India Struggles with a “Silent Killer”: Depression

INDIA - India is the world's second most populous nation with some 1.4 billion people.  But the ex-British colony that once spawned transformational figures like Mahatma Gandhi has also gained global notoriety for a host of glaring social problems, including poverty and air pollution.

 Less well known is India’s dubious honor as the country with the highest percentage of citizens suffering from depression.

International agencies and the government's own national mental health care body estimate that 10% of India’s population -- or 140 million people -- suffer from moderate-to-severe depression, including 2% that suffer from depression severe enough to require hospitalization.  

But those figures probably underestimate the actual size and scale of the problem because studies show that millions of Indians, especially in rural areas, have never been diagnosed and may not even know that they suffer from mental illness.  

Some analysts estimate that as much as 36% of India suffers from a mental disorder.

India, with its plethora of traditional ethnic, religious and linguistic groups, shares with many other countries a deep resistance to modern psychiatry which has helped reinforce a deep social stigma about mental illness.   

Many families are still ashamed to admit that their parents, children or siblings have a debilitating psychiatric disorder, and may try to hide or disguise it, fearing that it suggests a weakness in their lineage or care practices.  

There is also a pervasive belief, especially in rural areas, that mental illness constitutes a curse or a form of karma that only supernatural intervention can "cure.”

In central and southern India lower-caste Indians still make pilgrimages to Hindu "healing temples" to beseech their favorite deities to assist their mentally ill loved ones.  Some also bring their relatives to local exorcists in the hopes to freeing them of “demon possession."   

Mental health officials that try to discourage these practices – even sending teams of psychologists to the temples -- have often been met with fierce resistance.

Many scholars believe that the real fault for India’s ongoing depression problem lies with the national government which has failed to develop a comprehensive mental health care system and whose medical establishment suffers from the same depression sigma afflicting the general populace.

In 1983, the government established a National Mental Health Program (NMHP) with headquarters in Bangalore.  It soon pledged to devote significant diagnostic and treatment resources to depression and a host of other mental disorders, including schizophrenia.                       

But despite steady increases in annual funding, the NMHP has largely failed to integrate mental health services into India’s primary care system, studies show.  For example, more than 60 per cent of people with mental disorders still access specialized care at poorly funded district hospitals.  In addition, there are extreme regional disparities in the government’s mental healthcare infrastructure. 

India has 443 public mental hospitals, but six states, mainly in the northern and eastern regions with a combined population of 56 million people – a third of the country -- are without a single mental hospital.

Demographic disparities are also wide – and growing.  A 2015 study among 1,000 hospitalized mental health patients found that mental illness and depression rates were much higher among the nation’s poor.  Elderly Indians are especially subject to depression and depression stigma, as are women, especially pregnant women and those suffering from HIV/AIDS.  Some scholars believe female depression rates – and their comparatively high suicide rates – are linked to domestic violence, conflict with relationship partners, and confining social roles.                                          

Some notable bright spots exist in India's approach to depression and mental illness in specific locales and among some social groups.  Sikhs in the northern Punjabi region have long viewed depression as a “natural” part of daily life and prescribe meditation, yoga and other practices to help relieve it.  Muslim Sufis have also approached depression with a greater spirit of acceptance than other groups, analysts say.

And there have been sporadic experiments in mental health outreach led by non-governmental organizations and specially-trained “lay counselors” that have demonstrated what committed professionals can achieve, with sufficient resources, even in the most forbidding of environments. 

But the number of mental health clinicians in India continues to lag far behind most of the world’s nations, including other countries in the developing world.   For example, the median number of psychiatrists in India is only 0.2 per 100,000 population compared to a global median of 1.2 per 100,000 population.

The median figures for psychologists, social workers and nurses working in mental health in India are almost as severe, according to figures compiled by the World health Organization (WHO).

While the national government, egged on by the WHO, continues to debate new grassroots policy initiatives, depression sufferers have begun receiving support from an unlikely source:  Bollywood.

Last October, after several of the nation's top film actors went public with their struggles against depression, a coalition of health advocacy groups, including two of India’s leading psychiatric associations, joined with them to launch the country’s first nationwide mental health awareness campaign. 

The Bollywood initiative has spawned a separate campaign by Indian college students and their counterparts at American universities to raise depression awareness among adolescents and youth.  Photographs of students holding placards with depression awareness messages are disseminated through Instagram, Twitter and other social media sites.

