IPPF's HIV Blog

HIV Update: Learning Lessons

2011-12-13T16:36:00.001Z

By Kevin Osborne (IPPF)

Keeping abreast of all the latest developments and ensuring that our organizational response to HIV remains proactive requires that we must carefully and consistently apply the lessons that have been learned. But how do we apply these important lessons across the Federation?

While the HIV epidemic continues to be one of the most challenging health and development issues confronting the world today, it has acted as a catalyst for wider social transformation. From spotlighting the importance of gender equality and the necessity of the human rights aspects of health, to galvanizing the united power of activism – it has been transformative. And the latest data from UNAIDS shows some reason for cautious optimism, with evidence that new HIV infections have fallen to the lowest levels since the peak of the epidemic in 1997.

With new scientific advances, greater recognition of key populations at higher risk, and a tangible commitment to the SRH and HIV linkages agenda, we need to constantly renew our learning and adapt our response. This should be based on honest and critical reflection; systematic strengthening of our organizational capacity to respond to new trends and ensuring that strategic lessons are applied and shared.

As information is updated and new trends slowly emerge, we need to review and utilize this information to better inform our response. And we have a clear role to play in this, as demonstrated by the recent global IPPF survey to determine the involvement of Member Associations (MAs) in national processes of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was conducted in an effort to increase the number of proposals linking sexual and reproductive health and HIV (see page 3). With the news that the Global Fund has both cancelled Round 11 and has adopted a new strategy, this survey could help shape our ongoing engagement.

The end of a calendar year provides an opportunity for reflection on our own response. Recent IPPF data suggests a ten-fold increase globally in the HIV-related services provided by IPPF Member Associations between 2005 and 2010. Even with this impressive increase in service provision, it is important to assess these achievements critically. While the responsibility for this success is not equally shared across all MAs and regions; the framework for increased global action on linking SRH and HIV has been established. One of the key lessons for the Federation is, that by strengthening our collective HIV competency capacity, we have a reservoir of untapped potential to significantly increase our range of HIV-related services along the prevention-to-care continuum, and ones which go beyond just health services.

IPPF’s strategy of concentrated HIV capacity building for a select number of Member Associations, has demonstrated success that must now be shared. Working together on this can only lead to increased cumulative action and answers.

Love
Kevin

Download the December issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+28.htm

Older and Wiser

2011-09-21T12:26:00.000+01:00

By Rachel Albone, HIV and AIDS Policy Advisor (HelpAge International, United Kingdom)

HelpAge International has been implementing programmes addressing the needs of older people affected by HIV for 10 years. As the work of HelpAge initially focussed on mitigating the impact of the epidemic on older carers, Rachel Albone, HIV and AIDS Policy Advisor, gives her perspective on the changing importance for supporting older people living with HIV:

While supporting older carers remains central to HelpAge International’s work, we like others, have been witnessing a shift in the epidemic with an increasing number of older people living with HIV. In 2005, UNAIDS estimated 7 per cent of people living with HIV worldwide were aged 50 and over. While a more up to date global estimate is not available due to the focus on 15-49 year olds, where data is being collected, significant increases are being seen. Recent data shows 14 per cent of people living with HIV in sub-Saharan Africa are aged 50 and over. By 2015 at least 50 per cent of those with HIV in the US will be in this age group.

Despite these increases, the response to HIV remains largely restricted to the 15-49 year age group. Policies and programmes rarely include older people or their need for access to services and support. HelpAge is working in east and southern Africa to raise awareness of the impact of HIV in and on older people and to support older people to live positively.

Prevention, treatment, care and support programmes must be age sensitive and address older people’s specific needs. Our approach is one of peer education and support. We establish peer support groups for older people living with HIV, providing psycho-social support, advice on adherence, and support to mitigate the impact of epidemic. We also recognize the need for improved access to bespoke counselling services for older people. With an ever increasing number of older people living with HIV, what we need and want to see is a policy and programme response that is fully inclusive of the needs of older people.

For more information on HelpAge International: http://www.helpage.org

Article from IPPF HIV Update newsletter - Issue 27: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

David Kato Vision & Voice Award

2011-09-15T18:26:00.000+01:00

By Tewodros Melesse (Director General of IPPF)

On 26 January 2011, the world was deeply shocked and saddened by the news of David Kato’s murder. As the Litigation & Advocacy Officer with Sexual Minorities Uganda (SMUG), David campaigned tirelessly for human rights and particularly for the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people across Africa. And this campaigning work had lead him to work on a number of initiatives with the HIV team at IPPF on a number of occasions.

In recognition of his life and courage, and the continued struggle of LGBTI individuals around the world, I am pleased to announce the call for nominations for the David Kato Vision & Voice Award. IPPF - along with other partners - established this award to be presented annually to an individual who demonstrates courage and outstanding leadership in advocating for the sexual rights of LGBTI individuals, particularly in environments where they face continued rejection, marginalization, isolation and persecution. Nominations for the award can be submitted until 1 November 2011 and are accepted for any individual whose leadership and life work has directly contributed to addressing the sexual rights of LGBTI people in their community. The award recipient will be announced on Human Rights Day (10 December 2011) and will be invited to attend part of the IPPF Donors’ Meeting at the end of January 2012 to collect the award.

If you know someone in your community who is particularly deserving of this award, I strongly encourage you to submit a nomination. For further information and to submit a nomination, please visit the award website: http://www.visionandvoiceaward.com/.

50 Plus – the experiences of older people living with HIV

2011-09-12T13:11:00.001+01:00

By Lisa Power, Policy Director (Terrence Higgins Trust, United Kingdom)

As treatments for HIV improve in both quality and accessibility, people are living longer with the virus. In some countries, provided their HIV is diagnosed in good time and treatment provided, people can now hope to live well into old age. The over 50s is the fastest growing group of people living with HIV. But what quality of life can they look forward to, and how can it be improved?

The UK’s 50 Plus research, done by Terrence Higgins Trust (THT), MBARC and Age UK for the Joseph Rowntree Foundation, surveyed 410 older adults with HIV – one in twenty of all those with HIV in the UK. They found that HIV systematically disadvantages those infected across their lifetime in three key areas – health, financial and social wellbeing. Older people with HIV, as a group, have twice as many other long term conditions (on top of their HIV); they are less economically active and less likely to have savings for old age; they are less likely to have their own home; they have significant levels of social isolation and poor mental health and considerable fears for the future. Not everybody ends up alone and in poverty, by any means, but some do and many others are disadvantaged across their lifetime in ways that could be changed, with proper planning and support.

These findings echo similar research in the US and the Netherlands, which suggests that whatever your health and social care systems, some of these problems will occur. For all these studies, people over 50 with HIV were a mixed group of the long term and more recently diagnosed. Obviously, those diagnosed longer ago - when everyone expected to die and many stopped work and spent their savings, and when many people saw their friends and partners die - had the greatest problems with health, wellbeing and poverty but even those more recently diagnosed were often disadvantaged in comparison with their peers.

With HIV, however well you start off, you may encounter stigma and ill-health that leads to broken relationships, lessens employment opportunities and damages your ability to provide for the future. At THT, we believe this means we need to change our services, not only to support those currently over 50 who are in greatest need, but also to work with younger people and those more recently diagnosed to minimise the problems they may face as they age with HIV. We need to help people stay in work or get back to it; manage their money and plan for the future; guard against social isolation and poor mental health; live healthy lives to reduce co-morbidities and improve quality of life.

One of the important aspects of this research is that it was undertaken at every stage with the close involvement of older people with HIV; on the advisory panel, as community researchers, as writers and as communicators of the findings. In the West, our elders are often neglected and survey respondents reported experiencing as much stigma around age as HIV. But older people with HIV are an enormous resource for the future.

The full report of A national study of ageing and HIV (50 Plus) is available at: http://www.tht.org.uk/binarylibrary/peoplesexperienceofhiv/50-plus-final-report.pdf

Article from IPPF HIV Update newsletter - Issue 27: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

HIV Update: Ageing with HIV

2011-09-02T15:09:00.001+01:00

By Kevin Osborne (IPPF)

With increasing availability and options of effective antiretroviral treatment, people living with HIV are living longer and the population of people who are HIV positive is steadily growing older. Ageing is an inevitable process for us all, but what are the consequences of long-term HIV infection and treatment?

The face of HIV has altered dramatically over the past decade. A combination of earlier diagnosis, ART treatment adherence, and awareness of healthier lifestyle options translates into a drastically increased life expectancy for many people living with HIV. Globally, many people have now been living with the virus for over twenty years – some because they were born with HIV and others because they are long-term survivors of the epidemic. This unchartered territory raises many new and important issues about how long-term HIV infection and treatment affects the natural ageing process.

As people living with HIV grow older, they will have a unique set of clinical and psycho-social needs that need to be addressed in a more sustained and systematic manner. In the United Kingdom a recent study specifically investigated the needs, concerns and characteristics of people aged 50 and over who are living with HIV. Beyond health-related issues, a number of other challenges including financial and social wellbeing should increasingly be taken into consideration.

Many questions related to how older age affects the natural progression of HIV infection and the body’s response to long term treatment still remain unanswered. Clinicians and health practitioners are increasingly confronted by additional issues - from managing the expected and routine issues facing the over 50s living with HIV to dealing with some of the consequences of long-term ART use and resistance. It is clear that both providers and clients are entering a new phase in holistic health for people living with HIV.

As more people are living longer and healthier lives with HIV, IPPF Member Associations will have to find creative and innovative ways of meeting their sexual and reproductive health needs - from providing additional psycho-social support; strengthened integration with other health and care services for older adults to forging new partnerships with organizations specifically working with older adults.

Download the September issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

New release: Love, Life and HIV Toolkit

2011-08-22T09:38:00.000+01:00

The Love, Life and HIV Toolkit – developed by IPPF, UNFPA, Young Positives and the Global Coalition on Women and AIDS – aims to develop a greater understanding of some of the issues facing young people living with HIV today. It is available in English, French and Spanish and includes:

A 28 minute film. Young people living with HIV from the Dominican Republic, India, Mexico, Russia, South Africa and Swaziland talk about a host of issues that affect their lives. The film is split into six themes: 1. facing stigma; 2. accessing services; 3. finding love; 4. having a family; 5. being supported; and 6. getting involved.
A session plan to accompany each of the films themes. Each session includes adaptable discussion starters and activities, take home points summarizing the session, and links to further resources to enable users to maximize the potential learning in the stories shared in the film.
Handouts with further information on each of the themes. These can be used by educators and trainers when preparing to lead sessions or can be given to participants as resource materials.

Limited hard copies of the film can be ordered from info@ippf.org. The resource pack is available from http://bit.ly/lovelifehiv.

World Hepatitis Day

2011-07-28T10:03:00.052+01:00

Today, the 28th of July, is World Hepatitis Day to recognize the need to further raise awareness of chronic hepatitis B and C around the globe and to advocate for policy change to improve health outcomes for people affected by viral hepatitis. Together, hepatitis B and C affect one in 12 people worldwide and approximately one million people die from these viruses every year (World Health Organization).

The 2011 theme for World Hepatitis Day is ‘This is hepatitis... Know it. Confront it. Hepatitis affects everyone, everywhere.’ This inclusive theme emphasizes the scale of viral hepatitis and helps combat the stigma often associated with hepatitis B and C by conveying the fact that these viruses do not discriminate.

Hepatitis simply means inflammation of the liver and can be caused by a wide range of things. One of the most common causes of chronic (long-term) hepatitis is viral infection, which can be transmitted sexually. Hepatitis B and C are two such viruses and approximately 500 million people around the world are currently infected with chronic hepatitis B or C. Unlike hepatitis C, hepatitis B can be prevented through effective vaccination.

As viral hepatitis is transmitted in similar ways as HIV, coinfection is a growing concern. In people living with HIV, infection with viral hepatitis can lead to more serious complications, such as more rapid liver damage. Coinfection can also complicate the treatment of HIV infection. It is important for people living with HIV to be tested for viral hepatitis and take steps to prevent infection.

Hepatitis is a global problem and by working together we can deliver change in prevention and access to testing and treatment.

For more information about HIV and hepatitis, including prevention, diagnosis and treatment: http://www.aidsmap.com/Hepatitis-and-HIV/cat/1508/

For more information about World Hepatitis Day, including campaign materials in different languages: http://www.worldhepatitisalliance.org/Home.aspx

UN HLM on AIDS: IPPF Key Message 04

2011-06-09T17:31:00.000+01:00

Renew the political commitment to HIV

Recognizing the long-term benefits that have accrued from investing in HIV programmes, governments, international donors and the private sector need to re- commit to meeting the international targets, goals and accountability. Nuanced political commitment to HIV for this new millennium needs to be prioritized.

Rationale: In the last decade the HIV response has been transformed by increased political commitment and a dramatic increase in resources. Progress has been made towards the Millennium Development Goal (MDG) target for HIV, which is to have halted and begun to reverse the epidemic by 2015. At a global level, the epidemic is stabilizing. According to the 2010 UNAIDS Global Report, the number of new HIV infections declined by 16 per cent from an estimated 3.1 million in 2001 to 2.6 million in 2009. Improved access to services to prevent mother-to-child transmission has reduced the number of infants infected with HIV from 500,000 in 2001 to 370,000 in 2009. New interventions and emerging technologies, including male circumcision and pre-exposure prophylaxis, have the potential to further enhance HIV prevention efforts, if implemented at sufficient scale.

Current gaps to address:

Close the funding gap: The funding gap - the difference in the amount of money needed and the amount actually allocated - was $7.7 billion in 2009, compared to $6.5 billion in 2008. Funding is a shared responsibility. Donor and recipient countries must meet their commitments and be held accountable. International donors should ensure full funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and develop additional innovative financing mechanisms to ensure the long-term sustainability of the response.
Continue to scale up access to treatment: An estimated 10 million people who need treatment do not have access to ART. In 20 African countries, more than 80 per cent of treatment depends on donor funding. A recent survey showed that eight countries already face shortages of antiretroviral drugs and a further 22 countries - accounting for more than 60 per cent of people on treatment worldwide - expected an adverse impact on treatment programmes in the future.
Commit to a sustainable long-term response: HIV continues to be an exceptional epidemic and thus require an exceptional response. It is still a major threat to health and development and an effective response to HIV is critical to achieving all of the other MDGs. HIV spending is a down payment on a healthy future, yielding immense benefits for future generations, reducing human suffering and averting the large economic and development costs associated with the epidemic.
Plug the condom gap: Condoms are a critical element of any HIV prevention strategy and are the only dual protection method available for the prevention of HIV, STIs and unplanned pregnancies. Yet, the gap between the number of condoms needed and the number of condoms available for HIV prevention and family planning is high.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

UN HLM on AIDS: IPPF Key Message 03

2011-06-09T09:55:00.007+01:00

Uphold the rights of people living with HIV

HIV prevention programmes need to be ‘fit for purpose’ by ensuring they are rights-based, evidence-informed and support people living with HIV to live longer and healthier lives. ‘Treatment as Prevention’ should become an integral part of the HIV response and efforts need to be scaled up to increase access to HIV testing, adherence counselling and treatment.

Rationale: Increasing the impact of prevention programmes is essential to preserve the long-term sustainability of treatment initiatives and prevent the epidemic from further undermining the gains made across the broader development agenda. ‘Traditional’ prevention programmes have mostly targeted those people who are HIV negative and have promoted a wide range of behaviour change strategies. While this is crucial, they have largely ignored both the needs and important role of people who are living with HIV. The ‘Positive Health Dignity and Prevention’ movement has highlighted the need to promote an approach that goes beyond health related services and includes other interventions to deal with issues of disclosure, sexuality, drug use, and laws – all within a human rights approach. Key approaches in a ‘positive prevention’ strategy include protecting their sexual and reproductive health and avoiding other sexually transmitted infections; delaying HIV disease progression; and promoting shared responsibility to protect their sexual health and reduce the risk of HIV transmission.

Current gaps to address:

Promote positive prevention: PLHIV are a diverse group and have the right to live enjoyable and fulfilling sexual and reproductive health lives. Resources should be utilized to address the prevention needs of PLHIV and promote ‘treatment as prevention’ options.
End the criminalization of HIV transmission: There are over 60 countries that have HIV-specific criminal laws. The criminalization of HIV transmission or exposure weakens HIV prevention efforts and marginalizes people who are already vulnerable to HIV infection. Awareness needs to be raised about issues relating to the criminalization of HIV transmission or exposure.
Invest in evidence-informed programmes: The epidemic’s continued expansion stems from the frequent failure to apply proven prevention strategies tailored to the current realities of local epidemics, as well as the chronic and continuing underinvestment in evidence-informed prevention strategies. Funding needs to be increased for evidence-informed and rights-based prevention strategies that promote and support long-term social change to facilitate HIV prevention or that address the societal or structural factors that increase vulnerability.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

UN HLM on AIDS: IPPF Key Message 02

2011-06-08T09:54:00.002+01:00

Mention the ‘unmentionables’

Create enabling environments to reduce stigma and discrimination and protect human rights through the removal of punitive laws that criminalize key populations that are particularly vulnerable to HIV, such as sex workers, men who have sex with men, transgender people and people who use drugs. Without specifically mentioning the groups of people that are particularly vulnerable to HIV infection, they are all too often ignored or sidelined in HIV responses.

Rationale: All too often human rights is seen as a ‘soft option’ that is difficult to measure. However, experience shows that human rights need to underpin a response to HIV. Stigma and discrimination continues to limit access to essential services for people living with HIV and individuals particularly vulnerable to infection — young women and girls, men who have sex with men, transgender people, people who use drugs and sex workers. Multiple legal and socio-cultural barriers continue to prevent or discourage these groups from accessing and using healthcare services. Being among the most marginalized and discriminated against populations in society, they are often ‘hidden’ and are rarely involved in the formation and implementation of HIV policies, programmes and services to meet their specific needs. Any sustainable response to HIV must remove these punitive laws and address the other social drivers of the epidemic.

Current gaps to address:

Increase access to services for MSM: Globally, MSM are often denied access to basic health services due to the criminalization of sex between men, homophobia amongst healthcare workers and isolation due to stigma and discrimination. Recent studies have found high levels of HIV prevalence among men who have sex with men in Africa, ranging from 10 per cent to 43 per cent. It is imperative that restrictive laws and policies are repealed and healthcare workers are sensitized so access to vital SRH and HIV information and services for MSM can be improved.
Repeal punitive discriminatory laws and policies: Nearly three decades after the epidemic was first identified, stigma, discrimination, and punitive laws and policies continue to undermine efforts to prevent new infections. Key populations are reluctant to seek services in contexts where their behaviour is against the law. Such punitive and coercive policies are both counterproductive from a public health perspective and antithetical to the human rights basis of effective prevention.
Scale up gender transformative programmes: Gender transformative programmes aim to change gender norms and promote relationships between men and women that are fair and just. A ‘gender argument’ has often been used to establish and enhance women’s participation and rights but some groups of women, such as women who use drugs and female sex workers, are often overlooked. Programmes to support these women and girls who are particularly vulnerable to HIV also need to also be scaled up.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

UN HLM on AIDS: IPPF Key Message 01

2011-06-07T12:05:00.004+01:00

Maximize existing synergies between HIV and associated responses to improve the lives of young women and girls

Scale up the linking of sexual and reproductive health and HIV, using prevention of mother to child programmes as a key entry point to strengthen maternal, newborn and child health services and expand access to a wider range of sexual and reproductive health services.

