“I am a double target because I am a woman and I am Hazara”

The Hazara are a Shia minority who face constant persecution in Pakistan. Ruquiya Hashmi - the first female Hazara candidate for the national assembly - faces death threats daily.

Muhammad Ahmed stands at his small kiosk on the street in a working class district of Islamabad, selling tea and making conversation with the punters. He laughs and serves up cup after cup of steaming chai, made in the traditional Pakistani style with boiled milk and cardamom. His cheerful exterior does not give it away, but just a few months ago, Ahmed fled his home in fear for his life.

“I left everything in Quetta – my house, my shop,” he says. “But you cannot put a cost on your life, or your family’s life. It is not safe for us there. Every time my son stepped out to school it was a trauma wondering if he would come home. It is not a good place for us.”

Ahmed is a member of Pakistan’s beleaguered Hazara community. The Hazara are a Persian-speaking Shia minority who emigrated from Afghanistan more than 100 years ago. They have long been the target of a campaign of terror by sectarian Sunni militants. All Shias face a threat, but the Hazara are easily marked out by their distinctive central Asian features.

Around 500,000 Hazara live in Quetta, the capital of Balochistan, a lawless province in Pakistan’s south-west. They have been mercilessly targeted by violent militant groups such as Lashkar-e-Jhangvi, who continue to operate with impunity. According to the Human Rights Watch, 375 Shias died in 2012, with at least 100 of those from the Hazara community. In Quetta, as well as elsewhere in the country, individual Hazara have routinely been shot dead by gunmen on motorbikes, meaning that in certain areas, simply leaving the house is a major risk.

That death toll has already increased dramatically in 2013. On 10 January, two massive suicide bombs ripped through a snooker hall on Alamdar Road, in a predominantly Hazara area of Quetta, killing nearly 100 people. After the bombing, the community refused to bury their dead, sitting in the streets in sub-zero temperatures with the coffins until the government took action. The cabinet of the provincial assembly was dismissed and governor’s rule announced but on 16th February, another huge bomb was detonated near Hazara Town, this time killing 73.

Since then, security has been significantly tightened up in the main Hazara areas of Quetta, but this has had its own negative effects. Ahmed describes how these areas, already ghettoised, have been even more cut off. This affected business for shopkeepers, as people from other communities now avoid the area. University students also face problems getting out of the area to attend their lectures. “Fear was our constant companion, so I have brought my family to Islamabad,” says Ahmed.

He was not alone. Zaman Hussain, head of the central office of the Hazara Democratic Party (HDP) in Quetta, says that many Hazara have fled Balochistan. Many have sought refuge in Australia, America, or the United Kingdom, while others have left behind their property moved to other areas of Pakistan. There is no data to back it up, but he estimates that as many as 100,000 have left their homes.

Despite the grave threat to their lives, those Hazara who remain are refusing to be silenced. Pakistan is gearing up for a general election on Saturday 11 May, the first democratic transition in its history, and this incredibly vulnerable community is determined to take part.

Ruquiya Hashmi, 62, is Quetta’s first ever female candidate for the National Assembly. She is also Hazara. The first few times I call her mobile phone, she doesn’t answer. When we do speak, she is full of apologies: she has been wary of taking calls from unknown numbers because she has been receiving death threats for the last 10 days. “They call my phone and say, ‘don’t participate in this election’. Threatening letters have also been sent to my office, and my workers get calls too,” she says. “I am a double target because I am a woman and I am Hazara.”

She has not been given much state protection. “The government has totally failed to provide us security. They have given us one policeman and he barely knows how to use a gun, so I have my own personal security guards.”

Hashmi, a member of the Pakistan Muslim League (PML-Q), is standing for both the National Assembly and the Provincial Assembly (in which she has already held a seat for some years). Despite the very serious threats, she is undeterred. “I want to stand in this election for the people of Quetta – not just the Hazara. We want peace.”

Inevitably, the terrible law and order situation, and the high threat faced by her community in particular, has impacted on her ability to campaign. Unable to hold any campaign rallies or public meetings, Hashmi has been going door-to-door in the Hazara areas. For the last fortnight, she has been unable even to do that. “I try to go to one or two houses a day, but I cannot move around much. No-one is safe here, but I will raise my voice.”

She is not the only member of the Hazara community to defy the odds and stand in elections. Mohammed Raza, spokesperson of the HDP, says that from his party, there are five candidates standing for seven seats in the Provincial and National Assemblies. “Our party was already on the terrorists’ target list before the election period, so our movement is very restricted,” he says.

On 23 April, a suicide bomber blew up his car at a checkpoint at the entrance to a Hazara district. Six people were killed. Raza, and other HDP members who I speak to, believe that the target was their nearby campaign office. Many party members were gathered there when the bomb went off.

“We had some government security after the January bombing, but four months ago, they took it back,” says Raza. “At the start of April, the intelligence services told us not to even go to our local market because of hit men targeting our community.”
Hussain says that although security has improved since the bombings early this year, the government has stopped short of a targeted operation. “They know where the terrorists are but they are not doing anything about it,” he says.

