The dictator Kagame at UN

The dictator Kagame at UN
Dictators like Kagame who have changed their national constitutions to remain indefinitely on power should not be involved in UN high level and global activities including chairing UN meetings

Why has the UN ignored its own report about the massacres of Hutu refugees in DRC ?

The UN has ignored its own reports, NGOs and media reports about the massacres of hundreds of thousands of Hutu in DRC Congo (estimated to be more than 400,000) by Kagame when he attacked Hutu refugee camps in Eastern DRC in 1996. This barbaric killings and human rights violations were perpetrated by Kagame’s RPF with the approval of UK and USA and with sympathetic understanding and knowledge of UNHCR and international NGOs which were operating in the refugees camps. According to the UN, NGO and media reports between 1993 and 2003 women and girls were raped. Men slaughtered. Refugees killed with machetes and sticks. The attacks of refugees also prevented humanitarian organisations to help many other refugees and were forced to die from cholera and other diseases. Other refugees who tried to return to Rwanda where killed on their way by RFI and did not reach their homes. No media, no UNHCR, no NGO were there to witness these massacres. When Kagame plans to kill, he makes sure no NGO and no media are prevent. Kagame always kills at night.

19 Jan 2014

African studies identify strategies for improving treatment adherence, retention in care

African studies identify strategies for improving treatment adherence, retention in care

Mara Kardas-Nelson
Published: 07 January 2014
Jump to
·         References
Getting people tested for HIV is one thing; getting them onto antiretrovirals (ARVs) another; and retaining them in care for a long period something else entirely. A session at the 17th International Conference on AIDS and STIs in Africa (ICASA) in Cape Town, South Africa, last month, considered which patients are least likely to be retained in care, and innovative strategies to keep patients in care in the long run, using limited resources.
By retrospectively analysing data from patient files between February 2002 and May 2013 at a clinic in Masaka, Uganda, Juan Gozalez-Perez of the AIDS Healthcare Foundation presented findings showing that patients were more likely to die and least likely to be retained in care in their first year after diagnosis; and that men, adolescents aged 15-29, and those with a CD4 under 100 were least likely to be retained.
The study considered 12,475 patients, with 'lost to follow-up' defined as a patient not presenting for care 90 days after the last missed appointment. In the cohort, 2216 patients were lost to follow-up, 971 died, and 1734 were transferred out. Of these, 61.1% were female with a median age of 32.2 years and a median CD4 baseline of 162. Of those lost to follow-up, one-third of patients could not be reached, 11% had died, 24% were transferred out or not documented, 19% were alive and not taking their ARVs, 6% self-referred out, and 4% had their files lost.
The greatest loss to follow-up occurred in the first year of treatment. After one year, retention rates were 82.4%. Thereafter the rate of attrition was relatively consistent, and 63% of patients treated for ten years remained in care. Female patients were more likely to be retained, with 83% of women, versus 81% of men, being retained in their first year, and 63% of women, versus 58% of men, retained at 10 years. People aged 15-19 fared worse, with retention rates of only 43% at five years, compared with 70% in the overall cohort.
While their study did not consider rates of retention of people not yet on ART, Gonzelez-Perez noted that patients in pre-ART care, such as those taking cotrimoxazole, are even harder to retain. "We need to work more on this, it's a completely different situation."
A retrospective analysis of routine patient data in Shiselweni district, Swaziland, presented by Kiran Jobanptura of Médecins Sans Frontières (MSF) Swaziland and Switzerland, found that children and adolescents were less likely to re-suppress when considering viral load for patients in the Shiselweni district of the country, indicating that this group of patients may need tailored adherence and genotyping support.
By considering records of patients who had a first detectable viral load attending Ministry of Health facilities in Shiselweni between May 2012 and July 2013, MSF also found that those with a viral load under 1000 copies/ml, with a CD4 under 350, and who did not receive counselling were more likely to re-suppress viral load after an adherence intervention. In total, 54% of patients observed achieved re-suppression. Surprised by results that counselling did not lead to re-suppression, Jobanptura notes that treatment literacy may offer an explanation. "Just receiving detectable results, without counselling, may enable patients to re-suppress," he said, also noting, "we cannot say that we're doing the counselling in the optimal way." Currently the project is using lay counsellors who receive limited training for counseling, as nurses are in short supply.