Rationale: The majority of HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding; and the risk of HIV transmission and acquisition can be further increased due to the presence of certain sexually transmitted infections (STIs). Prevention of mother to child transmission (PMTCT) is a key proven entry point for strengthening both HIV services and maternal, newborn and child health (MNCH) services. However, these two programmes frequently tend to run in parallel, missing the opportunities to ensure more women and their partners have access to a wide range of sexual and reproductive and HIV-related services, including family planning and unintended pregnancies among HIV positive women.

Current gaps to address:

Make better use of proven strategies: Stakeholders in the response must significantly intensify their efforts to prevent new infections by making better use of proven strategies. Stakeholders should make a solid commitment to ending paediatric HIV transmission; promoting early infant diagnosis; and optimising the health of mothers living with HIV and their families.
Optimize integrated services: To ensure that HIV services are effective and properly delivered within an MNCH setting, there is a need to better understand how to ensure that services can be effectively integrated in resource-poor settings and reach out to poor and marginalized women, especially those living in rural and remote areas.
Putting women at the centre of PMTCT programmes: Women need to be put at the centre of any PMTCT programme by promoting primary prevention among women of reproductive age and encouraging women to know their HIV status. There also needs to be increased attention to the contraceptive methods and family planning options offered to women living with HIV.
Involve male partners: While most interventions have been focusing on ensuring women access to health care during the time of pregnancy, more needs to be been done to involve their male partners in health-related decisions. Increasing male involvement in PMTCT services may increase the chances of male partners practicing safer sex with, and providing support to their female partner when they learn their HIV status.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

HIV Update: HIV. Now more than ever.

2011-06-02T11:32:00.000+01:00

By Kevin Osborne (IPPF)

Thirty years since the United States Centers for Disease Control issued its first warning about a rare form of pneumonia among a small group of young gay men, ten years since the landmark United Nations General Assembly Special Session on HIV and AIDS, and five years since the political commitments towards universal access to prevention treatment, care and support: the AIDS response is at a crossroads.

Leaders from government and civil society will gather at the 2011 UN General Assembly High Level Meeting on AIDS in New York from the 8-10 June to review the progress and chart the future course of the global AIDS response. Efforts made over the past decade are now having an impact: global and country action is making a tangible difference as universal access to HIV prevention, treatment, care and support has increased. While not all the inspirational targets have been met, this trend is an encouraging sign of what collective and focused action can accomplish.

However, ‘AIDS fatigue’ is becoming a worrying reality. In particular, political and financial commitment is stalling and many of the hard-won gains are under serious threat. It is vital that the 2011 High Level Meeting on AIDS re-commits to overcoming the remaining barriers to an effective country-owned, sustainable, and accountable HIV response. Now, more than ever, a strengthened response to HIV should not falter. Intensified action to address the prevention and treatment needs of pregnant mothers and their children (including early infant diagnosis) should be prioritized. Linking resources to the realities of the epidemic to meet the needs of men who have sex with men (MSM), sex workers and their clients, and people who use drugs should be guaranteed. Advocacy action on creating an enabling policy environment that supports HIV responses should be promoted and, in light of the ‘game-changing’ results from the recent ‘treatment as prevention’ trial, prevention options need to be scaled-up. Until gaps like these are adequately addressed, much work remains to be done in a unique partnership between governments, civil society and the private sector.

In advance of this meeting, it is important to reflect upon the current gaps and our niche within the global response to HIV. This month's issue of HIV Update highlights the four key messages that IPPF delegates at the High Level Meeting will be promoting in our work with and in country delegation teams. Currently, the IPPF Member Associations in the following countries have already been invited to be part of their official country delegation teams: Belgium, Belize, Djibouti, Mali, Mauritania, Rwanda, Swaziland and Sweden. Our continued focus on the human rights approaches inherent in all prevention, treatment and care responses underpins all aspects of the epidemic and remains a much needed voice in the global arena. Words matter and actions count. While politics may eventually dictate the final negotiated outcome of the High Level Meeting; it is imperative that we raise our voices and strategically strengthen our actions.

Download the June issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

Tribute to David Cairns MP

2011-05-18T14:11:00.004+01:00

The International Planned Parenthood Federation (IPPF) is deeply saddened by the news of the death of David Cairns - Member Parliament in the United Kingdom and Chair of the UK All-Party Parliamentary Group on AIDS.

David was an outspoken supporter of the rights of people living with HIV, including through active involvement in IPPF’s work against stigma, discrimination and criminalization of people living with HIV.

He reached out to and showed his support for a wide range of people, demonstrating his passion for ensuring that human rights are not withheld from people living with HIV, people who are gay or lesbian, and people living in countries or circumstances less fortunate than his own.

David was a visionary parliamentary leader whose work on HIV will not be forgotten. He used his position to engage with diverse communities of people living with HIV in the United Kingdom to learn about the realities of life with HIV in this country, and actively advocated for enabling policy environments both in the UK and internationally. Recently, he eloquently expressed his concern about laws that criminalize transmission of HIV and how they are used to single out and stigmatize people living with HIV.

Our thoughts are with David’s partner, family, friends and colleagues at this time. David’s leadership, intuitive understanding of the issues and passion for human rights will be greatly missed.

A memorial service will take place on Wednesday, 18 May at 8pm at St Mary's Church, Clapham Common in London. In David's memory, please support the campaign against homophobia in Uganda with a donation to Sexual Minorities Uganda (SMUG): http://uk.virginmoneygiving.com/DavidCairnsMemorial

Reaching MSM and other LGBT people across the Federation

2011-05-17T09:00:00.099+01:00

Despite increasing acceptance of sexual diversity, lesbian, gay, bisexual and transgender (LGBT) people around the world continue to experience social exclusion, prejudice, and violence as a result of discrimination on the basis of sexual orientation and gender identity. Today, May 17th, marks the International Day Against Homophobia and Transphobia - the anniversary of the World Health Organization's decision to remove homosexuality from its list of mental disorders in 1990.

The fear or dislike of homosexuality and differing gender identities in others or oneself and the assumption that heterosexual relationships are the norm create stigma and discrimination in society. This societal homophobia is deepened in countries where laws exist that criminalize same-sex relationships. In 2011, 76 countries around the world still consider homosexuality illegal.

Homophobia and transphobia have a profound impact on many aspects of the lives of LGBT people, including sexual and reproductive health (SRH). Many LGBT people find it difficult to openly access the SRH and other health services they need due to fear of being identified as being LGBT or due to the real or perceived negative attitudes of the service staff. Across the Federation, there are many outstanding examples of IPPF Member Associations reaching out to men who have sex with men (MSM) and other LGBT people in an effort to more effectively meet their SRH and HIV needs.

Cameroon

The Cameroon National Assocation for Family Welfare (CAMNAFAW) is providing stigma-free SRH and HIV services for the LGBT community in a country where homosexuality is punishable by law. In recent years, stigma and discrimination has been fuelled by homophobic reporting in the local media to publicly denounce homosexuality, resulting in the persecution of many homosexuals. To overcome this and to reduce the vulnerability faced, CAMNAFAW initiated a project to build trust and provide safe spaces where LGBT individuals could receive non-judgemental counselling, support and sexual health information. CAMNAFAW is one of the few voices in Cameroon championing the rights of sexual minorities, and produced a film showcasing the project.

Macedonia

The Health Education and Research Association (HERA) developed a national report card on the current situation of HIV prevention among MSM in collaboration with Equality for Gay and Lesbians (EGAL), a national LGBT organization. The report card was developed through a review of SRHR and HIV policies and programmes; interviews with various stakeholders; and community focus groups with MSM. Most importantly, this report card is being utilized as an advocacy tool providing recommendations for future actions to enhance HIV prevention for MSM. Although sex between men is not illegal in Macedonia, there is no specific legislation to protect MSM from discrimination; therefore a main recommendation was to include sexual orientation as a non-discrimination clause in the law.

Peru
Instituto Peruano de Paternidad Responsible (INPPARES) has created a safe environment in its clinics to cater for the needs of MSM and other LGBT people, especially those who are young. Young people continue to have limited access to sexual health services in Peru. With an emphasis on freedom of expression on issues of sexual diversity, young LGBT individuals are equipped with the confidence and skills to express their views more openly, to respond to intolerant and hurtful comments, and to be more assertive when communicating with their families and with acquaintances. INPPARES also works to raise institutional and political awareness of sexual diversity, which has had a significant impact internally on staff awareness and openness. This is an important achievement in a country where conservatism prevails.

China

The China Family Planning Association (CFPA) is promoting sexual health among MSM in three cities of Gansu Province, northwest China. Although sex between men is not illegal in China, many MSM keep their sexuality hidden due to the stigma they might otherwise face, making it particularly challenging to reach them with information and support. One of the primary components of this project is peer educator recruitment, training and outreach. Peer educators conduct outreach in bars, shower centres, and other venues frequented by MSM to disseminate condoms, lubricant, HIV and sexual health information, and health service referral cards. The project supports MSM in making informed decisions with an emphasis on personal choice.

India

The Family Planning Association of India (FPA India) has increased access to a combination of HIV prevention and SRH services for MSM in a number of clinics. Clinic staff received sensitization training on sexuality issues, and the SRH needs of MSM. A male drop-in centre was established to provide a safe space for MSM to receive information on various issues. Better known for their work in family planning and maternal and child health, MSM were initially hesitant to enter such centres. However, in partnership with local MSM organizations, the clinics are now known within the community as a stigma-free service. The clinics are also another option for men who do not feel comfortable utilizing MSM-specific services and provide the opportunity to bring their sexual partners, including female partners.

Syria

The Syrian Family Planning Association (SFPA) is providing youth-friendly HIV and SRH services in established youth centres throughout the country. Due to the high level of stigma and discrimination in the country, this project does not directly target MSM, but aims to provide an environment accepting of all young people. This has enabled some young men to feel confident and free to discuss issues related to their sexual orientation with the centre’s educators and counsellors. In an effort to attract other young MSM, these young people were encouraged to attend a peer education training workshop and to bring along their friends to the centre. In a society that treats homosexuals as criminals, this is an important first step to build confidence with this marginalized group.

For more information on the International Day Against Homophobia and Transphobia: http://www.dayagainsthomophobia.org/

Dr Robert Carr: Moments and Memories

2011-05-13T17:39:00.001+01:00

IPPF commemorates the life of Dr Robert Carr—colleague, friend and human rights champion—and will honour his legacy

The global fight against HIV has generated many champions over the last 30 years, and the world has sadly now lost one of its true defenders of human rights—Dr Robert Carr—someone who stood up for those who were often overlooked by many or living in the margins of society. Robert was a man of absolute integrity whose honesty and passion for the greater acceptance of the rights of vulnerable people in the world often cut through the hypocrisy. Robert still had much more to contribute through his advocacy on sexual rights, his role as the civil society co-chair of the Global Coalition on Women and AIDS and on the Board of the Global Forum on MSM and HIV, and his endless championing of issues facing gay and other men who have sex with men around the world. He has gone too soon, but his legacy will no doubt continue to inspire action and commitment in these important areas for many years to come. His spirit will hopefully inspire a new generation of leaders to take up the issues he so fiercely defended.

For many of us at the International Planned Parenthood Federation (IPPF) what started out as a strong working relationship turned into a formidable friendship and camaraderie. Robert had that unique ability to ‘blur the edges’; connect with different kinds of people and link people together. From the Caribbean to Canada to Kuala Lumpur below are some thoughts and reflections from colleagues and friends.

“Robert worked tirelessly for HIV in the Caribbean. It’s like the light of a star has gone out. Collectively we need to ensure that his insights and vision continue to be present in our work. His spirit will inspire us to pay attention to the unnoticed, spotlight what may sometimes be invisible, and persevere with his efforts to serve the most vulnerable communities at home and around the world.”
--Dr Jacqueline Sharpe, President and Chairperson of the Governing Council

"We are grateful that Robert came into our lives at the time that he did. His understanding and mastery of the sexual rights concerns of our Caribbean sub-region has brought our work to the attention of many allies. It is important that we continue the important advocacy work that he begun, or we would have allowed his legacy to die with him."
--Dona Da Costa Martinez, Executive Director, Family Planning Association of Trinidad and Tobago

“Robert Carr was a longstanding colleague and friend of IPPF. His commitment to vulnerable people around the world—through his wisdom as a leader, his insight as a mentor, and his humility as a peer—was inspiring, and will be greatly missed by all.”
--Dr Gill Greer, Director General

“Outspoken, exuberant, passionate, spirited and always smiling, Robert had the same approach to life as he did to his work. And he lived each day to its full. Personally, I have a lost a dear friend and comrade. And the world has lost one of its greatest defenders of social justice.”
--Kevin Osborne, Senior Advisor HIV

“Rob was a powerful and unstoppable force with a strong commitment to human rights. He will heat a debate and always find ways to name the elephant in the room – he was not shy to talk about the need to stop the double standards and hypocrisy that permeates some of our work. He was a person of principles and integrity – and the sweetest man and dearest friend on earth! Working with Rob was amazing. His spirit and fierce determination will be with us forever. Rest in peace dear Rob.”
--Ale Trossero, Director of Programmes, East Asia and the Pacific Regional Office

“When I first met Robert Carr in London it was a night that was filled with loads of laughter, brilliant conversation, passionate debate and inclusion – but he called it "field work." I was dazzled. He became my friend and confident and to many people at an event in Toronto last year one phenomenal dance partner. Dance on Mr Carr!”
--Alastair Hudson, Stigma Index Team: United Kingdom

“I remember Robert as a person of the utmost integrity, yet full of laughter and fearless to speak his mind about issues passionate to him.”
--Daniel McCartney, HIV team

“With his sharp wit and incisive perceptiveness, Robert had a way of saying the unexpected and often illuminating the unspoken. I first met Robert at one of his many conference presentations, where he showed a news photograph of two men being ushered away from a shop into a police van, amid a violent onslaught from a small crowd. At first glance, the image appeared to show a prejudiced, destructive and pessimistic scene in Jamaica for gay men. Yet Robert spoke of the picture as a great sign of hope—of progress in Jamaica. The police in the photo were ‘serving and protecting’ gay men, rather than joining in or even initiating the violence. I have learnt mountains from Robert, and although we have many more mountains to go in terms of overcoming the issues he fought so passionately for, each step will be all the stronger, wiser and more determined for having known him.”
--Lucy Stackpool-Moore, HIV team

Gay men and other MSM: The right to sexual and reproductive health

2011-04-11T15:23:00.007+01:00

By George Ayala and Mohan Sundararaj – The Global Forum on MSM & HIV (MSMGF)

EVERY human being must enjoy the right to sexual and reproductive health, and that includes gay men and other men who have sex with men.

Gay men and other men who have sex with men (MSM), estimated to comprise about 5-10 per cent of the world’s population, have been historically excluded from health and HIV-related programme, policy or financing discussions. They face homophobia and a range of structural challenges that undermine their ability to realize health to the fullest level possible. In every country truthfully collecting and reporting HIV and health data, gay men and other MSM consistently record higher HIV prevalence rates or poorer health outcomes when compared to adults in the general population. Moreover, gay men are seldom, if ever, meaningfully engaged in the design of health and HIV responses meant for gay men. This has left a health sector that is weakly equipped to effectively cater for a population that continues to shoulder a disproportionate HIV and AIDS burden.

Sexual and reproductive health: a holistic approach

Sexual and reproductive health (SRH) of gay men and other MSM cannot be viewed as the mere absence of disease. It encompasses their physical, emotional, mental and social well-being in relation to their sexuality.

‘Coming out’ – a process through which gay men come to terms with their sexuality, which may or may not include revealing their sexual identity to others is therefore integral to mental health. Gay men who realize self and social acceptance, find it easier to seek sexual healthcare or speak candidly to a primary care provider about their sexual health needs. The integration of gay men with mainstream society can thus provide a more equitable and less biased health delivery platform from which they can access targeted HIV prevention, treatment, care and support services and other health interventions.

Gay men and other MSM have unique health needs

The accrual of compelling evidence over decades has led the international scientific community to increasingly regard homosexuality as a normal variation within the spectrum of human sexual expression. But rejection of gay men can begin at home with family members, and can often be compounded by societal ostracism. In many cases, this leads to isolation, abuse, violence or sometimes murder. In over 70 countries, sex between consenting adults of the same gender is considered a criminal offence. Broader society and national governments have failed to recognize gay men’s rights to privacy, non-discrimination and a decent life, fuelling prejudice against them at every level. It is in this context that gay men and other MSM attempt to navigate their HIV and health needs.

Research has shown that these individuals reliably bear higher rates of depression, anxiety, chronic stress, suicidal thoughts, and substance use. Fearing rejection, they may delay seeking health services including mental health care. In some contexts, gay men and other MSM are subjected to sexual abuse, physical harassment, rape and violence and therefore are robbed of any control over their own bodies. Consequently, they are unable to readily access screening services for sexually transmitted infections (STIs), including HIV or necessary prevention information, condoms and lubricants.

Core principles to working with gay men and other MSM

A sound approach to addressing the SRH needs of gay men and other MSM must take into account a broad set of issues and principles.

Principles of practice have long been deliberated by AIDS service providers and advocates, but are often overlooked in policy discussions in favour of a narrow focus on scientific evidence in substantiating HIV-related interventions and SRH programme strategies. The following are some important core principles of practice:

The imperative of reducing STI and HIV infection rates should not impinge on personal freedoms.
All people, including MSM and MSM living with HIV, deserve the same level of support, health care, support services and political rights as anyone else.
All people, including MSM and MSM living with HIV, are entitled to a fulfilling and satisfying sex-life.
All people, including MSM and MSM living with HIV, have the right to be self-determining.
All people, including MSM and MSM living with HIV, deserve to be free from rape, violence and discrimination and are entitled to adequate legal recourse when these rights are violated.
HIV prevention programs and SRH services should not take a singular focus on risks but rather leverage the strengths, resources, competencies, social connections, capacities, and resiliency that are already present in gay men and other MSM and their communities.
Pleasure, gender, satisfaction, intimacy, love, and desire are key concepts in a fuller understanding of sex and sexuality among gay men and other MSM and should be included when formulating more meaningful research, programmatic, and policy responses.
Researchers, prevention practitioners, and policymakers should consider structural, situational, and contextual factors in understanding HIV risk and in developing sexual health interventions tailored to the specific needs of gay men and other MSM.

Additional resources are available from the Global Forum on MSM & HIV (MSMGF) website: http://www.msmgf.org/

Article from IPPF HIV Update newsletter - Issue 25: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+25.htm

HIV Update: Sex between men

2011-03-29T14:04:00.001+01:00

By Kevin Osborne (IPPF)

Since its debut in the early eighties, HIV continues to disproportionately affect men who have sex with men (MSM). Despite some policy gains made over the past years, MSM still experience serious challenges when trying to access HIV prevention, treatment, care and support services. And much of this has to do with the prevailing culture of stigma and discrimination.

In every country in all regions of the world, relationships and consensual sex occurs between men. Yet in over 70 countries criminal penalties currently exist for same-sex acts between consenting adults, including imprisonment and death. Even in countries where consensual sex between men is not illegal, MSM are among the most marginalized and discriminated against in society. Individuals are often targets of exclusion and violence on account of their real or perceived sexual orientation. This reality was underscored earlier this year with the tragic loss of David Kato in Uganda. And despite being at a greater risk of HIV infection, MSM are too often overlooked in national responses with few, if any, targeted resources provided.

