TAN – The Afro News

Jamaican-born, Toronto resident, Kwasi Kafele recently became the first non-Krobo to be named Chief of the Traditional Area. (ManyaKrobo is situated in Ghana,

By michelle-lee The Afro News Ontario

Jamaican-born, Toronto resident, Kwasi Kafele recently became the first non-Krobo to be named Chief of the Traditional Area. (ManyaKrobo is situated in Ghana, east of the capital Accra). Read the full story

HIV & AIDS: A Troubling Issue for Black Canadian Immigrants

By Joy Walcott-Francis PhD Student SFU , The Afro News Burnaby

Leading up to World AIDS Day, I scoured the internet and newspapers in BC that target the Black Canadian population and apart from The World AIDS Day Concert, “Jamin Local and Impacting Global” held on East Hastings, Vancouver, put on by Youth Initiative Canada in partnership with local artists (a number of whom were Black), no where did I see an event being promoted by our community, for our community. And it made me wonder, was it that such events were being held, but for some reason, were being kept low-keyed? For I fail to believe that a disease that has such prevalence among Black populations both here in Canada and overseas is treated with not much regard by us. Or could it be that we have gotten complacent as we watch the rest of the world tackle the disease for us?

Similar to a number of persons in many parts of the world, December 1, 2009 came and went; unfortunately, oblivious to many of us. It was a day when the world again joined hands in solidarity to observe World AIDS Day, now dubbed as the longest running disease awareness and prevention initiative of its kind in the history of public health. Since its conception in 1987 and the launch of the first World Aids Day in 1988, the face of the epidemic has changed in significant ways. Awareness campaigns have led to increased knowledge of the disease, its prevalence and risk populations; in many cases have led to a decrease in stereotypes and discrimination and in general has brought about a greater degree of commitment and show of resources from governments, non-governmental organizations and private personnel alike. During the period November 24 through to December 1, 2009, a number of provinces, cities and territories in Canada, commemorated the observance through vigils, fundraising activities and various forms of awareness events, with this year’s theme being Universal Access and Human Rights.

But while this year’s theme comes with a number of controversies (a point to which I will later return), the issue of awareness is of grave concern to many segments of the population and a mounting one to Canada’s growing Black population which now stands at 15.5% of the visible minority population and 2.5% of the total population, making Canada’s Black population the third largest visible minority group behind South Asians and Chinese respectively .

The Public Health Agency of Canada (PHAC) notes that since reporting began in 1985, there have been a total of 64,800 positive HIV tests reported up to December 2007. The number of positive tests that were reported in 2007 was 2,432, which actually represented a 5.0% decrease from the previous year. It is also poignant to note that by 2007 more than 80% of all positive tests that were reported were from three provinces with British Columbia starkly comprising 16.3% of the cases. Ontario reported 44.0% and 21.5% came from Quebec. Trends in the rates of newly diagnosed HIV cases for 2007 were found to be highest in Saskatchewan, British Columbia, and Ontario. Reports also indicate that the number of reported AIDS diagnoses has steadily declined over the last 10 years. In 2007, 238 diagnoses were reported compared to 303 cases in 2006 and 347 in 2005, bringing the total number of cases since 1979 to 20,993. Research indicates that a major factor in the decrease in cases has been the delayed or prevented onset of AIDS due to highly active antiretroviral therapy (HAART) which has become widespread since 1996. HAART is a type of combination therapy used to treat HIV infection, and typically uses three drugs from at least two different anti-retroviral drug classes. This therapy aims to improve not just the physical health condition but also the quality of life of the person living with HIV. This kind of therapy is effective in boosting the immune system of the body and also in reducing the amount of viruses in the body. It is important to note here that HIV is the virus that causes AIDS. While HIV stands for the Human Immunodeficiency Virus, AIDS stands for the Acquired Immune Deficiency Syndrome. Once a person gets the virus, it slowly begins to attack the immune system, killing off healthy immune system cells and as the infection progresses, there is ongoing damage to immune defense cells and the body becomes increasingly less able to fight off infections. This means that individuals with an advanced HIV disease are susceptible to infections that don’t show up in people with health immune systems. The difference between AIDS and HIV is that a person is said to have AIDS, as opposed to simply being HIV positive, when either the numbers of specific types of cells in their immune system drop below a certain level or when the body’s defenses against some illnesses are broken down.

Conversely, it is believed that the increase in prevalence rates after 2002 can be attributed to changes in immigration policies that were introduced on January 15, 2002 at Citizenship and Immigration Canada (CIC). These changes have made HIV tests a mandatory part of the routine screening for all applicants who require an Immigration Medical Examination (IME) and are 15 years and over, as well as for those children who have received blood or blood products, or have a known HIV-positive mother. PHAC reported that between January 15, 2002 and December 31, 2007, 3,103 of the applicants who underwent an IME tested positive for HIV. In 2007 alone, there were 536 positive results. Of these, 318 were identified by HIV testing in Canada, and 218 were identified outside of Canada. Of the 536 diagnoses, 316 were born in Africa and the Middle East, 159 in the Americas, 42 in Asia and 19 in Europe.

