyn Martin, of the Iziko Museums of Cape Town, showed slides of moving contemporary art -- a poignant reminder to me that the AIDS crisis still exists as a matter of life and death in many parts of the world. I believe that she said 1,000 people die every day in South Africa as a result of AIDS.

The conference, held on May 30, 2008, was presented by The Center for Lesbian and Gay Studies at the Graduate Center of CUNY (CLAGS), which is carrying a summary of activities on its website, along with the Australian Research Council and Visual AIDS. The Leslie/Lohman Gay Art Foundation was a cosponsor.

This conference, highly informative, reaffirms that the important work of AIDS awareness and prevention, much of which has been a result of AIDS art, must go on.


Larry Schulte is a New York City artist.

Also see the ‘Knights’ sculpture of empowerment and transformation for victims of HIV by Art Editor Linda Stein in this edition of ON THE ISSUES MAGAZINE.

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Not Enough Women Use Web Resource
By Cindy Cooper

An invaluable health website has special promise for women with HIV-AIDS, but not enough are using it. The new site, PatientsLikeMe (a link is at the bottom of this story), is a "Facebook" for people with difficult illnesses.

A support, information and health research site, it accentuates the value of patients helping other patients. HIV is one of five specific diseases covered.

Patients can chart their symptoms, check treatments and ask questions of others with the disease. The "others" may be across town or across the globe. A quick tour of the site found registered HIV patients from Ohio, Brooklyn, Canada, Texas and Amsterdam. One patient asks how to prepare for his first visit with a doctor; another seeks help for depression. Cyber answers flow as if someone were face-to-face with the real-life counselors of Shanti, described by Sharon Walton in "AIDS and Listening to Women" in this edition of On The Issues Magazine.

But, sadly, only 15 percent of the 760 registered users in the HIV forum are women (according to self-identification). The figure is miles below the skyrocketing number of women infected with HIV, now 27 percent of new infections in the U.S. and as high as 62 percent in Africa.

Yet, women suffer from more stigma and prejudice about HIV status than men, according to Molly Ginty's story in this edition of On The Issues Magazine, "In the U.S., AIDS Spreads Rapid-Fire And Crosses the Gender Divide"

Patients offers a stigma-less way for HIV+ women to get help. A person may register with a pseudonym and choose what to say in a profile. Many are willing to share their stories. "I was infected by my ex-boyfriend who didn't know he carried the virus at the time," writes one woman. A 31-year-old Brooklyn woman reports that she was infected on purpose by an ex-boyfriend and is trying to come to grips with her anger. A 55-year-old woman in Toronto, says, "I was diagnosed June 21, 2000 after sustaining a needle stick injury on the job in Feb. of that same year."

Others offer tips. "When diagnosed, I thought my life was over. I couldn't have been more wrong," writes a 41-year-old single mother living in Houston. A Delaware woman diagnosed with advanced AIDS three years ago says she is now in good condition. "People newly infected and people afraid of medicines need to realize that we can live. long and happy," she writes. A 25-year-oldPennsylvania woman writes: "I currently share my experience with others and also help to educate the community."

The MIT developers of PatientsLikeMe applied a simple philosophy. "We're here to give patients the power to control their disease and to share what they learn with others," they write.

Find this welcome resource for women with HIV, at PatientsLikeMe.com.


Cindy Cooper is a journalist in New York and managing editor of On The Issues Magazine Online.

Also see: "Break the Silence, End the Stigma" by Mary Lou Greenberg.

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African Woman With Aids Rebuffed For Life-Saving Care
By Lisa Vives

While "medical tourism" is filling hospital beds in developing countries with patients priced out of the care at home, western countries are coldly dumping poor people -disconnecting them from life support in some cases - back in their Third World countries to struggle for medicines in short supply or simply to die for lack of care.

Most recently, England has denied life saving health care to an undocumented African woman, ordering her return to Uganda despite an advanced stage of AIDS infection.

