AIDS Care Watch at the IAC2006

Friday, August 24, 2007

Sri Lanka Hosts Summit On Denial Of Inheritance, Property Rights To HIV-Positive Women

By, Medical News Today, August 22, 2007

The first regional summit on HIV-positive women being denied inheritance and property rights was held on Saturday in Colombo, Sri Lanka, as part of the 8th International Congress on AIDS in Asia and the Pacific, Caitlin Wiesen-Antin, United Nations Development Programme regional HIV/AIDS coordinator in Asia and the Pacific, said Thursday, Xinhua/People's Daily reports. The summit aims to increase public awareness about challenges faced by HIV-positive women, Wiesen-Antin said.

According to Wiesen-Antin, 20 HIV-positive women will testify about their experiences in being denied inheritance or the right to hold property because of their HIV-positive status at the Asia Pacific Court of Women on HIV, Inheritance and Property Rights. In addition, about 30 experts from several Asian countries -- including Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Papua New Guinea, Sri Lanka, Thailand and Vietnam -- will offer testimony. "When women are denied their rights to inheritance and property, they are robbed of the social and economic empowerment needed to prevent HIV infection and cope with its impact on families and communities," Wiesen-Antin said. She added, "With little or no control over their sexual lives and burdened by abuse, exploitation and violence, women in the region are extremely vulnerable to HIV." About 30% of new HIV cases in Asia occur among women, Wiesen-Antin said (Xinhua/People's Daily, 8/17).

There were about 5,000 HIV-positive people in Sri Lanka at the end of 2005 -- one of the lowest case loads in Asia -- but many Sri Lankans are at risk of contracting HIV because of poverty and displacement, Reuters reports. