In his typical style, Hancock posted a video talking about the recent data from Public Health England that shows HIV transmissions have been on the decline in England – particularly amongst gay and bisexual men (GBM).

Indeed, without a shred of irony, Hancock stated that an ‘injustice’ was being reversed through the government’s efforts of reducing HIV transmissions by 73%.

Of course, without context, this figure sounds commendable, if not outright positive. The reduction in transmission rates comes from the rise in use of PrEP – a drug which is readily available in Scotland and has been attributed to reducing the risk of transmitting HIV by over 90%. Out of 2,000 people in Scotland, less than 0.25% contracted HIV after taking PrEP. Some experts say it’s 100% effective at stopping HIV transmission.

However, NHS England only started supplying PrEP in limited quantities through clinical trial sites – which now have major waiting lists – in 2017. And this was only after NHS England lost a high court battle regarding the commissioning of PrEP services.

The reason for NHS England’s complacency has been funding. Against my better judgement, I took a look at some of the opinions of Twitter users and regrettably found pockets of people who think that funding a proven HIV drug is somehow morally irresponsible.

It’s easy to see where these comments on social media are borne from. Take a look at the media coverage for topics relating to HIV and you’ll see hordes of articles talking about its impact on the LGBT+ community without any mention of its heterosexual impact.

For instance, many have argued that funding PrEP will reduce the rates of condom use amongst GBM communities. A valid concern, though it must be said that condom use is actually higher for gay and bisexual men compared to heterosexual males.

Sustaining condom use is of course important, but an awareness scheme that educates people about the need to use a condom alongside PrEP usage could be one answer to stemming any worries people have.

And it’s not like heterosexual communities wouldn’t benefit from a fully funded PrEP service. The report states how late stage HIV diagnoses are particularly bad amongst heterosexual men – perhaps the stigma of the disease stops this section of society from getting tested. 

Don’t get me wrong, it’s brilliant that less and less people are getting HIV, but when a clear and proven alternative is readily available, it seems hypocritical of the government to claim they’re doing all they can to stop the disease. In fact, read Hancock’s statement in the media and you’ll be forgiven for thinking that he’s solely responsible for helping tackle the rise in HIV.

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Dementia poses a threat to global health on the same scale as HIV and Aids, the Dutch government has said, warning that the number of people with the condition will not be far off the population of Germany by 2030.

In a speech to the World Dementia Council summit in Japan on Friday, Hugo de Jonge, the Dutch health minister, said dementia was underfunded, misunderstood and overlooked, as HIV and Aids were in their early days.

“Only when it became clear how quickly the epidemic of HIV/Aids was taking hold … taking millions of lives around the globe, did a global awareness emerge,” De Jonge said. “A huge sense of urgency arose … and around 15 years after the epidemic first took hold, an effective treatment had been found.

“Today, we are on the verge of another epidemic; not a disease that attacks our immune systems, but our brain, our memory, our personality, ourselves. Like HIV/Aids in its early days, dementia is a globally underfunded area of medicine.”

He pointed out that if all people believed to have dementia lived in one country, it would be roughly the size of Spain, and cited predictions that by 2030, this hypothetical nation would contain nearly 75 million people. “By then, it should become a member of the G7,” De Jonge said.

“The costs of dementia care by that time are estimated at a staggering $2tn (£1.6tn). No one should be in any doubt: dementia is one of the biggest medical and social challenges we’ll face in the years ahead. In some countries, it already is the main cause of death.”

Prof Philip Scheltens, the director of the Alzheimer Centre at UMC teaching hospital in Amsterdam, has lobbied the Dutch government for serious investment in research.

“The comparison with Aids is often made,” he said. “The urgency is unbelievably huge, as it was at the time, although it might be better to compare it with cancer. There is still no medicine and we need to go back to the drawing board to understand dementia. The worldwide budget must go up.”

The Netherlands will also call for other countries at the G20 health ministers’ meeting this weekend in Okayama, Japan, to participate in a joint research programme. In July next year, Amsterdam will host a strategy summit for 6,000 researchers.

Lenny Shallcross, the executive director of the World Dementia Council, who was at the Japan summit, said: “Dementia is the biggest health challenge of the 21st century.”