It is the second deportation of a terminally ill African woman this year. In January, a woman with cancer was ordered back to Ghana over an expired visa. She died soon after.

In the recent case, the woman, known as "N", had been diagnosed in 1998 with two illnesses known to be indicators of AIDS. An asylum application was filed on her behalf, noting she had been raped by government soldiers in Uganda because of her association with the Lord's Resistance Army. The lawyers argued that her life would be in danger if she were returned to Uganda.

Her asylum claim was rejected in March 2001. In the ruling, the British secretary of state determined that all the major anti-retroviral drugs were available in Uganda at highly subsidized prices.

An appeal was entered in her behalf, ultimately reaching the highest UK court, the House of Lords. In their ruling of 2005, the Law Lords were moved by the plight of the woman, but they did not conclude that her deportation would breach her human rights and nor would it be "inhuman, degrading treatment or punishment."

N's lawyers pursued the case further, with a petition to the European Court of Human Rights. They argued that her deportation would breach Article 3 of the European Convention on Human Rights as her removal from the UK would lead to her death within two years.

But this final legal avenue has now been closed by the European Court's dismissal of the appeal.

Lisa Power of the Terrence Higgins Trust said "HIV treatments are not universally available in Uganda. This decision, and others that will follow from it, is cruel and inhumane. HIV treatment is currently being rolled out globally but in many African countries it is still only accessible to a privileged minority, though we expect that to change."

Deportations have been quickening in the UK and elsewhere in the past few years. In the first quarter of 2006, the UK deported 4,930 people, 43% more than in the same period last year.

At the end of March 2006, there were 1,745 people in detention, pending deportation, up 20% on last year.

"Serious problems remain both in the quality of individual decisions and the context in which they are made," noted a 2006 report by the UN High Commission for Refugees. The National Coalition of Anti-Deportation Campaigns, which says it is seeing more deported women and children than ever before, believes this is because "women are easy targets, always at home and not likely to put up a fight". Whereas in 2005 the Home Office took up to six months to arrange a deportation, they pointed out, it can now be done in three days.

The Home Office denies targeting women with children. "If people are in the UK illegally and have exhausted their appeal rights, we will seek to remove them," says a spokesperson.


Lisa Vives is the Executive Director of the New York-based Global Information Network, which distributes news and feature articles about perspectives on Africa and the developing world that are overlooked or under-reported by mainstream media.

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High Rates of HIV and STIs Show the U.S. Is Flouting Teens' Human Rights
By Cynthia Soohoo and Katrina Anderson

More than half of all new HIV infections in the U.S. occur before the age of 25, and one in four teenagers has at least one sexually-transmitted infection (STI). One contributor to these startlingly high rates is the U.S. reliance on abstinence-only-until-marriage education.

On May 22, 2008, the United States appeared before a UN committee of human rights experts in Geneva to review its record in upholding children's and adolescents' rights. But the U.S. avoided a dialogue on important issues like health and education that go to the heart of the Convention on the Rights of Children (CRC).

The Convention on the Rights of the Child is an international treaty that articulates children's basic human rights. The U.S. has never ratified the CRC, and has only ratified the treaty's optional protocols that cover the important, but narrow, issues of child soldiers, prostitution, pornography and trafficking. Somalia is the only other country that isn't party to the CRC -- but it hasn't had a central government since 1991.

The committee meeting in Geneva oversees countries' compliance with the CRC. On teen health, the treaty doesn't dictate precise policies, but it supplies a sensible starting point. For example, it holds that governments should provide adolescents with appropriate, adequate and accurate information to enable them to protect their health and practice healthy sexual behaviors. This includes teaching young people to use contraceptives in order to decrease the risk of STIs and unintended pregnancy.

U.S. programs do not comply with that model. The U.S. spends $200 million a year on abstinence-only-until-marriage programs. Many abstinence programs exaggerate failure rates of condoms and give false information about their effectiveness in preventing STIs. Abstinence-only programs in the U.S. prohibit teaching about contraceptive use.