Stategies for retention in care

Two South African interventions are looking at how to retain long-term ART patients in care in a way that reduces the time they need to go to and wait at clinic – freeing up their own time, the time of healthcare workers, and decongesting overcrowded clinics.
Anna Grimsrud, a doctoral student at the University of Cape Town, presented data on ART adherence clubs in Gugulethu and Khayelitsha, townships just outside of Cape Town, South Africa. In clinics here, MSF South Africa and the Desmond Tutu HIV Foundation support clubs which allow long-term, stable patients – defined as those in regular clinic care on ART for two years, with a suppressed viral load and without another chronic condition, to meet outside of a clinic setting every two months to collect their medication. They are supported by a community healthcare worker who leads group counselling sessions and takes basic clinical measurements such as weight. Participants only have one clinic visit each year unless health issues arise.
The clubs have been going for several years now, and last year patients were given four-months ART supply over the Christmas holidays, with the intention of limiting patient interruptions. Grimsrud notes that many patients travel from Cape Town to homes in the Eastern Cape and other provinces throughout the holidays, and therefore miss their adherence club appointments.
Grimsrud notes that there was no difference in the percentage of patients falling out of care when given two-month versus four-month supply. Because of the positive results, this year all adherence club patients are receiving a four-month supply over the holidays. "We had to start to trust our patients and believe that a 4-month supply was best for them, and that they would return to us after," she said, further noting, "these findings have led us to ask: what is the optimal visit frequency for stable patients?... The adherence club model is just one model of care. We understand that there's a whole complex package of what can be done for patients. We need more operational research and data."
An in-clinic model has been used at the Ithembalabantu People's Hope Clinic in Durban, South Africa. Here, stable, long-term patients are only seen by a clinician every six months, and pick up their ART every two months in a "fast track wing" at the clinic. Staffed by two healthcare workers who check the patients' vital signs and hand out drugs, the wing is able to support 1200 patients a month.
Terisha Maharaj of the AIDS Healthcare Foundation, which owns the clinic, says the intervention has significantly reduced waiting times. In quarter one of 2013, before the intervention was fully at scale, 33% of people in the clinic waited less than 1-2 hours, with 61% spending 4 hours waiting. In the third quarter of 2013, more than 51% of patients were in and out of the clinic within 1-2 hours, with 47% waiting 2-4 hours. From February 2013, when the intervention was implemented, until May 2013, daily client visits increased from 967 to 1736. Over time, patients in the fast-track wing are picking up their drugs more regularly: in February 2013, just after the intervention was implemented, 13% didn't pick up their drugs, but in November 2013, only 2.2% failed to pick up their drugs.
Maharaj says the intervention is better for all patients – those in the fast-track wing, and in the regular clinic, and healthcare workers. "If you have a large, congested clinic you weigh down your human resources. This is a form of task-shifting, and also helps us to see more critical clients." Maharaj also said that reducing waiting times affords patients more opportunities to pursue work and family life. "We want them to be gainfully employed so that they don't have to rely on aid. When people are working, you achieve the economic benefits of ART. You have an economically productive and sustained population."

References

Gonzelez-Perez J et al. Rural Uganda: above 50% retention after 10 years on ART. 17th International Conference on AIDS and STIs in Africa, Cape Town, 2013, abstract ADS056. 
Jobanputra K et al. Predictors of virological resuppression following enhanced adherence counselling by lay counsellors in Swaziland. 17th International Conference on AIDS and STIs in Africa, Cape Town, 2013, abstract ADS059.
Grimsrud A et al. The impact of circular migration support utilising 4-month versus 2-month ARV refills on ART adherence clubs outcomes. 17th International Conference on AIDS and STIs in Africa, Cape Town, 2013, abstract ADS057.
Maharaj T et al. Strategies to address clinic waiting time and retention in care; lessons from a large ART center in South Africa. 17th International Conference on AIDS and STIs in Africa, Cape Town, 2013, abstract ADS058.
 
 
 
 

No comments:

Post a Comment

Note: only a member of this blog may post a comment.

-“The enemies of Freedom do not argue ; they shout and they shoot.”

The principal key root causes that lead to the Rwandan genocide of 1994 that affected all Rwandan ethnic groups were:

1)The majority Hutu community’s fear of the return of the discriminatory monarchy system that was practiced by the minority Tutsi community against the enslaved majority Hutu community for about 500 years

2)The Hutu community’s fear of Kagame’s guerrilla that committed massacres in the North of the country and other parts of the countries including assassinations of Rwandan politicians.

3) The Rwandan people felt abandoned by the international community ( who was believed to support Kagame’s guerrilla) and then decided to defend themselves with whatever means they had against the advance of Kagame’ guerrilla supported by Ugandan, Tanzanian and Ethiopian armies and other Western powers.