Hilary Evans, the chief executive of Alzheimer’s Research UK, said the Aids comparison was appropriate.

“One in three people born today will develop this devastating condition in their lifetime, unless we find new ways to prevent and treat the diseases,” she said.

“We’ve seen what can successfully be achieved in other areas of health by a movement of people coming together to call for change, tackle stigma and drive radical and sustained increases in research funding.

“Thanks to this research investment, today HIV is no longer a terminal condition in many countries, and research has changed so many lives. We want to see the same for dementia and the 50 million people worldwide affected by the condition.”

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PANAJI: A total of 11 acquired immune deficiency syndrome (AIDS) deaths have been reported in the state from January to July this year.

AIDS claimed a total of 31 lives in 2016, while the same number of people succumbed to the deadly disease in 2017. In 2018, the death toll came down to 21.

The latest data available with the Goa State AIDS Control Society (GSACS) reveals that a total of 192 new Human Immunodeficiency Virus (HIV) cases have been reported in the state from January to August this year while there are 14 HIV cases that have reached the stage of AIDS during the same period.

The figures indicate that the HIV cases, which were declining sharply from 959 HIV positive cases in 2009 to 345 in 2015, rose to 390 in 2017. However, the state witnessed a significant decline in 2018 wherein the new HIV cases recorded were 280.

In the year 2016, 30 cases of AIDS were registered followed by 55 cases in 2017. However, with a change in the treatment strategy and by providing antiretroviral therapy (ART) to the affected HIV patients at the very initial stage of the infection as per the guidelines of the World Health Organisation, from the year 2017, the state managed to bring the number of AIDS cases down to 29 in 2018.

The data reveals that 72 per cent of the cases detected in Goa during 2018 were in the age group of 15-49 years. In the same year, out of the total females infected, nearly 26 per cent belonged to the age group 15-34 years whereas around 28 per cent of the infected males were in this age group. Over 41 per cent infected males and about 50 per cent infected females belonged to the age group 35-49 years.

Between the years 1999-2018, sex has been the predominant mode of HIV transmission (83 to 93 per cent) followed by perinatal transmission of HIV (4 to 8 per cent).

According to the GSACS, HIV infection is prevalent in all parts of Goa and majority of the cases were reported in the four coastal talukas of Salcete (12.2 per cent), Mormugao (21.1 per cent), Tiswadi (7.8 per cent) and Bardez (7.8 per cent) in 2018.

To raise awareness, improve knowledge and understanding among the general population about AIDS infection and sexually transmitted diseases, routes of transmission and methods of prevention, the GSACS regularly conducts information, education and communication programmes.

The GSACS also conducts general education programmes on HIV/AIDS for youth organisations, voluntary bodies, government departments, women, high-risk groups, schools, colleges, industrial estate workers, etc.

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The Rajasthan state government has ordered that red ribbon clubs (RRCs) be opened in all 10 government colleges and five private colleges of Bhilwara to create awareness about HIV/AIDS, officials said.

RRCs are set up in colleges, both government and private, to make the youth aware about HIV/AIDS through a host of activities, such as debates, discussions and rallies. There are 12,000 RRCs in India, and 600 in Rajasthan across all 33 districts. Seven of them are in Bhilwara, all in private colleges. Bhilwara is a high-priority district in terms of creating awareness about HIV/AIDS.

Rajasthan State AIDS Control Society (RSACS) joint director Dr Pradeep Chaudhary said Bhilwara has high migrant population because it has textile, dyeing and printing industries. Workers from here also migrate out to Mumbai and Gujarat. “Bhilwara, therefore, is a high-priority district,” he added.

Out of 43,425 people living with AIDS in Rajasthan, 2,357 are in Bhilwara, shows RSACS data.

RSACS wrote to the college education department on September 5 for opening new RRCs in Bhilwara colleges. The letter said that it is important to check the rising rate of HIV/AIDS in the district and to protect and keep the youth away from the infections. “As per the HIV infection rate received from the district it has come to notice that the infection is increasing in the district,” said the letter.

“Under the new action plan of National AIDS Control Organisation (NACO) for 2019-20, the state government has approved red ribbon clubs in 15 colleges of Bhilwara district,” the letter added.