Many scholars believe it’s long overdue that India embraced social marketing techniques of the kind that have proven successful in the West in reducing stigma toward HIV/AIDS and other taboo illnesses, including mental disorders.

But time is running out.  Depression-related suicides are skyrocketing in rural areas, with the highest rates recorded among younger Indians who often lack the family and community supports their parents had.  Without an extraordinary social intervention, coupled with institutional reform experts fear that India’s debilitating depression syndrome could get even worse in the years ahead.

Top EU Diplomat Expelled on Orders from Gambia President Jammeh

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president yahya jammeh on vote campaign, photo courtesy flickr source afp seyllou

BANJUL, Gambia - After being expelled under orders that left Brussels “astonished,” the European Union (EU) representative to Gambia left the country within the 72-hour deadline by boarding a Brussels Airlines flight back to the EU headquarters.

Agnès Guillaud, the European Union's chargée d’affaires in Banjul, received her expulsion orders on Friday, 5 June 2015 and was asked to leave Gambia within a strict 72-hour deadline.

The Gambia’s president, Yahyah Jammeh, expelled the European Union’s top diplomat to his country without "much explanation" an EU spokeswoman said. In response, the EU summoned the Gambian ambassador on Saturday for clarification of the expulsion.

A clear explanation has yet to be released publicly, but what is certain is that the expulsion comes at a time of tension between the EU and the Gambia on issues of international human rights.

Last December the EU blocked over $12 million in aid to the Gambia, citing its “poor human rights record” as justification for the withdrawal. With the expulsion Guillaud, on top of the recent report released by the U.N. Office of the High Commissioner for Human Rights (OHCHR) stating that LGBT people must receive civil rights protections equal to those of any other citizen, to the suppression of free speech, and the unjustified execution of prisoners; Jammeh's government has become for all intents and purposes a dictatorship.

EU officials found the expulsion completely unjustified. "There appears to be no justification for the decision by the Gambian authorities. We are astonished by this announcement which came with no explanations," an EU spokeswoman said.

This expulsion comes in a wave of many anti-western political moves led by Jammeh who in 2013 withdrew his country from the British Commonwealth, with officials saying that the institution represented nothing more than “prolonged colonialism.”

The President has also received international criticism for his claim that he has a herbal remedy that can cure AIDS and his 2012 statements in which he vowed to execute dozens of prisoners in his jails during an “anti-crime” crackdown. In addition to President Jammeh's human rights abuses in terms of due process, he has openly expressed anti-homosexuality rhetoric which is an increasing phenomenon amongst many African leaders.

On 16 May 2015, the White House released a statement by U.S. National Security Advisor Susan Rice, in which she stated that the U.S. stands in solidarity the LGBT community and specifically accused President Jammeh of "unconscionable comments.....which underscore why we must continue to seek a world in which no one lives in fear of violence or persecution because of who they are or whom they love. We condemn his comments, and note these threats come amid an alarming deterioration of the broader human rights situation in The Gambia. We are deeply concerned about credible reports of torture, suspicious disappearances – including of two American citizens - and arbitrary detention at the government's hands." (Source: The White House)

In response to these accusations, Jammeh's office issued the following statement, “The National Security Advisor should instead address racism, abuses and impunity in America where lately innocent and unarmed African-Americans, for example, are being regularly shot by white police officers with impunity rather than prescribe human rights to Gambians who have a long history of civilization.” 

There is no proof that the expulsion had anything to do with Jammeh's hard-line positions dedicated to his so called "preservation of social norms", or the fact that Gambia has increasingly come under fire because of its gross human rights abuses, but it remains to be seen if the government will retract the order for the expulsion of Guillaud, or continue to forge a path that will further encourage sanctions and a decrease in international aid.

Contributing Editor: @AustinBryan
LinkedIn: Austin Drake Bryan

HIV Prevention Pill Now Available

HIV Infected H9 T-Cell, photo by niiaid

ATLANTA, Georgia -- An HIV prevention pill is recommended by the Center for Disease Control (CDC) for those at risk for contracting HIV.  The pill, called pre-exposure prophylaxis (PrEP, brand name Truvada), works by lowering the amount of the virus circulating in a person's bloodstream.  It has already been used as part of some HIV/AIDS treatment plans, but recently has been approved as a prevention method as well.

Each year in the United States, there are 50,000 new cases of HIV. Currently there are about 1.1 million people in the US who are living with HIV.  PrEP trials have shown that users of the pill can reduce their chance of contracting HIV by up to 92%.