The existence of punitive laws also makes it very difficult for MSM to openly access health services, and more needs to be done to effectively serve their sexual and reproductive health (SRH) and HIV needs. In recognition of this need, IPPF has recently entered into a partnership with the Global Forum on MSM & HIV (MSMGF) – a network promoting the health and human rights of MSM worldwide – to scale up our collective efforts. IPPF’s Sexual Rights Declaration clearly stresses that every human being has the right to sexual and reproductive health - including gay men and other MSM - and our lead article by MSMGF calls for this right to be honoured.

Our work with MSM has increased considerably over the last five years. In 2005, 25 per cent of IPPF Member Associations had specific strategies for MSM, and by 2009 this had increased to 45 per cent, with some outstanding examples. While much still remains to be done to meet the SRH and HIV needs of MSM and their partners, IPPF Member Associations are uniquely placed to provide much-needed services – including access to stigma-free clinical services, high-quality condoms and water-based lubricant, specific risk reduction strategies, and appropriate referrals for care and support. Working in partnership with regional and country level MSM organizations and networks will help shape and strengthen both our work and our collective voice to address the sexual and reproductive health and rights of MSM.

Article from IPPF HIV Update newsletter - Issue 25: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+25.htm

What do I do if I am living with HIV and…

2011-03-07T10:42:00.000Z

Ahead of International Women's Day on the 8th of March, IPPF has published a new informative booklet and poster for young women living with HIV. The booklet and poster answers questions raised by young women living with HIV about dating, relationships, sexuality, and parenthood.

It offers information to help young women to have a healthy, happy, and sexually fulfilling life and to decide on issues relating to sexual and reproductive health. The booklet covers the following topics:

What do I do if I’m living with HIV and...

...I want to date or be in a relationship?
...I want to tell my partner or my family that I am living with HIV?
...I want to protect my partner from HIV and other STIs?
...I want to practise safer sex?
...I want to get pregnant?
...I want to protect my baby from HIV?
...I do not want to get pregnant?
...I want to end a pregnancy?
...I want further support?

Like all people, there is a lot of diversity among young women living with HIV. We hope this guide provides information that is useful in helping young women decide how to best look after their sexual and reproductive health.

To download the booklet and poster: http://www.ippf.org/en/Resources/Guides-toolkits/What+do+I+do+if+I+am+living+with+HIV+and.htm

Girls Decide: Nomvelo's journey, Swaziland

2011-02-24T12:08:00.002Z

On 16 February, IPPF launched Girls Decide at the first screening of the Girls Decide film series. The films and publications are part of a larger initiative that aims to highlight the centrality of girls’ and young women’s sexual and reproductive lives for both individual and global development, and aims to ensure that girls’ and young women’s sexuality and pregnancy-related issues are effectively addressed by adopting policies and practices that work for girls.

The Girls Decide films share the stories of six girls from around the world in their journeys to make informed decisions about sex, pregnancy, abortion and relationships. They show how Member Associations of IPPF fulfil their commitment to young people’s sexual and reproductive rights through the provision of quality youth-friendly services.

The films are all based on true stories and were developed through a participatory process with young women from each of the six countries. The main characters are portrayed by actors. All interviewees are practising health professionals and community leaders.

One film shares the story of a girl in Swaziland. Nomvelo was born with HIV and she is interested in taking her relationship with her boyfriend further, but does not feel confident about how to talk to him about her HIV status. The Family Life Association of Swaziland, an IPPF Member Association, provides support to girls and young women living with HIV to lead positive and healthy lives.

IPPF believes that all girls and young women living with HIV have the right to experience their sexuality in healthy and positive ways. They also have the right to date, to be in relationships, to marry, to access sexual and reproductive health services and information, to have children and to decide if, how and when to disclose their HIV status.

To see the other films and for further information on the Girls Decide initiative: http://www.ippf.org/en/What-we-do/Adolescents/Girls+Decide.htm

I love you. A universal language.

2011-02-14T09:16:00.000Z

Valentine’s Day is about love, irrespective of gender, sexual orientation or HIV status.

In many countries, laws exist that do not allow people to express love without fear of persecution or violence. Laws that criminalize HIV transmission and exposure, and those that criminalize behaviours and practices associated with HIV transmission, have a profound impact on the lives of people.

Even on Valentine's Day, people living with HIV and people most vulnerable to HIV infection - including women, men who have sex with men, transgender people and sex workers - will experience stigma, discrimination and violence.

Everyone has the right to love – love does not discriminate.

Be conscious this Valentine’s Day.

Criminalize Hate Not HIV is part of a growing campaign to raise awareness about issues relating to the criminalization of HIV transmission. For more information: http://bit.ly/criminalization.

There must be a silver lining

2011-01-28T15:03:00.003Z

By Lucy Stackpool-Moore

Any day is a sad day for the world when senseless violence takes the life of a kind, compassionate human being. Yesterday was no exception, when David Kato, the litigation and advocacy officer for SMUG (Sexual Minorities Uganda) was killed in his home in Kampala.

David was a friend, and worked closely with IPPF on a number of occasions over the last two years. He spoke about the law and human rights at the Vienna International AIDS Conference. Just a few months ago, David, representing Africa, provided an important perspective at a meeting of the UK Consortium on AIDS and International Development about barriers to universal access of HIV care & support. He made sure that due attention was given to this issue for all people, including those from sexual minority groups.

David Kato speaking at IPPF satelitte session in Vienna. Placard he created read "AIDS 2010 demands withdraw of the Ugandan Anti-Homosexuality Bill in its entirety now!"

At times like this we must look for inspiration and compassion and hope, and we must find the silver lining hiding in even the darkest of thunderclouds. I was reminded of the great Archbishop Desmond Tutu’s humane and wise comment about homophobia in March 2010—which he called ‘a step backward on human rights’ in Africa:

“Hate has no place in the house of God. No one should be excluded from our love, our compassion or our concern because of race or gender, faith or ethnicity -- or because of their sexual orientation… It is time to stand up against another wrong.

Gay, lesbian, bisexual and transgendered people are part of so many families. They are part of the human family. They are part of God's family. And of course they are part of the African family. But a wave of hate is spreading across my beloved continent. People are again being denied their fundamental rights and freedoms…

These are terrible backward steps for human rights in Africa. Our lesbian and gay brothers and sisters across Africa are living in fear…The wave of hate must stop… Exclusion is never the way forward on our shared paths to freedom and justice.”

IPPF is deeply shocked and saddened by the news of David Kato’s murder. Our thoughts are with David’s family and friends and colleagues at SMUG (Sexual Minorities Uganda). We have lost a friend, a colleague, a committed human rights activist and a generous and compassionate human being.

Adherence: More than just about taking pills

2011-01-24T12:02:00.000Z

By Ashraf Grimwood (Kheth'Impilo, South Africa)

“I can't even complete a full course of antibiotics, how am I going to remember to take my ART?”

Adherence is usually understood to mean ‘the taking of medication as prescribed’ at the correct time and with the correct association with meals. But managing HIV infection is more than just about taking pills – adherence is about sticking to positive lifestyle choices.

The impact of HIV starts from the time of infection and earlier treatment will go a long way in avoiding complications. But before starting treatment it is important to be mentally ready and prepared. I always recommend to my patients that soon after diagnosis, regardless of how they feel, counselling is vital. The usual response is, “What would I talk about? I know how I got infected and I know what I need to do!” I say, “Just go. Talk about anything, give time to connect with the why and the how, understand your feelings and see if you can use this positively.”

The best way of managing an HIV infection is about making the right lifestyle choices and, critically, adhering to these. Adherence is about following lifestyle choices - irrespective of what they may be - that ensure the best health outcomes. Regular monitoring, CD4 counting, STI testing, exercise and a good dietary plan are crucial for good health maintenance before even starting to take pills.

Combination antiretroviral treatment is the best known way of controlling the virus. Pills need to be taken as directed by a clinician. It is important that personal lifestyle is discussed with a health care worker to ensure there is no clash. “How do I take my pills when… I work shift work? I travel often? I take recreational drugs? I am addicted to heroin? I am on methadone? I am pregnant? My partner does not yet know I am HIV positive?” These all need to be discussed with a health care practitioner. It is important to talk through any life issues that might impact on treatment adherence. Open honest communication is always the best option to ensure better health outcomes.

When starting treatment it is important to know what is being prescribed – learn the names, understand what they do, how they work, what their side effects are and when to seek professional advice. Ensure treatment is taken at the times prescribed and know how much leeway is acceptable with regards to the timing so the margin of safety is known when travelling across time zones or working shifts.

Any day forgotten gives the virus an opportunity to rebound and any resistant strain to dominate. This can lead to multi-drug resistance and treatment failure. Treatment failure means new drugs need to be prescribed. All these treatments have different side effect profiles which need different management. It is best to remain on the initial prescribed regimen if there are no adverse effects.

There are many tools that can be used to act as reminders for taking pills on time. Using a daily treatment tick-sheet or diary, pill boxes, and cell phone reminders are a few techniques that people have found work for them. Some take their daily ART at night after brushing their teeth, so they are often kept where this is done. Some have spare pills at their workplace. Packing pill boxes once a week or getting blister pre-packs for the month are other strategies that have worked for some.

All people living with HIV today have the opportunity to lead as normal lives as possible with this infection – and adhering to medication and selected lifestyle choices is often the starting point. No doubt it’s hard to stick to these. But being honest with ourselves and with our clients is always a great start.

Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm

Treatment 2.0: Therapeutic and prevention benefits of ART

2011-01-18T15:52:00.002Z

By Reuben Granich, Marco Vitoria, and Craig McClure (HIV/AIDS Department, WHO, Geneva)

Despite considerable progress, the global HIV situation remains serious. By the end of 2009, 5.2 million people were on antiretroviral treatment (ART); approximately 36 per cent of those estimated to be in need as per the new WHO recommendations. This, combined with the international fiscal crisis, has led to a growing concern regarding a weakening of the international commitment to universal access and to reaching the related Millennium Development Goals (MDG) by 2015. However, there are a number of reasons to be optimistic about our future efforts to confront HIV.

The 5.2 million people on treatment are a remarkable testament to the many outstanding examples of programmes that are doing great work on a large scale. However, our current response to HIV is often fragmented and unnecessarily complicated. This complexity often means late initiation of treatment, lack of continuum of care and increased costs for both programmes and patients. Retention of patients on antiretroviral therapy, which can mean the difference between life and death, is often hindered by our current approach to delivering treatment. Patients, where there is access to treatment, are often asked to travel great distances, wait in long queues, join lengthy waiting lists and return frequently to evaluate eligibility for treatment.

When placed on treatment, patients are often asked to adhere to difficult regimens with little hope of second line treatment in the case of toxicity or a failure to respond. Drug stock outs are also a stumbling block for adhering to ART programmes. Prevention, treatment, care and social support programmes are often in different locations and could be better integrated in order to effectively use scarce resources. There is a need to re-examine our approach to delivering prevention and treatment services to ensure easier access for people living with HIV.

Two key opportunities have the potential to hasten and expand the twin goals of saving lives and preventing new HIV infections. Firstly, the ongoing efforts to develop drug regimens and treatment strategies that will render HIV treatment easier to administer, more efficient to manage, and have a longer lasting impact for individuals and public health programmes. Secondly, it is also increasingly clear that universal access to ART can have a significant impact on HIV transmission. The potential individual and public health prevention benefits of treatment enhance the value of the universal access pledge from a life-saving initiative to a strategic investment aimed at ending the HIV epidemic.

‘Treatment 2.0’ was recently launched by UNAIDS and WHO to accelerate the simplification of ART in order to achieve and sustain universal access to treatment for all who need it and realize the significant potential for HIV and TB preventive benefits. The agenda of Treatment 2.0 involves radically simplifying drug regimens and diagnostics and monitoring, decentralizing service delivery, reducing costs and mobilizing communities.

When combined, expanding access to ART using simpler, more effective approaches and the use of ART as part of combination prevention will be critical in reaching the goals of universal access and will, most likely, result in cost savings over the medium and long term. Patient-friendly regimens should allow for improved adherence and increased access and retention to treatment. Our challenge is to understand how best to use new information regarding the role of ART for a reinvigorated, more effective and sustainable global response to AIDS. A simplified, public health approach to treatment is nothing new. WHO advanced this approach in 2003 to kick-start ART access in developing countries. Since then, the number of people on treatment has increased from 50,000 to over 5 million. What is potentially new is a renewed and intensified focus on simplification with accelerated expansion and full integration of treatment as a key aspect of HIV prevention efforts.

Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm

HIV Update: Adherence 4 Life

2011-01-10T12:06:00.001Z

By Kevin Osborne (IPPF)

Taking any routine medication on a regular basis is challenging for us all. More so if the regimen is life-saving and adhering to it requires a life-long commitment. With antiretroviral treatment (ART) reaching more people than ever, many more are now facing this challenge. As the world recognizes both World AIDS Day (1 December) and International Human Rights Day (10 December), it is important to ensure that our programmes are improving and maintaining the health and well-being of people living with HIV, including support for treatment adherence.

As treatment reduces a person’s viral load, it also reduces the risk of onward HIV transmission. This evidence shows that treatment should be part of a combination prevention strategy or ‘treatment as prevention’ approach. Starting treatment earlier means that viral load can be reduced earlier and this, in turn, can help to avert a significant number of new HIV infections. This is one aspect of the new ‘Treatment 2.0’ platform introduced by WHO and UNAIDS.

In 2010, WHO introduced updated guidelines promoting the earlier initiation of treatment, adding an estimated five million people who are now eligible for treatment. With more people receiving treatment, there is growing emphasis on issues such as treatment retention and resistance. Once treatment is no longer effective, it may be necessary to move to second- or third-lines of treatment – a luxury still not widely available in many low- and middle-income countries.

However, reflections by Dr. Ashraf Grimwood – CEO of Kheth'Impilo and a leading HIV clinician in South Africa for many years – indicates that adherence is more than just about taking pills. While scientists develop new treatment options to improve the effectiveness and ease of use, IPPF needs to provide further support to people living with HIV – in ways big and small – to help increase overall treatment adherence rates. From supplying pill boxes and promoting individual adherence, to scaling-up community-based support services and providing adherence counselling and peer support – a variety of interventions will help to realize the promise of treatment and treatment-centred HIV prevention.

Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm

Kenya: People living with HIV have rights like any other person

2010-12-10T09:00:00.001Z

“I suffered stigma and discrimination both from my relatives and at my place of work. I was afraid of disclosing my status to my employer. I thought it may cost me my job.

People living with HIV need to have their rights like any other person; they need the right to privacy, for their status to be kept confidential.”

Alice Mwangi, beauty therapist from Yamumbi, Kenya.

In August 2006 Alice Mwangi filed a case. She had gone for a routine appointment at an antenatal clinic when she was tested for HIV without her consent. The test was followed by the unauthorized disclosure of her positive HIV status to her family members.

“I suffered stigma and discrimination both from my relatives and at my place of work. I was afraid of disclosing my status to my employer and their reaction to the news. I thought it may cost me my job and this would make my life more miserable.

Later I went for a tooth extraction and my father shouted to the dentist that I ‘had AIDS’. The dentist then refused to provide dental services. It was difficult for me and I had to find an alternative dentist.

In Kenya HIV transmission is described as a criminal act in the HIV Act. If a person who knows his or her status infects another person willingly or intentionally, they can be charged in a court of law.

The impact of the criminalisation of HIV transmission has made me think about my own sexual behaviour and about protecting my partner and about discussing my partner’s own HIV status. It has made me develop a positive attitude towards people living with HIV. It has also made me think about confidentiality – after all, no one wants his or her status shared without her consent.

People living with HIV need to have their rights like any other person; they need the right to privacy, for their status to be kept confidential and rights to non discrimination, to liberty and freedom of movement in terms of being protected against imprisonment, segregation or isolation in a special hospital ward. They need their right education and information: their right to access to all HIV prevention education and information, especially sexual reproductive information.

Do I think people living with HIV should disclose their HIV status before every sexual encounter? That depends on the person whom they want to disclose to, and whether this person will give support. At the same time they should insist on protection.

We should all be responsible for preventing the transmission of HIV, not only the people who are infected. HIV prevention should be comprehensive, making use of all approaches known to be effective.

Laws addressing issues on HIV transmission should be reinforced to curb the rapidly increasing number of HIV infections but, at the same time, it should not be used to victimize the people who are already positive and doing something about it to protect themselves and others. Stigma has undermined the ability of individuals’ families and society at large to protect themselves and provide support and reassurance to those affected."

Macedonia: When the system falls apart

2010-12-09T09:00:00.002Z

“It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of guaranteed voluntary consent and confidentiality.”

Milena Stevanovic from Skopje, Macedonia, was a member of a medical team that was on duty in November 2008 when the police issued a court warrant to test arrested street commercial sex workers for STIs.

"In November 2008, the Ministry of Interior began a campaign to eradicate the so-called ‘socio-pathological occurrence of male and female individuals giving sexual services for money.’

According to the Ministry the official grounds for the police intervention, arrest and detainment of sex workers was the existence ‘of certain indications that these persons might be carriers of different sexually transmitted diseases, and consciously transmit them to other persons, which is in violation with the existent laws in the Republic of Macedonia.’ Calling on the Criminal Code the Ministry provided a court order to perform medical examinations.

The process started early in morning when the police called us on the telephone asking if we provided HIV and STI testing. Then they announced their intentions. Immediately I had a meeting with the director who said that we couldn’t perform such a service. When this fact was presented to the police it took them less than two hours to issue us with a court order.

There followed a statement informing the public of the results of the compulsory testing of the sex workers. According to the analyses, ‘Seven of them were carriers of the virus HCV-Hepatitis C, an infectious disease transmitted by sexual and blood contact with an infected person.’ The ministry said that they instigated criminal charges because of reasonable suspicion that ‘they performed a criminal act of transmitting infectious disease.’ Given the resistance they showed during the implementation of the court order, it was argued, they were aware of the virus they carried, and therefore they were negligent. After one year’s legal process the sex workers were found guilty of transmitting STIs but were given probation.

It was an example of the state system falling apart. The established counselling service was misused for a purpose contrary to its basic principles: that of the guaranteed voluntary consent and confidentiality. So it was a paradox. As someone who helped develop that system - and its voluntary counselling and testing (VCT) protocols and services - I can’t understand why anyone would use that same system for that purpose, especially on a group of people, such as street sex workers, who were being counselled and tested on HIV and STIs. So if you ask me, that’s the greatest tragedy of this incident.

Or maybe the worst thing is that a health institution, which should have been protected by law, ended up exposing test results without the consent of its patients.

This leads me to the conclusion that someone had the aim of destroying everything we’ve achieved. You feel completely powerless. You feel as if the only thing you can do is to help lessen the consequences for those poor women.

Previously there had been no cases of HIV or other infectious disease being brought up in court. We can’t predict what would happen if criminalisation became an everyday reality. What I do know is that some people will suffer from double stigma: being HIV positive and coming from the different key populations.

There is absolutely no reason for criminalising HIV transmission.

Maybe we need a legal discussion on the pros and cons. Objectively, there is no reason why HIV should be treated as a criminal offence. The explanation is very simple: everyone is responsible for their own behaviour and risks - that’s the end of the story.

Here, the chance of someone not knowing their HIV status is very high. But if we are talking about something that is a criminal offence like rape, and if HIV is transmitted as consequence of a violent act, then that would be something else. But, again, the reason for prosecution should be the criminal act and not HIV.