The officials said that since the district has a high in and out migrant population, as per the NACO guidelines, it is important to take preventive measures in the state especially among the youth.

Dr Chaudhary said it has come to notice that the migrants may develop high-risk behaviours which include unprotected intercourse with multiple partners.

“Also the people who inject illegal drugs may be at a high risk. Therefore, as per the NACO guidelines, there needs to be preventive measures in place to check spread of HIV/AIDS infections. Therefore, to keep the youth of Bhilwara away from such infections, we asked the college education department to establish RRCs in government colleges,” he said.

Commissioner of college education department Pradeep Kumar Borad sent a circular to Bhilwara government colleges on Thursday for setting up RRCs at the earliest. “Each college will appoint a nodal officer to run the club,” said Borad.

RSACS officials said that another programme, ‘Migrant Health Campaign’, will run in eight high-risk districts – Bhilwara, Chittorgarh, Dungarpur, Udaipur, Jalore, Pali, Rajsamand and Sirohi.

Officials said the programme will begin on October 14 to create awareness among the migrants in these districts.

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Every state government must appoint at least one ombudsman to hear the pleas of people living with HIV, under the Human Immunodeficiency Virus And Acquired Immune Deficiency Syndrome (Prevention And Control) Act, 2017. But it has been over two years since the Act was formulated that the Maharashtra government has failed to implement it. It could have helped fast track cases and given justice to patients, claimed medicos.

In 2017, the Act made it compulsory for state governments to appoint one or more ombudsman to bring legal accountability, and formulate a mechanism to inquire into the complaints of people living with HIV.

“The ombudsman shall, upon a complaint made by any person, inquire into the violations of the provisions of this Act, in relation to acts of discrimination mentioned in section 3 and providing of healthcare services by any person, in such manner as may be prescribed by the state government,” reads the new law.

As the government has failed to appoint an ombudsman, patients living with HIV have to approach the police for justice, which often takes a longer time. The Act also states that the ombudsman has to pass an order within 30 days of getting a complaint. Also, if the complaint deals with a medical emergency, the ombudsman has to give the verdict within 24 hours.

Talking about the Act, Dr I S Gilada, consultant in HIV/STDs and president, AIDS Society of India (ASI), said, “The Act was formulated to give faster and accurate justice to patients suffering from HIV. But sadly, it hasn’t been implemented in the state. Patients are often harassed and humiliated when people find that they are living with HIV. An independent body like an ombudsman can play a major role in protecting the rights of such patients.”

Dr Padmaja Keskar, project director, Mumbai Districts AIDS Control Society, did not respond to attempts to contact her. According to the Act, the ombudsman will have to submit his/her report about total number and nature of complaints received to the state government every six months. The report must be published on the website of the state ombudsman.

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On August 5, the Lok Sabha passed the Transgender Persons (Protection Of Rights) Bill, however, news about the legislation got buried as it was the same day that the Centre decided to revoke special status for Jammu and Kashmir.

While the nation grappled with the implications of amending Article 370, the transgender community took a closer look at the Bill that was supposed to protect their rights, and found that barely any of their demands had been included.

“The government makes rules without consulting us and it does not make any difference to our lives,” says Payal, a transgender from north Delhi.

“Our problems go much beyond a Bill. Only educated people know about the legislation,” says Shivanya, a transgender who has been associated with the Srijan Foundation for over two years.

Started in August 2008, the foundation, located near Adarsh Nagar metro station, has worked incessantly for the welfare of the transgender community.

Recalling the painful process to get an Aadhaar card that ended up involving the District Magistrate, MLA, a doctor and the Sub-Divisional Magistrate, Shivanya adds: “I know my problems will not be solved. I cannot even use washrooms when I go out in public.”

Fareen, another transgender associated with the foundation, says: “People do not give us jobs and insult us behind our back. What do we do if no one employs us?”

On the day Parliament announced the amendment to Article 370, the Lok Sabha also passed the revised transgender Bill.

The legislation has been criticised by the transgender community for replacing district screening committees with bureaucratic impediments.

