[hivaids-twg] Today's News (2009.11.09ex)
Diaz, Clara
diazc at unaids.org
Mon Nov 9 13:25:04 GMT 2009
Please find attached the following AIDS-related articles compiled by UNAIDS
AFRICA AND MIDDLE EAST
1. The Nation, Kenya - Forcible HIV testing by India amounts to discrimination
2. BuaNews, SA - Fight against HIV, AIDS must be intensified - Motsoaledi
3. New Times, Rwanda - Conference to Strengthen Fight Against HIV in Children
4. Business Day, SA - State Drug Tender System Under Fire
5. Leadership, Nigeria - Infant Microbobic Virology HIV/Aids Lab Established
ASIA AND PACIFIC
1. Nhân Dân, Viet Nam - National action month for anti-HIV/AIDS launched
2. Jakarta Post - The education sector role in HIV prevention
3. Times of India - Housewives more prone to be AIDS victims
4. The Age, Australia - Alarm on surge in HIV cases
5. Matangi Tonga - Women's second-class status hampers access to health care
EUROPE
1. The Lancet, UK - The GAVI, Global Fund, and World Bank joint funding platform
2. IPS Terra Viva-Europe - LESOTHO: AIDS ORPHANS GET HELPING HAND
3. IPS Terra Viva-Europe - UGANDA: COUNTERFEITS BILL THREATENS ACCESS TO MEDICINE
LATIN AMERICA AND CARIBBEAN
1. El Comercio, Ecuador - El sida se expandió a todos los municipios de Cuba
2. El Tiempo, Venezuela - La crisis amenaza la lucha contra el sida
3. Folha de S. Paulo, Brazil - Brasil fecha acordo de US$ 200 mi para Aids
NORTH AMERICA
1. New York Times - Bill Would Limit Needle Exchanges
2. TIME - In Fight Against AIDS, Kenya Confronts Gay Taboo
3. Chicago Tribune - Helene Gayle: Leading the anti-AIDS war
4. Seattle Post Intelligencer - Step Forward: Progressive LGBT Politics
5. Bloomberg.com - Obama Calls Botswana 'Extraordinary' Success as Khama Visits
UNAIDS WEB.SITE
1. UNAIDS - WHO report on the health of women: AIDS leading cause of death globally in women of reproductive age
2. UNAIDS - UNAIDS, ASEAN join hands to support work on gender and HIV
3. UNAIDS - Antiretroviral treatment for prevention
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AFRICA AND MIDDLE EAST
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Forcible HIV testing by India amounts to discrimination
The Nation, Kenya
06/11/2009
By PETER MWAURA
By allowing people with HIV/Aids to enter the US after January 1, next year, President Obama is holding up to shame countries left behind in removing discrimination against people who are infected.
The countries - and there are about a dozen of them - include India, which hosts thousands of African university students, many from Kenya. In a move apparently aimed at arresting the spread of the scourge, India still needs foreign students - most of them African or Asian - to take compulsory HIV tests. If they prove positive they are deported.
The mandatory testing of foreign students - there some 30,000 foreign students in India - not only discriminates against them, but also violates their basic human rights. It is particularly demeaning for people from a continent widely suspected to be the origin of Aids. Government centres in India have been carrying out these tests for more than two decades now, although forced testing violates international law.
ARTICLE 17 OF THE INTERNATIONAL Covenant on Civil and Political Rights Article states: "No-one shall be subjected to arbitrary or unlawful interference with his privacy". And the United Nations Commission on Human Rights, in a report issued on Aids and human rights, says:
"The right to privacy covers obligations to respect physical privacy, including the obligation to seek informed consent to HIV testing, and also privacy of information, including the need to respect confidentiality of all information relating to a person's HIV status."
The report adds that the individual's interest in his privacy is particularly context of HIV/Aids, firstly, because of the invasive character a mandatory HIV test, and secondly, because of the stigma and discrimination attached to the loss of privacy and confidentiality.
Testing for HIV infection should be voluntary, and conducted only if an individual gives informed consent after pre-test counselling. When it is made mandatory for a selected group of foreigners, it stigmatises. And it does not help India to fight HIV/Aids. It is futile.
Testing is needed before one can get the residence permit, but the testing does not take into account the "window period". A test is cannot detect the presence of the virus during the "window period", even though the person is infected and infectious. One, however, gets the feeling that India thinks that by requiring mandatory HIV screening for Africans, it is stopping the spread of HIV/Aids, that the disease comes from Africa, and that India "will not become another Africa".
The exercise shows unthinkable insensitivity. It is surprising that no African government has publicly put diplomatic pressure on New Delhi to stop the absurd exercise. Susan Sontag's Aids and Its Metaphors shows well this accusatory side of Aids infection: how fears, paranoia and stigma are associated with the disease, as well as how it is always assumed that the disease comes from somewhere else, that it is someone else's fault.
When the first Indian Aids case was diagnosed in 1986, the media and government officials attributed the disease to foreigners or returning Indians. The director-general of the Indian Council of Medical Research went as far as demanding a legal ban on sex with foreigners and non-resident Indians.
Foreign students were then screened and nine out of an estimated 1,200 at that time were found to be HIV-positive and deported. The government made it mandatory for all foreigners who intended to live in India for longer than a year to undergo a test.
BUT DESPITE THE QUARANTINE ON HIV-positive foreigners, the spread of Aids in India continues. In 2006, UNAids estimated that there were 5.6 million people living with HIV in India, that is more than in any other country in the world. In 2007, following the first survey of HIV among the general population, UNAids and India's National Aids Control Organisation agreed on a new estimate of between 2 million and 3.1 million people living with HIV.
Last year, the figure was confirmed to be 2.5 million, a prevalence of 0.3 per cent. Because of the size of India's population - nearly 1 billion - a prevalence of 0.3 per cent translates into large numbers of people living with Aids. Clearly, screening foreigners has had no effect on the Indian levels of infection. The sure way to prevent Aids is behaviour change, not blaming foreign students.
gigirimwaura at yahoo.com
2
Fight against HIV, AIDS must be intensified - Motsoaledi
BuaNews, SA
/11/2009
By Gabi Khumalo
Johannesburg - Health Minister, Dr Aaron Motsoaledi, has urged people living with HIV and AIDS to work with government to intensify the fight against the disease.
"Let's stop fighting with each other but fight this virus together. We are a sober nation to fight the scourge of HIV and AIDS, we need to come out with guns blazing to fight it," Motsoaledi said.
Motsoaledi assured people infected that government was on their side and there to support them.
He said the South African National AIDS Council (SANAC), together with government, were committed to cut the rate of the infection by 50 percent by 2011 and ensure that 80 percent of people who need the treatment have access to it.
"Everyone needs to know his or her status and those who need to be treated must get the treatment," he said.
About 300 people, including people living with HIV and AIDS and health experts, were gathered at Midrand for the inaugural Positive Convention on Living with HIV and AIDS.
Themed, "Positive Convention - It's about living with HIV and AIDS", the conference focused on multiple aspects of living with the disease including social and personal challenges.
SANAC Chief Executive Officer, Dr Nono Simelela, acknowledged government's efforts in allocating more funds to health to ensure that the country did not run out of treatment.
"We urge anyone who has a problem regarding access to treatment to let us know as we want to address all the blockages. We are here for you and seek your guidance in order to achieve the goals of National Strategic Plan 2007-2011," Simelela said.
Constitutional Court Judge Edwin Cameron, who is living with the disease, paid tribute to President Zuma for his commitment towards the fight against the scourge.
"He showed us that he knows what must be done, he encouraged us to have no shame, discouraged the discrimination of people living with HIV and we must now end this stigma attached with the disease," said Judge Cameron.
Dr Mary Fanning from the Health Attache for the United States Embassy also commended South Africa for the strides made in testing, treatment and care, especially for orphans.
He also stressed the need for change of hearts, minds, culture and attitudes towards people living with the virus.
For every person who has been treated, two more becomes infected, Fanning noted. - BuaNews
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Conference to Strengthen Fight Against HIV in Children
New Times, Rwanda
09/11/2009
Charles Kwizera
Kigali - This year's National Pediatric Conference on Children Infected and affected by HIV that is scheduled to take place this week will focus on strategies of achieving Millennium Development Goal six, according to the National Aids Control Commission (CNLS).
The MDG 6 aims at fighting HIV/AIDS, Malaria, Tuberculosis and other epidemics through halting and reversing their prevalence by the year 2015.
The three-day conference to be held under the theme, 'Count down to 2015 Targets for Children and HIV - Achieving MDG number 6,' will bring together over 350 policymakers, researchers, children, health workers, and different NGOs.
According to the Executive Secretary of CNLS Dr. Anita Asiimwe, the conference will bring together people from different backgrounds to recognize that the responsibility to reverse the spread of HIV belongs to all.
"The meeting aims at understanding and reviewing the existing national coordination mechanisms of implementing MDG 6 and to also explore mechanisms of strengthening areas that are still lacking," Asiimwe said yesterday during a press briefing.
The Minister of Gender and Family Promotion Dr Jeanne d' Arc Mujawamariya said that government has put much emphasis on ensuring that children's lives are protected from getting infected by their mothers at birth, and also taking care of the infected children.
She also revealed that out of the 438 health facilities in the country, 362 have the capacity to cater for HIV/AIDS patients, adding that the government was targeting to have equipped all the health facilities by the year 2012.
Statistics from CNLS show that over 17, 000 children from the age of 0 - 21 years live with HIV/AIDS in Rwanda today.
This year's conference, the fifth of its kind, will bring together high level representatives from the government, UN agencies, representatives of health facilities, together with those infected and affected by HIV as well as those providing direct services at the grass roots levels.
