As global health leaders struggle to meet the United Nations goal of reducing mortality among the world's poorest children, vaccines are attracting more and more attention. The purchase of the vaccine is just the beginning, however, as the effectiveness of a vaccine is only as good as its delivery system. According to a recent series of reports from PATH's Children's Vaccine Program (CVP), it is possible to rapidly introduce new vaccines and dramatically improve both immunization rates and injection safety practices. CVP’s experience in the field demonstrates that simple and effective technologies and management strategies enhance the success of developing countries’ efforts to promote immunization–shown to be one of the most cost-effective health interventions.

Efforts to bring antiretroviral treatment to AIDS patients in developing countries are threatened by the looming implementation of new World Trade Organisation's patent rules, the charity Médecins Sans Frontières warned this week. The organisation's TRIPS (trade related aspects of intellectual property rights) agreement comes into force for most signatories on 1 January 2005. It requires the organisation's members to grant 20 year patents to new pharmaceutical products. Only the least developed countries can postpone implementation until 2016.

Popular disc jockey Kaiboni could spend several years in prison for statutory rape and willful transmission of HIV. He is accused of having sex with a 15-year-old on several occasions, and consciously infecting her with the AIDS virus. Kaiboni denies the charges, claiming he was unaware of his HIV status at the time. For AIDS activists, the court proceedings focus attention on the effectiveness of a law that bans HIV-positive persons from knowingly engaging in sexual behaviour that might lead to their partners becoming infected.

Activists working to end female genital mutilation in Africa find themselves in a bitter phase of the struggle. Now that some traditional practitioners have disavowed it, many doctors and nurses are taking up the illegal practice. And these are people that activists thought were their friends. "With activists campaigning about the unhygienic conditions in which traditional circumcisers carry out their trade, some parents are taking their daughter to the modern doctors," says Efua Dorkenoo, a Ghanaian activist against FGM. "This is actually taking people centuries back," says Millie Odhiambo, executive director of The CRADLE (also known as the Child Rights Advisory Documentation and Legal Centre).

This document, produced by UNICEF and Roll Back Malaria (RBM), reviews the malaria burden in Africa and examines the role for UNICEF in taking forward the RBM initiative. The document focuses particularly on the critical importance of insecticide-treated nets (ITNs) for malaria control and outlines UNICEF's approach to increasing the use of ITNs. Case studies are also provided from UNICEF programmes across Africa.

On Monday 1st December 2004, the world marked World AIDS Day. The theme for this year's campaign, which was selected by the United Nations was, "Women, Girls HIV and AIDS". Globally, young women and girls are more susceptible to HIV than men and boys, with studies showing they can be 2.5 times more likely to be HIV-infected than their male counterparts. According to UNAIDS report released in February 2004, 55 percent of adults infected are women. Their vulnerability is primarily due to inadequate knowledge about HIV/AIDS, insufficient access to HIV prevention services, inability to negotiate safer sex, and a lack of female-controlled HIV prevention methods. The statistics are startling, that is why the African Women's Development Fund (AWDF) has since it's inception given grants for women's reproductive health and HIV/AIDS.

The World Food Programme (WFP) has confirmed that it plans to expand its support to 1.6-million Zimbabweans during December via its targeted feeding programme. WFP spokesperson in Zimbabwe, Makena Walker, said that about 25 000-million tonnes of food aid, left over from its assistance programme last year, would be distributed next month to vulnerable groups, including the chronically ill, child-headed households and the disabled.

A new weekly service is now available to provide you with expert medical knowledge about a variety of public health issues to help you design more effective communication programs. HealthWise is a joint product of the Health Communication Partnership (HCP) and the INFO (Information and Knowledge for Optimal Health) Project, both based at Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs (CCP) and supported by the U.S. Agency for International Development (USAID). HealthWise will research and summarize answers to your questions about public health problems in reproductive health, HIV/AIDS, maternal health, child survival and tuberculosis, malaria.