They have also highlighted that the provisions against discrimination have no enforceability. The Bill has also attracted disapproval for only providing separate definitions for intersex persons but no provisions for transgenders.

According to the Bill, a transgender is a person whose gender does not match with the one assigned at birth and includes transman or transwoman (whether or not such person has undergone sex reassignment surgery or hormone therapy or laser therapy), person with intersex variations, gender-queer and person having such sociocultural identities as ‘kinner’, ‘hijra’, ‘aravani’ and ‘jogta’.

Online media platform, Feminism in India, posted an elaborate critique highlighting the shortcomings of the Bill in an article published on August 5.

“The Bill has come to Parliament in this context of apathy, neglect and secrecy. A series of betrayal of assurances and a convolution of a law that would do nothing for the trans community and would rather snatch away the bare minimum that existed [sic],” it stated.

“An ideal Bill would be different and have separate provisions for transgender, transsexual and intersex persons,” said Umesh, manager of the foundation.

He claims that transsexual persons lead a very different life compared to a transgender. On the subject, Payal added that intersex persons more often than not align themselves with one of the sexes and “do not possess talents like that of a transgender”.

The new Bill states that transgenders, while obtaining a certificate, “shall be entitled to change the first name on the birth certificate”. This clause has not been well received in the community. “Our families often do not wish to associate with us. The community is our family. We should be allowed to take our guru’s name. They have given us everything,” says Shivanya.

Feminism in India believes that this provision alludes to the “impervious nature of caste in Indian society”.

Talking about Sex Reassignment Surgery (SRS), Payal pointed out that “in Delhi, these surgeries are only cosmetic and can cost up to ₹1 lakh, making them unaffordable”.

She added that a proper surgery is done only in Thailand, citing the example of celebrity Gauri Arora, who underwent a sex change surgery there.

Chandini, a transgender linked with the foundation since its nascent stage, dismisses the Bill saying “there always are problems”. Shivanya, however, still harbours some hope that the Bill could have a positive impact despite its many flaws.

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A law put up by Victoria’s Andrews government could expose women offering intimate services such as pubic waxing or underwear fitting to discrimination complaints if they reject trans women customers who still have penises, veteran human rights lawyer Moira Rayner has warned.

The new law would allow self-declared trans women, who possess a penis and have not undergone any sex-reassignment treatment, to change the sex that appears on their birth certificate, giving them access as women to equal opportunity protection.

Ms Rayner, a former state and federal human rights commissioner, said that, if enacted, the legislation could allow a Down Under version of Canada’s Jessica Yaniv case, in which a trans woman has lodged anti-discrimination complaints against 16 beauticians who did not want to handle her penis and testicles in order to grant her wish for a brazilian wax.

Ms Rayner said a female sole trader could come under pressure from a Yaniv-style action.

The Labor government said the current state law demanding surgery before any change to a birth certificate “sends a painful and false message that there is something wrong with being trans or gender diverse that needs to be ‘fixed’ ”.

Victorian Attorney-General Jill Hennessy said: “Everyone deserves to live their life as they choose, and that includes having a birth certificate that reflects their true identity.”

Critics of the new bill complain of a lack of robust debate, and Ms Rayner said Ms Hennessy “should be asked to make sure she is given proper advice” on its possible unintended effects.

The bill returns to parliament next month.

University of Melbourne philosopher Holly Lawford-Smith agreed a Yaniv-style anti-discrimination complaint would be possible in Victoria — “exclusion from being hired to fit clothing to women in a shop, or from admission to a girls’ school, or to a women’s room in a dormitory, or hospital ward … you name it, if it’s women-only, there could be a case”.

She urged outright rejection of the bill, which makes a statutory declaration sufficient proof of official sex status, and allows birth sex to be changed every 12 months.

“Sex should not be a matter of belief,” Dr Lawford-Smith said. “If progressives want to disincentivise sex-reassignment surgery, they should protect gender expression, or gender identity, or trans status, separately — rather than trying to shoehorn it into sex.”

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NEW DELHI:  The lack of sufficient number of sponsored Sex Reassignment Surgeries (SRS) in state-run hospitals and the delay in getting dates for treatment are the most common issues faced by the transgender community, said the Delhi Commission of Women (DCW).