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State Drug Tender System Under Fire
Business Day, SA
09/11/2009
Tamar Kahn
Cape Town - Generic drug maker Aspen Pharmacare, the biggest beneficiary of the government's multibillion-rand AIDS drug tender, says the system is not working and pharmaceutical companies should partner directly with the state instead.
Under the terms of the two-year contract, worth R4,2bn when it was announced last June, pharmaceutical companies were given no volume guarantees, yet had to make significant investments in production capacity, said Aspen senior executive Stavros Nicolaou.
Aspen had been disappointed by the volumes ordered by the state, he said. The government had tendered for 3,6-million packs of tenofovir, yet 18 months into the deal it had only bought 180000 packs, he said.
Although the state was providing AIDS drugs to an estimated 670000 patients by August, very few of them were using tenofovir -- current treatment guidelines reserve tenofovir for people who have experienced serious side-effects with a much cheaper drug called stavudine.
The actual value of the tender realised to date was about 60% of the value when it was floated, Nicolaou said. "Forecasting with such uncertainty is very difficult. You are far better off doing public private partnerships, which will give predictability of patient numbers," Nicolaou told delegates to a seminar hosted by Metropolitan Health Group and Qualsa medical scheme.
A public-private partnership for the provision of AIDS drugs would see the state enter into a long-term contract with drug makers with guarantees of patient numbers, Nicolaou said.
The health department expected that it would have to provide treatment to between 1,6-million and 2,5-million HIV patients in the next three to five years, he said.
"I don't believe a tender is the most competitive, nor the most sustainable, way to get antiretroviral medicines," he said.
Public-private partnerships should also be considered for pharmaceutical supply chain management, he said.
Delegates also heard Richard Friedland, CEO of SA's biggest hospital group Netcare , arguing that the government's model for partnerships with private hospitals should be expanded to allow them to provide clinical services.
The handful of public-private partnerships in the hospital sector are restricted to infrastructure upgrades and facility management.
Netcare's experience in the UK and Lesotho had shown that the private sector could improve the quality of care at state healthcare facilities at no extra cost to the government, and turn a profit for the company, he said.
"The private sector is willing to take the risk of providing clinical services. We need the government to allow us to do so," he said.
Netcare and its rival LifeHealthcare won contracts from the UK's National Health Service to provide cataract and orthopaedic services to reduce long waiting lists.
Netcare has also entered into a deal with the Lesotho government to upgrade and provide clinical services to a hospital in Maseru.
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Infant Microbobic Virology HIV/Aids Lab Established
Leadership, Nigeria
08/11/2009
Bernard Tolani Dada
Uyo - An infant molecular virology laboratory for early detection and monitoring of HIV/AIDS pandemic has been opened at the University of Uyo Teaching Hospital in Akwa Ibom State.
The new laboratory built by the Institute of Human Virology of Nigeria and the Clinton HIV/AIDS initiatives in colaboration with the Federal Ministry of Health will serve states in the South South geo-political zone of the country. Akwa Ibom State Governor Godswill Akpabio, who was represented at the occassion by his deputy Eng Patrick Ekpotu said his administration was ready to partner any agency to provide for the health needs of the people. He said to this end, his administration had embarked on the training of health personel in all hospitals across the state to enable them acquire more knowledge in the area of infant diagnosis services.
Chief Akpabio expressed the hope that the new laboratory would provide the needed diagnostic services to HIV/AIDS exposed infants born to HIV positive parents in the South South region. He advocated for adequate public awareness for the full utilization of the facility and commended all the partners for ensuring the completion of the project and for laying a solid foundation for the hospital. In his key note address, national coordinator HIV/AIDS in the Federal Ministry of Health, DR. Jide Coker, stated that since the programme started in 2007, more than six of such facilities had been built in various part of the country with over 2300 blood samples tested
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ASIA AND PACIFIC
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National action month for anti-HIV/AIDS launched
Nhân Dân, Viet Nam
09/11/2009
A national action month for HIV/AIDS prevention and control was launched in northern Bac Ninh province on November 8.
Addressing the launching ceremony, Vice State President Nguyen Thi Doan affirmed that the HIV/AIDS pandemic is on the increase and has not been put under control in Vietnam .
Vietnam will have almost 300,000 HIV carriers by 2010 and the nation will focus on how to help all needy people regardless of sex, social position and religion have access to HIV/AIDS treatment, care and preventive services, she added.
To keep its commitment and determine to preventing AIDS, Vice President Doan asked leaders of all branches and mass organisations from central to local levels, social organisations and all walks of life to raise their awareness and behaviours and increase assistance to people living with HIV/AIDS and oppose discrimination against HIV/AIDS victims.
For his part, Health Minister Nguyen Quoc Trieu said that the expansion and the increase of the quality of the HIV/AIDS treatment, assistance, care and preventive measures have facilitated people access the service.
However, people's knowledge on the pandemic and the discrimination against HIV sufferers and the service network in remote areas remain limited, he noted. "This is the barrier that we need to overcome to achieve the target to access universalisation in 2010," he said. (VNA)
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The education sector role in HIV prevention
Jakarta Post
07/11/2009
Irwanto
Intervention to curb the HIV/AIDS epidemic in Indonesia should be conducted in a manner that it is low in cost and high in impact, so say authorities in HIV prevention.
This is well understood as resources are severely limited, and yet the epidemic is alive and kicking, and spreading.
It also makes sense as we need to seize the moment, as most of the infections occur within a specific population who are engaged in risky behavior, i.e., sex workers, Men having Sex with Men (MSM), and injecting drug users (IDUs).
In fact, infections among members of this sector contribute more than 75 percent of all reported cases.
It makes a lot of sense also as currently the national aggregate prevalence is still low (0.16 percent), except in West Papua where the epidemic has been generalized (2.4 percent among the population aged 15-49 years old).
The window of opportunity for an effective, low-cost prevention agenda is still wide open.
Having said all of the above, I need to mention the following.
First, the Commission on AIDS in Asia (2008) reminds us that we need to carefully monitor and be concerned about the emerging epidemic among monogamous women who are infected through their husbands (or male partners).
This emerging issue brings serious consequences. When more women are infected it means diminishing support for children and more children will be born from infected mothers, which will in turn increase the likelihood of infant infections.
HIV/AIDS cases reported to the Health Ministry (as of June 2009) do indicate fast growing infection among the population below the age of 19 and school-age individuals.
The number of reported cases increased dramatically from 19 cases in 1996 to 976 cases in 2009.
Those under 14 years old may have been infected through their infected mothers and the older children may be infected through injecting drug use.
There are at least three embedded issues within this emerging epidemic.
First is the fact that, in Indonesia, condom use among men buying sex is still very low. Second, women in marital relationships either have low awareness of their partners' at-risk sexual behavior or they are culturally not equipped or empowered to negotiate condom use with their partners.
Finally, women in marital relationships are not a primary target for the IEC program on HIV prevention.
Second, we need to draw our attention to the strength of formal education. A survey in 2007 clearly suggests that the higher the level of education of the men and women who were in marital relationships, the higher their knowledge of HIV and how it is transmitted and prevented.
Of course, this may mean that better educated people may have a higher need for information. This may also mean, however, that currently information on HIV//AIDS is available in textbooks or on courses in higher levels of education (currently, in high schools and above). The second possibility warrants our serious consideration.
Third, we need to carefully examine how some people are socially constructed as the Most-at-Risk Population (MARP) in the HIV/AIDS epidemic. People are engaged in at-risk behavior for a number of reasons.
Simply put, some people may not know that their behavior risks HIV infection. If they know, they may not know what to do about it for a series of yet different reasons. One is isolation due to discrimination and stigmatization.
Sex workers, MSM and IDUs are groups of people whose behavior is not socially acceptable. They have to fight an uphill battle to get recognition and to preserve their entitlement to basic rights.
Another reason is poverty and, many times, a combination of minority status, "deviant" group status, and poverty. People living in destitution will do anything to survive, including behavior that may compromise their health and safety.
It is also worth noting that many individuals living in poverty are trapped in exploitative and abusive circumstances.
What has this to do with the education sector? There are a few important linkages.
No one is born vulnerable. Vulnerability is socially constructed. Social acceptance or rejection of certain behavior or certain characteristics of individual human beings is commonly preserved in the family or community. We should remember that one of the sectors which are constructed to inform individuals and affect their behavior is the education sector.
Most people, including those labeled as MARP have been, or are currently still, in the formal education system. The problem, however, is that the sector presently does not provide enough and appropriate information and skills to deal with HIV.
It is a great mistake to ignore the role of the education sector in the national strategic planning for HIV prevention. Our children deserve protection from the negative impacts of the epidemic early on.
Although it is acknowledged that changing the education sector to accommodate strategies to prevent HIV infection may be difficult, inevitably the sector should be more responsive, since children and other human resources within the sector are already affected by the epidemic.
The writer is a professor in the Faculty of Psychology, Atma Jaya University, Jakarta.
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Housewives more prone to be AIDS victims
Times of India
07/11/2009
Archana Mishra, TNN
KANPUR: The misconception of working women being more prone to HIV in comparison to housewives was recently proved wrong. Reports by the district health societies revealed that around 45 women in the city were detected as HIV positive during April to October, out of which 42 were housewives. Figures indicated that 19 (out of the total) housewives detected as HIV positive belonged to the age group 21-30 followed by 16 women in the age group 31-40. Fifteen infected women, however, were known to be from slum areas.