Naysayers of the pill claim that with increased availability of Truvada, at-risk individuals will be less careful with other methods. Dissenters also say that it will be hard for people to remember to take the one-a-day pill.

However, supporters say that there is no evidence that the availability of the pill will lead people to neglect other methods of HIV prevention. The CDC says that for various reasons, there are many at-risk people who have not been using condoms or who do not use condoms correctly. PrEP will provide another option for these people.

A three-city initial trial of the pill showed that 98% of subjects involved had some amount of the drug in their system at the end of the trial period -- disproving fears that people will forget to consistently take the daily dosage.

PrEP, which currently costs about $13,000 a year and is covered by most insurance companies, is not recommended for everyone. Its target group is people who are at a substantial risk for HIV, such as someone with a partner who has tested positive for an HIV, people not engaged in mutually monogamous relationships, people who practice anal sex without regular condom use and people who inject drugs under potentially unsanitary conditions.

Currently a vaccine version of PrEP is being tested in monkeys.  This injectable version would have the convenience of giving several months worth of protection.

So You Love Me? Use The FDA HIV Test Kit

Ayanna Nahmias, Editor-in-ChiefLast Modified: 00:57 AM EDT, 16 May 2012

WASHINGTON, DC – David Morgan of Reuters UK first broke the news that the United States Food and Drug Administration (FDA) is considering approval of an over-the-counter home HIV test kit. If approved, the test could further empower sexually active men and women, by arming them with a tool to quickly determine the HIV status of their partner.

However, other than abstinence, there is nothing which can provide 100% protection against contracting the HIV virus that causes AIDS. Although the FDA is considering various drugs and vaccines which could prevent the virus from proliferating if someone is exposed, this is an unlikely near-term solution.

By contrast, the over-the-counter HIV test is on the verge of approval despite criticisms about the potential accuracy of the test as well as the lack of governmental oversight. Similar to a home pregnancy test which is self-administered using urine, the home HIV test kit will use a mouth swab to gather saliva which is then tested. However, in both tests any number of factors could alter the accuracy of the outcome.

Usually, a false negative or positive is the result of administering the test incorrectly, but in the case of pregnancy, a false negative is not a life threatening miscalculation. By contrast, a false negative HIV test could have calamitous effects for the individual and each of their subsequent partners. The current home HIV test kits require a drop of blood which is securely packaged and sent to a certified medical testing lab for analysis and results.

There are many reasons why people would prefer to take the test in private. They are in complete control of the results of the tests and don’t have to inform anyone of their status. In some American states, when an individual is tested by their physician or at a public clinic, if it is determined that they are infected with HIV, the virus that causes AIDS, these results are reported to the State Health Department.

This becomes public knowledge and it is incumbent upon the individual to inform their sexual partners or risk legal action should someone contract the virus because of their duplicity. Additionally, the home HIV test kit would eliminate the ability for the medical and healthcare community to track the results or accurately gauge the rate of increase or decrease of the spread of AIDS.

For at least 30 years AIDS awareness campaigns have been aggressively promoted by public and private health organizations, so this option for self-diagnosis seems to be the next logical step in the fight against this pandemic. The Centers of Disease Control (CDC) estimates that there are about 1 in 5 people with HIV who are sexually active but don't know they are infected.

For information about HIV Counseling and Testing: Facts, Issues, and Answers click here.

The UNAIDS 2008 Report on the Global AIDS Epidemic estimates that young people aged 15 to 24 accounted for 45 percent of all new HIV infections. Today’s youth are much more comfortable discussing birth control options with their partners and this test may further empower them in their self-protective efforts.

Though it is true that some unethical individuals may utilize the test but not disclose the results, or use the test on an unsuspecting sexual partner and disclose an incorrect diagnosis of this individual’s status to the community; the benefits far outweigh these risks.

Many young people have lost their virginity, their health, and their lives to the promise of everlasting love in a moment of passion. Both men and women can recall at least one youthful indiscretion in which they compromised their health through the denial of the possibility that what has happened to other people could happen to them. Almost everyone can recall at least one episode of sweet, cajoling murmurs, “If you loved me you would let me do it…”

To which we can now respond, “I do love you, so in addition to a condom, please use this kit.”