The abstinence-only programs don't work in their abstinence message either. U.S. teens have sex as early and as often as teens in other developed countries. The difference is that U.S. teens are less likely to use contraception than their international peers. And those who complete the programs are less likely to seek STI testing and treatment. These government policies disproportionately affect low income women of color who rely upon public education during an era when the HIV/AIDS infection rate for African-American women is 23 times that of white women.

Despite these alarming outcomes, teen health wasn't on the table in Geneva and the U.S. side-stepped a discussion on its abstinence-only policy. Now, it's up to the U.S. Congress to show that it takes teenagers' human rights seriously. One step is for the Senate to ratify the Convention on the Rights of Children. Another is for Congress to eliminate abstinence-only funding and direct the money instead towards comprehensive sex-education.


Cynthia Soohoo is the director of the domestic legal program and Katrina Anderson is a human rights attorney at the Center for Reproductive Rights in New York.

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Talking Shop in the Medical Field: The Unfolding of A Strange New Disease
by Mahin Hassibi

Medical specialists in different fields complain about insurance companies or the Medicare rates; otherwise "talking shop" only occurs when a new disease appears. That's how it was in December1981 when my oncologist-friend asked me if I had seen the New England Journal of Medicine. She said there was the unusual report of a rare form of pneumonia that, until then, had appeared only in patients after heavy chemotherapy. The new cases were all men: homosexual, heroin addicts and the rest were Haitians. We agreed that the information was not complete and the report was indeed strange.

That evening I happened to talk to a Haitian colleague and mentioned the report. She was a skeptic about bias in reporting and became immediately incensed. She said she had two women friends, heterosexual, who had died in a Washington, D.C. hospital with the unexplained diagnosis of deficiency in their immune systems. Yes, indeed, they were Haitian. Maybe, she said, there is a new agent of destruction concocted somewhere to get rid of some undesirable group. Had we not read about the Tuskegee experiments? We kept the speculation going for a while, but no conclusion could be drawn.

The next time that I talked with my oncologist-friend, she asked what I thought about the unusual diagnosis of Kaposi Sarcoma, a new report in medical journals. Why should same-sex relations cause rare skin cancer? A researcher had found some connection between the use of amyl nitrate (used by some gay men as an enhancer of sexual pleasure) and Kaposi. But what explained the causative factor for Haitians?

Before long, the varied symptoms were replaced by a common underlying pathology and a scientific name: "acquired immune deficiency syndrome," AIDS. Around the same time, hemophiliacs came to replace Haitians as the third "H" in the groups most affected -- homosexuals, heroin users, hemophiliacs. This meant one way of getting the disease was through injection of blood products used to treat hemophilia.

The mass media created a panic, informing the public of every opinion, rumor or hypothesis. But the sense of panic was not limited to the general public. Some doctors refused to see patients with AIDS; hospital staff did not want to care for them. Some patients went without food because no one would feed them if they could not take the tray left near the door of their room.

Almost overnight, everybody knew somebody who was sick. The volunteer high school student who came to tutor the children on the pediatrics ward; the young black child psychiatrist who resigned to "write a book " and was found dead in a hotel room in Hawaii where he had gone to commit suicide; the colleague who was trying to convince me to buy his condo because he wanted to move out of the city. They were all dead and in such a short time. Some were known to be gay, others far from it.

A media psychiatrist was going on lecture circuit, saying that heterosexuals were immune to the disease because he had not seen women with AIDS among his acquaintances. Then in 1983 the French identified the virus causing the disease -- human immunodeficiency virus, HIV. But why did the virus choose to attack gay man? How was it transmitted? Doctors began reasoning by analogy and devising ways to eliminate or reduce the possibility of transmission. Cases soon appeared of women infected by husbands and HIV-positive babies were born to them. By 1985, the first test for AIDS was approved by the FDA. The disease of a few men at the beginning of the eighties became the killer of many men, women and children worldwide.