Attributing reasons for the cases where married women were contracting HIV from their husband, Dheerendra Kumar Dubey, coordinator of National AIDS Control Society (NACO) said: ``Women are more vulnerable to AIDS for biological reasons and are four times more susceptible to sexual transmitted infection than their male counterparts.'' He further informed that women are increasingly being infected due to low social and economic status and their dependence on male counterparts that limit their control over their own lives.
It is to be mentioned here that around 19 females in the age group 31-40 belonged to the rural areas. Dr SK Singh, medical officer, District Tuberculosis Hospital, informed HIV infected women belonging to 31-40 age group are more likely to be part of the labour force, adding, these women get the virus because their husbands are the clients of sex workers. He further informed that an interconnecting link between the general population and the vulnerable class is established by the bridge population which majorily includes all those who are the clients of sex workers. Another reason, according to Singh is the increase in the number of drug users. He said: "Everybody could be at a risk unless adequate measures are not taken. We need to change our mindset in dealing AIDS.''
Reports, however, revealed that a total of 121 cases (approx) have been detected as HIV positive during the period, April to October, out of which 107 have been referred to Anti Retro Viral Therapy (ART) Centre, Lucknow for treatment. Dubey said: ``The immediate affect of a HIV infected patient is visible economically and the direct impact is on the income of the household of People Living With HIV/AIDS (PLWHA).'' The increased expenditure on the treatment pulls them to back out, adding that poverty does not let them avail proper medication. Taking into consideration, HIV patients who need immediate treatment are taken to ART Centre Lucknow free of cost.
To subside the problem, Singh said: ``information is provided regarding the use of condoms and check-up at the district hospital is recommended in case of suspicion.'' The health authorities along with NACO are widening HIV/AIDS campaign to go beyond the vulnerable groups. Dr Ashok Mishra, Chief Medical Officer (CMO) said: "Although the situation in the city with AIDS patients is less in comparison to other districts, but it is still alarming.''
To put a check on the rising cases the district health authorities are trying to create awareness amongst masses through novel ways like that of maintaining a register at the petrol pumps located at national highways so as to get the entry of those drivers taking condoms from petrol pumps. Apart, condom vending machines are installed at various locations by NACO. Street plays and campaigns are being performed in areas of HIV positive cases.
4
Alarm on surge in HIV cases
The Age, Australia
07/11/2009
JULIA MEDEW
INFECTIOUS disease experts are calling for urgent changes to the way HIV is tackled in Australia as the virus continues to spread at alarming rates.
A draft strategy written by a group of specialists for the Federal Government said Australia was entering a challenging new period with resurgent epidemics among gay men and emerging epidemics among people travelling between high-risk countries and within Aboriginal and Torres Strait Islander communities.
It said there was a need to reinvigorate prevention messages and to re-invest in a long-term response over the next four years because public interest in the issue had waned.
''Strong leadership on HIV from government at all levels is now required,'' the strategy said.
The document called for major prevention programs for gay men, but said migrants from high-risk regions such as Africa and South-East Asia should be a priority, as should Australians travelling to these areas.
''Australian residents who acquire HIV while travelling and working in countries or regions with high prevalence are an increasing proportion of the epidemic,'' it said. There was also potential for rapid infection among indigenous Australians because of higher rates of sexually transmitted infections and injecting drug use. The call for action comes after a decade of increasing infection rates. Statistics released by the National Centre in HIV Epidemiology and Clinical Research last month showed new diagnoses had jumped 38 per cent across the nation from 718 in 1999 to 995 in 2008.
Trends have varied across the state and territories, but in Victoria infection rates doubled from 2.8 per 100,000 people in 1999 to 5.5 in 2006, and stabilised at 5.3 in 2008.
Michael Kidd, chairman of the Federal Government's ministerial advisory committee on blood-borne viruses and sexually transmitted infections, said some of the increases might have been linked to less investment in prevention campaigns.
"It's certainly true that we had a reduction, particularly in targeted prevention activities, about a decade ago and that following that we saw significant increases in HIV infection rates in a number of parts of the country," he said.
"Over the last few years there's been a focus on prevention in a number of areas. That seems to be becoming effective now, but we need to keep going with the prevention messages all the time because there are young people coming through now who might change aspects of their behaviour that put them at risk of HIV and other blood-borne viruses."
Professor Kidd said that although antiviral medication had transformed HIV from a terminal illness into a chronic disease for most, it was still very costly for all involved.
Federal Health Minister Nicola Roxon last night said the Government was determined to curb the rise in blood-borne viruses and sexually transmitted infections.
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Women's second-class status hampers access to health care
Matangi Tonga
09/11/2009
Geveva, Switzerland - DESPITE considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age, a WHO report has found.
Launching the report, entitled 'Women and health: today's evidence tomorrow's agenda', WHO Director-General, Dr Margaret Chan called for urgent action both within the health sector and beyond to improve the health and lives of girls and women around the world, from birth to older age.
"If women are denied a chance to develop their full human potential, including their potential to lead healthier and at least somewhat happier lives, is society as a whole really healthy? What does this say about the state of social progress in the 21st century?" asked Dr Chan.
Women provide the bulk of health care, but rarely receive the care they need
Worldwide, women provide the bulk of health care - whether in the home, the community or the health system, yet health care continues to fail to address the specific needs and challenges of women throughout their lives.
Up to 80% of all health care and 90% of care for HIV/AIDS-related illness is provided in the home - almost always by women. Yet more often than not, they go unsupported, unrecognized and unremunerated in this essential role.
When it comes to meeting women's health care needs, some services, such as care during pregnancy, are more likely to be in place than others such as mental health, sexual violence and screening and treatment for cervical cancer.
Marginalized groups
However, in many countries, sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of unmarried women and adolescents. Few services cater for other marginalized groups of women such as sex workers, intravenous drug users, ethnic minorities and rural women.
"It's time to pay girls and women back, to make sure that they get the care and support they need to enjoy a fundamental human right at every moment of their lives, that is their right to health," said Dr Chan.
Women live longer than men but these extra years are not always healthy
HIV, pregnancy-related conditions and tuberculosis continue to be major killers of women aged 15 to 45 globally. However, as women age, noncommunicable diseases become major causes of death and disability, particularly after the age of 45 years.
Globally, heart attacks and stroke, often thought to be "male" problems, are the two leading killers of women. Women often show different symptoms from men, which contributes to under diagnosis of heart disease in women. They also tend to develop heart disease later in life than men.
Because women tend to live on average six to eight years longer than men, they represent a growing proportion of all older people. Societies need to prepare now to deal with the health problems and costs associated with older age and anticipate the major social changes in the organization of work, family and social support.
Despite some biological advantages, women's health suffers from their lower socio-economic status
Lack of access to education, decision-making positions and income may limit women's ability to protect their own health and that of their families. Though major differences exist in women's health across regions, countries and socio-economic class, women and girls face similar challenges, in particular discrimination, violence and poverty, which increase their risk of ill-health.
For example, in the case of HIV/AIDS the risk posed by a biological difference is compounded in cultures that limit women's knowledge about HIV and their ability to negotiate safer sex.
"We will not see significant progress as long as women are regarded as second-class citizens in so many parts of the world," Dr Chan said. "In so many societies, men exercise political, social and economic control. The health sector has to be concerned. These unequal power relations translate into unequal access to health care and unequal control over health resources," she added.
Policy change and action is needed within the health sector and beyond
The report seeks to identify key areas for reform, both within and outside the health sector. These include identifying mechanisms to build strong leadership with the full participation of women's organizations, strengthening health systems to better meet women's needs throughout their lives, leveraging changes in public policy to address how social and economic determinants of health adversely impact women, and building a knowledge base that would allow a better tracking of progress.
Strategies to improve women's health must also take full account of gender inequality and address the specific socioeconomic and cultural barriers that prevent women from protecting and improving their health, the report points out. (WHO)
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EUROPE
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The GAVI, Global Fund, and World Bank joint funding platform
The Lancet, UK
07/11/2009
Volume 374, Issue 9701, Pages 1595 - 1596,
Correspondence
Roger England a
On Sept 23, the Taskforce on Innovative International Financing for Health Systems presented its report to the UN General Assembly.1 It proposed more aid for health systems, recognising that, currently, more than 50% of health aid is for infectious diseases, mostly HIV, with little for basic services. In response, GAVI, the Global Fund, and the World Bank are forming a Joint Funding Platform2 and significant new financing is expected.
Can these organisations support health systems? GAVI's remit is to improve immunisation and related services. Its systems support is largely for improving the training, supervision, and management of Expanded Program on Immunisation staff, supplies, and infrastructure. The Global Fund's remit is to improve prevention and treatment of HIV, tuberculosis, and malaria, and applicants must show how grants will do so. Although the World Bank can support systems reforms, it provides loans not grants, and few countries can borrow for that purpose. Its record in health systems is not good.3
Moreover, GAVI and the Global Fund share weaknesses emanating from their roles as funding bodies rather than technical ones.4, 5 These include little in-house technical capacity, little direct engagement with countries, and weak design and assessment mechanisms. GAVI relies on in-country WHO and UNICEF staff, both better versed in immunisation than in health systems, and the Global Fund relies on country coordinating mechanisms whose members have disease-specific interests, mostly HIV. Both use panels in Geneva-the Independent Review Committee (GAVI) and the Technical Review Panel (Global Fund)-to assess projects about which they know little. Whereas GAVI promotes good aid principles, the Global Fund requires complex applications and reporting, produces unpredictable funding, and weakens country planning and budgeting processes by bypassing them.
Potential donors should ask how a joint funding partnership could:
Develop in-house technical capacity and in-country engagement to reduce risk, build capacity in countries, and resolve tensions in favour of system strengthening rather than the status quo of vertical programmes.