The criminalisation of HIV transmission has had a completely demoralising effect on me. It means that whatever you agree upon within the community, to adopt a document, to establish a state service, it is worthless. There is always someone who has the political power to destroy for their own political promotion.

Human rights in our context are a mockery. The main reason is because there is no implementation in everyday life.

They are often misused by the institutions responsible for protection of human rights. There is no rule of law when human rights are concerned and sometimes patients in Macedonia are not well informed and refer to the human rights legislative for trivial issues.

Rights, but also the obligations, should be the same for everybody. What do I mean by obligations? Everyone is responsible for their own actions and the risks of those actions. So this is the basic philosophy when we are talking about HIV. Otherwise you can easily enter in to a labyrinth leading to millions of questions. Hypothetically all of my patients can start a court procedure against the person responsible for their HIV status. So I ask myself, what would be the consequence of all of these court processes?

Here is an example: I had a case where the husband wouldn’t disclose his status to his wife. We tried everything we could to motivate him to inform his wife about the possibility of HIV transmission. But he didn’t want to and continued to live a ‘normal’ married life. So the woman was left to discover that she had become HIV positive on her own, when she became really sick. I had to live with the knowledge that someone’s life is in danger. However my team followed the protocol and we didn’t disclose the status of the patient to his wife. In the end, although it took some time, the husband decided to tell his wife. This case illustrates why everyone should be responsible for their own actions and protection.

Although this example is an argument for obligatory disclosure, I would say that we can discuss this option only within marriage, but when we are talking about different sexual relationships, I can’t see the purpose of making the disclosure obligatory. To be more precise, you can’t solve all of the HIV problems with adopting legal instrument for prosecuting people living with HIV (PLHIV).

If we insist that PLHIV disclose their status in every sexual encounter than we are insisting on an ideal society, a utopia. I can’t find a good reason why we should ask PLHIV to be extremely responsible if the rest of society is not behaving in the same manner. In the same way, we can’t ask that from any patient living with any other kind of disease.

The things here in Macedonia are going to change. We needed 20 years to ‘grow up’ and to face HIV. There were no PLHIV in the past, simply because they were dying.

Today we have people living with HIV. So we are just starting to go through the HIV issues that other societies have already faced. Hopefully we will use their experience to find easier solutions."

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Malawi: A bad law is more breached than honoured

2010-12-08T09:00:00.000Z

“I have a learnt a lot from my interactions with people who are HIV positive. At a personal level it has also enabled me and my wife to discuss these issues more, because we discuss some cases looking at what happened, and we realize and learn that being HIV positive is not strange – it is just part of life. Nothing really changes when people are positive.”

Chrispine Sibande, is a lawyer and Deputy Director for Legal Services of the Malawi Human Rights Commission.

"HIV is being criminalized right now in Malawi. This is through the Penal Code – Section 192. It states that ‘any person who unlawfully or negligently commits does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be guilty of a misdemeanor.’ So, we have seen cases in Malawi where the courts have charged people under this provision on issues of HIV. People have been prosecuted because of their HIV status.

One example from 2009 relates to sex workers who were charged with an act of negligence (contrary to section 192 of the penal code) in Mwanza district, for ‘unlawfully and knowingly committing an act likely to spread infection of the disease HIV and AIDS by practicing prostitution’. This happened in three different cases.

The women were arrested at a bar, and taken by the police, with some men. All the men were released – only the women remained in custody. They were ordered to board a police vehicle and taken to Mwanza District Hospital. At the hospital, there were two police officers in the corridor, they were taken into a room where they saw they saw two medical officers and additional two police officers, and were simply told ‘can we have your hand?’ So then blood was taken from them, but they didn’t know what for - until they were taken to court. They were charged with the offence of spreading a venereal disease, specifically HIV.

These women didn’t have legal representation so they pleaded guilty because the police intimidated them. The court read out their HIV status, and it was then that these women realized that the blood samples taken at the hospital were meant for an HIV test. It was the first time that the women had learned of their HIV status. The test results were announced to everybody in court– in front of so many people. Anyone who was in the court room at that time knew the HIV status of the accused persons.

So we partnered with another NGO and followed up the cases – I interviewed the women, reviewed the court files to find out exactly what happened, and we are now considering a Constitutional Challenge. This kind of action violates the Malawi Constitution and international human rights standards. In our Constitution we have Section 20, which guarantees the right to non-discrimination, and Section 21 that guarantees the right to Privacy and to Dignity. In one of the cases, the women were asked to leave Mwanza as part of the judgment, which is also strange because that is a clear violation of liberty and violation of the person’s right to live anywhere in Malawi.

We are trying to challenge the action from a human rights perspective based on our Constitution. In the Judicial Review we are asking the court to condemn the action of the police, the District Hospitaland the Magistrate and say it was unlawful, arbitrary and unreasonable. We are seeking declarations from the court on all three issues and that these women should be compensated. I have drafted the papers and I am ready to go to court.

Many of these women have now settled outside Mwanza, out of fear of being labeled ‘HIV positive’ and seen as ‘stupid ladies deliberately spreading HIV’. When I interviewed the Magistrate and also the police, they said ‘Oh why are you bothering about sex workers?’ I think the sex workers were deliberately targeted because they were seen to be ‘less human’. Of course evidence shows that almost every day these women are beaten or have money or cell phones confiscated from them, but there is that feeling that these women are ‘after all, prostitutes’. Nobody will listen to them. That is the spirit of the message that I got from the Magistrate and the police when I interviewed them.

So when you look at these particular cases it is very clear that people are already being criminalised for the transmission of HIV in Malawi. At the same time we have a draft HIV Bill that states that we intend to criminalise HIV and AIDS. In Malawi we have a constitution and we have ratified several human rights instruments, so the application of the criminal law is a very serious setback in Malawi.

When you look at the human rights standards it is clear that they don’t encourage criminalisation of HIV and AIDS. And we made that position known, but the problem was that we weren’t part of the Commission – the Malawi Human Rights Commission were simply asked to make a submission. We made it clear that we should never ever criminalise issues of HIV and AIDS.

The reasons are quite obvious. We need to address HIV as a health issue and there are obligations that the State has to meet to make sure that services are available and that people have treatment, and also that information is available. It is also very clear that there is a lot of stigma attached to HIV.

Now the moment you try and criminalise it, then people fear prosecution, and it won’t help with the provision of condoms, of ARVS, or for people to come forward and go for testing. If we look at criminalisation you can see how it targets people who know they are HIV positive and limits them having sex. The response to HIV should be a whole crusade where we need to get everybody involved.

The proposed HIV Bill introduces a number of positive things so to condemn the whole Bill would be unfair. When the Bill addresses issues of stigma and discrimination – for example that an employer will be prosecuted if they deny employment to someone on the basis of their HIV status – then it can be helpful. But imagine the consequences of criminalizing HIV particularly for women and for vulnerable groups such as sex workers? There are certain issues in the Bill that would be a setback for the fight against HIV.

Not only as a human rights lawyer but also from looking at the context of HIV in Malawi, honestly, criminalizing HIV does not make sense. For example witchcraft – it is an offence in Malawi to allege that someone is a witch. Now this is the criminal position – the question is what are people doing about it? Everyday people are accusing each other of witchcraft. Everyday people are calling on traditional doctors. Everyday, people are being arrested for witchcraft. So the issue is when you have a bad law it is more breached than honoured.

For HIV you need to make sure that people have information, and then that there is a provision to access condoms, and that people know their HIV status, and, if they are positive, the government provides health services like ARVs and counselling. The solution that ‘we will lock you up or arrest you because you are HIV positive’ will just force people underground, and as a result there will be more - not less - people who have HIV. We would just be perpetuating the problem.

My work has simply helped me to know that a person who is HIV positive is not different from any other person. I have also realized that there are serious challenges for people living with HIV – treatment remains a challenge in terms of access to ARVs, there is a lack of information, and other things at the national level.

My work has just helped me to understand more things from a legal perspective, a social perspective and a psychological perspective. I have a learnt a lot from my interactions with people who are HIV positive. At a personal level it has also enabled me and my wife to discuss these issues more, because we discuss some cases looking at what happened, and we realize and learn that being HIV positive is not strange – it is just part of life. Nothing really changes when people are positive."

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

New Zealand: Discovering your former partner is HIV positive

2010-12-07T09:00:00.002Z

Marama Pala, an executive director from New Zealand, discovered that her former partner was HIV positive when she saw him on the front page of a newspaper article entitled 'Face of Fear'.

"The High Court Trial awful for me, he was found guilty by jury and sentenced to seven years imprisonment, on his release he was deported. During the trial he had large numbers of supporters trying to keep him in the country for his daughter. I was made the villain because I put him in jail and forced him out of the country.

I was infected on 23 July 1993 by an African Man in New Zealand – Peter Mwai. I found out that he had HIV from a newspaper article with his face on the front page saying 'FACE OF FEAR'.

The article below described how he had infected women with HIV and if anyone had had contact with this man to ring the police. I did, and then was asked that, if I should I test positive, would I help them stop this man from infecting any other women? I said yes, and then I was tested shortly after.

After a two week wait the test came back positive and charges were laid.

The police had evidence that he was told he had HIV in June by an infectious diseases clinician. I was infected in July, and fell within the time frame to charge him. Whereas the other women he infected didn’t, but five other women could charge him with reckless endangerment.

I had asked him to wear a condom, he refused. I did not insist, because I had very little knowledge about HIV, I thought he was too healthy-looking and he had already shown me a picture of his baby daughter who was healthy too.

HIV transmission is currently not the subject of a specific ‘law’ in New Zealand, but there is legislation from 1969 about intentionally infecting someone with a disease. Peter Mwai was originally charged with this, but the police could not prove ‘intent’ and the charge was lessened to Grievous Bodily Harm, as well as the reckless endangerment charges.

There was a High Court Trial - that was awful for me. He was found guilty by jury and sentenced to seven years imprisonment, on his release he was deported, and subsequently died of TB in Uganda. During the trial and his release time he had large numbers of supporters trying to keep him in the country for his daughter. I was made to feel like the villain because I put him in jail and forced him out of the country.

I think there is sufficient criminal law to stop the rare person who behaves irresponsibly. New laws would cause more stigma and discrimination for those already living with HIV.

Not all people living with HIV are reckless, 95 per cent of them would be deeply affected should they ever infect another person. It’s the people that don’t give a damn and intentionally or thoughtlessly expose people to the virus - that small five per cent is making it worse for the rest of us, and they need to be held accountable.

Age and wisdom have changed my mind about this issue. At the time the case was so hyped, and drama-filled. I believed I’d be supported afterwards, I wasn’t.

I was so young and easily influenced by the police. I had no idea of the consequences at the time.

This court case did no favours for dark-skinned men living with HIV in New Zealand. It created a stereotype that all ‘black’ men with HIV were intentionally infecting large numbers of women.

Yet the evidence shows there have only been a few cases. The few have made it worse for the rest of us. Now I’m married to a HIV positive man from Papua New Guinea, and he is dark skinned.

My husband and I have a great relationship, but he is very aware that, should it end, and if he was to live as a single man in New Zealnad, that the stereotype would follow him. The truth of this came home to me on one occasion when he was discriminated against, unfairly, by the police because of the colour of his skin and his HIV status.

I take the approach that no disclosure is necessary if safe sex is practiced, but if someone is having casual sex on more than one occasion, then that becomes a grey area.

I still support the idea that it is the decision of the person living with HIV, as long as they practice safe sex.

Apart from those two scenarios, I would still support the right of the person living with HIV to make that decision, either way; it’s a personal choice to trust someone with those details.

Personally, I have told every sexual partner since my infection, but because of my trial and the subsequent publicity, I was exposed and everybody knew of my case and my infection, therefore I had no choice but to disclose, in case they found out another way.

If someone has an unsafe sexual encounter, I would support the anonymous disclosure of the 'track and trace' system through a sexual health clinic. It isn’t only the responsibility of the person living with HIV to stay safe."

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Trinidad and Tobago: Persistence and patience are virtues

2010-12-06T09:00:00.000Z

“We have to make all our decisions based on evidence as opposed to emotion or knee-jerk reactions."

Former Director of the National AIDS Coordinating Committee working in Trinidad and Tobago, Amery Browne is currently a Member of Parliament in Opposition. He was formerly a Government Minister with responsibility for the policy direction for the social sector.

"One or two sensational stories and emotive reactions should not be guiding government policy, and wherever they occur, legislative initiatives to criminalize HIV transmission are not based on effective policy.

To those who are working toward sound legislation to benefit persons living with HIV and those at risk, I would encourage persistence and patience. There is no magic bullet and you cannot expect overnight change.

There is broad recognition within Trinidad and Tobago and in the Caribbean region that the law as it stands may not be serving us well in terms of an effective response to HIV. Bearing in mind that we are part of a Commonwealth System and some of what existed formerly in the United Kingdom has remained in our countries—we share a unique historical context.

There has been a fairly strong regional response to HIV and the law, and a recent legislation review has looked at issues of human rights, issues related to criminalization and looking at issues that some countries have with regard to HIV, sodomy and sex work.

The national consultations were very rewarding because there was some demonstration that the local population has matured to some extent in terms of the openness to change and progress with regard to some of the traditionally challenging issues.

The emerging strength of a number of advocacy groups has assisted additional sectors to recognize that the ‘traditional’ approaches to HIV policy and law have in some respects left some of our citizens at continued or increased risk.

There is often a very strong impetus for quick change or rapid action but I don’t know if that is always realistic or even desirable, and we must always bear in mind the possibility of a backlash from more conservative elements, but let’s say a country that has made positive changes and the government has not reaped any political whirlwind or collapsed because of a bold legislative decision, some of that change and those benefits should be shared across borders, utilizing key Commonwealth organizations and other agencies.

That dialogue is important specifically among politicians and parliamentarians who sometimes are not sufficiently included in multi-sectoral fora that could lead to change.

Many of the parliamentarians would have grown up with certain attitudes, constantly reinforced, and it is important to develop opinion leaders who can become beacons among their peers, as well as in the national context. The key qualities that I would encourage are persistence and patience.

There are very good reasons why HIV transmission should not be a criminal offence. It’s certainly not a cut and dried issue.

It has proven very difficult to prove or demonstrate willful transmission to the issue of attribution or causality—which person had HIV first—resulting in much controversy in some cases that have been pursued internationally.

Such laws have the danger of further stigmatizing key populations and persons living with HIV — being seen overall as potential perpetrators as opposed to very often the primary victims of social injustice and crime.

We have made a transition to seeing people living with HIV as part of the response and as the solution, but having laws or provisions like this would shift the concept back to persons living with HIV being perceived as the ‘problem’.

It is the stigma, it is the ignorance and it is the discrimination that contribute more to the transmission and propagation of HIV, than the sporadic cases of someone who has escaped the type of support that now exists and might be having unprotected sex and be willfully exposing others to the virus.

We have to make all our decisions based on evidence as opposed to emotions or knee-jerk reactions. One or two sensational stories and emotive reactions should not be guiding government policy—it must be much more evidence-based. So from a medical background the thing is to first do no harm. If what you are proposing as part of a solution has been proven or has the potential to do harm: is that really something you would want to do as a country?

People living with HIV should be encouraged to voluntarily disclose their status. Certainly the health services emphasize voluntary disclosure, sometimes with support, as opposed to coerced or enforced disclosure.

Bearing in mind that sexual contacts and sexual relationships occupy a very wide spectrum—those very complex and diverse human interactions. The law is not a useful instrument to enforce disclosure. Instead in Trinidad and Tobago we would continue to review our counseling protocols and those associated with diagnosis to ensure that disclosure support is part of how we interact with clients—as opposed to bringing in a law that would criminalize non-disclosure.

The law exists for a reason and that’s why we have laws against all sorts of things. But with regard to the desire to control certain types of human behaviour—especially sexual or intimate behaviour between women and men, men and men, or women and women—the law really is a very blunt instrument and it can be misused very often.

We have seen countries making the wrong decisions in regard to HIV and AIDS.

I am very confident that in my part of the world societies are maturing to a point where it is easier to make improvements in the law and harder to make the wrong types of decisions.”

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Egypt: New laws can create new opportunities for corruption

2010-12-05T09:00:00.002Z

“In the West it may work to change the law and then expect change on the ground. But this experience does not translate to my culture.

I am not saying stop working with the law, but first work within the custom, religion, and the culture of the people. Don’t just target the person to change his behaviour—you also need to work with his community.”

Sayed El Zemari is an International Health Expert and former practising Medical Doctor from Egypt.

“In Egypt the law does not have the same position as it does for people in the West. The law on the ground in the Middle East and Africa is not respected as it should be. Many times you change the law, but nothing changes on the ground.

So you say: ‘don’t smoke in enclosed places’ – yes it’s a very good law! But no one respects it, no one enforces it and people don’t believe they should.

Female circumcision, for example, is an age-old tradition in Egypt, Sudan, and Somalia. Due to exposure to other cultures and the results of evidence-based research we now realize its negative consequences. It is not unusual to find a Minister of Justice after giving an official presentation about such law, then go home to celebrate the circumcision of his daughter.

It is not criminalization (in the law) but the way people approach it that has a meaning in their lives.

It is the culture, the religion, the community that refuses to accept, say, public homosexuality. You can find articles addressing homosexuality in Arabic literature going back hundreds of years.

During my childhood I knew some peopIe who were known to be gay; whether practicing or not, and they had some sort of acceptance within their communities and were enjoying their standard basic rights, for instance: to live, to be educated, to work and to marry (the opposite sex). But when it comes to being out on the street and saying ‘Hey, I am gay and I have these rights ...’ - it’s not on.

There is law, and there is law in the traditional or customary sense. Let me give one example: I work with men who have sex with men (MSM) as part of HIV key populations, and one of them needed to have an operation on his bowel. He came to me for help to find a surgeon so I went to some colleagues and said ‘Do you know how HIV is transmitted?' He said: ‘Yes, I know’. I said ‘Do you think is it transmitted by coughing or sneezing?' He said:‘No’.

'What if a surgeon operates on someone who is living with HIV, is he in danger of HIV transmission if he uses normal precautionary measures for infection control?’ He replied: ‘No’.

Fine. So I told him that I have a person who is living with HIV and in need of an operation. Was he willing to do it? He told me 'No, no, no'.

I asked him 'Why?' He said 'No, just no'.

I moved from one to another until I increased the money to double the original cost for the operation and the fourth one agreed to do the surgery.

But I cannot describe for you how this patient was humiliated on the operating table. The way the surgeon was gossiping and talking—I mean maybe because of the change in anatomy he realized that he was an MSM? I don’t know, but the harm that the surgeon and nurses did to this patient in terms of what they said was much greater than the pain of the operation itself.

The question whether HIV transmission should be a criminal offence is a good one. If transmission is intentional, then yes, I think there is a need for some action to be taken. However there are many degrees of punishment. When it is careless or negligent, I would also say yes. As a medical doctor, I know that many people die because of malpractice, and I cannot forgive someone for that.

It is the same for the traffic accidents — if someone kills my son because he is reckless, I cannot forgive him. In the same way, if someone who knows that he is HIV positive is careless and just allows my son or my daughter to become HIV infected I would feel the same.

I am not saying he should get the highest degree of punishment but, for sure, something should be done. In terms of disclosure, I think if someone is not going to use a condom then they should disclose if they are HIV positive. Either use a condom or disclose, so that the other person can decide.

