In honor of World AIDS Day (December 1st), this week’s URB.im conversation focuses on the diverse and innovative ways cities around the world are combating HIV/AIDS in response to their unique local contexts. Globally, the spread of HIV is reversing course: UNAIDS reports that new infections have fallen by 33 percent since 2001. Government agencies and NGOs are tackling HIV/AIDS from all different angles, including interventions targeted at orphaned youth with HIV, outreach to eliminate barriers to testing, as well as initiatives to improve treatment for current patients. Read on to learn about some of the strategies being implemented in Chittagong, Bogotá, Bangalore, Lagos, and Mexico City to raise HIV/AIDS awareness and reduce its prevalence, then join the conversation below.
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লেখিকাঃ রুভানি নাগোদা নিসান্সালা, অনুবাদকঃ নুসরাত ইয়াসমিন
এইচআইভি/এইডসের সার্বিক প্রকোপ বাংলাদেশে এখনো নিম্ন, ১% এরও কম জনসংখ্যা এই রোগে আক্রান্ত হয়। তবে, ঝুঁকিপূর্ণ আচরণের উচ্চ প্রকোপ, যেমন,যৌনকর্মী এবং তাদের ক্লায়েন্টের মধ্যে অরক্ষিত যৌন-সঙ্গম এবং মাদক ব্যবহারকারীদের মধ্যে সুচ ভাগাভাগির সঙ্গে মিলিত হয়ে প্রতিবেশী দেশে (যেমন থাইল্যান্ড হিসাবে) এই ধরনের রোগের সূচকীয় বিস্তার, বাংলাদেশকে ভবিষ্যতে এইচআইভি মহামারীর উচ্চ ঝুঁকিতে রাখে।এই ঝুঁকি উপাদান ছাড়াও, বাংলাদেশের উচ্চ জনসংখ্যার ঘনত্ব, অত্যন্ত নিম্নমানের জীবনযাপন, কম উৎপাদনশীলতা, বেকারত্ব, এবং লিঙ্গ বৈষম্যের উপস্থিতি ও এইচআইভি সংক্রমণে উল্লেখযোগ্য ভূমিকা রাখে।
বাংলাদেশে এইচআইভি/এইডস ১৯৮৯ সালে প্রথম সনাক্ত করা হয়। জাতীয় এইডস এবং এসটিআই প্রোগ্রাম (এনএএসপি) অনুমান মতে, ২০১০ সাল পর্যন্ত ৭৫০০ বাংলাদেশী এইচআইভিতে আক্রান্ত হয়ে বসবাস করছে। এই বৃদ্ধিজনক ঘটনার বিপরীতে, মুষ্টিমেয় এনজিও এইচআইভির বিস্তার থামাতে এবং ইতিমধ্যেই সংক্রমিত যারা তাদের সেবা প্রদানের জন্য এইচআইভি/এইডস শিকার এবং তাদের সম্প্রদায়ের সঙ্গে ঘনিষ্ঠভাবে কাজ করা শুরু করেছে।
১৯৮৯ সাল থেকে বাংলাদেশ ইন্টিগ্রেটেড সোশ্যাল এডভান্সমেন্ট প্রোগ্রাম (বিআইএসএপি), একটি অরাজনৈতিক, অলাভজনক, এবং বেসরকারি উন্নয়ন সংস্থা, চট্টগ্রামে এইচআইভি/এইডস সচেতনতা সৃষ্টিতে উল্লেখযোগ্যভাবে অবদান রাখছে। চট্টগ্রাম দেশের সবচেয়ে জনবহুল শহরগুলোর মধ্যে একটি, যার মোট জনসংখ্যা ৪.৮ মিলিয়ন। বিআইএসএপি প্রাথমিকভাবে চট্টগ্রামে এইচআইভি/এইডস প্রাদুর্ভাব কমাতে সচেতনতা প্রোগ্রাম যেমন, এইচআইভি প্রতিরোধের কৌশলের উপর ফোকাস করে। এখন পর্যন্ত তারা বিশেষ করে ঝুঁকিপ্রবণ নারী ও শিশুদের লক্ষ্য করে তৃণমূল পর্যায়ের সামাজিক সংহতি প্রকল্পে কাজ করেছে। বিআইএসএপি বিশ্বাস করে সমাজের ঝুঁকিপ্রবণ গোষ্ঠীকে আর্থিকভাবে সচ্ছল করার মাধ্যমে দারিদ্র্যের বোঝা এবং এই ধরনের সংক্রমিত রোগের বিস্তার হ্রাস করা সম্ভব।