Replace "rounds-based" funding with processes supporting countries' mechanisms and cycles, resulting in predictable funding.
Reduce the burden of complex application and reporting (joint assessment will not help while participants require disease-specific strategies too).
Use monitoring indicators relevant to systems strengthening rather than disease outcomes, and tailored to countries' capacities, not to a common global framework.
The case for joint funding is overwhelming. But it always has been, and it is unclear how the Global Fund particularly can do this now when it has been unable to participate effectively in sector-wide approaches (eg, in Mozambique).
As conceived, a joint funding partnership risks doing little more than coordinating disease-specific funding. Although desirable, this leaves the glaring global gap of reforming the systems through which services are financed, produced, and delivered-the foundations for improving health for all. Without structural reform themselves, participants in a joint funding partnership are in no position to do this.
RE was part of a team evaluating the GAVI health systems strengthening funding window.
References
1 Taskforce on Innovative International Financing for Health Systems. More money for health, and more health for the money. http://www.internationalhealthpartnership.net/CMS_files/documents/taskforce_report_EN.pdf. (accessed Oct 13, 2009).
2 World Bank. Moving towards a joint funding platform for health system strengthening. http://go.worldbank.org/GARPCRAEV0. (accessed Oct 13, 2009).
3 World Bank. Improving effectiveness and outcomes for the poor in health, nutrition, and population: an evaluation of World Bank Group support since 1997. http://go.worldbank.org/U2T30HQKG0. (accessed Oct 13, 2009).
4 Naimoli JF. Global health partnerships in practice: taking stock of the GAVI Alliance's new investment in health systems strengthening. Int J Health Plann Manage 2009; 24: 3-25. CrossRef | PubMed
5 Technical Evaluation Reference Group. Synthesis report of the five-year evaluation of the Global Fund. http://www.theglobalfund.org/documents/terg/TERG_Summary_Paper_on_Synthesis_Report.pdf. (accessed Oct 13, 2009).
a Health Systems Workshop, Box 1350, Grenada, West Indies
3
LESOTHO: AIDS ORPHANS GET HELPING HAND
IPS Terra Viva
06/11/2009
Letuka Mahe
MASERU (IPS) - Fifteen-year-old Ntsebeng Tlokotsi* sighs with relief as she is given 140 dollars. Along with it she receives a bag of maize meal and cooking oil. It is a government handout, and she qualifies for this only because both her parents are dead.
Tlokotsi's mother died four years ago, and her father in August. Both were HIV positive.
In the face of growing vulnerability and chronic poverty among its children, the Lesotho Government this year launched, for the first time in the country's history, a child-grant programme. Tlokotsi is one of the first 5,000 beneficiaries.
Since August Tlokotsi has been living with her aunt Tiisetso (23) in Semonkong in the Maseru district. It is some 130 km and three hours of hard driving on a poor gravel road from the country's capital.
The difficult access to Semonkong is a hindrance in providing services to the community. The tarred road from the capital ends at the National University of Lesotho at Roma, some 40 km from the capital. A thin stretch of what used to be a tarred path goes a farther 17 km into Moits'upeli, before deteriorating into a ragged gravel path meandering over the mountainous terrain.
Semonkong, like many rural areas, has very limited health care, with only three clinics. The government and Roman Catholic Mission clinics are both free, while the private clinic is not.
This hard-to-reach district is one of the three areas of Mafeteng, Qacha's Nek and Maseru where the programme will be piloted. One local council was selected in each district based on its proximity to services; the number of orphans and vulnerable children who live there; and the area's level of development.
The government programme also receives financial assistance from the European Commission (EC) in collaboration with the United Nations Children's Fund (UNICEF).
It gives beneficiaries an unconditional quarterly payment of about 46 dollars. Through the World Food Programme commodities such as maize meal, cooking oil and pulses are also provided.
When it was launched in April, Mathuleng in the Mafeteng district was the first local council to receive the grant. In October Thaba-Khubelu in the Qacha's Nek district was included and recently Semonkong, in the Maseru district.
Because the programme is officially in its third quarter, children in Semonkong also received a back payment for the first two quarters.
A dollar in Lesotho can only buy a loaf of bread, or a can of soft-drink. But for Tlokotsi, 40 dollars every three months helps.
"It makes some difference in our lives as there is nowhere we could receive any form of cash to make our lives better," she says.
Life in her community has been difficult for her since her HIV positive parents died. "It is not easy to live freely in this community without someone casting a mocking glance at me, or saying something dreadful about me or my family," she says.
But there remains concern for how long the orphans and vulnerable children in Lesotho can expect handouts from donors. Semonkong's chief, Morena Mathibeli, says Basotho communities should devise their own sustainable projects to support these children, without relying on donors. "We should regard this effort (by UNICEF and the EC) as a temporary measure, and an encouragement for us to start helping these orphans ourselves," he says.
The ministry of health and social welfare says the main objective of the programme is to assist the ever-increasing number of children affected by HIV/AIDS. National AIDS Commission statistics show that the number of AIDS orphans in Lesotho has increased from 108,000 in 2007 to 120,000 this year.
"We expect to reach a total of 60,000 orphans and vulnerable children through grants, counselling, guidance on safety measure against HIV/AIDS, as well as decreasing food insecurity," says the ministry's deputy principal secretary Moliehi Khabele. Khabele says the aim is to ensure that, at the very least, each child attends school and has three meals a day.
High levels of poverty, chronic food insecurity and the high prevalence of HIV have seriously endangered the children of Lesotho. Many leave school early to look after their siblings, or fend for themselves after their HIV positive parents die.
Tlokotsi was fortunate she had family to rely on after her parents passed on.
She is a Form A (Grade 7) student at Amohelang High School in Semonkong. Before his passing, her father had managed to pay only half her school fees of about 70 dollars. Her uncles have promised to pay the remainder of the fees. If her fees are not paid by November, she will not be able to sit for her end of year examinations.
They also promised to pay for the rest of her high school education. But in a country where almost half the population live on less than a dollar a day, the future is never certain.
"I do not know how long we are going to survive this way, and I do not know how long my uncles will keep supporting me with fees," she says.
So there is no doubt the child grant will help pay for her school fees and other necessities. And Tlokotsi says she is glad for the extra money. With it she can buy herself a second uniform. She will no longer have to use the same one every day.
*Not her real name
4
UGANDA: COUNTERFEITS BILL THREATENS ACCESS TO MEDICINE
IPS Terra Viva-Europe
06/11/2009
Wambi Michael
KAMPALA (IPS) - Uganda is considering an anti-counterfeit bill which analysts say will impair the country's ability to import and export cheap but effective generic medicines. Activists fear that the bill, once enacted, will deny Ugandans access to safe, effective, quality and affordable generic medication which currently forms the bulk of Uganda's medicine imports.
The Counterfeit Goods Bill seeks to prohibit trade in goods that ostensibly infringe intellectual property rights. The bill, which was tabled by Uganda's trade ministry, will empower the commissioner of customs to seize suspected counterfeit goods.
The bill defines "counterfeiting" as manufacturing, producing, packaging, re-packaging, labelling or making, whether in Uganda or outside Uganda, any goods which are imitated so as to be substantially similar to the protected goods without the authority of the intellectual property right owner subsisting in the country or elsewhere.
President Yoweri Museveni in February asked his trade ministry to draft a strict law to curb counterfeit goods that he said were affecting local industries.
"I think in China they've got some good solutions because you remember the other man who sold milk which killed children? I think he was put in front of the firing squad. If somebody kills children, do you think the Chinese are very wrong?" he asked.
But Edgar Tabaro, a Ugandan lawyer specialising in trade-related matters, questions the necessity of the bill. He told IPS that whatever the bill ostensibly seeks to address is covered by different laws like the Trademarks Act, Copyright Act, the Patents Act and the Trade Secrets Act.
"So we are asking whether this bill is being pursued on behalf of our national agenda or whether there are some embedded interests behind this bill. Why should we deny our people cheaper drugs by making laws that are not in our interest?" he asked.
Rosette Mutambi, executive director of the Coalition for Health Promotion and Social Development (HEPS-Uganda), regards the bill as a threat to the lives of many Ugandans who largely depend on generic anti-retroviral drugs and other medicine. HEPS is a health consumers' organisation advocating for health rights and also represents health practitioners.
Mutambi said only about 10 percent of the medicines used in Uganda are locally manufactured. And only about five to seven percent of the imported medicines are original brands, meaning that about 93 percent of imported drugs are generics. These are mostly imported from India.
Patrick Mubangizi, the coordinator of Health Action International Africa's (HAI-Africa) office in Nairobi, said during a recent meeting in Kampala that he was "very concerned" about the bill because policy makers and the public didn't understand its implications for public health. HAI-Africa is part of an independent global network seeking to enhance access to medicines.
HAI-Africa is opposed to the Ugandan bill because it deviates from the official definition of counterfeit medicine as provided by the World Health Organisation (WHO).
"WHO describes counterfeit medicine as 'medicine which is deliberately and fraudulently mislabelled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients, or with fake packaging'," explained Mubangizi.
Geoffrey Nalima, a manager at Quality Chemicals Limited, the first antiretrovirals (ARVs) manufacturing plant in East Africa, told IPS that they were alarmed by the bill because it classifies their products as counterfeits. Moreover, the bill will make it difficult for their products to be exported to other countries in the region.
Other countries in the region have expressed interest in the drugs, which are being manufactured under a license from Cipla of India.
Sisule Musungu, a policy analyst specialising in intellectual property, trade and innovation, told IPS that Uganda, like Kenya, will become a victim of multinational companies pushing for intellectual property right enforcement.