I am not a legal person and I am not sure what an appropriate punishment should be, but, for example, in the case of medical doctors and malpractice, they can be stopped from practicing for a month or two, or fined. I consider it to be a minor incident, not a major one, there are worse things that could happen, but there should be some penalty in place.

There have been a lot of efforts in using the law to change risky social behaviours — like female genital mutilation (FGM) or MSM. In the West it may work to change the law and then expect change on the ground.

But this experience does not translate to many other cultures. I am not saying stop working with the law, but first work within the custom, religion, and the culture of the people. Don’t target the person to change his behaviour—you need to work with the community.

No one can deny that the law is important, but in many countries new laws means new opportunities for corruption. So it is better to work with communities and with their leaders rather than devoting too much attention to the law.”

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Bangladesh: I want to break free from this hatred and stigma

2010-12-04T09:00:00.002Z

"The neighbours started to avoid my family. They used to shout at me and my daughter and we were not allowed to participate in any community activity".

Kaniz Fathema, Peer counsellor
Mukta Akash Bangladesh, Khulna, Bangladesh

"I was born in Khulna, a city in Bangladesh. In 2002 my parents arranged my marriage with a guy who had just returned from Saudi Arabia. I was in the second year at college. I was married in June 2002, against my will.

From the first year of our marriage, I noticed that my husband was often unwell. He had frequent fever, aches and stomach trouble. He was not willing to go to a doctor. In 2006 we had a daughter. In the same year he went to India and found out that he was HIV positive.

After he came back he wanted me and my daughter to be tested for HIV. In April 2006, he took me to the Khulna district hospital for an HIV test, and we found out that I was HIV positive. A few days later we found out that my daughter was positive as well.

Once my husband and in laws found out that I was HIV positive their attitude towards me changed.

They started to blame me for everything. My husband started to beat me. Although I have never asked him how I become HIV positive or if he knew before that he was HIV positive. Finally they wanted me out of the family and I returned to my parent’s house. After a few days he (my husband) came to my parent’s house and told the neighbours that I was HIV positive.

Soon my daughter started to become unwell. She was having frequent fever, mouth ulcers and pneumonia.

I took her to the local children’s hospital. I informed the doctor that she was HIV positive. Within minutes the whole hospital knew.

People were coming to see us, as if we were some kind of animal in a cage. Nurses were using gloves all the time. We were hated by everyone.

One day one of the cleaners told me that they were going to burn the beddings once we leave. After hearing this I took my daughter to a private clinic.

In this clinic, once the nurses got to know they started to avoid us. So, the doctor requested that we leave.

He feared that no one will come to his clinic if they heard about us. After returning home, I got in touch with a doctor from India. I used to get ART treatment for my daughter from India.

I started to look for a job but no one was willing to employ me knowing my HIV status.

The situation is really sad. Although I have a job now, I want to break free from this hatred and stigma.

Females are especially criminalised by HIV laws in my country, even considering the social status of women in Bangladesh.

It is breaching our human rights. It is causing spread of HIV/AIDS, and people are not willing to come forward to test because they fear to be criminalized.

I think criminalisation is a disincentive to finding out your HIV status. The criminalization and discrimination that I face are too much to bear.

If one transmits it willingly, then, I think HIV transmission should be a criminal offence. There should be support for HIV positive persons. We need to build more awareness. The number of awareness programs that we are doing is not sufficient at the moment.

Having HIV has changed me.

I used to know nothing about the world. But since I have been struggling for my daughter, I have changed. I know about HIV/AIDS and where to seek help now.

I am humiliated by my status. I hate when people hate me and look at me as if I am something strange.

The rights of people who know their HIV status should be the same as those who don’t. Because they are both human, and a positive person is also a normal human being".

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Swaziland: HIV is everybody’s business

2010-12-03T11:56:00.000Z

“As a country we’re really struggling with what to do with HIV from a legal perspective."

Lomcebo Dlamini, Swaziland
Lawyer and Activist, Women in Law, Southern Africa (WLSA)

“As a country we’re really struggling with what to do with HIV from a legal perspective—not only the criminal lawyer. There was initially a panic and a lack of understanding of the issues—a hard line taken by the criminal law in terms of wanting to punish HIV transmission under things like ‘attempted murder’. But overtime and with the additional education that has been around, I think we have moved from that extreme position.

At the moment we don’t have any criminal law explicitly mentioning HIV, which is fine, and that is how we would want to keep it. But when issues of HIV arise in criminal cases you can tell that there is difficulty with the issue because of the capacity of the judicial delivery system—the judges, lawyers and judicial officers. They tend to focus on procedural issues rather than on the more controversial issues in a case. For example in terms of explicit criminalisation of HIV transmission it is clear that there should be no offence. I formed this opinion through my work with women.

There are so many things that impact on a woman’s life—well beyond the legal—for example reasons why someone may or may not disclose, or may or may not feel that they are able to disclose. But in terms of aggravating circumstances such as in a rape case, it is more difficult. Although it could be seen as stigmatizing, there is no doubt that an added impact occurs for the victim of rape if HIV transmission also occurs. It is very difficult.

I don’t know why this has happened with HIV and AIDS, but for whatever reason now the onus seems to be on people living with HIV to disclose their status. Why should that be the case?

I mean we all have a responsibility over our own lives. We’re all receiving the same education and the same information. You’re rights come with responsibilities and at the end of the day are you expecting someone else to do it for you? You have to do it for yourself. The onus should not be on another person—ultimately we all have the responsibility. If someone chooses to disclose or doesn’t choose to disclose, you should still have consistent behaviour in terms of protecting yourself.

When the issue arises in cases we’ve got challenges dealing with it. There doesn’t seem to be clarity within the justice delivery system or direction in terms of what they should do. Let’s not put HIV in the law—it is just a condition. How is it different from other conditions like TB? And it really is not practical. It would be very difficult to prove HIV as an aggravating offense. You would have to prove transmission at the time, which in our country could have been two or three or four years before the case goes to court.

Was the perpetrator HIV positive at that time? Was the victim HIV negative at that time? Reducing HIV to have consequences in the law as an aggravating circumstance doesn’t have much utility. How do you ensure that you protect the rights of all involved and not add to stigma? Criminalization would just compromise the efforts that have already been made, and people would not test for HIV.

Instead of focusing on the law, efforts should focus on the after care treatment that people receive for example after rape, or gender based violence or during HIV testing and counseling.

We need assistance to understand how we can deal with HIV in a lot of other ways rather than using the law. As a country we haven’t quite had the conversations, and the legal sector and parliamentarians need help to really look at the issues.

I am a lawyer and activist in Swaziland at the moment. When you start engaging in these issues it initially starts as something objective—issues in the research or issues for clients. But in reality, as soon as you lose friends or as soon as you go for your own test, it brings it home closer. Then your clients become not just faces but part and parcel of your life.

Working with HIV issues has challenged individuals in organizations to reflect on their own values. HIV raises difficult issues - it’s like King Mswati’s saying: HIV is everybody’s business.”

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Sweden: Why turn a proportion of our population into potential criminals every time they have sex?

2010-12-02T10:32:00.001Z

“As researchers our main purpose is to work for disease control, not to contribute to criminal investigations...the legal situation makes our work harder.”

Jan Albert is Professor of Infectious Diseases and has worked at the Swedish Institute for Infectious Disease Control (SMI). Currently he works as an HIV researcher at the Karolinska Institute. He has been an expert witness in several trials regarding HIV transmission.

"HIV is interesting from a scientific point of view, the organism itself, but it’s also important and meaningful work. I’m interested in the areas where research, patient care and public health overlap.

We have had quite a few convictions for wilful or reckless HIV transmission in Sweden. We have also had a few convictions for exposure without transmission. There are no specific HIV laws, instead HIV transmission is dealt with under the regular criminal law. The problem is that it has not been handled in a uniform way by Swedish courts, and the length of imprisonment varies substantially.

We also have a Communicable Diseases Act that involves a number of contagious diseases, including HIV, chlamydia and gonorrhoea, but not only STIs.

The main principle of the act is that people who have these contagious diseases, and their doctors, have several obligations. As a doctor, you’re obliged to trace the people the infected person has had contact with, and, as a patient, you should avoid spreading the disease by informing your sex partners and using a condom.

I think a general discussion is needed regarding the way we deal with HIV transmission – but no other infectious disease - under the criminal law.

In my opinion the lengths of penalties are way too long. I don’t think we should remove all legislation around HIV, but I believe that it would work better if it were handled under the Communicable Diseases Act.

I see HIV transmission from three different perspectives, as a member of a public authority, as researcher and as human being. Of course, it’s impossible to not be affected as a human being and sometimes it has been problematic to juggle these different roles.

Since I’ve been an expert witness in court trials, my personal opinion regarding people living with HIV (PLHIV) has changed.

In my experience the accused persons are seldom ‘raw criminals’. Instead, they are people who have been careless or even reckless. There are many reasons for neglecting to inform sexual partners about HIV status, including denial. None, or very few, have had the intent to transmit HIV, which is how these acts often are described by the media.

Instead, my impression is that they hope that transmission will not happen, or sometimes they do not care, but even then there is no intent to transmit. You can relate this to drink driving, the drunk driver acts carelessly but the intent isn’t to kill someone. I think you have to make this reasoning a part of the debate, especially in the media and also in relation to the penalties.

I’ve seen prejudice in the media reporting of these cases, but that’s how the media works and I have learnt how to deal with it. They often want the sensational and spectacular news, especially tabloids. I wished there was place in the media for a more nuanced view; sometimes we see it, but not very often.

I know about the genetic evolution of HIV from my research and public health work. I use genetic methods to study the principles of HIV transmission, but the same methods can be used to investigate whether it is likely that a person has transmitted HIV to another.

Thus, genetic research to improve our understanding of how the infection is spread can also be used as evidence to convict.

Because of the practise of applying criminal law to cases of HIV transmission it is hard for public health authorities to collect information about the spread of HIV in Sweden.

Research ethics are really brought to a head in these issues. As researchers our main purpose is to work for disease control, not to contribute to criminal investigations. So the legal situation makes our work harder. Aside from that, criminalisation maintains stigma around HIV. If you’re trying to normalise HIV as a disease, it’s counterproductive to put people in jail and have big headlines in the media about ‘HIV criminals’.

Of course, it’s important that people living with HIV have rights and the same rights as everybody else. But the critical question is whether this means that they have the same rights as everybody else to have unprotected sex whenever they want to.

I don’t think that’s straightforward. We need a balanced discussion and legislation, which protects the rights of both infected and uninfected persons.

I don’t think we will see a dramatic change in Sweden in the next few years. But I hope that we will get a more nuanced and moderate view on HIV. There will be more and more HIV infected people living in Sweden, and the rest of the world.

Do we want to turn a proportion of our population into potential criminals every time they have sex?"

This is one of the stories exposing the effect criminal laws on HIV transmission are having on people’s working and private lives in 'Behind bars: life stories of people affected by the criminalization of HIV'. For more information and to read the other stories: http://bit.ly/criminalization.

Criminalize Hate Not HIV

2010-12-01T10:06:00.000Z

Launched at the International AIDS Conference in Vienna, July 2010, Criminalize Hate Not HIV is part of a growing campaign to raise awareness about issues relating to the criminalization of HIV transmission. As part of this campaign, a short conscious raising film was released today - World AIDS Day.

The short-film is stylized and artistic, showing the humanness of sex, of relationships and of HIV. The people in the film are from many walks of life, are not professional actors, and many are living with HIV. It builds on IPPF’s Declaration of Sexual Rights and purposefully focuses on sex - irrespective of how, where, with whom and why people have sex. The film hints at not only the laws criminalizing HIV transmission and exposure but also laws criminalizing behaviours associated with HIV transmission (drug injection, sex work, and sex between men).

Arabic, French, Spanish and Swahili versions of the film are also available: http://www.youtube.com/IPPFHIV

Behind Bars: Life Stories of People Affected by the Criminalization of HIV

2010-12-01T09:47:00.001Z

By Kevin Osborne (IPPF)

Almost 20 years after the HIV virus was discovered, law and policy is still used to criminalize the transmission of HIV. In some countries this happens under old laws (from the nineteenth century or exported through colonialism) and in others under new laws explicitly drafted as part of the national response to HIV.

The nature and impact of the criminal law and its impact on the response to HIV is neither well documented nor well understood. But it risks further marginalizing people already vulnerable to HIV infection, including women, men who have sex with men, sex workers and people who use drugs. Legislation and legal practice is different in every country around the world, and collectively we need to become more conscious of the impact of both the criminal law and its implementation on national responses to HIV.

To call attention to these and other related issues, the International Planned Parenthood Federation (IPPF) has published "Behind Bars" a collection of interviews that exposes how criminal laws regarding HIV transmission are affecting people's working and private lives all around the world.

The stories illustrate the personal and professional dilemmas faced by doctors, lawyers, researchers and advocates. They include the stories of a doctor who, against her ethical principles, was forced to aid a police investigation, a woman living with HIV who prosecuted her former partner, and a lawyer who advocated in an HIV transmission case.

By fueling stigma, criminalization undermines efforts to prevent, treat and care for HIV.
From the UK to the USA, Mali to Mozambique, Azerbaijan to Australia, criminal laws are increasingly being used to prosecute HIV transmission or exposure. But, as the interviews reveal, criminal law is a blunt instrument for HIV prevention.

Behind Bars show how a simplistic "law-and-order‟ response to HIV can intensify a climate of denial, secrecy and fear and provide a fertile breeding ground for the spread of HIV. The drive for criminalization of wilful transmission of HIV is proving a costly intervention - in terms of time and money spent on investigating individuals' private lives and determining the burden of proof - and seems to have had limited impact on HIV prevention.

Contributor Jan Albert, Professor of Infectious Diseases at the Karolinska Institute Sweden, said:

“Since I‟ve been an expert witness in court trials, my personal opinion regarding people living with the virus has changed. In my experience the accused are seldom "criminals".

There are many reasons for neglecting to inform sexual partners about HIV status, including denial. None, or very few, have had the intent to transmit HIV, which is how these acts often are described by the media. There will be more and more HIV infected people living in Sweden, and the rest of the world. Do we want to turn a proportion of our population into potential criminals every time they have sex?”

These stories show that criminalizing the transmission of HIV is actually undermining our efforts to prevent the spread of HIV. Fear of prosecution deters people from coming forward for testing and counselling; policing the bedroom effectively drives the problem underground.

Behind Bars is published as part of IPPF's Criminalize hate, Not HIV campaign, for World AIDS Day, December 1, 2010. Each day, one of the nine stories will be posted to our blog.

For more information and to view all the stories: http://bit.ly/criminalization

Original article posted to RH Reality Check: http://www.rhrealitycheck.org/blog/2010/11/29/behind-bars-life-stories-people-affected-criminalization

Malawi: A guaranteed income

2010-11-16T18:00:00.001Z

Outside a faded apartment in the capital Lilongwe stands Violet. She has traded sex for money since 2006. But now she is not selling sex; instead she is selling hairdressing services. Violet recounts her story:

‘Sometimes I cry myself to sleep when I look back at my life. I never thought I‘d measure a successful day at work by the number of men I had entertained in bed. I entered the sex trade at the age of 22 after losing both parents. I have five younger siblings to look after. I needed to work to provide for them, but there was nothing I was trained to do so I began to have sex for money.

As a young sex worker life was difficult. I was beaten by clients, robbed of money by older sex workers, had clients who refused to pay and was arrested by the police a number of times. All this for barely $3 a day.

Then I was given a life-changing chance by the Family Planning Association of Malawi (FPAM) – to learn a skill. I was given a choice to learn about catering, tailoring, hairdressing or mushroom farming. I opted for hairdressing. When I finished my training I was lent some money to start up my own hairdressing salon in a market. It’s called ‘Tithandizane’ which means ‘Let’s help each other’.

I now make enough money to support myself and my siblings. When I was a sex worker, I had no guarantee about clients, and many days I returned with nothing. Now, I go home everyday with money in my pocket.

Before I became involved with FPAM’s project, I knew little about sexually transmitted infections, family planning or HIV. But part of my training was also about how to look after my sexual health. FPAM’s clinic provides a number of sexual health services for sex workers, such as pregnancy tests, STI treatment, voluntary counselling and HIV testing. There are also free condoms! I am now a peer educator for the project. I help other sex workers and let them know about this clinic where they can receive healthcare from people who will not judge them. They too have the opportunity to learn some new livelihood skills, giving them the chance to earn money in other ways than selling sex.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

Egypt: Knowing my HIV status

2010-11-12T14:03:00.000Z

Organizations such as the Egyptian Family Planning Association (EFPA) are reaching out to young people. EFPA provides the sexual heath and family planning services that young Egyptians are often unable or too scared to ask for:

‘As a young man in Egypt I had never discussed HIV. After attending a seminar about it, I suddenly realized that my past sexual behaviour may have put me at risk. I desperately wanted to know my HIV status but at the same time I was afraid.

Some friends told me about a youth seminar that EFPA was holding at my school. They said it would be fun, so I decided to go.

At the seminar EFPA gave us information on HIV prevention and transmission. I didn’t know anything about HIV and was terrified because I hadn’t thought about it before and I’d had unprotected sex. Immediately after the session I decided to ask one of the young peer educators some questions because I was very anxious and needed answers.

I didn’t want to ask directly so I asked on ‘behalf of a friend’. When he finished answering the questions, he smiled and said “Tell your friend to come to the youth friendly corner at the clinic where he can ask questions and receive counselling and testing for HIV if he wants to. It is done in privacy and total confidentiality.”

After agonizing about it, I took the decision to visit the clinic.

When I arrived I saw the young peer educator from the seminar there. I told him that my friend wanted more information, but he refuses to come himself. We went to the information corner together. It was easy to talk to him and I suddenly forgot that I was asking these questions on behalf of my friend. I confided in him about all the unsafe sexual behaviours I’d practised. He told me about what I could do to find out my HIV status. At the end of the meeting I decided to have an HIV test. I was very scared until I had the post-test counselling.

When I received the test results, they were negative. I was very relieved but also very glad that I had been tested as I understand a lot more about HIV. I now know about the risk of unprotected sex and have decided to always protect myself in future. I’ve also told all my friends about the EFPA clinic. It is a place where you can confidentially talk about your sex life, get some good advice and services.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

The role of pleasure in condom programming

2010-11-04T08:13:00.000Z

By Arushi Singh (IPPF SARO)

S-E-X. Hardly have three letters been so controversial. One would almost think that sex is not a central part of people’s lives, but the fact is that human beings are sexual beings.

People have sex for many different reasons; however, the pursuit of pleasure is often the primary motivation. As most new HIV infections are transmitted sexually, we need a prevention approach that is innovative and honest about the role of pleasure in sexual behaviour. We need a pleasure approach, one that takes a positive, liberating and sexy approach to safer sex.

Unfortunately, pleasure is a relatively unexplored avenue for safer sex promotion and HIV prevention, especially in resource-poor settings. This is due to many reasons, including societal norms about sex and sexuality that tend towards silence and shame. Gender roles, in mostly patriarchal societies, demand that women remain unaware of sex and be passive ‘receivers’ rather than active pleasure seekers. Equally, young people’s sexuality tends to be denied with limited information on the male and female body, sex, sexuality and relationships available to them. When it comes to people living with HIV, there is often heightened stigma surrounding their sexuality, some people are of the opinion that they shouldn’t be having sex at all – let alone for pleasure!