২০০৮ সালে, আয়ারল্যান্ড দূতাবাসের সঙ্গে অংশীদারিত্বের মাধ্যমে, বিআইএসএপি চট্টগ্রাম শহরে এইচআইভি / এইডস ও অন্যান্য যৌনরোগ প্রতিরোধ একটি প্রধান প্রচারণা চালু করে। সমাজের সদস্য ও স্থানীয় কর্তৃপক্ষকে কিভাবে এইচআইভি ছড়ায় এবং কারা রোগ ছড়ানোর উচ্চ ঝুঁকির মধ্যে আছে ষে সম্পর্কে সচেতন করাই এই তিন বছরের প্রকল্পের মূল লক্ষ্য। এই উদ্দেশ্য বাস্তবায়নের লক্ষ্যে, বিআইএসএপি শিক্ষক, ছাত্র, স্বাস্থ্য পরিসেবা প্রদানকারী, স্থানীয় নেতা, এবং পরিবহন ইউনিয়ন নেতাদের জন্য শিক্ষণীয় ও সচেতনতামূলক প্রোগ্রামের আয়োজন করে। উদাহরণস্বরূপ, ২০০৯ সালে, বিআইএসএপি চট্টগ্রামে বিজ্ঞান ও প্রযুক্তি বিশ্ববিদ্যালয়ে ৫০ ডাক্তারদের জন্য এইচআইভি / এইডস প্রশিক্ষণ কর্মসূচী আয়োজন করে। এই প্রোগ্রামের মূল উদ্দেশ্য হচ্ছে, চিকিৎসকদের শিক্ষিত করে তোলা যেন তারা সামাজিক সচেতনতা সৃষ্টি এবং সামাজিক সংহতি উন্নয়নের মাধ্যমে এসটিআই ঝুঁকিপূর্ণ তরুণ, যারা তথ্য ও চিকিৎসাসেবা থেকে বঞ্চিত তারা যাতে বাধা অতিক্রম পারে, তা নিশ্চিত করা। বর্তমানে, বিআইএসএপি বিশেষভাবে স্থানীয় রিকশা ও সিএনজি (স্বয়ংক্রিয় রিকশা) ড্রাইভার, ছোট ব্যবসায়ী, এবং গার্মেন্টস কারখানা শ্রমিকদের জন্য শিক্ষাগত উদ্যোগ অব্যাহত রেখেছে। এটা যাদের সঙ্গে যারা উভয় ছুঁয়েছে বিআইএসএপি এর এই উদ্যোগ শক্তিশালী কারণ এটি চট্টগ্রামের ঝুঁকি এবং অভিক্ষিপ্তাবস্থা এবং কর্তৃপক্ষের নিকট পৌঁছাতে পেরেছে।
যদিও এইচআইভি / এইডস-এর বোঝা সম্প্রতি বাংলাদেশে বৃদ্ধি পেয়েছে, এর বিস্তারের ঝুঁকি উপাদান উপস্থিতি সত্ত্বেও রোগ এবং মৃত্যুহার ক্ষুদ্র রয়ে যাওয়া প্রমাণ করে যে, এই ধরনের সম্প্রদায় সংহতি উদ্যোগ রোগ সংক্রমণ রোধ করতে সাহায্য করতে পারে। বিআইএসএপি এর এইচআইভি / এইডসে এখনো আক্রান্ত হই নি ব্যক্তিদের মধ্যে সচেতনতা উত্থাপনের এই তৃণমূল কৌশল বিশ্বের অন্যান্য উৎস-দরিদ্র শহরগুলোতেও কার্যকরী হতে পারে।
Photo credit: BISAP
Ruvani Nisansala, Dhaka Community Manager
The overall prevalence of HIV/AIDS is low in Bangladesh, as less than 1 percent of the population is infected. However, the high incidence of risky behaviors, such as unprotected sex between sex workers and their clients, and needle-sharing among drug users, coupled with the exponential spread of the disease in neighboring countries (such as Thailand), puts Bangladesh at high risk for a future HIV epidemic. In addition to these risk factors, the high population density, extremely low living standards, unemployment, and gender inequality present in Bangladesh are underlying contributors to HIV infection.
The first case of HIV/AIDS in Bangladesh was detected in 1989. By 2010, the National AIDS and STI Program (NASP) estimated that 7,500 Bangladeshis were living with HIV. In response to this increase in cases, a handful of NGOs have begun to work closely with HIV/AIDS patients and their communities to halt the spread of HIV and to provide services to those already infected.
The Bangladesh Integrated Social Advancement Program (BISAP), a non-political, non-profit, and non-governmental development organization, has significantly contributed to HIV/AIDS awareness in Chittagong since 1989. Chittagong is the one of the most densely populated cities in the country, with a population of 4.8 million. BISAP primarily aims to reduce HIV/AIDS prevalence in Chittagong through awareness programs, which focus on HIV prevention strategies. To this end, they conduct grassroots-level community mobilization projects, particularly aimed at vulnerable women and children. BISAP operates on the understanding that by empowering those most at risk in the community, the burden of poverty and related disease can be reduced.