-“The enemies of Freedom do not argue ; they shout and they shoot.”

-“The hate of men will pass, and dictators die, and the power they took from the people will return to the people. And so long as men die, liberty will never perish.”

-“The price good men pay for indifference to public affairs is to be ruled by evil men.”

-“I have loved justice and hated iniquity: therefore I die in exile.”

The Rwanda war of 1990-1994 had multiple dimensions.

The Rwanda war of 1990-1994 had multiple dimensions. Among Kagame’s rebels who were fighting against the Rwandan government, there were foreigners, mainly Ugandan fighters who were hired to kill and rape innocent Rwandan people in Rwanda and refugees in DRC.

READ MORE RECENT NEWS AND OPINIONS

SUMMARY : THE TRAGIC CONSEQUENCES OF THE BRITISH BUDGET SUPPORT AND GEO-STRATEGIC AMBITIONS

United Kingdom's Proxy Wars in Africa: The Case of Rwanda and DR Congo:

The Rwandan genocide and 6,000,000 Congolese and Hutu refugees killed are the culminating point of a long UK’s battle to expand their influence to the African Great Lakes Region. UK supported Kagame’s guerrilla war by providing military support and money. The UK refused to intervene in Rwanda during the genocide to allow Kagame to take power by military means that triggered the genocide. Kagame’s fighters and their families were on the Ugandan payroll paid by UK budget support.


· 4 Heads of State assassinated in the francophone African Great Lakes Region.
· 2,000,000 people died in Hutu and Tutsi genocides in Rwanda, Burundi and RD.Congo.
· 600,000 Hutu refugees killed in R.D.Congo, Uganda, Central African Republic and Rep of Congo.
· 6,000,000 Congolese dead.
· 8,000,000 internal displaced people in Rwanda, Burundi and DR. Congo.
· 500,000 permanent Rwandan and Burundian Hutu refugees, and Congolese refugees around the world.
· English language expansion to Rwanda to replace the French language.
· 20,000 Kagame’s fighters paid salaries from the British Budget Support from 1986 to present.
· £500,000 of British taxpayer’s money paid, so far, to Kagame and his cronies through the budget support, SWAPs, Tutsi-dominated parliament, consultancy, British and Tutsi-owned NGOs.
· Kagame has paid back the British aid received to invade Rwanda and to strengthen his political power by joining the East African Community together with Burundi, joining the Commonwealth, imposing the English Language to Rwandans to replace the French language; helping the British to establish businesses and to access to jobs in Rwanda, and to exploit minerals in D.R.Congo.



Thousands of Hutu murdered by Kagame inside Rwanda, e.g. Kibeho massacres

Thousands of Hutu murdered by Kagame inside Rwanda, e.g. Kibeho massacres
Kagame killed 200,000 Hutus from all regions of the country, the elderly and children who were left by their relatives, the disabled were burned alive. Other thousands of people were killed in several camps of displaced persons including Kibeho camp. All these war crimes remain unpunished.The British news reporters were accompanying Kagame’s fighters on day-by-day basis and witnessed these massacres, but they never reported on this.

Jobs

Download Documents from Amnesty International

25,000 Hutu bodies floated down River Akagera into Lake Victoria in Uganda.

25,000  Hutu bodies  floated down River Akagera into Lake Victoria in Uganda.
The British irrational, extremist, partisan,biased, one-sided media and politicians have disregarded Kagame war crimes e.g. the Kibeho camp massacres, massacres of innocents Hutu refugees in DR. Congo. The British media have been supporting Kagame since he invaded Rwanda by organising the propaganda against the French over the Rwandan genocide, suppressing the truth about the genocide and promoting the impunity of Kagame and his cronies in the African Great Lakes Region. For the British, Rwanda does not need democracy, Rwanda is the African Israel; and Kagame and his guerilla fighters are heroes.The extremist British news reporters including Fergal Keane, Chris Simpson, Chris McGreal, Mark Doyle, etc. continue to hate the Hutus communities and to polarise the Rwandan society.

Kagame political ambitions triggered the genocide.