Condom programmes need to re-focus people’s attention on the ways in which condoms can enhance pleasure, not reduce it. In fact, evidence from around the world suggests that a sexier, more pleasure-focused approach to promoting male and female condoms could increase safer sex practices and lower rates of sexually transmitted infections worldwide . The Global Mapping of Pleasure, a publication by the Pleasure Project, provides exciting examples of a wide range of such initiatives.

The case studies show that creating an effective intervention requires getting specific information about the kind of sex the target audience is having – or wishes to have. Moreover, it requires getting specific information about how to have safer, pleasurable sex; using language more commonly used with sexual partners than with health providers or promoters. Providing extra thin, coloured, flavoured or textured condoms, along with water-based lubricants, can go a long way in promoting the use of condoms. And teaching people how to put on a condom with conviction – including with the mouth – can be both pleasurable and preventative.

The female condom presents similar options for promoting pleasure with its use for vaginal and anal sex and the possibility of using oil-based lubricants. In addition, non-penetrative sex can be just as exciting, pleasurable and kinky. Thigh sex, breast sex, mutual masturbation, sex toys, all with lots of lubrication thrown in, are useful tips for a peer educator to promote. If we are really going to address the HIV epidemic, we need to change mindsets about sex, sexuality and condoms. The Pleasure Project believes that you can have safer sex if you know how to have good sex.

Useful Internet resource:
• The Pleasure Project

Article available from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

The condom gap: widening or narrowing?

2010-11-03T11:53:00.000Z

By Taina Nakari (SUPPORT) and Dieneke ter Huurne (IPPF)

Condoms should be a critical element of any HIV prevention strategy. When used consistently and correctly, male and female condoms are approximately 80% effective in preventing HIV transmission. This is significantly more than male circumcision or current microbicide candidates. Moreover, condoms are the only dual protection method available for the prevention of HIV/STIs and unintended pregnancies.

Yet, the gap between the number of condoms needed and the number of condoms available is staggeringly high. In 2005, UNFPA estimated that at least 17.5 billion condoms were needed for HIV prevention and family planning. However, only 10.4 billion condoms were distributed that year – 22% of those through donor support (http://www.avert.org/condoms.htm). Male condoms make up the vast majority (99.6%) of globally distributed condoms. As a result, the condom gap for female condoms is even greater. In sub-Saharan Africa, for example, female condoms are only available at a rate of one for every 300 women per year.

Why is there a condom gap?
Donor support is a contributing factor. In low- and middle income countries, almost one in four people depend on donor-financed condoms to meet their HIV prevention and family planning needs. However, funding for condoms has stagnated in recent years – despite the fact that funding for the HIV response increased dramatically until 2008 (from $ 1.6 billion in 2001 to $15.6 billion in 2008). Donors appear to have lost interest in condoms and are shifting their resources and attention to newer and seemingly sexier issues.

In 2008, for example, donors spent $80 million on purchasing male and female condoms, while investments in research and development for an HIV vaccine and microbicides reached more than $1.1 billion (http://www.aidsmap.com/page/1435164). In their search for new methods, donors have overlooked condoms, which already exist as an effective prevention method and need to be scaled up. The choice to fund either new prevention research or condoms is a false dichotomy (often promoted by donors) and should not be the reason to neglect comprehensive and sustainable condom programming.

National governments often also fail to include commodities in their national budget, or reduce the money for condoms to fill gaps in other budget lines. IPPF Member Associations in Bangladesh, Tanzania, Uganda and Mexico took on this issue, and – through targeted advocacy – helped to increase government and state funding for reproductive health supplies by $11.5 million between 2008 and 2010. Such measures are all the more important as donors are now increasingly providing development aid through basket funding and budget support.

But there is more to the condom gap than funding for the commodity alone. Condom programmes need to be comprehensive in their approach to both supply and demand – ensuring quality, sound storage and distribution, and effective promotion. These components are often overlooked, or not carried out properly. This has resulted in inadequate supply and stubbornly low utilization figures.

With a growing population and the largest generation of young people in history becoming sexually active, the need for condoms is expected to increase significantly over the coming years. For the condom gap to be narrowed, efforts need to be exponentially expanded –by fully integrating condoms into existing HIV and sexual and reproductive health strategies and programmes.

As part of the UNAIDS Interagency Task-Team (IATT) on Comprehensive Condom Programming (CCP), SUPPORT and IPPF are working with UNFPA and other organizations to scale up global and national efforts. The IATT has developed a 10-step approach for CCP, and is finalizing guidance on strategic planning, training, demand generation and monitoring and evaluation. Moreover, SUPPORT offers pro-bono technical assistance to develop and implement programmes to increase the availability of - and access to - male and female condoms.

Useful Internet resource:
• UNFPA Comprehensive Condom Programming

Full article available from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

HIV Update: Condoms

2010-11-02T11:06:00.000Z

By Kevin Osborne

Over the past decade a great deal of attention, research and funds have been dedicated to the development of new HIV prevention technologies including male circumcision, microbicides, and vaccines. Yet it sometimes appears as if the most effective and proven strategy to prevent the sexual transmission of HIV and other sexually transmitted infections (STIs) has seemingly fallen off the global agenda – condoms.

The recent CAPRISA trial using a tenofovir gel as a microbicide is promising but, at present, condoms are still the most effective tool in our prevention package. However, without an increased investment by governments and donors the substantial discrepancy between the number of male and female condoms needed and the number available will grow ever larger. This ‘condom gap’ is also reflected in IPPF’s service statistics. In 2009, 122 Member Associations distributed over 151.8 million male condoms – a rate of approximately one for every 28 people of reproductive age per year. Only approximately 580,000 female condoms were distributed – that’s only one for every 3,740 people of reproductive age per year.

Generating demand for - and ensuring the ready availability of - condoms and lubricants is seen by many as the cornerstone of a dual protection strategy. In line with IPPF’s goal of linking SRH and HIV, the accessibility of male and female condoms helps prevent both unintended pregnancies and HIV. In many countries – particularly those with generalized HIV epidemics - this is surely the most basic of all solutions. In an environment of scarce resources this ‘back to basics’ approach for a renewed and re-energized focus on comprehensive condom programming needs to complimented by a sound strategy to ensure that the information given translates into practical accessibility for a variety of groups including young women and girls, men who have sex with men and people living with HIV. Advocates for the female and male condom, SRH and HIV programme managers, social marketing agencies and donors should ensure that, irrespective of other competing priorities, condom provision is not compromised. It should be a measure of real organizational and political commitment. No longer should we allow our collective attention to be swayed by a new or sexier topic while work on this basic provision remains to be done.

Pitting prevention against treatment is not a useful argument as both are mutually re-enforcing of each other. At IPPF we have an ever increasing and important role to play to ensure that every sexually active person has access to good quality condoms whenever and wherever they are needed, is motivated to use them appropriately, and has the knowledge to use them correctly. Maybe it is time for us to lead a stronger, sexier condom campaign, one which focuses on pleasure and creates demand for both male and female condoms, as well as lubricant.

Article from IPPF HIV Update newsletter - Issue 23: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+23.htm

HIV prevention revolution

2010-11-02T08:56:00.000Z

UNAIDS have just launched a social media initiative to revitalize interest in HIV Prevention as every day more than 7000 people are newly infected with HIV worldwide.

Their aim is to inspire and encourage people using social media to know more about preventing HIV in the lead up to World AIDS Day.

Starting October 26 for six consecutive Tuesdays UNAIDS will introduce different themes related to HIV prevention via discussions on facebook, twitter, and AIDSspace.

What are the themes?

Week 1: Why do we need a PreventionRevolution? ● Week 2: Condoms ● Week 3: HIV testing ● Week 4: Knowledge and HIV ● Week 5: Gender Equality and Human Rights ● Week 6: Join the PreventionRevolution!

Each week there will be a different animated film, quizzes and polls as conversation starters. Follow this link to see the first film: http://bit.ly/aWYxoJ

If you like this:

Re-tweet the key message: Everyday more than 7000 people are infected with HIV. We need a #PreventionRevolution.
Add a #twibbon to your avatar! http://twb.ly/a3LMUO
Share the PreventionRevolution Facebook page—where people can find out about the initiative http://on.fb.me/95aBoI
Add a sticker to your Facebook profile: http://twb.ly/bQSXBj
Become an online advocate for the PreventionRevolution and help shape the initiative.
Join the Google group http://bit.ly/cXDMEK

As this week's theme is CONDOMS, we will be posting articles related to condom programming.

Dominican Republic: Understanding HIV stigma and discrimination

2010-10-27T17:26:00.000+01:00

In 2009 Profamilia and Redovih y Asolsida led a study using the People Living with HIV Stigma Index, to discover the type of stigma and discrimination faced by people living with HIV (PLHIV) in the Dominican Republic. There were a number of interesting results:

Almost one in four respondents reported that their rights as PLHIV have been violated. Most common forms of discrimination were verbal aggression, emotional violence, verbal and physical threats, harassment and exclusion from family activities. One in ten of those interviewed had been refused a job and eight per cent had been refused health services. In general women were more affected by these forms of discrimination than men.

Violence against women living with HIV was extremely common. Thirty-four percent of the women had been pushed, shoved or had something thrown at them, and eleven per cent had been threatened with a weapon.

Thirty per cent of the women and seventeen per cent of men had been advised against having children. Twenty per cent of women had been forcibly sterilized.

The research was an empowering experience for many of those interviewed as well as the interviewers. The interview process helped the interviewees identify experiences of discrimination and violence that they had not realized before. It also enabled the provision of education, counselling and service referrals where necessary.

The results of the study are an important tool for advocacy, development of public policies and programs. Dulce Almonte, Redovih’s president said:

“The Stigma Index is a base to fight and demand our rights, to participate in meetings regarding national plans and present proposals, raise our voices regarding the high incidence of stigma and discrimination at the workplace, socially and especially in the health sector.”

All those involved in the study agree that the results achieved constitute invaluable tools to address stigma and discrimination against PLHIV, especially against women. One interviewee summed this up perfectly:

“I really like it that this study was about discrimination, as, being HIV-positive, this I what I have lived with most.”

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

Annie Lennox asks HIV to become part of our ‘common language’, at launch of photography exhibition

2010-10-05T14:47:00.000+01:00

A new photographic exhibition ‘Exposures: lives lived in the shadows and light of an epidemic’ was opened this week at the Embassy of Japan in London.

The exhibition was opened by H.E. Ambassador Shin Ebihara and Annie Lennox, HIV campaigner, founder of the SING campaign and singer/songwriter.

It showcases the work of the IPPF Japan Trust Fund for HIV and AIDS, and some of the many lives it has touched. The exhibition marks the tenth anniversary of the IPPF Japan Trust Fund.

The IPPF Japan Trust Fund is a partnership between the Government of Japan and the International Planned Parenthood Federation. Established in 2000, the Japan Trust Fund has been a pioneering programme that has actively provided some of the most stigmatised and marginalised communities around the world with essential services.

Ten years on, IPPF Member Associations in Africa, Asia and the Middle East have implemented more than 110 Japan Trust Fund projects in 40 countries. The breadth and scope of their work is evident in its reach and the array of project highlighted in “Exposures”, including:

Supporting women engaged in sex work to access HIV and sexual health services and stand up for their rights in the conflict prone districts of Nepal
Ensuring that package of workplace HIV services are available for construction workers and surrounding communities during the construction of the second Mekong International Bridge on the border of Laos and Thailand
Working with organizations of people living with HIV in Cameroon, to secure their right to have a family and prevent mother to child transmission of HIV
Meeting the sexual and reproductive health needs of people who use drugs, and their sexual partners, in Nagaland, India
Increasing access to integrated HIV and sexual and reproductive health services for returning refugees in Rwanda, and addressing gender-based violence within these communities

H.E. Ambassador Shin Ebihara, said: “Japan is committed to helping achieve the Millennium Development Goals (MDGs). Last week at the United Nations, Prime Minister Kan announced the new “Kan Commitment”, promising to provide 5 billion US dollars in health and 3.5 billion US dollars in education over the next five years. He also offered to host a MDGs follow-up conference in Japan next year.　Japan believes active collaboration with civil society is important in achieving the MDGs. It is therefore my sincere hope that today’s event will provide a good opportunity for strengthening our ties with the IPPF and civil society.”

Annie Lennox, said: “It is such a challenge to put a face to HIV – a virus that you can’t see and often goes unnoticed. The images in the photo exhibition show so many diverse people, from so many diverse places; Nagaland, Ethiopia, Palestine…. What combines their experiences is stigma. Even here in the West, in the UK, there is still such strong stigma. HIV needs to become part of our common language.

"Real change is happening through initiatives like the ones showcased in this exhibition. What has been achieved by this partnership between the Government of Japan and the IPPF in 10 years has been amazing. And just imagine what can be achieved in the next 10 years. I am honoured to be part of it.”

Kevin Osborne, Senior Adviser HIV and AIDS at the International Planned Parenthood Federation, said: “Today, there are proven and compelling arguments supporting the linkages between HIV and sexual and reproductive health. But 10 years ago these arguments were not well understood or accepted.

It is a sign of incredible foresight that, in 2000, the Government of Japan supported IPPF to integrate HIV services into our sexual and reproductive health programmes. The images and stories highlighted in ‘Exposures’ illustrate the positive impact of the IPPF Japan Trust Fund for HIV and AIDS on the lives of many on the margins of society. It provides a compelling argument for scaling up our joint efforts.”

'Exposures: lives lived in the shadows and light of an epidemic' can be viewed until 12 October 2010 at the Embassy of Japan, 101 – 104 Piccadilly, London W1J 7JT.

For further information please contact Paul Bell at IPPF on: 44 (0) 207 939 8233 or pbell@ippf.org

For more information on the SING campaign please visit www.annielennoxsing.com

Indonesia: Men matter

2010-09-27T14:16:00.000+01:00

Rahmad has been working in the construction industry since he was 17 years old, a job with short term contracts which require men to work far from home and away from the company of their wives. He says for these men, there are few more important things after receiving their weekly wages than seeking pleasure.

‘I am 31 years old, a husband and father of two children. I work as a steel concrete labourer for one of the construction companies that are developing the Tanjung Priok Access Road.

I‘m lucky because I can go home everyday as I’ve rented a small house near the project site. But for men who live far from their families, to relieve stress they will look for sex workers, male or female. Their wages are about $3–5 a day, but they’ll happily pay $5–20 to have sex. If they are not having sex, they’re getting drunk.

Although most of us have heard from the media about gonorrhoea, syphilis and HIV, and that they can be transmitted through sexual intercourse without a condom, most don’t pay any attention. I… no, my friends buy antibiotics or herbs if they feel uncomfortable or feel pain around their genitals. Do we visit the doctor? No way, it would be shameful. Sometimes I feel guilty that men don’t care about the risk to our wives.

One day my foreman asked me and some friends to attend a discussion during our lunchtime. At first we objected but he insisted that we join the other workers. At first, I could not believe it! A young man from the Indonesian Planned Parenthood Association (IPPA) was speaking frankly about sex. He explained what a sexual transmitted infection (STI) is and all about HIV and how it can be transmitted. He also distributed a leaflet with information on STIs and HIV, and the address and telephone number of his organization. Not only did he visit us regularly, but so did his colleagues. Over time, many workers considered these educators as friends. They helped us to understand about STIs and HIV and have encouraged us to use a condom when having sex. We were also allowed to use their mobile health services to have genital examinations and blood tests.

I now see some of my colleagues trying to look for condoms on pay day, although they are still ashamed to ask for them! How long should this programme should continue? I suppose for as long as men work far from home.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

Pakistan: Delights, Dogs and Destiny

2010-09-24T14:03:00.000+01:00

Fatima* is a sex worker who has become involved with a peer education group set up in Quetta, Pakistan, to increase HIV prevention and care among sex workers.

‘I nearly quit on my first day as a peer educator because a pack of dogs was set on me! I’d been to a brothel and the owner refused to let me talk to her sex workers. I can earn up to 30,000 rupees ($350) a night as a sex worker. Being mauled by dogs for 4,000 rupees ($47) per month as a peer educator hardly seemed worth it. I’m so glad I didn’t quit because I later helped save a woman’s life.

My manager came with me the next day. She reassured the owner, Auntie, that nobody planned to change her girls’ attitude towards sex work and that we were concerned only about their health and safety.

My eyes fell on a frail woman sitting in a corner in agony. The emptiness in her eyes made me wonder what she might have been going through. I tried talking to her, but was stopped. Before leaving, I scribbled and hid my telephone number under the sofa, making sure the hollow-eyed woman noticed.

Her name was Zeba*, and she called me the same night. Sounding petrified, she whispered that she needed medical attention and help. The next morning my manager and I visited Auntie, armed with ‘gifts’ including medicines and condoms. She was happy for us to distribute these among the girls.

We told them about the ‘Drop-in Centre’ run by Rahnuma Family Planning Association Pakistan where free medical check-ups are conducted by doctors. We reassured everyone that the medical attention provided was non-judgemental and stigma-free, and Auntie finally gave her girls permission to visit.

Zeba needed medicines for sexually transmitted infections and post abortion care. After she was stabilized, she shared her story. She was a mother – though her three children lived with their grandmother in Gujranwala village. She came to Quetta five years ago to work in a toy factory, but soon found herself sold by the factory owner to Auntie. Unfortunately, Auntie discovered Zeba talking to us, and Zeba disappeared without a trace.

I later found Zeba at the Drop-in Centre. Her time with us had given her confidence to stand up for herself. She had more than 18 clients a day, but before meeting me she only got a minor percentage, but now she felt better and had the courage to negotiate a better deal.

I am still a sex worker, but my work as a peer educator has given me a great sense of achievement.’

*Name changed to protect confidentiality

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

Sudan: Stigma-free treatment

2010-09-21T09:58:00.000+01:00

Living with HIV in Sudan is not easy. The media demonises HIV, this is both a symptom and a cause of the high level of HIV related stigma and discrimination faced by people living with HIV in Sudan. This stigma affects their access to medical treatment as well as care and support services. The head of a stigma-free HIV-clinic opened by the Sudan Family Planning Association takes up the story:

‘Our biggest problem in Sudan is knowing how to give people living with HIV a decent life. Our priority is finding support for people living with HIV that allows them to live positively and access the medical services they need. The situation in Sudan is very difficult. Many people living with HIV do not want to go to government health facilities as they often have a harrowing experience as the following examples show:
Through the Sudan Family Planning Association, we have been able to open a centre where people living with HIV can receive stigma-free HIV treatment, care and support services such as voluntary counselling and testing, prevention of mother-to-child transmission, antiretroviral therapy and treatment for sexually transmitted infections and opportunistic infections. There is also counselling and psychosocial support available for people living with HIV as well as home care visits. We do all this so people living with HIV can live a normal, decent life and have access to the support, treatment and care they both require and need.’

“I had a cut in my hand, so I went to the emergency unit at my local hospital. When I was seen by the doctor, he was about to seal my wound when I realised that he was not wearing gloves. When I told him to put gloves on, he looked surprised and asked me why? I told him I was HIV-positive. He told me to wait where I was and that he would be back shortly. He never came back but left me bleeding in the treatment room so I bandaged myself and left.”

“People living with HIV cannot bear the public hospital. This is because the doctors there refuse to deal with us. I will always go to the HIV clinic if I can, to avoid being stigmatized by the doctors and nurses in the public hospital.”