While this year’s World AIDS Day theme demands that governments focus on challenging discriminatory laws, policies and practices that stand in the way of access for all to HIV prevention, treatment, care and support, it appears that Canada’s immigration policies are still lacking in this respect. In September 2000, it was made known that Health Canada had recommended to CIC that the “best public health option” was to test all prospective immigrants for HIV and to exclude those who tested positive from immigrating to Canada on the grounds of public health and “excessive cost” to the government. Such an announcement did not sit well with many organizations and individuals who argued that such a measure was in violation of human rights. The following year, the Minister of Health provided revised advice to CIC and what we now have is an immigration policy that does not automatically exclude applicants on the basis of being HIV positive but one which says that foreign nationals can be deemed “medically inadmissible” to Canada and denied a visa (or refused entry at the border) based on their medical condition if:

• They are likely to be a danger to public health or public safety; or

• They might reasonably be expected to cause excessive demand on health or social services.

The implied meaning of this policy is that the Canadian government holds that persons with HIV do not themselves represent a danger to public health and safety. In general, Canada therefore only excludes people with HIV if they can be expected to place an “excessive demand” on publicly funded health and social services. This “excessive demand” barrier does not apply to a person who has applied for permanent residence as a refugee or “person in similar circumstances”, or who has been deemed “in need of protection”, whether applying from inside or outside Canada.

Where the problem lies however, is in the fact that there is no clear definition in the Immigration Act or in the Regulations of what is deemed as “excessive demand”. And while immigration personnel and examining physicians (the Immigration Act demands the physician’s opinion on whether an individual applicant’s medical condition is such that the applicant is likely to be a danger to public health) are provided with a list of factors for use in determining whether a person is likely to be a danger to public health or to cause excessive demands on health or social services, it would appear that an HIV positive prospective immigrant’s entry to Canada is often left to chance given such vague and subjective decisions criteria.

Whereas Canada’s concern for the health and safety of its citizens as well as that for the country’s continued economic development are well warranted, care must be taken in ensuring that people’s human rights are not violated. Attention must be paid to the fact that stigma, discrimination and severe ostracization is very real for many persons who apply for Canadian immigration status, whether they are in or outside of Canada. Therefore, the question which needs to be asked is: Does or will “routine” testing contribute to subsequent abuses against people who test positive? Further, it is not a fallacy that a significant proportion of immigrants to Canada migrate primarily for economic reasons and thus it could also be argued that in admitting an HIV positive person to the country could potentially place them in a much better position to be able to afford care rather than for them to remain in their own country and suffer. Is the right to health not a human rights issue?

BY Wallace Mawire The Afro News International

 Zimbabwe’s Forgotten Street Folk   HARARE  : While Zimbabwe has just hosted the first regional conference on immunization in Africa to strengthen the delivery of immunization services in all member states in the African region , it is believed that most people living on the streets are being left out in the immunization campaigns being carried out in the country.

As a result of this Zimbabwe is currently facing challenges which include emerging and re-emerging infections of communicable diseases.

Zimbabwe’s Minister of Health and Child Welfare, Dr Henry Madzorera was evasive when he was quizzed by journalists at the just ended immunization conference to explain how immunization campaigns are reaching out to marginalized groups like street kids and the homeless who are oftenly with limited resources including medical.

Dr Madzorera who appeared not very confident to confront the question posed by the journalist at the press conference convened by the World Health Organisation (WHO) remarked:

‘l am sure street kids and the homeless are covered in our immunization campaigns, we go everywhere including into farms.” He did not say how they covered the streets.

However, despite the Minister’s ascertations that there are no groups which are left out in the immunization campaigns, his presentation at the regional conference exposed some glaring shortcomings and challenges which easily point to the fact that immunization coverage is not 100% in the country.

He articulated to regional and international delegates that communicable diseases continue to be a major public health concern in Zimbabwe, which has one of the highest sero-prevalence rates of HIV and is among the highest tuberculosis burdened country of the world.

“This is further compounded by the challenges imposed by the threat of emerging and re-emerging infections,” Madzorera says.

He notes that there is a need to improve the country’s surveillance systems which are currently faced with human resource constraints, poor communication networks and limited utilization of data collected and lack of transport.

“Communicable disease control needs strengthening,” he says.

The main objective of the Expanded Programme on Immunization (EPI) is to reduce under five morbidity and mortality from vaccine preventable diseases in line with MDG number 4 to reduce child mortality.