Individual residents of Hazara areas have been receiving threatening phone calls, and there is the possibility of attacks on polling day. But Hazara politicians and community leaders are confident that people will come out to vote, despite the very real risks. “We want to raise our voices,” says Hussain.

At his kiosk in Islamabad, Ahmed, who has registered for a postal vote, is cautiously optimistic. “We Hazara are Pakistanis too and it is our right to cast our votes. Most of us have lost relatives and friends. When we protested peacefully on the streets, we had the provincial government dismissed. So who knows what we can do at the ballot box?”

Click here to read more from Samira Shackle on the run up to the general election on 11 May and the place of minority communities in Pakistan

National Assembly candidate Ruquiya Hashmi at an election campaign meeting in Quetta. Photograph: Getty Images.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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What male contraceptives are scientists working on? And how soon can we use them?

The male Pill, the male coil, and a medication made from papaya seeds. 

When you think about it, male contraception makes more logical sense than female contraception: to put it bluntly, it’s safer to unload a gun than to shoot at a bullet-proof vest. 

Yet scientists have found it harder – or have been more reluctant – to control a million sperm a day than a single egg a month, and so there are, to date, ten different types of contraception available for women and only two (condoms and vasectomy) currently available for men.

This places a tremendous amount of pressure on women to avoid pregnancy. But it’s not just women calling for more options for their partners: men are demanding more control over their reproductive ability, too. A study published in the journal Human Reproduction indicated that around half of men would be open to using a male contraceptive, while three in eight wanted to know more information first.

Aaron Hamlin, executive director of the Male Contraceptive Initiative, tells me that this may be an underestimate: “[The researchers] asked about a hormonal contraceptive. Had the survey asked about a non-hormonal contraceptive, the acceptability may have been even higher due to the lower likelihood of side effects and potentially faster onset of action.” Hamlin is very clear that “contraception isn’t an either/or equation between men and women”, but its development for men has been slowed by a lack of funding:  

“Drug development is expensive. And if governments and philanthropists are interested in people being able to control their family sizes and futures, then they need to start taking funding for male contraceptive development seriously. The pill for women was funded practically single-handedly by philanthropist Katharine McCormick.  So far, there has been no modern-day Katharine McCormick for the male pill.”

There are, however, many male contraceptive options in the works. So what are they? And when will they be available?

On the way soon

Vasalgel: a sperm barrier

What is it? A hydrogel, which is a network of polymers suspended in a water-based gel. They’re quite flexible; much like the body’s natural tissue.

How does it work? Sperm are produced in the testes and then transported through a duct called the vas deferens. Vasalgel is injected into this duct, where it creates a semi-permeable barrier that allows fluid through, but not sperm. Vasalgel is reversible and works for up to a year, after which sperm flow returns almost immediately, or it can be removed by another injection that simply flushes it out of the system.

How soon can we use it?  Human trials are due to begin at the end of 2016 and men should be able to get the injection by 2018. Rights for the gel are owned by the non-profit organisation Parsemus Foundation which was started by Elaine Lissner, who while at Stanford University became frustrated by the almost-exclusive pressure on women to sort out contraception.

The male Pill

How does it work? This contraceptive is, rather amusingly, known as the “clean-sheets” pill for its ability to prevent fluid ejaculation. The pill relaxes the longitudinal muscles of the vas deferens whilst still allowing contraction of its circular muscles. This stops the sperm from being pushed out, but still allows orgasmic function. The blocking of fluid ejaculate also helps prevent the spread of some STIs.

How soon can we use it? The side effects of the major component of the drug, phenoxybenzamine, currently include dizziness, drowsiness, nasal congestion, stomach upset and tiredness. (It’s worth noting though that these are all common side effects of the pill for women.) However, researchers at King’s College London and University College London have created a prototype that evades these problems and together, they are now seeking funding to start trials of the pill on rams.

Intra Vas Device (IVD): the male coil

What is it? Like an inter-uterine device (IUD), or coil, for women, IVDs are inserted into the men's vas deferens and block sperm from moving down into the ejaculate.

How does it work? There are two types in development. The first, made in the US, involves inserting two sets of tiny, flexible silicone plugs into each vas deferens so that there is a space between the two plugs for the sperm to store. Researchers say the plugs can’t be felt by the patient, and the procedure is effectively like getting a vasectomy, but without cutting your tubes. 

The second, developed in China, is a flexible urethane tube with one end closed which is implanted into each vas deferens. Each tube is lined with a nylon mesh that acts as a sieve to collect sperm. A tiny hole at the closed end of the tube allows fluid, but not sperm to pass through, preventing the build-up of pressure that is often associated with a vasectomy.

Both procedures don’t require a scalpel and take less than twenty minutes to perform under general anesthetic. There are lower levels of side-effects compared to a vasectomy too, and reversal is thought to be a fast, out-patient procedure.