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

Iran: The longest night of the year

2010-09-13T17:49:00.000+01:00

In a clothing factory in southern Tehran, Yalda, a 19 year-old girl, earns a living folding and packing clothes eight hours a day. The last four years have been a roller coaster for her, as she explains:

‘My name Yalda means ‘the longest night of the year’. I think it reflects my past, which has been long and dark. I lost my mother at the age of seven and had to take on a mother’s role, while raising my younger sister.

At 15, I committed a sin under Islamic law. I lost my virginity to my boyfriend Mohammad, who had promised to marry me. My father is very conservative and religious, so could not accept this. I was left with no option but to run away with Mohammed.

My life quickly spun out of control. It all started with my first cigarette. That cigarette became the gateway to a life of addiction. The first time I got high I had no idea what to expect, but once it hit and I started feeling the tingle I couldn’t help but smile. For the first time I was able to escape my life. I moved on to drugs to numb the pain, shut down my brain and get through the day. Mohammad and I felt free. We shared needles for drugs, and enjoyed sex with no fear of sexually transmitted infections.

Things changed when the drug addiction set in. Mohammad wanted to sell me to fund his daily fix. Scared and heartbroken I ran away. I was 17 years old, with no money or place to stay. I turned to sex work to survive but I was often raped, beaten and had nowhere to sleep but the park.

An outreach team associated with the Family Planning Association of the Islamic Republic of Iran (FPAIRI) approached me one night. I registered at their clinic and saw their gynaecologist. After receiving some counselling I decided to test for sexually transmitted infections and HIV. The HIV test result was positive.

The staff at FPAIRI were very supportive. They gave me free condoms and information on safer sex practices. I learnt about contraceptives, preventing sexually transmitted, and life skills development. They also helped me access methadone therapy and offered me vocational training to find work. These free services helped me back on my feet. I first decided to become a peer educator to help other girls and then I retrained and took a job at the clothing factory.’

This is one of the twenty-four, real-life stories highlighting how IPPF's work is having a real impact in the lives of people around the world. 'In A Life' is available at: http://www.ippf.org/en/Resources/Reports-reviews/In+a+life+2010.htm

A 'miscarriage' of justice

2010-09-09T08:52:00.000+01:00

On Sunday 22nd August I mentioned that a number of women are imprisoned in Guanajuato (the state in Mexico where the World Youth Conference took place) for having an abortions and that some of these women had been imprisoned for having a miscarriage! There is finally some good news on this story - see below:

7 women in 'miscarriage' cases freed in Mexico
By MARK STEVENSON (AP) – 17 hours ago
MEXICO CITY — Seven women in Mexico serving prison terms of up to 29 years for the death of their newborns were freed Tuesday after a legal reform enacted in the state of Guanajuato lowered their sentences.

The women's cases case drew national attention in Mexico and their release is unlikely to staunch the fiery debate about whether some conservative states are trying to overzealously enforce bans on elective abortion by charging women who may have suffered miscarriages.

The complete story is available here: http://www.google.com/hostednews/ap/article/ALeqM5gwlqCTH27c7bNv925zRTxUNsnhuwD9I3GER00

However,the women were not absolved, but rather released under a legal reform passed by the state and abortion is still illegal in the majority of cases. There is a lot way to go to ensure that women have the right to choose and access safe abortion services in Guanajuato.

When all is said and done...what next?

2010-09-01T10:15:00.000+01:00

Well I'm finally back in the UK and have just caught up with the final outcomes of the conference. A government declaration was signed in the end but with just four changes made. Still at least language was added on looking after the sexual and reproductive health of young people and language was kept on comprehensive sexuality education - two things which we know work!

The final text of the government declaration (called the Guanajuato Declaration after the Mexico State that the conference was held) is available on the youth 2010 website at http://youth2010.org/portal/?lang=en

The final Statement of the NGO Global Meeting - the text which was agreed by 200+ youth delegates is also available in the same place http://youth2010.org/portal/?lang=en

What next?
Well the Guanajuato Declaration will be delivered to the MDG+10 Conference at the UN in September and to the 65th UN General Assembly. However the year of youth will climax with the UN Conference on Youth next July. It will be interesting to see whether this youth statement is used as a foundation for this meeting. Whether it will or not is still in question.

A useful first step...
Whilst the World Youth Conference wasn't a shining example of how to meaningfully involve young people, it was a step in the right direction. The fact that there was a forum for young people to meet and discuss a youth statement to feed into the governement declaration is an improvement. There were also youth representatives on the goverenment delegations. The next (and somewhat obvious step) in now to listen to the voices of these young people, trust their judgement and expertise on youth issues, and meaningfully involve them by taking on board their ideas, suggestions and comments. If this had happened, instead of being a Government Declaration on Youth Issues (closely observed by youth), the Guanajuato Declaration would have been a youth declaration.

Me. A cynic?

2010-08-27T18:53:00.001+01:00

Maybe I am when it comes to small scale demonstrations at conferences. So often I have walked past the group of people and thought, whatever they are hoping to achieve, this is surely not the way to go about it. Well my experiences from this week have shown that small peaceful demonstrations, can be a very effective form of advocacy. For example, the media interest created by the abortion demo on Tuesday generated a lot of column inches and discussion about the issue in the local and national press.

A further example was at a small demonstration we carried out this morning (actually, it's still going on). Due to the lack of a transparent and democratic process and hearing that the Government Forum had been instructed to disregard the NGO recommendations, we stood quietly outside the entrance to the Governments Forum with messages urging governments to think again. The messages are below:

Before the demonstration, I honestly thought, what can this do? What difference can it make? Surely security will not let this happen. Well, I had to eat my words a couple of hours later. Many of the government delegates read the messages on the way in to the meeting, security left us alone and other delegates who had already entered the meeting came out to read the messages. It turns out that many governments were just as fed up about a lack of transparency and democracy in the process and the demonstration showed that they were not the only ones thinking this. Therefore, when the meeting started, the European, African and North and South American delegates all refused to continue the meeting without the opportunity to read the NGO declaration and discuss and democratically vote on the language in the Government Declaration. They also asked us to stay where we were and keep protesting!

Therefore, people are still there, the TV crews turned up and the closing ceremony for the Government Forum has been shifted from 11:30am to 5pm to give time for the discussions to take place.

What's going to happen? I have no idea and will not know the outcome for the next few days as I have to get on a plane in a couple of hours. I will write more about it as soon as I know.

Quote of the day: (In a session on youth participation from one of the youth NGO Delegates) "I was an observer in the Governments Forum yesterday and one of the Government representatives asked me about the process that had been used to decide the NGO declaration. I told him and he was surprised and said "wow, your process was much more transparent and democratic than ours is, we should learn something from you!"

Marching for young people's rights

2010-08-27T17:21:00.000+01:00

Here are some pictures from the march on Wednesday.
"The World March of youth" - we started at the city's central arch and marched towards the conference centre.

The IPPF presence in the march - Healthy, Happy and Hot

As you can see, there was a lot of media interest and made the front page of all of the local and some of the national newspapers.

5 tips on how NOT to organise a Government Forum

2010-08-27T06:36:00.000+01:00

As I have mentioned before, the whole World Youth Conference has been at best a little chaotic and at worst completely shambolic. Here are 5 lessons to learn about how NOT to organise a Government Forum:

Hospitality: Invite the Minister of Education for Brazil to speak at the opening ceremony and then don’t call on him to give his presentation. Yes this really happened! As a result Brazil withdrew from being the vice chair of the meeting.
Communication: Nominate countries to be part of the drafting committee without telling them, or letting anyone know why they were picked. The list of countries who would be part of the board were read out and a number of them complained saying “I had no idea that I would be doing this and therefore have not prepared – how was I chosen?” The decision was quickly made to let governments meet in regional groupings to choose their own representatives.
Transparency: Say that you would like to take comments on the draft Declaration from the various government delegations but these will be included or excluded on the decision (whim?) of the Chair (i.e. the Mexican Government). An interesting take on a democratic decision making process.
Accountability: Close the Declaration drafting process to observers – but still let the World Youth Council and the Holy See be involved whilst barring anyone who is apparently too progressive, such as UNFPA who had been helping to facilitate the drafting working groups.
Participation: Hold a two day NGO meeting made up of youth representatives and then completely disregard their declaration as it seemed to be too progressive. The board were told explicitly by a Mexican government representative "There is no need to take into account the NGO declaration, that is not why you are here. This will be included as an annex which will be sufficient." An interesting take on meaningfully involving youth!

As a result of the above, the outcome of the conference is currently very much in jeopardy. It is uncertain whether there will be an agreed upon Declaration as a number of the government delegates are getting very frustrated at the lack of transparency and chaotic organisation of the meeting. However, many others feel that any Declaration is better than no Declaration and will vote on whatever text is put before them.

Currently the best possible outcome is for the Conference is for there to be no Government Declaration but for the Governments Forum to formally recognise the NGO declaration. As I mentioned before, the NGO declaration is by no means perfect, but is a darn sight better than the draft Government Declaration!

All will be made clear tomorrow!

The plot thickens

2010-08-27T00:50:00.000+01:00

A lot has happened today and I don't have much time to write this as we've got a planning meeting to discuss the events of today shortly. Therefore, I will simply share some text from an email that was recently sent around from the organisers of the Social Forum Organising Committee regarding the NGO statement which was agreed upon at the end of the NGO forum late on Tuesday evening:

Although many UN entities and Governments are very happy about the NGO
statement it is too controversial for our hosts, meaning that we are
experiencing trouble distributing it (the support to go to the Legislators
Forum [taking place in Mexico City] to present it has for example been
withdrawn).
We are also experiencing that delegates to the Government meeting (Mexican delegates - and they had TEN seats) are distributing alternative documents presented as the statement and so on. It is important for us to get this document, which is the true one, out there, so please share it on websites, send it to your member organisations and governments etc. We do have many supporters amongst governments pushing for the inclusion of paragraphs and points from the declaration in the Governments declaration - but the more recognition world-wide the better.
Clearly none of us are 100 per cent happy with the content - but we are organisations with democratic traditions and respect that this is the final outcome. We need to mass mobilize a bit now, and we in the Social Forum Organizing Committee trust in
your support :-)

As I mentioned in my post yesterday, the text is weak in places. However, it is one heck of a lot better than the "alternative" versions which have been circulated as official copies. As soon as I have a link to the document - I will add it as mentioned in the email.

I need to run to my meeting - more later!!

Phase II

2010-08-26T01:37:00.000+01:00

We’re now halfway through the conference. The NGO forum of youth delegates finally finished their negotiations over the recommendations to be presented to the Government forum at 11:30pm last night. Whilst it was touch and go for some of yesterday evening about how strong the recommendations were going to be, the negotiations were a success and the final recommendations do include language around safe abortion, LGBT rights, comprehensive sexuality education (CSE) and the right to comprehensive health services for young people living with HIV.

This morning, the recommendations were presented to the Government Forum by 10 of the NGO delegates (one of which was our very own Katie Chau). The Forum is made up of the 100+ government delegations whose job it is to finalise the high-level World Youth Conference Declaration by Friday.

In the Global Interactive forum, the themes for today were Education, Sustainable Development and Culture. A UNESCO organised session on comprehensive sexuality education and we were concerned there would be a lot of disruption in the session. Whilst a lot of people turned up who were against teaching school children about sex, they listened respectfully to the presentations and there was a lively debate afterwards. Progress!!

The other key event for today was a march for youth rights. Many of the groups were arguing for sexual rights (like IPPF!), LGBT rights and the right to a safe abortion. The organisers were very worried about security during the march and had received guarantees from the police that we would be protected. This was the case and about 200 people marched through the streets of Leon. However – due to the sensitive nature of the topics we were shouting about in this conservative town – the march had not been widely promoted and therefore there was hardly anyone watching, apart from the local media (which included at least two Mexican TV crews and a number of newspaper reporters/photographers!).

Unfortunately, I cannot currently post any pictures from the march. Whilst I took loads, I used the IPPF-WHR camera which I gave back. I’ll try and post the photo’s tomorrow if I can download them...

"Take your rosary off our ovaries" - pictures

2010-08-25T15:44:00.000+01:00

So my title makes a little more sense from yesterday's post - here are some pictures of the demonstration which I failed to upload yesterday (dodgy internet connection!). Look carefully at the bottom picture (second sign from the left)

I'll have more news later...

"Keep your rosary off our ovaries"

2010-08-25T02:53:00.000+01:00

It’s been a really busy day. As I mentioned earlier the themes of today were health and gender, and all the IPPF sessions were this morning. At the same time frantic negotiations at the NGO forum have been taking place to ensure the final youth recommendation are rights based and progressive.

Here is a flavour about what has been happening today:

Showcasing the Love, Life and HIV DVD: the video was shown this morning on the main stage of the Global Interactive Forum followed by some short interviews with three of the participants from the videos. The showing of the DVD video, only being partially in Spanish, didn’t have a huge audience (40 people or so) given that 85% of the people currently in the Global Interactive Forum are from Latin America. However, as soon as we began the interviews, we gathered a crowd of 150 people or so. The interviews were great as they clearly touched on some of the key issues faced by young people living with HIV such as:

“In Mexico people are not very friendly to people living with HIV – the stigma and discrimination is very strong. Please here do not know how to treat you and make you feel like you are a bad person because of your status.”
“Being an adolescent living with HIV was very difficult. At school, people didn’t want to talk to me or have anything to do with me. I just wanted to be a normal teenager
like they were. It was very difficult for me.”
“I have been living with HIV for four years and have decided that if I want, I can live a completely normal life. Living with HIV is not much different to living with any other illness.”

Legal Abortion Flash-mob: similar to yesterday we organised a short protest to turn some heads. This time the topic was on the right of women to a legal safe abortion. Whilst the idea was very simple (35 people walking through the conference centre in silence holding placards with various messages and statistics about unsafe abortion), it was an effective demonstration and landed up with a lot of media interest. By this I mean a bit of a scrum around the organiser Oriana (see picture to the left!). It will be interesting what the papers say tomorrow.

UNAIDS outcome framework: this afternoon I attended a session introducing the UNAIDS outcome framework 2009 – 2011. Whilst I was aware of this document, I hadn’t clocked its importance in terms of working with young people given that one of the 10 priority areas is “We can empower young people to protect themselves from HIV”. This is certainly something I’m going to be reading a bit more about over the next few weeks. To read more about it see http://data.unaids.org/pub/BaseDocument/2010/jc1713_joint_action_en.pdf

This is all the information at the moment as negotiations are still ongoing at the NGO forum and I don’t have the latest. I’ll write about this further tomorrow!

Turning some heads

2010-08-24T13:39:00.000+01:00

In order to help you understand a little bit more about why we are at the World Youth Conference let me explain a little bit more about how the conference is set up and what the outcome of the conference will be.

What is the World Youth Conference? The conference is the second, and largest, Inter-governmental Conference to be held solely on youth issues. It is taking place across three different fora:

Governments forum: From Wednesday (25th) to Friday (27th), 47 ministers of youth and education from around the world and 103 government delegations will meet to discuss a high-level declaration around the 11 themes of the conference (see below). The final declaration will be presented for countries to sign at the next UN General Assembly.

NGO forum: To ensure youth participation in the process, 400 young people (two per country) have been selected to meet for two days to drafting recommendations for what should be included in the declaration. This meeting takes place on Monday (23rd) and Tuesday (24th). There are a number of IPPF youth representatives from across the Federation who are a part of this.

Global Interactive Forum: This is open to the general public and includes 270 parallel sessions (round tables, youth dialogues, lectures and workshops) on the 11 themes of the conference as well as an exhibition hall and cultural activities.

What are the 11 themes of the conference? They are as follows:
1. Poverty
2. Education
3. Health
4. Employment
5. Gender equality
6. Technology and innovation
7. Culture
8. Access to justice and security
9. Participation
10. Sustainable development
11. International Migration

What stage is the Declaration at? A draft of the Government Declaration has already been prepared by the Mexican Government and has been reviewed by the UN. Even though it is still in a draft state, it has already been subject to a lot of lobbying and change. For example, in one of the latest rounds of changes, a key paragraph on young people’s right to access sexual and reproductive health services was recently removed. Text on sexuality education is still in the draft but is one area that is being strongly objected to. Therefore, the negotiations and advocacy work over the next few days are important!

What has happened so far: Each day of the Conference has a theme. Monday’s theme was “poverty and international migration”. However, given the poor state of organisation for the conference so far, no programme for these sessions currently exists (though one did finally go up online after lunch!). And for those involved in activities at the Global Interactive Forum, most of the morning was spent registering! However, the teething problems seem to be being ironed out!

Turning some heads: In order to create a bit more noise in the chaos that is the Global Interactive Forum and to raise the issue of comprehensive sexuality education (CSE), we organised a short flash mob demonstration at lunchtime, spelling out the initials “CSE” and “ESI” (Spanish for CSE!) with our bodies whilst some statements about how important it is were read out in English and Spanish to the groups who gathered around us. Apart from it drawing the obvious crowd, a lot of people started asking questions about CSE which is no bad thing!!

Looking ahead: Today is the health day and IPPF have four sessions scheduled including:

“Love life and HIV” screening: young people living with HIV sharing their experiences, dreams and desires for the future. This will be followed by three of those featured in the video talking about their own experiences and taking questions from the audience.
Exclaim: Youth perspectives on sexual rights. This youth dialogue will bring together young people from various regions to discuss what sexual rights mean to young people and how to translate these rights into concrete actions.
A training workshop on sexual rights, HIV and advocacy for young people by young people.
Young People: autonomy and confidentiality in health services

This is the day that will focus most of the sexual and reproductive health and rights of young people. I’m looking forward to it!

Lines in the sand

2010-08-23T01:44:00.000+01:00

Leon is a small city in the state of Guanajuato, located in the geographical centre of Mexico. It is best known for its shoe making and leather tanning but it is also one of the most conservative cities in the whole of Mexico. An interesting place to hold the World Youth Conference!

What do I mean when I say conservative? Let me give you an example:

In the state of Guanajuato, access to a safe abortion is illegal as in the rest of Mexico. However, in Guanajuato, the penalty is particularly harsh, 25+ years imprisonment is standard and 73 women have already been arrested in the state this year for allegedly having an abortion. I say allegedly as a recent review of the women who are currently serving time in jail for having an abortion has highlighted that at least 6 women have been imprisoned for simply having a miscarriage! There has been a lot of advocacy by human rights groups over the past year on this issue but these have met with a lot of opposition, some of which has been violent. Why do I mention this here?

The main issues that have been discussed in the Mexican newspapers in the run up to the World Youth Conference have concerned the sexual and reproductive health and rights of young people. A large number of people in the ‘Conservative’ camp have therefore come to Leon to attend the conference and today an estimated 3000 of them marched through the streets for the ‘protection of family values’. Amongst other things they argue that condoms promote promiscuity, emergency contraception is abortion, homosexuality is a clinical/mental disorder. In other words, they are clearly against the rights of women, LGBT and young people.

All the progressive Mexicans we have spoken to have warned that the numbers of conservative people are going to far outweigh the numbers of progressive young people at the Conference. However, all is not lost. The progressive youth met together this weekend to carefully strategise for the week ahead as there are going to be a lot of people at the Conference who have not yet made their minds up as to where they stand on these issues. What is going to win, conservative rhetoric or evidence-based human-rights?

The lines in the sand have been drawn. Let the Conference commence.

Off to the World Youth Conference

2010-08-20T00:05:00.000+01:00

I’m off to Leon, Mexico to attend the World Youth Conference with a number of other IPPF delegates. The conference will be held from 23-27th August and this blog will chart IPPF's presence there. Here's a little bit of background...

What’s the Conference All about? 2010 marks the 25th anniversary of International Youth Year and is also the 10 year review of Millennium Development Goals. In line with this, the Mexican government is hosting the World Youth Conference The conference aims to recognize young people as essential partners for achieving the MDGs and to set priorities related to young people for international and domestic policy.

Why are we going? The main goal of IPPF’s participation at the WYC is to ensure that governments, parliamentarians, youth leaders and NGOs recognize young people’s sexual and reproductive health and rights as critical priorities for development.

The conference will have considerable impact and influence. As such, IPPF believes it is important for a large number of progressive young people to participate at the conference to ensure the outcomes reflect rights-based perspectives on young people’s sexual and reproductive health and rights, gender and sexuality.

For more information about the conference visit http://www.youth2010.org/ (the website is in English, Spanish and French)

Over the weekend I'll let you know what we've got planned for the week ahead...

Photos: Vienna

2010-07-26T17:43:00.000+01:00

Photo Blog: Human Rights March

2010-07-22T15:42:00.000+01:00

Thailand: Practising what you preach

2010-07-22T15:35:00.000+01:00

The Planned Parenthood Association in Thailand (PPAT) began working on HIV projects in 1987 and many of their projects were aimed at reducing the stigma and discrimination faced by people living with HIV. However, these good intentions were not reflected internally as an HIV workplace policy. Montri Pekanan, the Executive Director takes up the story:

‘We already had a supportive environment for people living with HIV working and volunteering for PPAT. However this did not go far enough and was not reflected through an HIV workplace policy. In April 2009, in order to show that we practise what we preach, we began to develop an HIV workplace policy to formally adopt into our Constitution.

There are many benefits to adopting an HIV workplace policy. It will ensure that we continue to have a non-stigmatizing work environment with positive attitudes towards people living with HIV and will improve the quality of the services we provide. As part of the policy there will be ongoing training for all staff and volunteers. This will cover HIV prevention and treatment, legal and ethical issues, stigma and discrimination, and how best to support colleagues, family or friends who are living with HIV. The training will help staff and volunteers to provide non-stigmatizing services and to better understand some of the varied needs of people living with HIV. The policy will also mean that we will actively encourage people living with HIV to apply to PPAT positions, to take part in projects and to volunteer for us. This meaningful involvement of people living with HIV will help us to further improve our HIV projects as a result.

The workplace policy was formally adopted in April 2010 and implementation is currently underway. Developing and implementing a workplace policy is another step forward in our response to HIV. It shows that we are a proactive employer with regard to HIV issues and will help us to be a role model for other sexual and reproductive health and HIV organisations in Thailand.

Criminalize hate, not HIV

2010-07-21T18:14:00.000+01:00

IPPF's 'Criminalize hate, not HIV' campaign was launched on Tuesday, 20 July at the conference. This campaign aims to raise awareness about the criminalization of HIV transmission and how this impacts efforts in reducing stigma and discrimination towards people living with HIV and other key populations thought to be at high risk.

IPPF is involved in a number of activities at the conference surrounding this issue, including a satellite session - Policing Sex and Sexuality: The Role of Law in HIV. The session explored the role of the law - including criminal, anti-discrimination, human rights and public health law - and how it can both facilitate and impede national efforts to address HIV.

The speakers highlighted the complexity of the process of translating law into action, the important role of civil society in advocating for promoting health and human rights, and the complicated process needed (that goes beyond the law) to support efforts to effectively achieve universal access and address HIV.

Colombia: Stepping out and coming alive

2010-07-21T17:56:00.000+01:00

The Lesbian, Gay, Bisexual and Transgender (LGBT) Community Centre is the first of its kind in Bogotá, Colombia. It was brought about by two NGOs (Profamilia and Colombia Diversa) and a disco, Theatrón. Together they promote and defend lesbian gay bisexual and transgender rights. This is Clara’s story:

‘I am a transsexual. Initially I was so apprehensive about coming to the LGBT Community Centre for the first time. I contacted them many times to find out about what they did and I even tried to visit twice. Both times I could not pluck up the courage to go in and returned home. It was daunting, and I was scared I wouldn’t be accepted for what I am. I am a woman trapped in a man’s body and I didn’t think the people at the Centre would understand me. Luckily I was wrong.

When I finally managed to visit the Community Centre, it was to my great relief that everyone treated me with respect, and I felt well supported by the staff. I was able to access many services such as counselling about my own feelings being a transgender woman. I am now receiving therapy to help me to understand my own identity.

Even though I look like a man, after visiting the Community Centre several times, people started calling me by my female name. It was a hard personal challenge to make that first move to come, but now there is no looking back. Everyone here has been so respectful, I can’t express how much that means.

I now visit the community centre regularly. There are loads of things to do here such as tuition in other languages and social activities such as yoga, games and movies. I now work as a volunteer at the Centre. I am an artist and enjoy sharing my knowledge and skills with the other people who come to the Centre.’

AIDS 2010

2010-07-19T15:11:00.000+01:00

Yesterday was the first day of the 18th International AIDS Conference in Vienna, Austria.

We started off first thing on Sunday morning with a satellite session - Gender Gaps: Sex and Stigma - organized by the German BACKUP Initiative and IPPF. Speakers from Bangladesh, Dominican Republic, Ethiopia and the United Kingdom discussed the emerging stigma trends intheir countries and shared experiences of stigma and discrimination.

We also set up our exhibition booth with the theme 'Tried and applied' to highlight IPPF's efforts to scale up links between SRH and HIV andresearch to stregthen the evidence base. This will be the theme of the booth until Tuesday morning.

'Exposures - Lives lived in the shadows and light of an epidemic' is proving to be very successful. This photo exhibition highlights the work of IPPF Japan Trust Fund for HIV and AIDS. Located in front of the main session hall, this exhibition is receiving a lot of traffic by conference delegates. For more information about the exhibition: Exposures.

Over 80 IPPF delegates joined us for our 'Coffee & Cake' reception. Gill Greer and Kevin Osborne welcomed the delegates and gave insightful and motivating talks to ensure we all make the most of the conference. This was also a great opportunity for us to meet volunteers, board members, and staff from across the Federation.

UK: A journey of self discovery

2010-07-19T01:39:00.000+01:00

Between May and September 2009, 867 people living with HIV in the UK were interviewed by their peers about experiences of living with HIV, stigma and discrimination, living positively, accessing health and other services. Pamela was one of the peer interviewers:

‘When I was diagnosed with HIV in 2005 I didn’t know much about it and had no idea how it would impact on my life. I thought that HIV would never happen to me so why should I worry about it?

Since my diagnosis I have worked my way up, realizing that there is life after HIV! In actual fact, I have been so much happier overall since my positive diagnosis. It has helped me to be even more focused on looking after my wellbeing over everything else. I have learnt a lot from listening to other people’s experiences of living with HIV and this was especially true when I got involved in the People Living with HIV Stigma Index research.

The research was done in three main stages; the training on how to be good interviewers, the interviewing process itself, then the data analysis and entry. I have to say that I was most grateful and gratified to be involved in all of these stages as a person living with HIV. For me, to be at the forefront of trying to influence change and policy was something that I never thought would be possible. While doing the interviews someone asked me if it wasn’t boring to live with, work and build a career around HIV. I replied that, while I wasn’t there when the Stigma Index started, I will make it a point to be there when change happens. I will be able to testify that, in the end, I was part of it.

Being part of the IPPF UK Stigma Index research team was one of my proudest moments as I was able to connect and reconnect with different people. More than that was listening to people’s experiences. It just spurred me on to want to do even more to reduce the stigma and discrimination of people living with HIV. The journey continues…’

Time to Pull the Plug on the International AIDS Conference?

2010-07-19T01:27:00.000+01:00

By Kevin Osborne, International Planned Parenthood Federation (IPPF)

This Sunday, July 18th, 2010, 25,000 participants and 2,500 media representatives will converge on the XVIII International AIDS Conference (IAC) in Vienna, Austria. This biennial shindig brings together all those involved in combating the global AIDS epidemic: researchers, healthcare workers, governments, UN organizations, activists, donors, industry, the media, and, critically, people living with HIV and AIDS.

As a veteran of over ten such conferences, I believe the time is long overdue to take stock, to question its value.

Is it, whisper it, time to pull the plug on the International AIDS Conference?

When the first Conference took place in 1985, it was a cutting edge forum for researchers and activists to come to terms with a new, deadly and unknown threat to human health. We agreed that no community, organization or government can effectively address the HIV and AIDS pandemic working in isolation, and the International AIDS Conferences have provided a global venue for this effort.

Back then we were still working in the dark. The first FDA-approved antiretroviral drug AZT didn't debut until 1987. The same year latex condoms were found to be effective in preventing the transmission of the virus through sexual intercourse. Transcriptase inhibitors, drugs that help suppress the transcribing of viral RNA into healthy cells, were years away. And treatment as prevention was a pipedream.

Since then we have learned so much about HIV: about both prevention and treatment, about the side effects of stigma and discrimination and how they direct the path of an epidemic.

Meanwhile the conference has taken its own path, from an inspiring research-based symposium to a multi-million pound behemoth. At a conservative estimate the conference costs about $27 million to stage. Then there's inestimable outlay in terms of time and effort preparing for this colossal event. When you throw in the costs of travel, accommodation (as much as 300 EUR a night in Vienna) and cultural programmes, you can see it's quite a bankable enterprise, and one which the IAC secretariat is understandably reluctant to change. Whether it is really at this stage of the AIDS response the best use of our time, talents and money is another question.

Then again, can a conference really be said to have credibility when the largest implementer of HIV programmes has been missing in action for the past few years? The US Government made the political decision to effectively withdraw from the conference since 2004, a move interpreted by many AIDS experts as payback for the heckling of the then Health and Human Services Secretary Tommy G. Thompson at the 2002 AIDS conference.

There is an alternative. On alternate years to the IACs, regional conferences are held. Inevitably they are overshadowed by the more glamorous and cosmopolitan IAC. But these regional gatherings are where, I believe, we should be directing our funds and our energies. For too long the global stage has been used as a platform to utter platitudes about what we should do - only for these very politicians and speakers to return to their home countries and regions with very little intention of changing the status quo. This is especially true for those at the forefront of the epidemic in different regions: young women and girls; men who have sex with men; sex workers and their clients and people who use drugs.

In the scramble to surpass the last conference, to stage a bigger and better spectacle, these global summits lose sight of one quintessential feature: this is an extremely parochial pandemic.

One thing we've learned over the last 25 years is that one size doesn't fit all. Paying more attention to and gaining real political commitment to the regional variations means the difference between life and death. By focussing on the nuances of each regional epidemic and addressing the structural determinants of HIV, we can better meet the needs of those in different regions and from contrasting cultures. Take the conference venue for example. Central and eastern Europe is experiencing one of the fastest growing epidemics fuelled primarily by drug use, but in Africa where sex is the primary mode of transmission, young woman and girls are bearing the brunt. In Latin America, a region which struggles to catch donors' attention, men who have sex with men are disproportionately affected; as they are in the Arab World from where there is an ill-omened silence.

In this age of both scarce resources and if we really want to convince governments of the importance of continued HIV investment we need to do it through better targeted regional meetings. For that reason, it¹s time to give the IAC a rest, or, at least, cut it back to every four years. Time enough for new research to bear fruit, for strategies to have been tested and for data to have been evaluated. That way, the next time the great IAC bandwagon rolls into town, there will be something genuinely new onboard.

Accessed: Time to Pull the Plug on the International AIDS Conference? RHRealityCheck.org

Rwanda: Life on the move

2010-07-15T23:00:00.000+01:00

A 44 year old grandmother, Frida, heads the Women’s Association in Kageyo in the Eastern Province of Rwanda. She, and her whole community have recently returned from Tanzania after spending 14 years there as refugees after the Rwandan genocide. Frida says:

‘If it wasn’t for the Association Rwandaise pour le Bien-Etre Familial (ARBEF), we women would still be in the dark hole we have been in our entire lives. Being beaten by our husbands was part of our custom. In fact, it was even believed to be a sign that they cared, but now we know better.

I have seven children and four grandchildren and before ARBEF came to our community I had never heard of HIV nor family planning. When I was approached by a peer educator I was very reluctant to listen at first as I felt I would be going against my beliefs.

The peer educator talked about diseases that kill our kin. We always thought that we were victims of witchcraft when we got a sexually transmitted infection. We had never heard of HIV or AIDS. We used to think that cow’s milk could curse anyone. Now we know that most of our sisters and brothers died through ignorance.

Armed with this information, I realized that I had a lot to gain by changing my attitude. Therefore I wanted to convince my husband to also become involved. His peers had tried talking to him several times. But it was only when he started noticing the positive changes in his friends’ lives as a result of challenging the harmful beliefs and practices the community had followed that he too changed. To my delight, he began to follow the advice of the peer educators too. We both began to regularly attend the community education sessions and encouraged our children to do the same.

I am very grateful for the knowledge I have gained through the peer educators trained by ARBEF. Now we always have the strength to work hard, confident that we can afford our children’s needs as we no longer worry about unplanned pregnancies and know about HIV prevention. Without this project we would still be trapped in the dire situation we were in before returning to Rwanda.’

Macedonia: Under one roof

2010-07-14T20:28:00.000+01:00

Sutka is home to the largest Roma community in Macedonia. People living in this neighbourhood are in the lowest social and health demographic in Macedonia. In 2007 after health reforms left around 8000 Roma women of reproductive age without access to a gynaecologist, the Health Education and Research Association (HERA) opened the Sakam da Znam Centre. Juksela, a 26 year old housewife, remembers the first time she heard about the Centre.

‘We were left without a single gynaecologist. When I heard of free gynaecology services at the new HERA Centre I thought I’d go for advice regarding family planning. I was surprised at how fast I was seen and how friendly the gynaecologist was. I was used to waiting for services, to get only a receipt or a referral. My opinions and needs were never taken into consideration. Here I had the chance to understand different methods of birth control, like condoms, pills or an intrauterine device. Best of all, I was given the opportunity to choose the method I wanted.

During subsequent visits I found out about other services relating to my sexual and reproductive health. The doctor told me that, if I wanted too, I could take a test for sexually transmitted infections (STIs) including HIV. Again there was a process of counselling before any tests were taken. Before the counselling, I didn’t know that HIV could also be transmitted from mother-to-child. I just thought it was only a sexually transmitted infection.

I was so happy with my visits to the Centre that I wanted everyone to know about it so I told all my friends. Since then I’ve heard that many have started going there too. The best thing about the Centre is that they offer is a wide range of services. You can go for help with things like medical insurance, advice on family planning, or have an HIV test, all under one roof.’

India: Marrying into HIV

2010-07-13T22:28:00.000+01:00

Amita* is a 31 year old outreach worker for the Family Planning Association of India’s Comprehensive HIV and AIDS Management Project in Madurai, India. On the steps of the village’s community hall, her laughter and the vibrant colours she wears suggest little of the challenges Amita has overcome.

‘I was sixteen when I married. Sex with my husband was both physically and emotionally painful. He had sores all over his genitals and I soon got an itchy rash. He told me he only married me to have children and he would continue his relationships with other women. I am sure he knew he was HIV-positive before he married me. With no idea about sexual and reproductive health matters, I asked my neighbour what I should do about the pain and itching. She suggested cleaning myself with rice water and soap and said girls sometimes got this the first time they have sex.

After having our second child, my husband became very sick. He was bed-ridden with diarrhoea and couldn’t work. His mouth was ulcerated and his muscles had wasted away. His uncle took him to a private hospital to find out what was wrong. The doctor told my husband’s uncle that he was HIV-positive and then the entire village found out. My in-laws blamed me. People stood away from me, I wasn’t even allowed to touch the village tap. At school my child was made to sit and eat separately. Worst of all the village men said my husband would die soon and they would be able to have sex with me. The whole village thought they would get infected with HIV and eventually we were driven out. I wanted to die.

After some time, we returned to the village. Things had calmed down a little and people had a bit more understanding of HIV. I decided to help increase this understanding and to support people living with HIV by becoming an outreach worker for the Family Planning Association of India. I feel strong now. Due to treatment, my husband is fit and working again. I feel proud that I took care of him and saved his life. I don’t want other people to ever have to experience that I did – therefore I use my outreach work to provide the help that I was never got when I was a young married woman.’

*Name changed to protect confidentiality

Cameroon: What love is all about

2010-07-12T23:25:00.000+01:00

Emmanuel is 22 years old and is living with HIV. He has a bright spark of enthusiasm when talking about his life. He works as a cook in Yaounde, Cameroon. Accepting both his homosexuality and his HIV positive status in a hostile environment has given him cause for reflection.

‘Cameroon is quite an unforgiving country for homosexuals. There are laws to suppress homosexuality and this is supported by many people in Cameroon. Discrimination runs deep within families. People living with HIV also face a lot of stigma and discrimination – therefore it is terrible if you are a homosexual living with HIV.
When I was a kid I was never into the kind of games ‘real’ boys liked. This really frustrated my parents. As I grew up, I felt more and more attracted to men but realized that I would never be able to freely love a man in Cameroon.

In my teens I met Julio. He was much older than me, and he helped me discover what love is about –what my body and heart were longing for. It was at this time that I think I contracted HIV. I met him secretly so that no one knew, but my family began to suspect. They accused me of ‘not being virile’ or as macho as my friends. I was scared by their questions and harassment. My family seemed to be looking for evidence by searching through my things.

Finally I cracked, and I told them I was gay and HIV positive. This was the beginning of hell. I was brutally rejected by everybody I knew. I was assigned a specific space in our home. I couldn’t mix with others and I was given separate dishes to eat from, a place to cook my food and when I became seriously ill, nobody helped me. Eventually, a neighbour took me to hospital. It was then a gay friend told about the MESDINE project run by Cameroon National Association for Family Welfare (CAMNAFAW) where I could go to safely meet with others and also receive non-judgemental counselling, support and sexual health information. This was the most important moment of my life! It was like being born again. I’ve met people like me and people totally different from me but who accept me. Nobody judges one another. I have made so many friends and have been given information about how to take care of myself.

The hatred in me has gone. I’m happy with myself, I’ve reconciled my conscience and I’ve even tried to start a dialogue with my parents.’

In a Life

2010-07-12T23:13:00.000+01:00

Sex, love and intimacy play an important part in what it means to be human. Whether for pleasure and/or procreation; whether straight, gay or bisexual; and irrespective of gender or HIV status making informed choices about our sexual and reproductive lives helps shape our dreams and desires. Linking sexual and reproductive health and HIV recognizes the vital role that sexuality plays in people’s lives.

The real-life stories reflect IPPF’s core values in linking sexual and reproductive health and HIV: evidence-informed programming, a recognition of vulnerability and the full protection of rights. 'In a Life' highlights how our work – shaped and pioneered by the efforts of thousands of committed staff, volunteers and partners – is having a real impact in the lives of people the world over.

Each day, one story from 'In a Life' will be featured on this blog. The first story is from Cameroon.

Welcome to the 'IPPF at AIDS 2010' blog

2010-07-08T15:58:00.000+01:00

I’m Daniel McCartney, HIV Officer at IPPF. I’ll be blogging at the International AIDS Conference in Vienna. Come and visit us at our exhibition booth E-437. You can find out more about our activities during the conference on our website.

At the conference we will be launching our new publication 'In a Life'. This collection of 24 real-life stories reflect IPPF’s core values in linking sexual and reproductive health and HIV. I will be posting individual stories in the lead up and during the conference.