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Waris Dirie | FGM vs Circumcision

SOMALIA - Female Genital Mutilation (FGM) is one of the most egregious women's rights abuses globally. It is a subject that is hard to discuss because of its intimate, sexual and graphic nature.

However, it is precisely because of the lifelong psychological and physical effects this barbaric practice has on its innocent and unwilling victims that it is incumbent upon us to publicize this abuse until it is eradicated.

This issue was first brought to the public's attention by Waris Dirie, Somalian author, activist, and victim of FGM, when she published her memoir titled 'Desert Flower.' The book was subsequently made into a movie in 2009, and Liya Kebede, an Ethiopian supermodel, played Waris Dirie in the heart-wrenching but ultimately a victorious story of survival.

Initially, when we featured a post about this topic, several readers commented about male circumcision and how this is just as barbaric as FGM and should also be classified as a human rights abuse.

Though any type of unwanted genital mutilation is indeed a crime, the significant differences between male circumcision and FGM are as follows:

1. Most boys are circumcised at birth, or in the case of Jews and some Muslims, on the 8th day of life;

2. Men who are circumcised later in life often elect to have this procedure for personal, religious, or health reasons;

3. The surgery is performed in a sterile environment, usually under anesthesia;

4. Male circumcision is usually performed in a non-invasive manner that ultimately results in few if any adverse psychological effects.

By comparison, FGM has more in common and correlates best to physical castration in men.

1. Girls who undergo FGM (aka female circumcision) are forcibly mutilated anywhere between 13 and 15 years of age;

2. The 'procedure' occurs without anesthesia in unsanitary environments;

3. Rusty razor blades, old knives, or shards of glass are used to cut the flesh;

4. The clitoris and the inner and outer labia are torn away;

5. Finally, the wound is crudely stitched together and must be cut open for sex and childbirth.

According to the World Health Organization (WHO), there are benefits to men and boys becoming circumcised, particularly in Sub-Saharan Africa.

"Strong evidence from Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%, and studies have concluded it is cost effective in sub-Saharan Africa. The World Health Organization (WHO) currently recommends circumcision be recognized as an intervention as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV." (Source: WHO)

The effects of FGM are profoundly debilitating and deleterious to women's reproductive health and serve no useful purpose. It is a practice deeply rooted in misogyny, tyranny, and the concept of women as chattel.

Men who have been circumcised can still enjoy a robust sex life filled with numerous encounters, whereas women who have undergone FGM must suffer immense pain to remove the sutures. As one can imagine, sexual intercourse thereafter would be excruciating.

In Europe, between the 16th and 17th centuries, the 'Chastity Belt' was developed to prohibit women from having sexual intercourse. This device was also a contrivance of men desiring to control the sexuality of women in their societies.  A 'Chastity Belt' was infinitely less egregious than FGM but a women's rights violation.

Surprisingly, FGM procedures are rising in Western nations such as the United Kingdom.  It is easy for most people to acquiesce in the face of such a daunting problem occurring halfway across the world. It is also more comfortable to believe that this is an Islamic problem though FGM is not prescribed in the Quran.

It is easiest to effect change in one's backyard. Thus, in Western societies where there are no health reasons to recommend FGM, it is up to the medical establishment and authorities to intervene and halt these procedures.

Misogyny, like rape, is less about the object of abuse, in this case, women, and more about control. The net result of FGM is that it diminishes all women everywhere, even if it hasn't personally impacted your life or those of your friends and family.

Follow Nahmias Cipher Report on Twitter Twitter: @nahmias_report Editor-in-Chief: @ayannanahmias

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Jim Yong Kim, New World Bank President

Ayanna Nahmias, Editor-in-ChiefLast Modified: 00:16 AM EDT, 17 April 2012

WASHINGTON, DC – The World Bank announced today that they selected President Barack Obama’s nominee Jim Yong Kim to serve as its president. Mr. Kim has been selected to replace the out-going president Mr. Robert B. Zoellick.

Mr. Kim, a Korean-American doctor, will be the first leader of the institution who doesn’t come to the post with a financial pedigree. He successfully challenged the Nigerian nominee, Finance Minister Ngozi Okonjo-Iweala, and Colombia's former finance minister and development expert, Jose Antonio Ocampo.