In 2008, through a partnership with the Embassy of Ireland, BISAP launched a major campaign to prevent HIV/AIDS and other STIs in Chittagong city. The key goal of this three-year project was to make community members and local authorities aware of how HIV is spread and who is at high risk for contracting it. BISAP conducted educational and awareness events targeted at teachers, students, health service providers, local leaders, and transport union leaders. For example, in 2009, BISAP organized an HIV/AIDS training program for over 50 doctors at the University of Science and Technology in Chittagong. The goal of this event was to educate doctors so that they could better raise community awareness of HIV and promote social mobilization to overcome the barriers that stop young people at risk for STIs from seeking information and treatment. BISAP continues to run such educational initiatives, which often specifically target local rickshaw and CNG (automated rickshaw) drivers, small businessmen, and garment factory workers. BISAP’s initiative is powerful because it reaches both those at risk and those with prominence and authority in Chittagong.
While the burden of HIV/AIDS has recently increased in Bangladesh, the fact that it remains a minor cause of morbidity and mortality despite the presence of risk factors for its spread indicates that such community mobilization initiatives can help prevent disease transmission. BISAP’s grassroots strategy for raising awareness of HIV/AIDS among those not yet infected may be effective in other resource-poor cities around the world.
Photo credit: BISAP
Jorge Bela, Gestor Comunitario de Bogotá
Colombia no ha escapado del castigo del HIV. Según datos del Sistema de Vigilancia Epidemiológica (SIVIGILA), al que deben ser reportados todos los casos identificados, desde el año 1983 hasta el 2011, último del que se disponen datos completos, se conocen 86.990 casos de HIV/Sida, de los cuales 10.676 han fallecido. En Bogotá se han detectado hasta septiembre del 2013 23.330 casos, un 40 por ciento del total a nivel nacional. Sin embargo, es importante destacar que esto se debe a su elevada población, como lo ilustra que en el 2011 se reportaron 8,7 casos por 100.000 habitantes, mientras 8 departamentos superaban 20 casos por 100.000 habitantes, y los dos en cabeza, Barranquilla y Quindío superaban 30.
Se estima que por cada persona diagnosticada con HIV hay al menos otra contagiada pero que desconoce su estatus, lo que probablemente nos aproxima a una dimensión mas real del problema. Pero la falta de diagnóstico es un problema con un alcance mucho mayor que el estadístico: la detección precoz puede mejorar el tratamiento y el pronóstico, y es un instrumento de gran importancia para frenar el contagio. Para la ONG Liga Colombiana de Lucha Contra el SIDA, la falta de infraestructura, laboratorios y asesores, así como la falta de confianza en el sistema de atención a la salud, y, muy especialmente, el temor a la no confidencialidad de los resultados, constituyen los dos factores decisivos a la hora de frenar el acceso a las pruebas de diagnóstico. Ha estos factores hay que sumar la falta de información sobre la enfermedad, y en especial el desconocimiento de que los síntomas pueden tardar años en manifestarse.
Para intentar reducir estos problemas, la Alcaldía de Bogotá, a través de la Secretaría de Salud, ha firmado un convenio con la Liga Colombiana de Lucha contra el Sida, para llevar a cabo el programa Ponte a Prueba con el que buscan que el mayor número posible de personas. Entre sus objetivos están la realización de 10.000 pruebas gratuitas y voluntarias antes de junio de 2014, la certificación de 215 profesionales de la salud para que puedan efectuar las pruebas, y la capacitación de otros 300 profesionales para que puedan servir de asesores. Las acciones de sensibilización rápidas, de unos 20 minutos, darán a conocer a los profesionales que las pruebas son un derecho para todo aquel que tenga interés en realizarlas. Adicionalmente, se ha llegado a acuerdos con locales de ocio asociados con las poblaciones de mayor riesgo para realizar acciones de formación preventiva.
Según Edison Aranguren, de la Liga, el programa por un lado busca identificar y eliminar las barreras que dentro de los centros de salud frenan el acceso de las personas a las pruebas, y por otro realizar campañas de formación no solo entre los grupos de alto riesgo, sino también hacia a todos aquellos que tengan interés, por las razones que sea, en hacerse la prueba. También se contará durante toda la vigencia del proyecto con una compañía de teatro que llevará a cabo actuaciones didácticas gratuitas tanto en espacios públicos como cerrados. Finalmente, se colaborará con otras ONGs para llevar a cabo acciones formativas.
El lanzamiento del programa se va a hacer coincidir con el “Día Mundial de Respuesta ante el VIH,” que se celebra el 1 de diciembre.
Foto: AIDSVaccine
Jorge Bela, Bogotá Community Manager
Colombia has not escaped the devastating consequences of the AIDS epidemic. According to the Sistema de Vigilancia Epidemiológica (Epidemiology Watch Service, SIVIGILA), there have been 86,990 cases of diagnosed HIV/AIDS from 1983 and 2011, and 10,676 fatalities (reporting HIV/AIDS diagnosis to the SIVIGILA is mandatory). Bogotá registered 23,300 cases from 1983 to September 2013, which is 40 percent of the national total. However, this is due more to the large population of the Colombian capital rather than high rates of infection, as the region recorded only 8.7 cases per 100,000 inhabitants, while eight other departments recorded over 20 cases per 100,000 inhabitants, and two of them, Barranquilla and Quindío, reported over 30 cases per 100,000 inhabitants.