"Internationally, there is a big push towards intellectual property enforcement for trade reasons. With the trade negotiations going on at the World Trade Organisation (WTO), the U.S. and European Union will have to reduce subsidies for agricultural production. All that remains are technology-based goods. That is where intellectual property rights enforcement comes in," Musungu explained.
Uganda as a least developed country (LDC) which, under the WTO's Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, does not have to provide protection for trademarks, copyrights, patents and other intellectual property rights until July 2013. Regarding pharmaceuticals, Uganda does not have to put in place protections on medicine until 2016.
The idea behind these "allowances" is for developing countries to take advantage of technological advancements and gain the capacity to produce their own drugs. Uganda would therefore be preventing itself from doing so by adopting this bill, according to Musungu.
"If Uganda wants to pass an intellectual property rights law, the benchmark should not be to comply with TRIPS. The benchmark should be determined by asking what Uganda wants for this law. And, therefore, which type of law should we have. The draft bill goes beyond TRIPS's requirements," he said.
Nathan Irumba, a former Ugandan ambassador to the WTO and now senior strategic advisor to the Southern and Eastern African Trade Information and Negotiations Institute (SEATINI), agreed that Ugandan government needed to protect its citizen from counterfeits. But, he said, the problem with the bill is that it mixes issues of trademarks and the question of standards.
"I agree counterfeits should be dealt with but in the process we should not outlaw generic medicine. We should not be tricked by multinationals to have their rights enforced in our courts. We should instead utilise our space for development. TRIPS gives us leeway. But in the bill we (Ugandans) are trying to restrain these flexibilities," he pointed out.
Elimu Elyetu, a project manager with Uganda's Trade Capacity Enhancement project that is also steering the bill, told IPS that they were ready to include amendments to the bill to take care of activists' concerns.
Uganda's trade minister Gagawala Wambuzi told IPS that government was determined to have the bill enacted into law before the end of this year. "There has been a disease of counterfeits. People are crying. Some of the counterfeits are manufactured inside here; some are from abroad. And we are saying this must stop."
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LATIN AMERICA AND CARIBBEAN
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El sida se expandió a todos los municipios de Cuba
El Comercio, Ecuador
08/11/2009
La Habana - Los 169 municipios cubanos " tienen algún grado de afectación" por el VIH y el sida, lo que marca una expansión geográfica pues en 2006 sólo estaba presente en 41 de ellos, dijeron hoy autoridades sanitarias citadas por el diario Juventud Rebelde.
En esa expansión puede estar incidiendo "variaciones en los patrones de conducta de los jóvenes que van a trabajar o estudiar temporalmente a otras ciudades", dijo al diario Manuel Hernández, del Centro Nacional de Prevención de ITS/VIH/sida
También el aumento de hombres que "experimentan" con mujeres y otros hombres al margen de su relación estable.
Desde 1986 que se registró el primer caso hasta mayo de este año, el Ministerio de Salud Pública contabilizó 11 208 personas infectadas, de ellas 4 528 enfermaron de sida y 1 971 murieron, 137 por otras causas diferentes a esa enfermedad.
"Hoy viven en el país 9.237 personas con VIH. El lado bueno de esta cifra es que mueren menos personas al año gracias al tratamiento con antirretrovirales" que es gratis en la isla, dijo Juventud Rebelde.
El 80% de los portadores son hombres y de ellos, el 85% se infectó directamente en relaciones sexuales homo o heterosexuales, principal causa de la transmisión de la enfermedad en la isla, pese a una fuerte campaña mediática y el muy bajo costo del condón.
Las autoridades mantienen un riguroso control sobre la sangre en los hospitales, todos estatales, y sobre las embarazadas portadoras del virus y otras posibles vías de transmisión.
Científicos cubanos trabajan en una vacuna terapéutica para mejorar la calidad de vida de las personas infectadas.
"Estamos desarrollando una vacuna que es lo que se llama ahora terapéutica, es una vacuna que está diseñada para la curación de los enfermos, en este caso pensamos probarla no en enfermos de sida, sino en seropositivos", dijo el doctor Gerardo Guillén, del Centro de Ingeniería Genética y Biotecnología al telediario local.
Añadió que se "está en estos momentos en fase de someterla a la autoridad regulatoria nacional para comenzar el primer ensayo clínico". (AFP)
3
La crisis amenaza la lucha contra el sida
El Tiempo,Venezuela
08/11/2009
INTOPRESS/CARACAS, NOVIEMBRE 8 - Con la excusa de la crisis financiera, los fondos que deberían estar disponibles para la lucha contra el sida están cada día más menguados.
En veremos quedaron nuevos programas, que podrían suponer salvar la vida de enfermos (6 millones necesitan tratamiento actualmente), corren el riesgo de ser congelados, mientras que pacientes ya enrolados verán suspendido el acceso a medicamentos que les evitan la muerte.
Y este no es la única amenaza a la que se enfrenta la lucha contra el sida en el mundo, de acuerdo con un informe hecho público ayer por Médicos Sin Fronteras (MSF).
Bajo el título "¿Castigando el éxito?", el informe alerta sobre los crecientes llamamientos para la diversión de fondos de la lucha contra el sida a otras prioridades sanitarias, traspasando fondos de un presupuesto a otro, que no va a satisfacer a nadie y que puede poner en la picota los avances obtenidos en la última década contra la enfermedad.
Fondo global
El Fondo Global para la Lucha contra el Sida, Tuberculosis y Malaria, pone como evidencia MSF, debatirá la semana que viene una moción para la cancelación de nuevos proyectos en el año 2010, mientras que PEPFAR, el plan de emergencia del presidente de los Estados Unidos, ha congelado su presupuesto para los dos próximos años, incumpliendo los compromisos adquiridos en 2008.
"El apoyo internacional está declinando" dice el informe, "y en países con alta incidencia, los pacientes son rechazados y los médicos forzados a racionar un tratamiento indispensable".
Muchos países africanos, el continente con la tasa más elevada de enfermedad, dependen en gran manera de uno de los dos fondos, "por ejemplo, en Uganda, en programas sufragados por PEPFAR ya están negando el tratamiento a nuevos pacientes", explica Tido von Schoen-Angerer, director de la campaña Acceso a Medicinas Esenciales, "corremos el peligro de regresar a la situación de principios de los años 90, en los que se racionaba el tratamiento, cuando dabas medicinas a uno, pero enviabas a otros tres a morir a casa".
Entre las causas de la falta de cumplimiento político se encuentra, de acuerdo con von Schoen-Angerer, "la voluntad de los donantes de pasar página y dedicar sus fondos a algo más novedoso, de moda, la crisis financiera es más que una razón, una excusa".
MSF considera que para una lucha contra la enfermedad eficaz los fondos deben continuar incrementándose "y llegar a una cobertura del 100%, que es a lo que se comprometieron los líderes mundiales en 2005.
Congelar
"Congelar o recortar fondos sería una traición internacional", dijo esta semana en rueda de periodistas en Johannesburgo, Eric Gomaere, coordinador médico de MSF en Suráfrica.
El informe de MSF constata, además, que en los países en los que el tratamiento se ha hecho más extenso, "no sólo se han salvado vidas, sino que también se ha reducido la mortalidad en general, se han hecho avances en el control de la tuberculosis o de la mortalidad materno-infantil".
MSF es consciente de que es necesario dotar de mayores fondos otras áreas de salud, como la malnutrición o la mortalidad materno-infantil, "pero debe ser a base de replicar el éxito de la lucha contra el sida, no en su detrimento, que no beneficia a nadie", considera von Schoen-Angerer.
Unusida apunta que los fondos necesarios para la lucha contra el sida en el año 2015 (en teoría con más enfermos en tratamiento) deberían llegar a entre 41 mil y 48 mil millones de dólares.
En el 2008 se presupuestaron 22 mil millones, de los que se recaudaron 14 mil. La Organización Mundial de la Salud reafirmó la necesidad de acceso universal a retrovirales para el tratamiento de pacientes seropositivos y enfatizó el beneficio clínico de que éstos tomen los medicamentos en los primeros estadios de la enfermedad.
Un mayor acceso a retrovirales impacta asimismo en una mayor prevención por parte de la comunidad, en reducción de la transmisión de VIH y en una menor incidencia de tuberculosis.
4
Brasil fecha acordo de US$ 200 mi para Aids
Folha de S. Paulo, Brazil
06/11/2009
SÉRGIO DÁVILA DE WASHINGTON
O Brasil finaliza os últimos detalhes de acordo feito com o Banco Mundial (Bird) que destinará US$ 200 milhões ao programa de combate a doenças sexualmente transmissíveis e HIV/AIDS do Ministério da Saúde. Do total, US$ 67 milhões virão da instituição, baseada em Washington, e os outros US$ 133 milhões, do governo brasileiro. O dinheiro será desembolsado em quatro anos, a partir de 15 de janeiro.
Segundo dados do projeto ainda sigiloso, ao qual a Folha teve acesso, há ênfase no monitoramento dos resultados e na prestação de contas do dinheiro, e parte da verba será dedicada a ampliar a transparência no uso da verba, cujo desembolso será vinculado a metas. O projeto deve ser recebido e aprovado pelo banco até o fim do ano e então submetido ao Senado brasileiro, para aprovação.
Estão previstas 230 bolsas, com valores mensais de R$ 600 a R$ 3.000 durante quatro anos, destinadas a técnicos, tutores e consultores da área, mas também a líderes comunitários de populações vulneráveis e à formação de pessoas vivendo com HIV/AIDS para liderança comunitária, num total de R$ 14,78 milhões.
Além disso, serão contratados 40 funcionários para o departamento de combate à AIDS.