The Strategies for Hope Trust has launched a new video, designed to combat HIV-related stigma, shame, discrimination and denial in churches. The video features Rev. Canon Gideon Byamugisha from Uganda - the first African priest to disclose his HIV-positive status.

While churches throughout the world have provided health care, counselling and material support to many people living with HIV/AIDS, they have been less effective in addressing issues such as HIV-related stigma and discrimination. Many churches have ignored HIV/AIDS as an issue affecting their own members, or have expressed judgemental attitudes towards people living with HIV.

In this video, entitled 'What can I do?', Canon Gideon talks about the need for his fellow Christians to do away with judgemental attitudes towards HIV-positive people, and instead to offer them love and support. 'Churches need to spread hope, not fear,' he says. He goes on to tell how his wife died of an HIV-related illness and that he too found out he was HIV-positive. He accepted his status and disclosed it to his family and friends, and also to his Bishop. Later he married a woman who was also HIV-positive.

Canon Gideon speaks on the video about the difficulty he has faced when buying condoms, because people usually associate condoms with immorality. He describes how he has turned these situations into impromptu AIDS education sessions.

With the support of his family and friends, his church and World Vision International, Canon Gideon has taken his unique HIV/AIDS ministry to many countries in sub-Saharan Africa, as well as to Asia, Europe and North America. He is driven by the conviction that HIV/AIDS is both a preventable and a manageable illness - providing the barriers of stigma, shame, denial, discrimination and ignorance can be broken down. He wants to encourage others, especially religious leaders, to get this important message across to the general public.

The video is 49 minutes long and is divided into short segments on topics such as 'Coping with stigma', 'Why be tested for HIV?' and 'Challenges for the church'. It is accompanied by a 48-page Facilitator's Guide, to enable groups to explore in greater depth the issues which it raises.

The production of the video and the Facilitator's Guide has been supported by Christian Aid, World Vision International, The World Bank and Lutheran World Federation.

The video and the Guide can be ordered from TALC: e-mail: [email protected]; Web site: www.talcuk.org; telephone: +44 (0) 1727 853869. For general enquiries about these or other Strategies for Hope materials please contact Glen Williams: [email protected]; telephone: +44 (0) 1865 723078.

Urban malaria is emerging as a potential but "avertable" crisis in Africa, scientists are warning. Malaria kills millions around the globe and until recently was believed to be a disease of rural areas, since the Anopheles mosquito - which transmits the deadly parasite between people - breeds in stagnant waters. But now, scientists at the Liverpool School of Tropical Medicine (LSTM) in the UK are issuing a global alert that "urban malaria is a new, emerging tropical disease".

Read the obituaries in Swaziland, and you will discover that many people here die from unspecified "lingering illnesses". Attend funerals, and you may hear that tuberculosis, dysentery, diarrhea – even flu – are also proving surprisingly lethal. Virtually no-one, it seems, is dying of AIDS. This is despite the fact that an HIV prevalence of 38.8 percent has given Swaziland the highest AIDS infection rate in the world.

Yesterday was World Aids Day. The previous week and the rest of this week is being used to focus global attention on the pandemic and what we all, rulers and subjects, victims and carers, local, national, regional and international actors can do to fight the scourge. Africa, as the continent with the largest number of infected people is rightly getting a lot of attention. 25 million people (almost half of the global total) across this continent are living with the killer disease which has not even peaked in some of the worst affected countries like Botswana, who have an almost 40% infection rate. The gender impact of the disease, the class burden and demographic distribution is even more devastating, with at least one in six children affected. Meanwhile the daily death rate is mounting.

Whatever one's view of statistics, its uses and abuses, the stark truth is that our peoples are dying and dying in great numbers and doomed to die in greater numbers and we have to (and can) do something, something very drastic, to arrest the situation. There is no point arguing about how the disease arrived or quarrel with the apocalyptic scenarios. While the arguments may be useful to historians of science and medicine and academics they do not address the problems at hand. Our people are dying.