It is generally estimated that for each person diagnosed with HIV, there is at least another one for whom the infection goes undetected. This estimate brings us much closer to the problem’s real dimension. But the lack of proper diagnosis goes far beyond a statistical issue: early detection and treatment can significantly improve prognosis, and can also help to significantly reduce transmission. For the NGO Liga Colombiana de Lucha Contra el SIDA, there are several reasons why people who might be infected do not get tested, including the lack of appropriate infrastructure and laboratories, not enough trained advisors to assist during testing, and the lack of trust in the health services, particularly fears that confidentiality will not be properly secured. Lack of information about the condition, and the fact that many people are not aware that symptoms may take many years to appear, are also significant contributing factors. In the last 12 months, the number of diagnosed cases in Bogotá has increased by eight percent, which has given a sense of urgency to the need to increase the number of people tested.
In order to alleviate these problems, the Mayor of Bogotá, through the Secretaría de Salud, has signed an agreement with the Liga Colombiana de Lucha Contra el Sida to create a program known as Ponte a Prueba (which can be translated as “Test Yourself”). Under this program, 10,000 HIV tests will be performed before June 2014, and 215 health professionals will be trained to do the testing. In addition, another 300 health practitioners will be trained as counselors. With short, 20-minute trainings, health practitioners will be advised that under local legislation, HIV testing is a right for anyone who wants it. Information will also be distributed in several establishments associated with vulnerable populations, which have agreed to participate in the program.
For Edison Aranguren, media coordinator at the Liga Colombiana de Lucha Contra el Sida, the program seeks first of all to eliminate barriers within the health centers that keep many potential carriers away from testing. These barriers include lack of sufficient knowledge, not only on the part of health practitioners, but also by personnel such as staff at reception desks. It also seeks to heighten awareness of the benefits of testing in groups considered high-risk, as well as in individuals who can also benefit from testing even if they do not belong to any of those groups. Innovative ways of raising awareness include performances in public spaces by a theatre company, hired for the duration of the program. The Liga will also collaborate with other NGOs in preparing training activities.
Ponte a Prueba will be officially launched on December 1, World Aids Day.
Photo: AIDSVaccine
Carlin Carr, Bangalore Community Manager
The AIDS crisis continues to loom large in India, with more than 2.5 million people infected with HIV. The country has taken steps toward addressing the issue, including launching a National AIDS Control Program. Still, the virus has taken the lives of millions of mothers and fathers, and UNICEF estimates that there could be as many as 4 million children affected in India, including those living with HIV — estimated to number nearly 100,000 — those orphaned by AIDS, and those whose parents are living with HIV.
Critics say that there has been a major lapse in the focus on children in addressing HIV/AIDS. An article in the journal Lancet says that while the National AIDS Control Program places special emphasis on “medical treatment and after care, access to schooling, and adequate nutrition, government interventions for AIDS orphans are conspicuous by their absence in any area other than pediatric ART.” Children often drop out of school to care for their sick family members, and if they are orphaned, they often face severe social stigmas against them.
In the absence of comprehensive government interventions, NGOs and civil society have stepped in to address the needs of, and care for, these children. Milana, a Bangalore-based organization, provides support for people living with HIV in the city, many of whom are children. In the Lancet article, Jyothi Kiran, founder of Milana, says, “Children are the worst affected by the problems that HIV brings with it. They suffer severe stigma and neglect and are very often abandoned. Orphaned children are denied even basic necessities like food and nutrition by their extended families. If they are themselves HIV-positive, the situation becomes worse and their very existence is threatened.”
Milana gives families and children a safe and supportive meeting place to share information, learn how to access proper care, and discuss the difficulties of living with the virus. Classes and sessions on nutrition are also given to help affected clients live healthier lives with the challenges they face. Children who have tested positive for HIV are often malnourished and underweight.
One of the biggest unmet challenges is lack of shelter for AIDS orphans. In Bangalore, another NGO, ACCEPT, runs a 35-bed facility for HIV-positive patients as well as a separate home for orphans. Eighteen children stay at the home with two full-time care staff, a teacher, and other counseling and support. All the children attend the local school — a big step, given that even the schools often discriminate against these children.
While NGOs such as Milana and ACCEPT address one of the most devastating gaps in the fight against AIDS, so much more needs to be done. These children deserve the right to appropriate care as well as to all the necessary services and support so they can live happy and healthy lives free of stigma and judgment.