O valor total do acordo equivale a 24% do orçamento anual do programa brasileiro, que é de R$ 1,4 bilhão. Quando deduzido o valor gasto anualmente com medicamentos, de R$ 1 bilhão hoje, o acordo equivale a 50% do dinheiro aplicado em outras atividades por ano.
Segundo o documento, desde 1988 o Bird destinou US$ 432 milhões ao programa brasileiro. O de 2009 será o quarto acordo e um dos maiores. Um memorando de intenções já foi assinado em julho.
O projeto está detalhado em dois documentos. Num deles, uma versão preliminar e de uso restrito datada de outubro, fica patente a ênfase na transparência. O projeto "apoia o aprimoramento da governança", diz, "no campo do accountability [prestação de contas], transparência e controle social".
Isso ocorrerá "por meio da promoção da gestão por resultados e orientada por evidências e da coordenação e integração de serviços de prevenção e atenção primária em saúde; da implementação e consolidação de um sistema robusto de monitoramento e avaliação; e da implementação de mecanismos de financiamento baseado em desempenho".
Entre os 13 indicadores previstos para medir o cumprimento de metas e para acionar os desembolsos estão "aumento de 15% entre homens relatando o uso do PRESERVATIVO na última relação sexual anal com um parceiro masculino" e "aumento de 10% entre profissionais do sexo femininos e masculinos relatando o uso do PRESERVATIVO com o último cliente".
Embora elogiado por sua eficácia e inovação, o programa brasileiro já foi criticado pelo Bird no passado, pelo que o banco chamou de "falta de monitoramento e avaliação" e "pouca análise de custo-benefício para embasar futuras definições de prioridade e critérios na alocação de recursos".
O acordo vem à luz dias após um projeto brasileiro semelhante ter sido recusado pelo Fundo Global, o braço do G-8 (grupo dos oito países mais desenvolvidos) que financia programas de saúde em países em desenvolvimento. Somado a outro projeto, de combate à tuberculose, o valor rejeitado foi de cerca de R$ 230 milhões
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NORTH AMERICA
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Bill Would Limit Needle Exchanges
New York Times
09/11/2009
By KATIE ZEZIMA
BANGOR, Me. - For years, the location of this city's needle exchange program, in a nondescript strip mall close to highways and bus lines, was seen as a major asset.
But now, AIDS activists say, that very location could undermine what happens inside the exchange.
A bill working its way through Congress would lift a ban of more than 20 years on using federal money for needle exchange programs. But the bill would also ban federally financed exchanges from being within 1,000 feet of a school, park, library, college, video arcade or any place children might gather - a provision that would apply to a majority of the country's approximately 200 exchanges.
"This 1,000-foot rule is simply instituting the ban in a different form," said Rebecca Haag, executive director of the AIDS Action Council, an advocacy group based in Washington. "Clearly the intent of this rule is to nullify the lifting of the ban."
Under a separate bill, all exchanges in Washington within the 1,000-foot perimeter would be barred from receiving city money as well as federal money.
"Let's protect these kids," said Representative Jack Kingston, Republican of Georgia, who introduced the Washington bill. "They don't need to be playing kickball in the playground and seeing people lined up for needle exchange."
Both bills have passed the House and a Senate subcommittee and await Senate action.
Advocates and organizations including the N.A.A.C.P. are lobbying Congress to kill the 1,000-foot provisions. The promise of federal money could not come at a better time, these officials say, as states are cutting their health and human services budgets and private donations are dropping precipitously. At least four needle exchanges have closed this year because of a lack of financing.
Many exchanges are run by organizations that provide broad-based health services like testing for the AIDS virus and hepatitis C, mental health counseling, medical referrals and condom distribution. Advocates worry that if needle exchanges disappear, drug users will lose access to those other services.
The rule "is going to kill us," said Ellis Poole, executive director of the Harm Reduction Center of Southern Oregon, which is 997 feet from a high school in Roseburg. The center runs a needle exchange and offers antidrug programs to high schools in the area. With donations plummeting, it has a $374,000 budget deficit for 2009. Mr. Poole said he worried that the center's programs would be threatened if the bill passed.
"We could move a few feet down, but the building is more expensive at the other end," Mr. Poole said. "I have to beg for money for computers. I have to ask people to come clean the carpet at no charge."
Officials at exchanges in cities like Chicago, New York and Washington say there are few, if any, places that could house a needle exchange under the rule.
"I was thinking, 'A thousand feet, how much is that?' " said Raquel Algarin, executive director of the Lower East Side Harm Reduction Center in Manhattan. "And then I found myself thinking, 'We'd probably be doing syringe exchange in the middle of the East River, and any exchange on the West Side would be in the Hudson River.' How do you work that out?"
Many advocates also worry that smaller, rural exchanges, which lack the fund-raising abilities and infrastructure of many larger, urban exchanges, will be affected by the 1,000-foot rule.
In Maine, which officials say has one of the highest rates of prescription drug abuse per capita in the country and is grappling with a recent influx of heroin, AIDS activists worry that they will receive less money just as their client base is growing. The state's four exchanges - in Augusta, Bangor, Ellsworth and Portland - would be ineligible for federal money.
"The federal funding would be key for us," said Patricia A. Murphy, executive director of the Eastern Maine AIDS Network in downtown Bangor.
Upon entering the office, squeezed between a veterans center and a music store, drug users are escorted into a small room, where a trained staff member checks them in, using only first names and case numbers, and carefully counts their needles.
Under Maine law, drug users may receive one clean needle for every dirty one they turn in. The exchange offers users a variety of needle sizes, along with tourniquets, antiseptic ointment, condoms and information on safe needle use, and helps refer clients to clinics and treatment centers that deal with sexually transmitted diseases. The center also has a food bank, which clients are urged to use.
Those who have built a level of trust with Ms. Murphy and her staff send fellow drug users to the office. The number of users enrolled in the needle exchange here has doubled in the past year, while funding fell by about 15 percent.
The federal money, Ms. Murphy said, would allow the exchange to grow with the number of clients, many of whom come from rural northern and eastern Maine, and set up mobile needle exchange units in communities more than 100 miles from Bangor.
"This is a critical piece of harm reduction," Ms. Murphy said.
According to the Centers for Disease Control and Prevention, intravenous drug use directly or indirectly accounts for about one-fifth of the nation's 1.1 million H.I.V. cases, and needle exchanges are an effective way to stem the spread of infection. The World Health Organization said in a 2004 report that there was "compelling evidence" that increasing needle exchanges reduced H.I.V. transmission. It cited studies showing that the rate of infection dropped up to 18 percent in cities with an exchange.
Luke, a 30-year-old Bangor resident who did not want to give his last name, said he exchanged his needles, and sometimes those of his friends, about once a week. He said he had become addicted to Suboxone, a drug intended to treat opiate addiction that officials say more people are starting to abuse.
In a black hooded sweatshirt and red sneakers, Luke said he often also picked up condoms and guides on how to inject drugs more safely. He said he came to the facility because its location made it discreet and few people knew what it was.
A 23-year-old man who is addicted to heroin and exchanges needles at the Down East AIDS Network in Ellsworth called the 1,000-foot limit "ridiculous." The man, who did not want to give his name because of his addiction, said he started using heroin eight years ago and exchanging needles four years ago. He said he often picked up needles he saw on the ground and brought them in for safe disposal.
"It's a dangerous thing to do," the man said of his heroin use, "but it's best to take every precaution you can. If you're going to do this stuff, you should do it right."
A version of this article appeared in print on November 9, 2009, on page A9 of the New York edition.
2
In Fight Against AIDS, Kenya Confronts Gay Taboo
TIME Magazine
07/11/2009
By Nick Wadhams / Nairobi
Confronted by growing evidence that sex between men is a significant driver of new HIV infections, the Kenyan government has shed a long-time refusal to acknowledge the existence of homosexuality and will launch a survey of gay attitudes and behaviors in its three biggest cities next year.
The project is considered a landmark because the government and the vast majority of Kenyan people have long refused to address homosexuality in the fight against AIDS. Sex between men is illegal in Kenya - punishable by up to 14 years in prison - and is seen by many as a Western-imported, morally wrong behavior that is limited to areas visited by tourists. (See TIME's photos of Africa's AIDS crisis)
But officials say the country is in the middle of a full-blown HIV/AIDS epidemic, with about 7 percent of the population now infected and only 15 percent of those people even aware that they are HIV positive. While the vast majority of HIV transmissions are through heterosexual sex or intravenous drug use, research conducted in 2007 suggests that the spread of the disease through gay sex is far more common than skeptics believe. Fifteen percent of all new HIV infections each year are thought to be among men who have sex with men. And because some men who engage in gay sex are married and do not identify themselves as gay, it is seen as one way in which the virus crosses from "at-risk" categories to the general population.
"It will be a tricky issue that is likely to polarize everybody," Dr. Nicholas Muraguri, director of the National AIDS/STI Control Program, tells TIME. "But what we are saying is that we cannot as a country socially exclude these groups and hope that we will win the war against HIV at the same time." (See TIME's photos of the crisis in Kenya)
Initial media reports said the project, which was announced last week, would be a gay census - raising fears that gays could be exposed against their will and questions about whether such a count could possibly be accurate. But Muraguri says all information collected by the government will be kept confidential and officials will not seek to contact all men who have sex with men in Kenya. The government will also seek to interview both male and female sex workers and intravenous-drug users.
While Kenyan attitudes toward homosexuality are considered more liberal than the rest of sub-Saharan Africa outside South Africa, gays say they still face overwhelming hostility in the country. The law banning sex between men is a holdover from colonial times but won't be repealed soon; one member of parliament, asked if a draft constitution in the works would enshrine gay rights, said recently that doing so would destroy the document's chances of passing.