The sad truth is that the situation is not hopeless; it is reversible. While there may not be a cure there is enough progress in science research and medicine to stem the rise, prolong the lives of infected people and provide even more information on various preventive measures. What is making Africa and Africans more vulnerable than other peoples is a combination of ignorance and poverty. The situation is not limited to Africans on the continent. There are alarming reports about the rapid spread of the disease among Africans in the diaspora, especially African-Americans and in particular African-American women.

It is not all bad news across Africa. A country like Uganda has a deserved image globally as a country which has shown openness and innovative local and national leadership in confronting the disease. But even Uganda's positive record for many years risks being undermined by complacency. If you have a winning formula why change it? This may be contributing to an atmosphere one concerned HIV/Aids activist described thus: “One hundred percent HIV/Aids awareness, Zero % Sex education.”

People who know enough (and some believe know too much ) about the disease take whatever care they can but in some sections of the population the law of diminishing returns may be setting in and even fatalistic attitudes (‘this thing will kill all of us’) may substantively drive the deadly curve up again. Thus more concerted efforts need to be continuously embarked upon to warn people that HIV/ADS remains real. Until there is a cure or effective vaccine everybody is still vulnerable. The fear about Uganda's continuing success in confronting the disease centres around more creative communication methods with vulnerable social groups (especially in rural areas, women and the Youth), prospects for universal access to cheap (if not free) anti retriovirals and relentless educational campaigns. There is also an unnecessary dilution of the message in the secondary argument imported from the neo-con religious right in America and other fundamentalists across the world about ‘abstention’ . The argument is not either or but effective education on all forms of preventive measures and safe sex including the active but culturally sensitive promotion of the use of condoms.

Many other African countries are unfortunately in various stages of denial. While every country now has one form of national campaign strategy or the other the full impact of the threat posed by HIV/AIDS is not generally appreciated, therefore the fundamental lifestyle and behavioural changes needed are not being addressed systematically. For instance, in many countries in the West African region the use of condoms is still resisted for many reasons including convenience, reactionary cultural attitudes and general ignorance.

Talking to educated people (who should, theoretically, know better) many of them in NGOs, academia, media, public institutions and local elite in their communities I discover an alarming mountain of ignorant complacency. Some of them have inverted tired racist arguments about the origins of AIDS by concluding that as long as they do not mess around with white partners they are safe! Yet I look in the newspapers and see death notices of many big people and the not so big who died ‘after a long illness’ or ‘heart attack’ or ‘high blood pressure’ or ‘pneumonia’ or ‘malaria’ or ‘short illness’ or ‘hypertension’ and my mind races back to similar coded messages in Uganda many years ago. And I wonder if all of these deaths are due to the stated public reasons or could be AIDS-related complications.

It took many years for even countries that are Uganda's neighbours to come out about HIV/AIDS. Kenya for instance thought admitting HIV/AIDS may affect its tourism trade. Actually, not so long ago a prominent politician who shall remain nameless died almost certainly of Aids-related illness. But both the public and high level political burial could not disclose the reason even though media speculation went close enough to suggest this was the case. Even in Uganda public disclosure about ‘big people’ is not common. There are many issues involved including stigma against the widows left behind, orphaned children and the right to privacy of affected peoples both living, dying and the dead.

The first task in confronting the disease is combating the mass ignorance that still surrounds the disease and associated social stigma that makes it extremely difficult for people suffering and living with the disease to admit it and seek necessary treatment. This will require both public and community leadership to raise general awareness that can turn the disease away from ‘death sentence’ to ‘can live longer’ hope. The second task is the poverty that makes poorer and marginalised peoples (especially Women, Youth and the majority of our peoples in rural areas) more vulnerable in terms of access to information and anti retriovirals and prevention programs. But addressing poverty and access issues alone will not deal with the problem fully. Even the relatively rich who have the money or middle classes who have easier access to the available medicines need the power that existing knowledge and available technology can afford them to appreciate that they need not ‘die of ignorance’. HIV/AIDS is real, knows no social boundaries and threatens all of us but together we can all do something about it.

