Patients Charter for TB Care

I'm over-joyed to see all these posts expressing interest in addressing rights issues and improving care for DR-TB patients. Yes yes yes, I agree. I know firsthand that this is very needed and very overdue. Reading the comments that call for the Patients' Charter to be better promoted and implemented is uplifting, as I have often thought that the PCTC could be a powerful organizing tool for patients and many progressive partners, driven forward dynamically with a planned roll-out adequately funded. Shamefully, this has not happened, and all of us who had contributed to the original are deeply dismayed by the lack of progress. However, when I read all these comments of the last few days, I'm excited again, and an old expression comes to mind which sums-up my feelings : " Don't Moan, Organize !! "
Instead of just citing examples of rights abuses, dignity denied, and casting blame on vague faceless authorities at the top, we should collectively work pragmatically to develop a practical model for the promotion of the Patients' Charter in MDR treatment centers. Although many of the comrade's comments highlight the need for PCTC promotion across all TB programs, I think we could, and should, first strive to have a ground-breaking impact specifically on MDR and XDR programs — exactly where Rights are most commonly denied and death the most likely outcome. Together, we might be able to organize change.

Although this article by Drs Joseph Amon, Françoise Girard, and Salmaan Keshavjee, and the WHO reply, are very well written and may help to raise awareness of a nasty extreme of MDR TB Control, I see with interest the other comments on the general rights situation of DR-TB patients. I think this is the area that needs to be directly addressed in priority. The ethical/judicial question of forced confinement is just one aspect, whereas the shameful way millions of people with TB are dealt with by most TB programs is where broad discussion and urgent intervention is needed. To speak of 'limitations' is not accurate, the discourse should be about violations of human rights.

(I found this paper on MDR-TB - it's interesting and important.)
Recent attention to multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) has increased discussion and debate over the extent to which limitations to human rights can be justified in the name of public health. In their recent article “Limitations on human rights: Are they justifiable to reduce the burden of TB in the era of MDR- and XDR-TB?” Andrea Boggio et al. argue that involuntary treatment and other compulsory measures for patients with tuberculosis (TB) can be justified as a “last resort” under international human rights law, particularly the Siracusa Principles. Although there is little international disagreement with this position in theory, in practice TB policies that limit individual freedoms and restrict rights are not always determined on an individual basis or as a “last resort.” Particularly in the case of drug-resistant TB, some countries have adopted rights-limiting measures before offering appropriate and proven programmatic interventions that respect human rights.

The UN programme on HIV/Aids says HIV has become the leading cause of death and disease among women of reproductive age worldwide. At the start of a ten-day conference in New York, UNAids launched a five-year action plan addressing the gender issues which put women at risk. One of the key issues, it says, is that up to 70% of women worldwide have been forced to have unprotected sex. UNAids says such violence against women must not be tolerated. "By robbing them of their dignity, we are losing the opportunity to tap half the potential of mankind to achieve the Millennium Development Goals," said Executive Director Michel Sidibe.

Scaling down HIV requires scaling up human rights, testing and treatment
To the participants at the WHO consultation on ART as HIV prevention:
We, the undersigned organizations, are encouraged by emerging evidence that ART may be an effective means of reducing HIV incidence and applaud the attention of WHO and UNAIDS to identifying scientifically sound and innovative ways to accelerate progress toward universal access to HIV prevention, treatment, care and support services. We appreciate that exploration of ART as prevention is being undertaken with that crucial goal in mind, including significant gains in increasing the number of people who know their status and, if positive, have timely access to treatment.

The realities of HIV depend on geography. We can't treat our way out of this epidemic. It's been a bad few months for HIV prevention. We've learned that our best candidates for vaccines and virus-killing microbicides don't work. Now we're ­clutching at another straw: maybe we can treat our way out of the HIV epidemic. At an HIV research meeting this week, boffins from the World Health Organisation revived a mathematical model that shows that if we test everyone in Africa for HIV once a year and give everyone who tests positive expensive drugs right away and for the rest of their lives, we'll wipe out new HIV infections within seven years. That's because HIV is passed on most easily when there's lots of virus in the infected person's blood and body fluids. Antiretroviral medicines cut the "viral load" (the amount of virus in the body), so they make it more difficult to pass on HIV. Ergo, more treatment means fewer new infections.

Anti-retroviral treatments (ARVs) and universal testing could stop the spread of Aids in South Africa within five years, a top scientist says. Dr Brian Williams says the cost of giving the drugs to almost six million HIV-positive patients in the country would be $2-3bn per year. Only about 30% get the life-saving drugs, he said, but early detection and treatment would prevent transmission. This, he said, should be complementary to the search for an Aids vaccine. An effective vaccine, he said, was still a long way away. Dr Williams, a leading figure in the field of HIV research, is based at the South African Centre for Epidemiological Modelling and Analysis (Sacema) in Stellenbosch.

In every country audited by the Global Fund's Office of the Inspector General since 2006, there were numerous instances of PRs not complying with clauses in their grant agreements. A recent report by the OIG points out that the Fund does not have mechanisms in place to monitor and enforce compliance with these clauses. In every country audited by the Global Fund's Office of the Inspector General (OIG) since 2006, there were numerous instances of principal recipients (PRs) not complying with clauses in their grant agreements. The Global Fund does not have mechanisms in place to monitor and enforce compliance with these clauses.

Pleased to see that the recent posts about the UN ESC Rights Committee are becoming more than just words. The comments and ideas are transforming into a campaign for reform of the UN - where it goes I don't know but it's good, so good to see people taking the initiative and not just talking talking blogging blogging. I am ready for action to help this campaign advance.