Photo credit: Lydur Skulason
Olatawura Ladipo-Ajayi, Lagos Community Manager
According to the 2010 sentinel survey of Nigeria, Lagos has an HIV prevalence rate of 5.1 percent. The survey shows that the majority of the state’s HIV presence is in urban areas; the rural prevalence is only 1.3 percent. In light of the high and growing HIV prevalence in Lagos, a number of agencies, private firms and civil society organisations are working hard to spread the word about HIV prevention and to care for patients.
The state runs a program for the city under the Lagos State AIDS Control Agency, which aims to fight prevalence of HIV/AIDS within the city. Its programs include monitoring and evaluation, care and support outreach, counselling and testing services, and information and communication outreach programs regarding the prevention and treatment of HIV. The program has set up over 50 HIV counselling and testing centers (HCTs) around the city of Lagos, making the program available to both private and state-owned health facilities.
The HCT workgroup of the agency assures that HCT centers and partners are visible to the public and that they meet standards for testing and care of HIV-positive people. It works with the Information, Communication and Education (IEC) group of the agency to expand the locations and capacities of the HCT centers around the city. This workgroup also sponsors infomercials regarding tolerance, and sensitizes the public against stigmatisation of HIV-positive people. This year the IEC workgroup aimed to increase HCT intake by 10 percent, to be accomplished through various promotional information sessions about HCT and promoting health care to the public. Earlier this year, the state disclosed that 9,660 of the 102,279 patients examined in the last year tested positive for HIV.
While considerable effort is being made to galvanize the mitigation of HIV prevalence in the city of Lagos through the creation of agencies whose programs work to support civil organisations programs and advocate HIV prevention and care, there is a clear need for increasing efforts towards communication of screening centers and available care services in the city. Considering the population of the state — roughly 17.5 million people— a few hundred thousand people screened is relatively low. Also requiring more attention is the cost of these services: while the state can provide information on where to get services, protect the rights of people living with HIV, and advocate for care and prevention methods, most important is the cost of treatment. Subsidizing this cost will go a long way in providing care, as most people living with the virus cannot afford its care. It is understandable the state may not be able to afford free care for all, but incorporating favorable payment and affordable cost systems will help move the mission forward.
Photo credit: Planet Aid and Skye Bank
María Fernanda Carvallo, Gestor Comunitario de Mexico D.F.
De acuerdo a Juan José Calva, en el artículo “25 años de SIDA en México,” uno de los ejemplos mundiales en los países en desarrollo es Brasil, que ha logrado brindar acceso universal a tratamientos de terapia antirretroviral en su población afectada por el VIH/SIDA. El éxito en esta cobertura ha dependido de tres factores: el compromiso oficial a través de la legislación para asegurar que todos los ciudadanos que lo requieran reciban la terapia, la capacidad del sector público para manufacturar medicamentos, y una enérgica acción de la sociedad civil.
En comparación, en México se identifican grandes desafíos para tratar esta enfermedad. En primer lugar, es necesario lograr la cobertura universal, porque se encuentra un subregistro de personas asintomáticas que viven con VIH/SIDA y esto es un fenómeno recurrente que no permite identificar la cobertura necesaria. El segundo desafío es ofrecer mejor atención médica por profesionales altamente calificados que respondan ante las complicaciones de la enfermedad que abarcan diversas áreas de especialidad. Por último, el tercer reto es buscar medidas eficaces y éticas que garanticen la identificación temprana de las personas contagiadas y asintomáticas. De esta manera, los tratamientos tendrán mayor eficacia en mejorar la calidad de vida de las personas y en la reducción de la propagación del virus.
En este último factor, la Ciudad de México va avanzando en rumbo a la detección oportuna y a la atención universal de las personas que viven con VIH/SIDA. Un ejemplo es CAPPSIDA, una de las organizaciones en la Ciudad de México que brinda diversos servicios para la atención integral y que mantiene y mejora la calidad de vida de las personas con VIH/SIDA. Sus servicios van dirigidos a la prevención, atención y acompañamiento de la enfermedad. Algunos ejemplos son: la aplicación de pruebas rápidas para el diagnóstico de infección por transmisión sexual acompañada de consejerías pre y post-prueba; atención especializada para Infecciones de Transmisión Sexual; taller para padres sobre “La salud sexual y reproductiva”; terapias individuales, familiares y en pareja; atención domiciliaria; atención médica especializada y distribución de condones. Una de sus estrategias innovadoras son las jornadas de prevención que constan de aplicación de pruebas para el diagnóstico en las estaciones del Metro, reclusorios, ferias de salud municipales y visitas a instituciones.
Por su lado, el Colectivo Sol dio origen a la organización Condomóvil, una camioneta móvil que recorre la Ciudad de México y diversas rutas en el país y Centroamérica, para realizar campañas de prevención a través de la realización de pruebas, distribución de preservativos y talleres informativos con la asistencia de promotoras de salud sexual y reproductiva, las cuales realizan sus intervenciones caracterizadas de Dragg Queen. Esta unidad es una estrategia de alcance directo con la población, que ha permitido visitar zonas vulnerables de paso de migrantes en México en las rutas de Centroamérica a Estados Unidos a través del Latin Condom 2013, el cual parte desde la Cd. de México hasta Chile y es patrocinado por Aids Healthcare Foundation (Fundacion del Tratamiento de Salud para el SIDA), Positive Action (Acción Positiva) y Viiv Healthcare.