The cost of sex reassignment surgery for male-to-female in private hospitals vary from around Rs 2 to 5 lakh, while the bill may come anywhere between Rs 4 lakh and Rs 8 lakh for female-to-male sex change surgery. The same surgeries are provided free of cost in government hospitals. The DCW, which had recently set up a Transgender Cell to look into complaints of violence, abuse, harassment and discrimination faced by the community, held a meeting where DCW chief Swati Maliwal learnt about the problems faced by the community.

Maliwal has written to the Delhi government seeking information about hospitals that provide free surgeries and those which charge. The Commission has also sought information on surgeries performed, successful surgeries conducted and pending cases. “Considering the immense stigma and trauma suffered by the community, it is imperative that the choice of sex reassignment is readily available. It is the duty of the state to provide for such basic necessity of a large but marginalised community,” she stated.

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Before Sanjana underwent the male-female sex reassignment surgery (SRS) 20 years ago, resistance from the family and society was not the only obstacle before her — arranging the money required for the surgery seemed like an equally insurmountable task.

Fast forward to now, and the 47-year-old is among the many transgenders whose voices were taken into account by the Delhi Commission for Women, which issued notices to the Centre, pressing for government-sponsored SRS.

“Considering the stigma suffered by the community, it is imperative the choice of sex reassignment is available to those who want to exercise it. It is the duty of the state to provide for such basic necessity of a large but marginalised community,” said Maliwal.

Recalling her plight 20 years ago, Sanjana said, “ No one in my family supported me, so I had to arrange all the money by myself. I took several loans. I have so many friends of different ages that want to undergo surgery but are unable to because it costs Rs 2-3 lakh in private hospitals in Delhi,” said Sanjana. She has been regularly attending meetings of the newly formed Transgender Cell of the DCW.

Maliwal said the notice was issued after she, along with DCW member Promila Gupta, interacted with hundreds of transgender people, in addition to members of the newly formed Transgender Cell of the DCW. Among the issues raised by the community are presence of just a handful of hospitals in Delhi to perform SRS. The officials were further told that the hospital that perform SRS are not efficient.

In the notice, the commission has also asked the government to clarify by July 31 whether the surgery is provided free of cost in Delhi hospitals and requested for details on the number of such surgeries undertaken. The government has also been asked to provide the steps taken to expand the provision of SRS in all government hospitals.

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The alleged discrimination over the admission of a 15-year-old HIV positive boy at a government in Perambalur, has propelled the the Director of School Education into action. ToI reports that director S Kanappan has sought a report on the denial of admission and directed the district Chief Education Officer to ensure that the student is allowed to join the school. 

According to reports, Kumar* studied at this school till Class 8 but shifted to another government-run institution when his mother passed away. He however wanted to return to the first school to continue class 10. When he approached the headmaster, K Kamaraj, he was told to attend classes for a week. The recently appointed headmaster stated that Kumar will be evaluated for a week and then a decision taken on whether he can stay. 

However, TNIE reports that Kamraj discovered that Kumar was HIV positive within days of this decision and forced him to drop out. Following this, on Wednesday, Kumar’s family demanded an explanation from the school. 

This is then resulted in an argument with Kamaraj and the boy’s aunt has told ToIthat her nephew was being discriminated against because he was HIV positive. His father, who is also HIV positive, alleged the same. 

Even the CEO K Arularangan, who they next approached, reportedly gave the headmaster a long rope and offered to admit Kumar to a government school in the neighbouring village. Relatives told TNIE that the CEO claimed other boys in the school might feel ‘uncomfortable’ and that the headmaster was an ‘adamant person’. 

However following media reports, the CEO has now admitted that the headmaster could have handled the situation better and promised admission to the student. The government has promised to look after the boy’s admission as well but his relatives have demanded action against the headmaster. 

But the president of the parent teachers association A Raghavan pointed out that this episode is likely to affect the student. 

“The boy used to travel all the way to Chennai every month to get his tablets from a government hospital instead of procuring it from Perambalur. He didn’t want people in the village and his classmates to know about his ailment but now the entire village knows about it after the episode,” he told ToI. 