Kagame  political  ambitions triggered the genocide.
Kagame’s guerrilla war was aimed at accessing to power at any cost. He rejected all attempts and advice that could stop his military adventures including the cease-fire, political negotiations and cohabitation, and UN peacekeeping interventions. He ignored all warnings that could have helped him to manage the war without tragic consequences. Either you supported Kagame’ s wars and you are now his friend, or you were against his wars and you are his enemy. Therefore, Kagame as the Rwandan strong man now, you have to apologise to him for having been against his war and condemned his war crimes, or accept to be labelled as having been involved in the genocide. All key Kagame’s fighters who committed war crimes and crimes against humanity are the ones who hold key positions in Rwandan army and government for the last 15 years. They continue to be supported and advised by the British including Tony Blair, Andrew Mitchell MP, and the British army senior officials.

Aid that kills: The British Budget Support financed Museveni and Kagame’s wars in Rwanda and DRC.

Aid that kills: The British Budget Support  financed Museveni and Kagame’s wars in Rwanda and DRC.
Genocide propaganda and fabrications are used by the so-called British scholars, news reporters and investigative journalists to promote their CVs and to get income out of the genocide through the selling of their books, providing testimonies against the French, access to consultancy contracts from the UN and Kagame, and participation in conferences and lectures in Rwanda, UK and internationally about genocide. Genocide propaganda has become a lucrative business for Kagame and the British. Anyone who condemned or did not support Kagame’s war is now in jail in Rwanda under the gacaca courts system suuported by British tax payer's money, or his/she is on arrest warrant if he/she managed to flee the Kagame’s regime. Others have fled the country and are still fleeing now. Many others Rwandans are being persecuted in their own country. Kagame is waiting indefinitely for the apologies from other players who warn him or who wanted to help to ensure that political negotiations take place between Kagame and the former government he was fighting against. Britain continues to supply foreign aid to Kagame and his cronies with media reports highlighting economic successes of Rwanda. Such reports are flawed and are aimed at misleading the British public to justify the use of British taxpayers’ money. Kagame and his cronies continue to milk British taxpayers’ money under the British budget support. This started from 1986 through the British budget support to Uganda until now.

Dictator Kagame: No remorse for his unwise actions and ambitions that led to the Rwandan genocide.

Dictator Kagame: No remorse for his unwise actions and ambitions that led to the  Rwandan genocide.
No apologies yet to the Rwandan people. The assassination of President Juvenal Habyarimana by Kagame was the only gateway for Kagame to access power in Rwanda. The British media, politicians, and the so-called British scholars took the role of obstructing the search for the truth and justice; and of denying this assassination on behalf of General Kagame. General Paul Kagame has been obliging the whole world to apologise for his mistakes and war crimes. The UK’s way to apologise has been pumping massive aid into Rwanda's crony government and parliement; and supporting Kagame though media campaigns.

Fanatical, partisan, suspicious, childish and fawning relations between UK and Kagame

Fanatical, partisan, suspicious, childish and fawning relations between UK and Kagame
Kagame receives the British massive aid through the budget support, British excessive consultancy, sector wide programmes, the Tutsi-dominated parliament, British and Tutsi-owned NGOs; for political, economic and English language expansion to Rwanda. The British aid to Rwanda is not for all Rwandans. It is for Kagame himself and his Tutsi cronies.

Paul Kagame' actvities as former rebel

Africa

UN News Centre - Africa

The Africa Report - Latest

IRIN - Great Lakes

This blog reports the crimes that remain unpunished and the impunity that has generated a continuous cycle of massacres in many parts of Africa. In many cases, the perpetrators of the crimes seem to have acted in the knowledge that they would not be held to account for their actions.

The need to fight this impunity has become even clearer with the massacres and genocide in many parts of Africa and beyond.

The blog also addresses issues such as Rwanda War Crimes, Rwandan Refugee massacres in Dr Congo, genocide, African leaders’ war crimes and crimes against humanity, Africa war criminals, Africa crimes against humanity, Africa Justice.

-The British relentless and long running battle to become the sole player and gain new grounds of influence in the francophone African Great Lakes Region has led to the expulsion of other traditional players from the region, or strained diplomatic relations between the countries of the region and their traditional friends. These new tensions are even encouraged by the British using a variety of political and economic manoeuvres.

-General Kagame has been echoing the British advice that Rwanda does not need any loan or aid from Rwandan traditional development partners, meaning that British aid is enough to solve all Rwandan problems.

-The British obsession for the English Language expansion has become a tyranny that has led to genocide, war crimes and crimes against humanity, dictatorial regimes, human rights violations, mass killings, destruction of families, communities and cultures, permanent refugees and displaced persons in the African Great Lakes region.


- Rwanda, a country that is run by a corrupt clique of minority-tutsi is governed with institutional discrmination, human rights violations, dictatorship, authoritarianism and autocracy, as everybody would expect.