The Global Immunization Vision and Strategy (GIVS) strategic area number one emphasizes reaching out to more people with vaccinations in a changing world. The EPI in the SADC region was launched in the 80s under the auspices of the Primary Health Care (PHC) programme. It sought to improve the accessibility of health services, quality of life and health of the general populace.

Dr Madzorera adds that although the EPI in Africa has made tremendous progress in the past few years following the stagnation observed in the 1990s, the routine immunization, unlike supplemental immunization has suffered some setbacks partly attributable to the current socio-economic constraints such as inadequately trained and de-motivated staff, high attrition rate and inadequate transport.

“It follows therefore that these challenges need to be addressed if EPI has to make a headway,” Madzorera says.

Adding that government of Zimbabwe remains committed to the Zimbabwe Expanded Programme on Immunization (ZEPI) as a pillar for child survival and improvement of the child health goal and the country also registered some progress despite the numerous challenges he alluded to.

According to Mrs Duduzile Moyo, Director of Streets Ahead, a registered welfare organisation which assists under-priviledged children aged between 6 and 18 years living and working on the streets of Harare, the organisation has children born on the streets and all those that come into contact with the organisation are encouraged and refered to baby clinics to have their babies immunized.

“We hold workshops with the young mothers giving them information on child care and general health. We do not work on absolute health projects and as such we can only complement ,inform and refer our clients to the medical centres,” Moyo says.

Moyo adds that most of the street children come from homes and the initial immunisation should have been done by the time they are old enough to come into the streets. She adds that the community of people living and working on the streets is fueled by the community in which all people live.

“This means that the street dwellers are coming from the communities where the immunisation programmes are supposed to be implemented,” says Moyo.

She did not elaborate on how the organisation was making a follow up on whether its members were getting immunized or facing any challenges.

Zimbabwe is not exempt from the global risks of outbreaks of wild polio virus, viral hemorrhagic fevers, avian influenza, SARS, small pox, measles and neonatal tetanus.

Dr Madzorera says that despite achievements made there are still significant challenges in relation to the use of immunization services to reduce childhood morbidity, mortality and disabilities in the region including Zimbabwe. He adds that surveillance towards measles and neonatal tetanus elimination and polio eradication need further strengthening.

In Zimbabwe this has been reaffirmed by the recent measles outbreak which has hit the country and claimed at least 41 victims since November 2009.

A contact from the Community Working Group on Health (CWGH) says that there is an absence of mobile clinics in Zimbabwe which should be re-introduced to help on immunization campaigns.

She said that mobile clinics would be accessed by all children offering them free immunisation. She wondered why children or people were falling prone to communicable diseases like measles when immunisation services should be free to be accessed by all even street people.

She accussed government of negligence saying that it has a duty to make sure that communicable diseases are prevented.

Dr Madzorera says that vaccine preventable diseases such as polio still remain a major cause of morbidity, disability and mortality mainly among children in Africa region. It has been documented that immunisation coverage in many countries in Africa has remained stagnant and in some countries has even dropped to as low as 30 to 40% during the past decade.

The reasons for the decline include lack of countries’ capacity to incorporate new changes, innovations and technologies, exodus of skilled human resources, competing health priorities for example HIV and AIDS, reduction of government health budgets, non-utilisation of data to improve systems performance at all levels for example reduction of missed opportunities for vaccination, dropout rates, vaccine stock outs and increased vaccine wastage rates.

Also decline in performance of the surveillance for acute flaccid paralysis has been noticed including case-based measles and neonatal tetanus surveillance.

Madzorera also notes that the Ministry of Health has noticed decline in the routine immunisation coverage, especially at the district level.

“In order to prevent the resurgence of wild polio virus transmission in our country and in the sub-region, which may result from importation from countries that still have transmission, there is the urgent need to strengthen disease surveillance through harmonization and alignment with all our partners and the community,’ Madzorera says.

Strategies which have been introduced include the reaching every district (RED) approach and organisation of integrated child health weeks/days in the delivery of immunisation services.

While some marginalized groups are reportedly being left out, Dr Madzorera reiterates that the region should remain committed to the primary health care principles as agreed 30 years ago in Alma Ata.

He says the International Conference on Primary Health and Health systems held in Ouagadougou in Burkina Faso in April 2008 urged member states through the Ouagadougou declaration which Zimbabwe is signatory to among other issues, address the creation of sustainable mechanisms for increasing availability, affordability and accessibility of essential medicines, commodities, supplies, appropriate technologies and infrastructures, the provision of adequate resources, technology transfer, south-south cooperation, the use of community directed approaches, the promotion of African traditional medicines and strengthening health information and surveillance systems and promotion of operational research for evidence based decisions.