“During the bank’s 68-year history, an American has always headed the institution, while the top job at its sister organization, the International Monetary Fund (IMF), traditionally goes to a European. But emerging economies have recently been contesting that informal arrangement at both the IMF and the World Bank and presenting their own candidates.” (Source: VOA)

Although, some of the Bank’s 187 members have expressed concern that Kim lacks the requisite financial acumen to head the institution, other view his tenure as the director of the World Health Organization and a co-founder of global non-profit Partners in Health as vital to his understanding of the needs of the countries to which the World Bank provides financial and technical assistance.

President Paul Kagame of Rwanda gave a ringing endorsement of Kim, as he reflected upon the dedicated support he provided in helping Rwanda to restore its health system. He went so far as to say, “Kim is a true friend of Africa and well known for his decade of work to support us in developing an efficient health system in Rwanda."

When Kim headed the World Health Organization he successfully implemented a program to increase access to affordable HIV drugs in the developing world.  He was tenacious in his efforts to extend treatment for HIV and AIDS to over 7 million people in developing nations.

Kim’s nomination has become controversial, with opponents angered by the upset of the pro forma appointment of wealthy nominees being selected to lead the institution, and in the process enrich themselves and their cronies; and proponents who believe that it is time for a new selection process and applaud the US' bold move in nominating an unlikely candidate.

It is fitting that President Obama would take the bold step of appointing an outsider to ‘change’ an entrenched culture and reform an organization which has lost sight of its mission to assist countries better support and improve the lives of their citizenry.

Kim will begin his five-year tenure in July 2012.

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The HIV Murders Club

Ayanna Nahmias, Editor-in-ChiefLast Modified: 18:11 PM EDT,  7 March 2012

MASVINGO PROVINCE, Zimbabwe - Shocking news hit the internet six days ago when a 17-year-old HIV positive maid from Mupandawana, Gutu, was sentenced to a 10-year prison term for trying to infect her employer's four-year-old child with the HIV virus.

People deliberately infecting other people with the virus that causes AIDS is a very real problem both here and abroad. Perpetrators engage in this type of immoral behavior for a number of reasons including denial, anger and revenge.

In the case of Pelagia Mureya, originally from Choto Village in Chief Magonde area in Chinhoyi, she is purported to have sought revenge by putting menstrual blood in porridge which she prepared for her employer's child. She alleged that this was done in retaliation for the ill-treatment to which she was subjected at the hands of her employers. (For information on how HIV is transmitted visit the CDC website here.)

On 11 September 2011, the ABC News program 20/20 featured a report about Philippe Padieu, who was convicted in 2009 for infecting several women with HIV between the years 2004 to 2007. Padieu, actively pursued his victims, convinced them that he was HIV negative, psychologically manipulated them into engaging in unprotected sex with him, and then discarded them when his interest waned or the money ran out.

Padieu was subsequently convicted in a Texas court of aggravated assault with a deadly weapon for infecting the women and sentenced to 45-years in prison.

[youtube=http://www.youtube.com/watch?v=Y3PA1x8JJkY] In featuring the Mureya case, we also presented Padieu's case to provide balance, because perpetrators of this crime come from all backgrounds. It was especially important to provide this juxtaposition because many of the comments that readers wrote on other sites that reported on Mureya's case were either outright racist or had racial overtones.

This does not excuse the heinous and disgusting manner with which Mureya tried to infect the infant in her care, and from a moral standpoint, both she and Padieu should be considered monsters.

It is alleged by the court and the parents of the 4-year old child that Mureya laced the porridge she was feeding the child with drops of her infected menstrual blood. Even the most callous individual would be incensed at the thought of such an unclean substance being ingested by an innocent and trusting child who is ill-equipped to protect themselves against harm.

This post does not defend Mureya's behavior, and in fact, we believe that the 10-year prison term to which she was sentenced was not harsh enough when a two-year reduction in sentence for good behavior is factored into the equation. Mureya's case would evoke a visceral response in almost anybody, and thus reports of this case have focused on the sensational aspect rather than the fact that a child was used by an adult to exact vengeance on another adult.

The Nahmias Cipher Report's primary mission is to attempt to bring balance in reporting about people of the Continent and in other Emerging Economies. This is why we chose to present an alternative perspective to this story, one that would make readers realize that the deliberate infection of healthy people with the HIV virus is more prevalent than one would think. To that end, though this case is sensational, it is not an isolated occurrence, nor is this crime a uniquely 'black,' 'African,' or 'impoverished people' problem. If you think you are safe, just ask the women assaulted by Padieu.

Follow Nahmias Cipher Report on Twitter

Twitter: @nahmias_report Editor: @ayannanahmias</address

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