En este sentido, Condomovil es ejemplo de que un fuerte activismo en el tema atrae la sinergia de diversos actores para lograr un mayor alcance e impacto en las soluciones de las problemáticas sociales.
Foto: Condomovil A.C.
María Fernanda Carvallo, Mexico City Community Manager
In the article “25 Years of AIDS in Mexico,” Juan José Calva takes Brazil as a prime example of a developing country that has been able to provide universal access to antiretroviral therapeutic treatments for the population affected by HIV/AIDS. The success of this medical coverage has depended on three factors: the official legal commitment assuring that all citizens who need treatment will receive it, the capacity of the public sector to manufacture drugs, and a strong civil society.
Compared to Brazil, major challenges remain to treating the disease in Mexico. First, achieving universal coverage is necessary because there is underreporting of asymptomatic people living with HIV/AIDS. This is a common phenomenon that limits proper coverage. The second challenge is to provide better medical care by highly qualified professionals in a wide range of specialties who can respond to the complications of the disease. The third challenge is to find effective and ethical measures to ensure the early identification of infected and asymptomatic people. The treatments will therefore be more effective in improving the quality of life of patients, and in reducing the spread of the virus.
To address this third challenge, Mexico City is taking steps to provide early detection services and healthcare to those living with HIV/AIDS. CAPPSIDA is one of the organizations that provides services for comprehensive care to improve the quality of life of people living with HIV/AIDS. Its services aim at prevention, care, and support for those with the disease. Some examples of services offered include the use of rapid tests to diagnose sexually-transmitted infections accompanied by pre- and post-test counseling; parent workshops on sexual and reproductive health; individual, family, and couple therapy; specialized medical attention; and condom distribution. The innovative prevention strategies include providing diagnostic tests in metro stations, prisons, health fairs, and in local institutions.
The Colectivo Sol established the organization Condomovil, a mobile van that drives through Mexico City and through various routes in Mexico and Central America, to campaign for prevention through testing, condom distribution, and information workshops run by sexual health promoters dressed as drag queens. This unit uses a direct outreach strategy that has been able to target vulnerable areas that migrants cross on their way to the United States from Central America, on the so-called “Ruta Latinoamericana-Latin Condom 2013”. This initiative is sponsored by the AIDS Healthcare Foundation, Positive Action, and Viiv Healthcare.
The example of Condomovil demonstrates that strong activism attracts the synergy of several actors to achieve a meaningful outcome and impact in the solution of social issues.
Photo: Condomovil A.C.
Counter Currents: Experiments in Sustainability in the Cape Town Region (2010): Cape Town is undergoing a growth spurt driven by both public and private sector investments, although there are very few book-length perspectives on the nature and direction of this growth. Addressing the gap in the literature and to shift public ideas and discourses, the book argues that Cape Town’s physical metamorphosis is both unsustainable and culturally questionable. It explores several alternative urban development initiatives or “counter currents” to these processes, toward creating a more inclusive, vibrant, and sustainable city.
African Perspectives – [South] Africa. City, Society, Space, Literature and Architecture (2012): This book is the culmination of a series of discussions that began at the Faculty of Architecture at the Delft University of Technology. It forms the seventh volume of the Delft School of Design Series focusing on particular questions of urbanism and sustainability related to the South African urban context. The book seeks to construct a contemporary critical dialogue of current spatial practices and contemporary design instruments in relation to social, political, and governance structures. Topics within this volume are addressed under headings of ‘Other Urbanisms’, ‘Tradition, Culture and Education’, ‘Urban Design, Civic Action and Agency in South Africa’, and ‘Future Perspectives’.
Rogue Urbanism: Emergent African Cities (2013): Rogue Urbanism is the outcome of a research exploration by the ACC at the University of Cape Town. The ambition of Rogue Urbanism is to produce new and relevant theoretical work on the “specificity” of African urbanism, working between theory, artistic representations of everyday practices, and phenomenology in African cities. The result is a series of exchanges between scholars and artists through textual and photographic essays, which showcase an ensemble of diverse perspectives to approaching and understanding African cities.
As competition for land intensifies in Africa’s rapidly growing towns and cities, planning laws assume a fundamental importance. They determine how urban growth is managed and directed. In most countries outdated, inappropriate and unintegrated laws are exacerbating urban dysfunction. Read more.