During the past quarter of century our knowledge has increased, but not all behaviors are based on knowledge. In South Africa, the government is still looking for some agent other than HIV and treating patients with unproven medications. In the west, many ignore necessary precautions for preventing a sexually transmittable disease; others remain uneasy when it comes to testing pregnant women to prevent the birth of ill children. My Haitian friend was right in observing that black females were also infected. It now appears that HIV infection is the 4th cause of death among black women in the U.S.

Aspects of AIDS remain puzzling, such as the very small likelihood of transmission from infected women to men, as opposed to the high percentage of women infected by HIV-positive men. And medicine has lost much of its optimism regarding infectious diseases: AIDS now looks like other diseases that are here to stay.


Mahin Hassibi is a Professor of Clinical Psychiatry (Ret.) at New York Medical College.

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Having Children When You Have HIV Still a Problem?
by Dr. Ann Boyer

When I began working with HIV in the 1980s, women still had a 9 to 30 percent chance of passing it to their babies (depending on whether or not they were adequately treated with AZT). And after they had a child, arrangements needed to be made to assure that continuity of love and care for the infant if, and more likely when, the mother died of HIV-related causes.  

Obstacles abounded.  Doctors declined treatment.  Discussions raged about the ethics of women bearing children if they were found to have the HIV virus, and, whether women were immoral to decline testing. Hidden issues of race and class infiltrated people's attitudes.. (A 1988 On The Issues Magazine carried an article by Barbara Santee, “Women, AIDS and Choice” that described vividly many of the debates around women and HIV.)

Well, we have come a far distance from there. With the advent of more potent antiretrovirals with less side effects and once or twice daily dosing of only a few pills, the probability of mother-to-infant transmission in a woman who is receiving medical care is close to zero.  If the mother continues in care, she may lead a very normal life and see her children grow to adulthood – as with any other chronic disease.

There are still some providers, however, who believe that an HIV+ diagnosis will inevitably lead to a shortened life and are opposed to HIV+ women having children.

Therefore, any HIV+ woman who is considering pregnancy should discuss it with her provider. If the provider is less than supportive – stick to your guns, don’t be dissuaded – and seek a second opinion from an Ob-Gyn who has experience with HIV (when a woman is actually pregnant, she is no longer cared for by her primary care doc, but by an Obstetrician until she delivers). Just call any medical center, ask for the Obstetrics department and request a referral to someone who specializes in ‘high risk pregnancy’ (not that having an HIV diagnosis, per se, makes a woman ‘high risk’ – but it did in the past).

Getting Pregnant for the HIV+

In terms of the “mechanics” of conception in the presence of HIV in one or both partners, there are several practices that work well:

If a woman is negative, but her partner is +, they can get “washed” sperm, so they become pregnant without the threat of the woman becoming infected with HIV.

If a woman is HIV+, but her partner is not, the “turkey baster” approach works beautifully (I, personally, have coached three clients who now have children.) This method is a home-grown version of artificial insemination: a woman keeps track of her temperature and establishes when ovulation is imminent, her partner ejaculates into a sterile container; the ejaculate is drawn up into a turkey baster which is then gently inserted into the vagina of the woman lying on her back, and the semen is allowed to flow over the cervix.

If they are both HIV+, some combination of the two approaches will work.

The need for such precautions in the presence of well-controlled HIV with undetectable Viral Loads for 2 years or more is unclear. We know that the chances of sexual transmission of HIV under those circumstances are extremely low. I would not be surprised if a growing number of couples in that category are creating their families in traditional ways.


Dr. Ann Boyer began in Ob-Gyn, expanded to women's health and then into HIV and substance use.  She is currently on the faculty at Mt. Sinai Medical Center and Medical Director of Concourse Medical Center, a methadone and drug treatment program, where she treats HIV/Hepatitis C and is creating a program for pregnant and parenting women.

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