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GUWAHATI: Over 5,000 people are detected with heart disease while nearly 50 die of stroke every day in Assam.

Sources told The Sentinel that compilation and analysis of data from medical records available with various government and private hospitals during the last 20 years has revealed that two to five persons become disabled for life because of stroke every hour in the State. Hypertension or high blood pressure, which is one the prime causes for heart disease and stroke, affects over 15,000 people daily in Assam.

“Earlier people above 50 used to suffer from strokes, but now people even in their early 40s suffer from strokes because of sedentary lifestyle,” a senior doctor at Gauhati Medical College & Hospital said.

The doctor warned that the situation would turn worse if a massive awareness drive was not carried out by the government as well as private sectors to educate people about the causes, early symptoms and prevention of such fatal diseases.

According to doctors at government as well as private hospitals, hypertension has greatly increased in recent years. Both modifiable and non-modifiable factors are responsible for causing strokes. Modifiable factors include conditions like hypertension, heart diseases, diabetes, dyslipidemia (high cholesterol level) and other lifestyle related factors like smoking, poor diet and alcohol.

“Modifiable factors like health conditions and lifestyle can be modified to control stroke. Non-modifiable factors like age and gender cannot be modified,” Dr A. Ali, a senior doctor at a leading private said.

“Among modifiable factors hypertension is the leading cause of stroke. It is essential to take proper steps to control it. A healthy lifestyle, daily exercise even in the form of a walk for 30 minutes and consuming low-fat nutritious diet are the keys to control high blood pressure,” Dr Ali said.

Dr Ali said the warning signs of stroke are sudden numbness or weakness in your face, arm or leg, especially on one side, confusion or trouble understanding other people, trouble speaking, trouble seeing with one or both eyes, trouble walking or staying balanced or coordinated, dizziness and severe headache that comes on for no known reason.

“If people can be educated on the causes and symptoms of such diseases, many lives could be saved. For example, if one gets stroke symptoms he or she could immediately swallow an aspirin tablet which helps in preventing blood clotting. Immediate identification of symptoms of stroke helps patients to reach hospitals at the earliest and ensures chances of survival or recovery to more than 80 per cent,” Dr Ali said.

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Ukraine has announced that it is to allocate $16 million to the country’s AIDS response for 2019-20, which will sustain and expand HIV prevention and support services for key populations as well as care and support services for people living with HIV.

The procurement of HIV services for key populations and people living with HIV from suppliers, including non-governmental organizations, will be managed by the Ministry of Health’s Centre for Public Health, using public procurement procedures. The new process will begin in July.

The move is an important part of Ukraine’s transition from donor funding to a nationally funded AIDS response.  

“Ukraine has taken an important step towards moving from international funding to a nationally coordinated policy and ownership,” said Vladimir Kurpita, director of the Centre for Public Health at the Ministry of Health.

The list of services covered by the new policy includes targeted HIV information services and consultations, harm reduction programmes, including needle exchange and distribution, the distribution of condoms and lubricants, HIV testing and screening for tuberculosis. Key populations prioritized include gay men and other men who have sex with men, sex workers, and people who inject drugs. HIV care and support services include strengthening treatment adherence and retention under medical supervision and the involvement of partners of people living with HIV in health care services.

Mr Kurpita promised a smooth transition and said that the government would procure quality-assured services from local non-governmental organizations with the relevant experience and capacity to deliver.

“Nobody who was reached through prevention, support and care services that were funded by external donors should ever be cut off from the transition to government support,” he said.

The head of the All Ukrainian Network of People Living with HIV, 100% Life, Dima Sherembey, encouraged everyone to engage in the process.

“If you are an NGO service provider, engage in bidding; if you are a representative of the donor community in Ukraine, motivate your partners and subcontractors on the ground; and if you have resources and knowledge, provide technical support and assistance to bidders so that they can be successful recipients and implementers of this important wave of government funding,” he said.

UNAIDS country director Roman Gailevich welcomed Ukraine’s commitment to increase domestic funding for the AIDS response.

“We are entering a new era of the national response to HIV in Ukraine,” he said. “We hope Ukraine will not only show that this new model of procurement of HIV services is viable, but that it will also serve as an example to other countries in the region.”

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