With urbanisation becoming a rising topic on the research agenda it is interesting to see how new models for urban planning, and laws, are being constructed. Recently, an event by the African Research Institute raised such ideas. The speakers introduced how the contextual diversity across Africa required exploration, and consultants need to focus on adapting a checklist of rule making, rather than make the rules, in planning Africa’s emerging cities. Current African cities were presented as ‘un-planned’, or in need of a re-visioned approach to become inclusive and equitable. Urban planning was the solution — a means of enabling tax reform, effective management, and equal rights to the city. However, urban planning law needed to be re-written to work for ‘African cities’. Read more.
Caminhar é uma das minhas atividades favoritas. Sempre considero ir até um lugar caminhando – e se a distância for até 5 Km é bem provável que o faça. Essa paixão me motivou – e também minha amiga e colega de Mestrado Tais Lagranha, a escrever um artigo sobre a experiência de caminhar na cidade. O objetivo foi inspirar novos projetos de design no contexto urbano para qualificar espaços públicos e a experiência dos usuários na cidade. Leia mais.
London, England
Walkability and green spaces are not the same thing, but it feels as if they ought to be related somehow. This is because walkability in its most basic form is more than some version of “is possible to walk there”, but also “is possible and pleasant to walk there.” Or is it? One published definition of walkability, for example, is: “The extent to which the built environment is friendly to the presence of people living, shopping, visiting, enjoying or spending time in an area.” (from Walkability Scoping Paper, 2005). All the action is in the word “friendly”, and there’s a lot of unpacking to do. Read more.
Mumbai’s streets are a scary battleground. Rickshaws nudge ahead of beastly city buses; cows wander aimlessly through jams of oversized cars; and pedestrians push across busy intersections in droves, hoping the power in numbers will help them reach the other side safely. Everyone is vulnerable in this situation, but no one more than the thousands of school children who walk to school, often in the streets, in the absence of school buses and navigable sidewalks. Read more or join the discussion.
O fato que Curitiba seja reconhecida como uma cidade verde, acessível e organizada não é um resultado improvisado, mais é resultado de uma cultura sólida de planejamento urbano e da liderança de suas administrações. Apresentamos alguns dos motivos que ajudam a explicar aquela boa reputação de Curitiba especialmente sobre por que é verde, acessível e “humana”; também apresentamos alguns dos desafios que enfrenta na matéria. Leia mais o discutir.
Travel in South Africa, and Southern Africa in general, is highly skewed by economic means. It is dominated by walking (often great distances on poor quality footpaths) and by public transport, primarily among the poor. In Johannesburg, the situation is exacerbated by the marginalisation created by historic spatial planning and the sprawling, low-density nature of the city. According to the City of Johannesburg’s Department of Transport, urbanisation and urban poverty require not only urban transport solutions but also low-cost modes of travel such as cycling. This strategy, known as “Non-Motorised Transport” or NMT, over recent years has gradually become a priority area at National, Provincial and Local Government levels, resulting in the City of Johannesburg’s Framework for NMT in 2009. Read more or join the discussion.
Desde mediados del siglo XX Cali ha experimentado un crecimiento muy significativo. La población que en 1951 era de 284.000 personas, pasó a 1.400.000 en 1991, y a 2.3200.000 en el 2013. El antiguo dentro histórico se ha visto rodeado por una sucesión de hasta 22 comunas en una extensión de 120.000 km2. La creciente necesidad de traslados dentro de la ciudad, y la ausencia de un sistema de transporte masivo, resultaron en un crecimiento explosivo en el número de vehículos circulando por la ciudad, y que en el último censo publicado, con datos del 2011, superaban ya el medio millón. Para acomodar todo este tráfico rodado, los sucesivos gobiernos municipales buscaron ampliar las calzadas y crearon vías rápidas, desplazando al peatón a un segundo lugar. Como consecuencia de todas estas dinámicas, Cali se convirtió en una ciudad sumamente congestionada, difícil y peligrosa para los peatones y ciclistas, y con un considerable déficit de espacios públicos. Leer más o discutir.
Sejak terpilihnya Jokowi sebagai gubernur, Jakarta terus mengalami pembenahan. Jika dalam masalah pendidikan dan kesehatan, pemerintah provinsi melancarkan gebrakannya melalui kartu Jakarta Sehat dan Jakarta Cerdas – kini kota yang menjadi pusat pemerintahan nasional tersebut juga memperbaiki kotanya melalui tata kelola pemerintahan. Reformasi birokrasi, begitu kiranya istilah yang dapat digunakan untuk mencapai Good Governance. Baca lebih lanjut.
Permasalahan kemiskinan merupakan salah satu pekerjaan rumah DKI Jakarta yang perlu segera diselesaikan. Setidaknya, sebanyak 360 ribu warga miskin di Jakarta menunggu perhatian pemerintah agar bisa “dipindahkan” ke dalam kelompok ekonomi yang lebih mapan. Apalagi bila angka ini juga dikaitkan dengan jumlah penduduk yang berada di kelompok ekonomi rentan (vulnerable). Meski secara grafik penduduk di kelompok ini berada di luar garis kemiskinan (red: sekitar garis kemiskinan); namun kenyataannya jumlah mereka jauh lebih banyak, dengan kondisi yang juga memprihatinkan. Baca lebih lanjut.
