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Thailand, Tak, Thailand (Citizen News) – Constanze Ruprecht (Citizen News Service) – In late October 2010, a large group of people living in and around Mae Sot, Tak province were closing in on a terrible ‘milestone’ of sorts: all of them – over 60 migrant children, women and men – were living with HIV and taking antiretroviral (ARV) drugs, which they needed to stay alive. Some were also co-infected with tuberculosis (TB), the most frequent opportunistic infection (OI) experienced by people living with HIV/AIDS (PLHIV).

Each group member’s daily regimen of drugs – a one-year ‘buffer’ provided by an international non-governmental organization (INGO) pulling its operations out of the country – was about to run out, with no new supplier in sight.

“We have been unable to secure a sustainable source of ARVs for our patients,” explains a staff of the Mae Tao Clinic, a clinic providing health care services to migrants and displaced people near the Thai-Burma border. “If they stop taking their medication, we face a crisis.”

DRUG RESISTANCE

Adherence to a prescribed ARV drug regimen is essential; people living with HIV and/or TB who stop taking medication for whatever reason, and even only for a few days, can develop a resistance. Drug-resistance is dangerous, because it is irreversible and the new strains of the disease can be passed on to others.

Multi-drug- and extensively drug-resistant tuberculosis (or, respectively, MDR and XDR TB) is an even greater potential threat than HIV drug resistance in terms of impact, because unlike HIV – a blood-borne disease -, TB is transmitted from person to person through the air. A rampant increase in drug resistance can thus indeed fuel a public health crisis.

The Mae Tao Clinic representative said that “from a public health perspective TB is more difficult to handle, mainly because of time-related compliance issues. People with TB have to take medication daily for six months. If they interrupt this treatment, which happens frequently with migrants who are on the move and may stop taking drugs when they feel better, then drug resistance can occur.”

Another often under-estimated problem accompanying drug resistance is the subsequent need for different drugs to replace the first regimen. These second- or third-line drugs are much more expensive and difficult to procure – here in Thailand, for example, the main first-line ARV combination therapy (for example GPO-VIR S30) is locally produced and distributed, bringing down the cost; but second- or third-line drugs must be imported, tend to be much more expensive than first-line medicine and may require special handling, like refrigeration, which complicates delivery in unstable settings.

MIGRANTS MARGINALISED

Thais living with HIV have the right to, and usually receive, free ARVs through the National Access to Antiretroviral Program for People living with HIV/AIDS, or NAPHA. People without a Thai ID can buy ARVs for a minimum of 1,350 baht per month, although NAPHA set up a provisional extension programme to cover vulnerable populations who do not have access via regular channels like Thai social welfare card holders.

Access is inevitably restricted for individuals or families already subject to the most dire of circumstances: many migrants and displaced people along the Thai-Burma border live a day-to-day existence that may include a lack of food security and reliable shelter. This can, and does frequently lead to greater vulnerability to infection and illness. An HIV positive migrant in poor health is thus more likely to contract opportunistic infections (OI) like TB, or Hepatitis C, another highly problematic OI.

A representative of a community-based organization in northern Thailand shared that “along the Thai-Burma border abutting Shan State, in Chiang Mai province, we support 125 members of the Shan community living with HIV, of whom 50 currently receive free ARVs. Unfortunately, beginning in December 2010, any new patients will have to pay for treatment – so this will affect any of the 75 not yet on ARVs who might need them in the future.” There are about one or two new cases every month, and some of them also have TB.

She added that they “…have a limited budget aimed at helping with general hospital costs for community members, but we’ve been using it to cover ARV-related costs for our PLHIV.”

Given the existing obstacles to accessing adequate and appropriate treatment, it is not surprising that migrants may start with the TB six-month short course, but then, despite doctor’s instructions, stop taking the drugs once they feel better. Many migrants are by nature already mobile, which further complicates consistent compliance and follow up by medical staff.

It is this population – in addition to other key populations like sex workers, injecting drug users and prisoners – that should be the main beneficiary of effective prevention efforts and increased access to a regular supply of drugs.