Anti-gay attitudes have been on full display in recent weeks as the Kenyan media have breathlessly reported on the civil ceremony of two Kenyan men in Britain. They were dubbed a shame to Kenya, their parents were harassed and The Nation newspaper's website has been inundated with comments, most of them condemnatory.
Because of the stigma they face, gays rarely seek information about the dangers of having unprotected sex. One commonly held myth in Kenya is that HIV cannot be contracted via anal sex, when in fact that is one of the easiest ways to get it. Gays have trouble receiving treatment at hospitals, particularly if they show symptoms of sexually transmitted diseases that might lead doctors to suspect they had engaged in sex with other men.
"Some of us have gone to a public health facility and if the doctor realizes we are gay, they will draw attention to us, even from the reception, calling people, 'Come and see a gay person, come and see a gay person,'" says Peter Njane, director of the Ishtar MSM gay health rights group in Nairobi. Muraguri's NASCOP group, which will lead the survey with funding from the U.S. President's Emergency Plan for AIDS Relief, says those beliefs must not be allowed to impede the country's efforts to fight HIV.
The researchers will ask a series of behavioral questions to men who have sex with men starting next year in Nairobi, the western city of Kisumu and the coastal city of Mombasa. They will also try to estimate the number of men who are HIV-positive or have sexually transmitted diseases. Such a widespread survey has never been attempted in Kenya before. In a 2004 study in Nairobi, 500 men who have sex with other men were interviewed about their health practices, and in Mombasa in 2006 and 2008, 400 male prostitutes were questioned as part of two different sex surveys.
"What we've primarily been slowed by is just not having the clear sense of where those populations are centered in the country and where socially and otherwise we can most effectively reach them," Warren Buckingham, Kenya coordinator for the U.S. President's Emergency Plan for AIDS Relief, tells TIME.
Much of the gay community has largely decided to abandon the fight for gay rights for now because the hostility they face is too intense. But they hope that initiatives such as the NASCOP research will help reshape Kenyan opinions about AIDS. "As a country and as an African culture, we live in full denial of the existence of homosexuality," says James Kamau, national coordinator of the Kenya Treatment Access Movement, which aims to increase the availability of all essential medicines to Kenyans. "Because of the cultural background, we shut our eyes, our minds and everything, yet it is happening every single day."
3
Helene Gayle: Leading the anti-AIDS war
Chicago Tribune
08/11/2009
By Dahleen Glanton
It is not as though Dr. Helene Gayle didn't have enough on her hands fighting poverty across the globe as president and CEO of CARE. But she has never been known to turn down a chance to do battle against HIV/AIDS.
This time the invitation came from President Barack Obama, who recently tapped Gayle -- a more than 20-year veteran of directing HIV/AIDS programs at the U.S. Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation -- to chair the Presidential Advisory Council on HIV/AIDS.
Gayle will help shape a national HIV/AIDS strategy, which for the first time will provide a blueprint for using resources and developing programs across the country. However, she is quick to point out that that her additional duties will not interfere with her mission at CARE.
She says the two missions are not all that different. In her view, fighting poverty and combating HIV/ AIDS should work hand in hand.
In the three years she has been at CARE, she has set out to merge those two issues, primarily by empowering women to become self-sufficient while taking control of their sexual health.
"Few things demonstrate how interconnected the world is today more than the AIDS epidemic and the U.S. government's response to it," she said.
There are obvious parallels.
Women and girls make up 50 percent of the new HIV infections around the world, and in Africa, women and girls make up 60 percent of new infections, she said.
In the U.S., HIV/AIDS has soared among women of color, particularly African-Americans, who now account for the majority of new HIV/AIDS cases among women and the most women living with the disease.
More than three-fifths of the global HIV infections are in Africa, the worst-affected region of the world, according to the World Health Organization.
In the U.S., African-Americans have surpassed other racial and ethnic groups, charting the most new HIV infections, the most cumulative AIDS cases, the greatest number of people living with HIV and the highest HIV-related deaths, according to the Henry J. Kaiser Family Foundation.
Gayle, who is based in Atlanta, recently was the keynote speaker at the Chicago Council on Global Affairs' Women and Global Development forum. Below are excerpts from an interview with the Tribune.
Q Why are HIV trends in African-American communities increasingly mirroring those in Africa?
A If we look at health in general in this country, we know that communities of color are disproportionately impacted by a whole range of things, whether it's HIV, diabetes, heart disease, drug use or teenage pregnancy. Health disparities, in some ways, bring to light existing social and economic inequities overall. In many ways, diseases are a harbinger of social inequities.
Q How does the economy affect HIV rates?
A It is not the lack of money but the things that go along with poverty that impact HIV rates, such as not having the economic resources necessary to access information, good facilities, testing services, treatment of other sexually transmitted diseases or drug treatment.
Q Why is HIV spreading so quickly among women globally?
A Young women between the ages of 15 and 19 are, in some countries, five times more likely to be infected with HIV than young men in that same age group. That is because older men who are more likely to be infected often have young girls as sexual partners and these young girls are unable to demand that the man use condoms, or are unable to say no to sex, sometimes from teachers or other adult men in their communities.
Q Do you see parallels in the U.S.?
A Oftentimes young girls are in situations where they don't feel that they are in control of their sexuality and they aren't in the position to make sure that if their partner is not faithful to them, that they get their partner to use condoms. We've got to make sure that women and girls have the tools and the ability to keep themselves safe.
Q What changes can be expected under the Obama administration?
A Part of what the administration has made a pledge to do is a national HIV strategy. We've never had a national strategy that looks at the needs in prevention, treatment and in care and services and support.
Q Where should immediate attention be focused?
A The rural South and some urban communities continue to have pockets of very high rates of HIV, increasingly infecting women, but it continues to be a huge problem among young men of color, particularly men who have sex with men.
Q With numbers surging in African-American communities, does federal funding disproportionately target the white gay male population?
A People often say the (white) gay community or the black community, and the reality is they overlap. The group that is most impacted by this epidemic is young men of color who have sex with men and that is where our resources need to go.
Q What funding disparities need to be addressed?
A We have not invested in prevention as much as we probably should. We haven't really put the resources into making sure that people have access to their HIV status. Over half the people who are HIV-infected don't know it and continue to spread the disease.
Q How can you effectively fight HIV in minority communities where even talking about sex is taboo?
A It's figuring out who are the best people to speak to these issues. We find ministers are better at speaking to other ministers and young women are better at talking to young women. Peer-to-peer education is oftentimes much more effective.
Dahleen Glanton is a Tribune reporter. dglanton at tribune.com <mailto:dglanton at tribune.com>
Copyright © 2009, Chicago Tribune
4
Step Forward: Progressive LGBT Politics
Seattle Post Intelligencer
07/11/2009
Reader Blog
The House passed the Affordable Health Care for America Act, H.R. 3962, by a vote of 220 to 215. Thanks to lobbying efforts by the Human Rights Campaign and leadership from Representative Jim McDermott, several LGBT provisions were included in the legislation. According to a statement from the Human Rights Campaign:
HRC lobbied the three committees involved in drafting the bill to include provisions that would help LGBT people in particular obtain the improved access to health care that the Act is designed to provide. Some of these measures have been part of HRC's legislative agenda as free-standing bills for many years. The key provisions in the bill that the House passed are:
Health Disparities - the bill specifically designates LGBT people as a health disparities population, opening up health data collection and grant programs focused on health disparities related to sexual orientation and gender identity. With collection of data and funding of research, we can better address the specific health issues facing LGBT people.
Unequal Taxation of Domestic Partner Benefits - the bill ends the unfair taxation of employer-provided domestic partner health benefits, incorporating the language of the Tax Equity for Health Plan Beneficiaries Act. Without this tax penalty, more people will be able to afford employer-provided coverage for their families, and more companies will be able to offer these important benefits.
Early Treatment for HIV under Medicaid - the bill also incorporates the Early Treatment for HIV Act, which allows states to cover early HIV treatment under their Medicaid programs, instead of withholding treatment for Medicaid recipients until they develop full-blown AIDS, This will dramatically improve the quality of life for low-income people with HIV, as well as saving taxpayers money and reducing the transmission of the virus.
Comprehensive Sex Education - the bill provides funding for comprehensive sex education programs that focus not only on abstinence, but also reducing teen pregnancies and sexually transmitted diseases. After more than $1 billion wasted on failed and discriminatory abstinence-only programs, this funding will provide youth, including LGBT students, with the tools they need to live healthy lives.
Non-discrimination - the bill prohibits consideration of personal characteristics unrelated to the provision of health care. HRC worked with a coalition of civil rights groups to develop and lobby for this language and we believe it will help protect LGBT people from discrimination in the health care system, where there are currently no federal protections for our community.
The House is far more friendly to LGBT issues. The tough work remains ahead. We must make sure that the health care bill that arrives at the President's desk is one that includes the provisions. The Senate can not leave us on the cutting room floor. These basic protections are incredibly important. It is only fair that all American families are treated equally under the law.
Posted by Joe Mirabella
5
Obama Calls Botswana 'Extraordinary' Success as Khama Visits
Bloomberg.com
05/11/2009
By Nicholas Johnston
Nov. 5 (Bloomberg) -- President Barack Obama said Botswana is one of the "extraordinary success stories in Africa" and a "great partner" to the U.S.
Obama cited more than 40 years of good governance and sound economic management in the landlocked southern African country, after a White House meeting with Botswana's president, Ian Khama.