Jakarta merupakan area perkotaaan terpadat di Indonesia dengan pertumbuhan penduduk yang cepat dan juga signifikan. Kota ini menjadi tempat temu jutaan manusia yang berasal dari penjuru tanah air untuk melakukan perpindahan. Mereka berbondong-bondong menjalani mobilitas spasial ke Jakarta semata-mata untuk memperoleh kemudahan. Di kota ini, hampir semua jenis kebutuhan bisa didapatkan, mulai dari pekerjaan, pendidikan, bisnis, layanan kesehatan, hiburan, dan lain sebagainya. Jakarta menjadi pusat segala aktivitas kehidupan disamping peran utamanya sebagai pusat pemerintahan Republik Indonesia. Baca lebih lanjut.
There has likely been no greater generational divider than the advent of technology. Across the world, youth populations have access to technology — smarter, sharper, and more affordable — that was not available to previous generations. Youth in places like India, for example, can access a vast new world with mobile technology — and a vast new world can access them. The result is that more poverty-alleviation initiatives have focused on catering to youth with innovative uses of technology, particularly focused around education and training initiatives. Learn more.
Public space in Mumbai is a rarity. In fact, a recent report by the Mumbai Metropolitan Region Environment Improvement Society found that just six percent of the city’s land is reserved for open spaces. Within that meager amount, some 60 percent is neither developed nor accessible. The few green parks that do exist are unknown to most residents or have been encroached upon or abandoned by the city. As Neera Punj of CitiSpace said in a New York Times article on the lack of open space in Mumbai, “The biggest challenges to open spaces in the city are misuse, abuse, and neglect.” Learn more.
In a distant northeastern corner of the city, Mumbai discards its waste — refuse, animals, and unwanted people. M-Ward is home to the city’s dump yard, slaughterhouse, and some of the worst squalor in a city of dire extremes. There is one toilet for every 87 people, children attend school at the lowest levels in Mumbai, medical care is nearly non-existent, and 85 percent of its 800,000 residents live in slums. In short, “M-Ward is an extreme example of skewed development in the city.” Learn more.
India’s urban poor newborns have some of the lowest survival rates in the world. There are more than 52,000 babies born to urban poor families every week in India, and that number is expected to double by the end of this decade. Each year, nearly 1.2 million newborns in India die within their first four weeks. The shockingly high number amounts to a quarter of all neonatal deaths worldwide. These newborns face grave risks to survival given the complex circumstances into which they are born. Poor nutrition, inadequate housing, and unsafe water are among the myriad issues that reduce life expectancy and make healthcare solutions more than just medical interventions. Learn more.
Climate change is no longer lurking in some remote or hypothetical future. Cities across the developing world now face the realities of extreme weather caused by global warming, as flooding, heat waves, and severe storms wreak havoc on ill-prepared urban centers. Coastal cities like Mumbai are at such risk, scientists warn, that parts of the city could become completely uninhabitable due to flooding and rising seas. Mumbai was brought to a standstill in 2005, when in just 24 hours nearly three feet of rain fell on the city, leaving more than 1,000 dead — mostly in slum settlements — and 14,000 homes destroyed. Rising temperatures could make such nightmare scenes a more regular — and even more disastrous — occurrence. Learn more.
Stories of community life in Dharavi are often told through the shocking statistics — from life expectancy to labor hazards — that form the backbone of arguments to tear down Mumbai’s “eyesore” and replace it with shining towers of pride. Redevelopment plans rarely try to fathom the social fabric woven among the house-of-cards shanties stacked tightly in this tiny space. Recently, though, more creative platforms have emerged to tell the stories of Mumbai’s best-known slum. There, art provides a powerful means to educate the local community and a creative way to bring the private struggles of the poor to a very visible place. Read and discuss.
Mumbai is a city filled with complexity — economically, socially, religiously, and politically. Nowhere is this more apparent than in Dharavi, the city’s largest informal settlement and one of the world’s most famous. The one-kilometer-squared area houses 600,000 residents who come from all over the country, speaking dozens of different languages and practicing a variety of traditional customs from their home regions. While the diversity of the area is evident, most of the half-million residents have been united on one particular issue: the tenuous future of their community. Read and discuss.
Fourteen tangled lanes in Mumbai’s Kamathipura area house the city’s oldest, and Asia’s largest, prostitution district. An estimated 100,000 female sex workers live in deplorable conditions, with little hope of escape. The back-room brothels expose many of the social ills of Mumbai’s underbelly: human trafficking, prostitution, poverty, and the HIV/AIDS epidemic. Though each woman has her own story, nearly all share backgrounds of extreme poverty, coming from some of the most deprived areas of India and neighboring countries like Bangladesh and Nepal. Read and discuss.