In a country that currently receives generous funding from the Global Fun to fight HIV/AIDS, TB and Malaria (GFATM), how is it possible we cannot manage to take care of our most vulnerable fellow humans?

SERVICES AND GAPS

A representative of the Thai Northern Network of People Living with HIV stated that “local hospitals do provide ARVs to migrants and displaced people as part of NAPHA’s extension programme, but they are bound by a quota system which always favours Thai citizens over unregistered migrants.”

He admitted that “sometimes Thais who fear being stigmatized and discriminated against by colleagues will request treatment under the extension programme instead of the regular system, because this way they can remain anonymous.”

Mae Tao Clinic already offers a number of relevant services for PLHIV, including voluntary counseling and testing (VCT), home-based care and peer educators. Relatively simple preventive approaches can also be applied in the context of TB-related services, such as face-masks and better ventilation in places where people go to get tested.

“A more systematic, consistent integration of HIV and TB programmes is key,” claimed another Mae Tao Clinic staff; he went on to say that “since it was at this point beyond the clinic’s capacity to offer TB treatment, it was essential to have one group or entity able to take full responsibility for managing a comprehensive TB programme and willing to deal with problems such as non-compliance or adherence due to mobility.”

There is an international NGO currently providing TB services in Mae Sot, serving part of the area previously covered by the INGO that pulled out last year. Yet the new organisation has limited reach and cannot accept patients outside of its focal communities, including those likely to move across the border. These unfortunate ones have to look elsewhere, and more often than not, they end up at Mae Tao Clinic.

Regarding the ‘stranded’ HIV-positive people, clinic staff approached the closest hospitals for help, and only Propha agreed to treat 20 people under its NAPHA extension scheme. Mae Sot, Mae Sariang and Mae Ramat hospitals were not accepting any new patients.

“We are now waiting to hear whether the Regional NAPHA Extension Unit in Pitsanuloke can help coordinate the provision of ARVs directly to Mae Tao,” said the first Mae Tao Clinic staff. “This is easier and more cost-effective than transporting a large group of patients back and forth each month.”

WHAT NOW?

It seems that drug resistance is here to stay – at least for now – and so the best response would include not only addressing the most immediate needs to mitigate impact, but also introducing some longer-term measures.

In addition to the interventions mentioned above, anti-stigma and -discrimination campaigns targeting Thai society would help PLHIV at all levels access existing ARV providers without fear of being socially outcast.

The representative of the Northern Network of People Living with HIV wondered whether “everything could be related to national security issues and that maybe there is no real will to find a sustainable solution to these urgent cross-border issues.”

Also, “there seems to be little real interest among TB service providers to collaborate more with the HIV/AIDS sector,” an independent consultant supporting HIV/AIDS-related work at national and local levels in Thailand noted. “Because TB has for so long been considered ‘solved’ as a public health issue here, they do not have a sense of urgency…”

Well, it can’t get any more urgent for those people living with HIV/AIDS and TB here, and now – and who may soon become drug resistant due to apathy and ineffective programme design and interventions. Acknowledging and fully understanding the reality of this is the first step, acting decisively and comprehensively, the second. Here, and now.

—–

Constanze Ruprecht – CNS

(The author has worked in international development cooperation since 2000. Focusing on a broad range of areas including public health, gender, advocacy and communications, politics and the environment, she supports people and programmes in Asia, Africa and Europe. She is a Key Correspondent (KC) and writes for Citizen News Service (CNS).

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Montreal, Quebec, Canada (AHN) – Canadian border agents have arrested nine people in Montreal who entered the country illegally aboard a vessel from Morocco.

The nine were found inside a container van on the MSC Lugano shortly after the ship docked about 2 a.m. Thursday.

Officials of the Canadian Border Service Agency said the migrants lacked identification documents and were in good health. The agency declined to provide the names, genders and ages of the migrants.