* Dr Tajudeen Abdul-Raheem is General-Secretary of the Pan African Movement, Kampala (Uganda) and Co-Director of Justice Africa

* Please send comments to

Africa Action marked World AIDS Day by co-sponsoring a major rally outside the World Bank and IMF to condemn policies that undermine the fight against HIV/AIDS for women and girls in Africa and throughout the global South. This year’s World AIDS Day theme focuses on the disproportionate impact of HIV/AIDS on women and girls around the world. At this morning’s rally, Marie Clarke Brill of Africa Action said, "In Africa and increasingly around the world, AIDS has a woman’s face. If we are to turn the tide of this pandemic, we need to promote strategies that will address the gender inequalities that leave women and girls most vulnerable to HIV/AIDS. Instead, the policies of the World Bank and IMF continue to undermine women’s health in Africa and around the world."

This brief examines the policy implications of increased activity between the UN and the corporate sector, specifically focusing on the increased collaboration between the corporate sector and the World Health Organization (WHO), UNICEF and UNFPA. The brief also explores the major global health-related public-private partnerships (GHPPPs) which operate primarily outside the UN, such as the Global Alliance for Vaccination and Immunisation (GAVI). The brief concludes that, although guidelines and procedures to address public-private interactions (PPIs) have been developed within UN agencies, they are inadequate to ensure UN integrity.

Health reforms based on market principles have been introduced widely in both developed and developing countries over the past 20 years. In developing countries, international donors have insisted on health reform as a precondition of providing external aid. The reform packages that have been introduced have been strikingly similar across countries as wide apart as Uganda, Bolivia, and Russia. Uganda embarked on market based health reforms in 1994. These reforms have not only failed to improve health services and the health of the population but have arguably been the key factor behind their deterioration. What can we learn from Uganda's experience?

The heads of the United Nations World Food Programme (WFP) and World Vision have joined forces to urge a massive increase in donor funds for school feeding - a largely untapped yet effective way to attract children to school and stem HIV/AIDS infections among the young. There is growing evidence linking the level of education to a stable or lower incidence of HIV. For instance, research shows that AIDS spreads twice as fast among uneducated girls in Zambia, while young rural Ugandans with a secondary education are three times less likely to be HIV-positive than those with no education.

The national HIV/AIDS prevalence rate in Kenya has dropped from 14 percent four years ago to about seven percent and the level of public awareness of the disease has risen to an estimated 90 percent across the country, the government said on Wednesday. "HIV/AIDS is now an established epidemic in Kenya," a statement issued by the Ministry of Health to mark World AIDS Day 2004, said. "It is a declared national disaster and all efforts are being directed to evoking the necessary response to containing it."

What care do sufferers of AIDS receive in sub-Saharan Africa (SSA)? If their lives cannot be saved, are their last days made as comfortable as possible? As more funding is made available for the care of terminally-ill AIDS patients, it is important to look at the level of care currently available. King's College London, together with the US Office of National AIDS Policy, conducted a survey across 14 SSA countries to discover the end-of-life care AIDS patients are currently receiving.

The annual AIDS epidemic update reports on the latest developments in the global HIV/AIDS epidemic. With maps and regional summaries, the 2004 edition provides the most recent estimates of the epidemic’s scope and human toll, explores new trends in the epidemic’s evolution, and features a special section on women and AIDS.

A new study to be published in the Lancet has, for the first time, quantified the dangerous scarcity of healthcare workers in countries with climbing rates of HIV, tuberculosis and malaria. The report, 'Human Resources for Health: Overcoming the Crisis', says health workers from developing countries are lured by better salaries and safer working conditions in urban areas or richer countries, creating the so-called "brain-drain".