How far is it in development? Both types of IVD are currently undergoing human trials, which means they could be available within the next several years.  

On the horizon

Herbal contraception

What is it? Researchers in Indonesia have managed to isolate the active ingredient in a shrub called Gendarussa to make a contraceptive pill. Local tribesmen and villagers on the island of Papua have been boiling the plant and drinking it as a tea half an hour before sex for generations now.

How does it work? Upon contact with an egg, sperm secrete an enzyme that allows them to break through the surface. Scientists at the Airlangga University in Indonesia have discovered that this plant is able to inhibit this enzyme whilst not affecting sperm count, mobility or sexual pleasure.

How soon can we use it?  The pills have just passed Phase II of clinical trials and following a third, the drug could go onto the market in Indonesia. To reach the UK, however, the pill would need to undergo more clinical trials to meet our health test standards.

Heat, part one 

What is it? We all learned in school biology lessons that the testes rest at a cooler temperature than the rest of the body in order to allow sperm production. Logically then, it follows that increasing the temperature of them will lower if not stop sperm production.

How does it work? Known as “wet heat”, this method was first investigated in 1946 by Dr Marthe Voegeli in India in a study with only nine volunteers. Keeping the testes in a testes-only bath for 45 minutes daily for three weeks resulted in six months of sterility. The tests’ success meant that the practice was used widely during a famine in India and children born after it had no abnormalities. It is easily reversible, can be used multiple times and is non-surgical. However, Voegeli’s conclusions were never taken seriously at the time, in part because she was a woman.

How soon can we use it?  It is now being explored as an option of "booster" contraception for men. Hot packs, heating pads and over-the-counter fertility packs to check sperm count are now becoming available.

Heat, part two

How does it work? The second option, Cryptorchidism, mimics "Cryptorchid", or the condition of undescended testicles. Both the testes and their temperature are raised by a pair of underwear that contains a ring which hoists the testes up close to the canal through which they ascend in Cryptorchid. This increases their temperature through their proximity to the body, and the soft ring of material holding them in place reduces fertility and the sperm’s mobility. This is a reversible method that allows for the return of fertility in twelve to eighteen months.

How soon can we use it?  So far, only short term tests of one to four years have been conducted. Longer-term tests on a larger scale would show whether men who still want to have children in later life can do so after the treatment or not. Scientists are also worried that the treatment could increase the risk of testicular cancer.

Carica Papaya: the seed contraceptive

What is it? Seeds of a carica papaya haven been commonly eaten by men for many a generation in parts of South East Asia.

How soon can we use it? In the first study conducted on this, an extract of papaya seeds was fed to rats, resulting in decreased semen and a one hundred per cent efficacy, but with less than ideal side effects - due to the extract’s toxicity, the rats experienced dramatic weight loss. A chloroform extract of seeds tested on monkeys, however, caused low sperm production, no toxicity, no change in testosterone levels and full recovery within five months. If human trials go as well, we might soon start seeing men on the tube scoffing papaya seeds.

A bit of a pipe dream

Ultrasound

How does it work? Scientists believe ultrasound could be used to reduce men’s fertility temporarily, but they’ve yet to make it work in humans. The Parsemus Foundation funded a study on it on humans at the University of North Carolina and another in Italy on the sterilisation of dogs with ultrasound.

It was found that simply three applications for five minutes each with breaks of 48 minutes rendered dogs permanently sterile. Only one man was tested on and he found that even after exposure to ultrasound for ten days for twenty to thirty minutes, his fertility returned after just a few months.

How soon can we use it? Funding of this method has dried up given the poor results so far, though ultrasound is readily available online for men who wish to try it themselves (a science background is recommended though) and in doctor’s and physical therapist’s offices around the world.

Neem: the tree contraceptive

What is it? The Neem tree is native to India and was used as a male contraceptive in ancient times.

How does it work? For long-term contraception, a small amount of Neem oil injected into the vas deferens seems to provide eight months of contraception with no change in testosterone levels. In the 1980s it was found that Neem leaf tablets provided reversible male infertility but with no change in sperm production or libido in monkeys.

How far is it in development? Further study is still needed. Men in many rural parts of India however, continue to take the herb, apparently with the desired effects.

Adjudin/Gamandazole: derivatives anti-cancer medication 

What is it? Lonidamine, an anticancer medication, was found to cause infertility but at the expense of kidney damage at high doses. Scientists searching for a drug similar to Lonidamine discovered Adjudin and Gamandazole.

How does it work? In New York, a non-profit called the Population Council dedicated to finding more options for male contraception, discovered that Adjudin disrupts the process of sperm maturation in the testes by blocking the hormone that enables this and researchers at the University of Kansas Medical Centre found that Gamandazole does the same by preventing the sperm from developing its head and tail.

How soon can we use it? Adjudin researchers are still trying to find ways to improve its delivery into the body while Gamendazole, although promising, still has to undergo human testing and it will be several years before it’s available at the doctor’s office.