The agency is conducting an investigation into the incident and is looking at the possibility that the stowaways are part of a human trafficking ring because they were well cared for, fed and cleaned up when the ship docked in Quebec. The Immigration and Refugee Board of Canada is scheduled to hear the case of the nine migrants on Monday.

The vessel, which had a stopover in Sines, Portugal, is owned by the Mediterranean Shipping Company, which is based in Switzerland and owns 423 ships worldwide.

The arrival of the stowaways came at a time that Canada is considering tougher rules against human smugglers. A few months ago a vessel full of Sri Lankan asylum seekers arrived in British Columbia. The incident, which sparked a debate in Canada, led Ottawa to review its immigration and refugee laws and policies.

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They can ruin everything from your bags to your clothes, your bed sheets to your curtains.

HUNTING THE RIGHT HOUND

Generally, sturdier, active dogs love kids, but unless your dog is well-trained, he may pose a risk to your children. Often used interchangeably, the terms “mixed breed” and “crossbreed” have slightly different meanings.

Dog Potty Training is really essential

If it weren’t for the fact that most terriers, such as the Cairn and the Norfolk, are fairly small, their tenacious nature and boundless energy would make them hard to control.

This is the list of dog Herding Breeds according to The American Kennel Club:Australian Cattle Dog, Australian Shepherd, Bearded Collie, Beauceron, Belgian Malinois, Belgian Sheepdog, Belgian Tervuren, Border Collie, Bouvier des Flandres Briard, Canaan Dog, Cardigan Welsh Corgi, Collie, German Shepherd Dog, Old, English Sheepdog, Pembroke Welsh Corgi, Polish Lowland Sheepdog, Puli, Shetland Sheepdog, Swedish Vallhund. These fiery little dynamos would dig up underground dens and burrows while barking furiously, forcing the inhabitants out where hunters awaited. The poodle is by far the most popular of the non-sporting breeds.

Sporting dog breeds. The instinct to herd in some of them can be strong in these breeds even if most of these are now plain companion dogs that have never even seen a sheep. Unfortunately, the sheer popularity of some of the sporting breeds, most notably cocker spaniels but also Labrador and golden retrievers, has led to a rise in health and behavioural problems. Terrier dog breeds. Belonging to this group are some of the intelligent dog breeds which includes the admired German shepherd dog, most famous for its police work and the Border collies, the most intelligent of all breeds. Working Dog Breeds. When these dogs bite, they don’t let go.

Combining the taut muscles and compact power of the bulldog with the tenacity and aggressiveness of the terrier, some controversial bull terrier breeds have been involved in some highly publicized biting incidents, several involving small children. But despite what those who breed and sell crossbreeds might try to tell you, these are not, nor will they likely ever be, recognized as purebred dogs.

THE ANATOMY OF A CANINE

Pricked Ears. A lot of information can be garnered from a quick sniff. The wire-haired coat of the dachshund features a higher quantity and density of the harsh primary hairs in a dog’s coat. Species such as wolves that inhabit cold climates sport double coats, with a thick, insulating under layer to retain heat and keep the cold at bay. Button ears can been seen in Shetland Sheepdogs and many terriers.

The ears of wild canids, like wolves and foxes, come in only one shape:natural. Other breeds such as German shepherds and golden retrievers have been trained to detect hidden drugs, explosives, and even termites. Called thermoregulation, this ability allows canids to thrive in all types of climates, from the subarctic to the Sahara.

Hairless. Sixteen sharp premolars, including the carnassials, allow the dog to cut and slice flesh, while ten powerful, grinding molars mean the dog can chew the non-flesh parts of its diet-typically vegetables, other vegetation and grains. As omnivores, canids need a variety of specialized teeth to eat the different types of foods in their varied diets.

WHY THE HELP?

You won’t need any dog training equipment. A few dog treats will do the magic. Well, here’s a gift for you:You can now learn it in a snap. Dog Potty Training. You can leave him alone for hours in your home.

Dog Potty Training
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Article Source:http://www.articlesbase.com/pets-articles/dog-potty-trainingsave-the-carpet-1369846.html