"Although Botswana is not a large country, it is truly one of the extraordinary success stories in Africa," Obama told reporters in the Oval Office. "It's also been a great partner to the United States. Our governments have cooperated extensively throughout the years."
The two leaders met to discuss regional issues including the spread of HIV/AIDS across Africa. Obama campaigned on a vow to increase funding for global pandemics, including HIV/AIDS, and in his proposed budget released earlier this year doubled U.S. foreign assistance to $50 billion.
Botswana has the world's second highest HIV-infection rate and last year agreed to borrow $48.7 million from the World Bank to fight the disease. Almost one in four people between the ages of 15 and 49 in Botswana are HIV positive, according to the Web site of the United Nations AIDS agency.
To contact the reporter on this story: Nicholas Johnston in Washington at njohnston3 at bloomberg.net
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UNAIDS WEB.SITE
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WHO report on the health of women: AIDS leading cause of death globally in women of reproductive age
UNAIDS
09/11/2009
In a landmark report on the health of women and girls across the globe, the World Health Organization (WHO) states that AIDS-related illness is the leading cause of death and disease among women of reproductive age in low and middle income countries, particularly in Africa. Also, globally, unsafe sex is the single leading risk factor contributing to deaths among women of reproductive age. These findings support the contention in Women and Health: Today's Evidence, Tomorrow's Agenda that in a multiplicity of areas female health is neglected and must now be considered an urgent priority
The report maintains that women and girls are especially vulnerable to HIV infection due to a variety of biological and social factors. These include low socio-economic status that can limit choices and lead to high risk behaviours and norms and laws that subjugate women and which discourage them from seeking and obtaining the information they need to keep themselves safe. For example, globally only 38% of young women are able to describe the main ways to avoid infection and they are less likely to know that condoms can protect against HIV than young men. Data from 16 countries in sub-Saharan Africa from 2001-2007 also show that HIV prevalence is generally higher among adolescent girls aged 15-19 than their male counterparts. A significant cause of this is young girls partnering with older men who are more sexually experienced and more likely to be infected.
Violence against women
Violence against women is also a major cause of their increased vulnerability to HIV. It can make it difficult or impossible for them to control their sexual lives, abstain from sex or get their partners to use condoms. Violence, or the threat of it, can also result in women avoiding HIV prevention, treatment, care and support services
For UNAIDS, this is a major area of concern and its Outcome Framework 2009-11 has stopping violence against women and girls as one of nine priority areas. According to Michel Sidibe, Executive Director of UNAIDS, "'We know that there is a strong relationship between violence against women and HIV. We need to help young people develop the skills for mutual consent in sex and marriage and put an end to violence and sexual coercion. This is key to preventing HIV and to achieving gender equality in all aspects of life."
Gender inequalities
Women and Health has an extremely broad scope and addresses a range of women's health issues. The factors that come into play to increase women's vulnerability to AIDS are also shown to profoundly affect women and girls' general health and well-being. As the report contends, gender inequalities in the allocation of resources such as education, income, health care, nutrition and having a political voice are very much associated with poor health and reduced well-being.
"Despite considerable progress over the past two decades, societies are still failing women at key moments in their lives," says Dr Margaret Chan, WHO Director-General, in the foreword to Women and Health. "These failures are most acute in poor countries, and among the poorest women in all countries. Not everyone has benefited equally from recent progress and too many girls and women are still unable to reach their full potential because of persistent health, social and gender inequalities and health system inadequacies."
Key stages relevant for health: early childhood, adolescence, adulthood and older age
The report explores the lives of women and girls through key stages relevant for health: early childhood, adolescence, adulthood and older age, and shows that women face "widespread and persistent inequities" during each of these stages. It not only highlights women's health needs- and how they are not being currently met in terms of HIV and other areas- but also the valuable contribution that they make to the health sector and society in general.
By using today's evidence, sharing what is currently known about the health of women from all regions and throughout their lives, the report attempts to set out tomorrow's agenda, a key element of which is championing reforms to enable women to not only be seen in their sexual and reproductive capacity, but to become active agents in health-care provision, playing a central role in the design, management and delivery of health services.
Women and Health draws attention to four areas where policy action could make a real difference to women's health: building strong leadership and a coherent institutional response coalescing around a clear agenda; making health systems work for women; leveraging changes in public policy to encourage fundamental social change (through, for instance, targeted action to help girls enrol in school); and finally, building the knowledge base and monitoring progress.
WHO hopes that by reviewing the available data and charting a cogent way forward that the health of women and girls, and society as a whole, can be ameliorated. As the report has it, "Improve women's health, improve the world."
2
UNAIDS, ASEAN join hands to support work on gender and HIV
UNAIDS
07/11/2009
Studies in Asia indicate that most women in the region acquire HIV because of their partners who engage in unsafe behaviours. It is estimated that more than 90% of women living with HIV acquired the virus from their husbands or boyfriends while in long-term relationships. An effective AIDS response must address intimate partner relationships to prevent HIV infections in the female partners of men with high-risk behaviours.
In an effort to fill this gap in the AIDS response, UNAIDS and the ASEAN Foundation signed an agreement in Bangkok to support work on gender and HIV in the Asia Pacific region.
The partnership began in 2007 when the United Nations Development Fund for Women (UNIFEM) and UNAIDS joined hands with the ASEAN Foundation in order to strengthen joint work on the gender aspects of HIV.
In 2008 the partnership expanded to include the United Nations Development Programme (UNDP); the Asia Pacific Network of People Living with HIV/AIDS (APN+); the Coalition of Asia Pacific Regional Networks on HIV/AIDS, also known as the Seven Sisters, and the International Community of Women with HIV/AIDS (ICW). The partnership at country and regional levels also included researchers, civil society, people living with HIV and national AIDS commissions
The agreement, which cements this commitment further, was signed in the presence of UNAIDS Director of the Asia Pacific Regional Support Team, Prasada Rao; Executive Director of the ASEAN Foundation, Filemon Uriarthe Jr; UNIFEM Regional Director East and South East Asia, Dr Jean D'Cunha; and APN+ Regional Coordinator and Director, Shiba Phurailatmam.
Speaking on the occasion, Mr Rao said, "The project is not only to understand what needs to be done but to pave the way to programmes that work on the ground." He added that a range of strategies was needed, including scaling up efforts with key populations at risk in urban areas and through reproductive health programmes for rural women.
Dr D'Cunha stressed the importance of working on gender power dynamics, especially for positive women whose voices must be heard. "All the issues are interconnected and cannot be tackled by any one agency," he said.
Mr Phurailatham stressed the need to approach women who are considered "low-risk" through their "high-risk" partners. He also stated that it was all the more important that laws criminalizing HIV were changed, as "laws that hamper HIV prevention, criminalize those men at risk can only have a negative impact on the lives of those women."
According to the agreement, funding from the ASEAN Foundation will be leveraged to aid the resources provided through UNAIDS, UNIFEM and UNDP.
HIV and Intimate Partner Relationships
In July this year representatives of AIDS commissions, UNICEF, WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria and 90 delegates from 15 Asian countries unanimously agreed that intimate partner relationships had to be included in national HIV policies and programmes. A report titled HIV Transmission in Intimate Partner Relationship in Asia was an outcome of this unanimous decision.
The report recommends that HIV prevention interventions be scaled-up for men who have sex with men, injecting drug users and clients of female sex workers. It also suggests that structural interventions should be initiated to identify and address the needs of vulnerable women and their male sexual partners.
3
Antiretroviral treatment for prevention
UNAIDS
06/11/2009
People living with HIV who are following an effective antiretroviral therapy regimen can achieve undetectable viral loads - the amount of virus in a body fluid such s blood, semen or vaginal secretions - at certain stages of their treatment. Research suggests that when the viral load is undetectable in blood the risk of HIV transmission is significantly reduced. However, antiretroviral therapy for prevention has not proven to completely eliminate the risk of transmitting the virus.
To explore the issue WHO earlier this week convened a meeting to review the scientific data available on the use of ART for prevention and also explored the implications of this approach for individuals and communities as well as take into consideration human rights and ethical and public health implications.
Participating in the meeting, UNAIDS Deputy Executive Director, Dr Paul De Lay, provided closing reflections. Dr De Lay said the meeting had raised the hard fact that many people living with HIV - including many who need treatment today - are unable to access HIV testing and counseling and to initiate timely treatment, as a result of a range of social, cultural and economic barriers.
Dr De Lay congratulated the participants in their effort to identifying scientifically sound and innovative ways to accelerate progress toward universal access to HIV prevention, treatment, care and support, and maximizing the effects of ART both for extending full and productive life for people with HIV, and also for primary prevention.
"These are exciting and challenging times. The diverse perspectives heard in this meeting reflect the best of the AIDS response, and continuing this dialogue - this committed questioning and the research agenda coming from this meeting - will undoubtedly lead to more lives saved and fewer new infections" continued Dr De Lay.
UNAIDS strongly recommend a comprehensive approach to HIV prevention that plans and delivers an evidence informed and human rights based combination of programmes and policies, tailored to meet the needs of those most at risk, and including practical programmes to reduce underlying causes of vulnerability, such as gender inequality and HIV related stigma and discrimination.
Antiretroviral therapy will play several roles in combination prevention strategies, along with other key strategies including, but not limited to, social and behavioral change communication to delay sexual debut, promote mutual fidelity and reduction of the number of sexual partners, promote safer sex including correct and consistent male and female condom use, harm reduction programmes for people who use drugs, prevention of vertical transmission, and other biomedical, behavioural and structural prevention programmes.
The WHO hosted antiretroviral treatment (ART) for Prevention was held in Geneva from the 2 to the 4 of November, 2009.
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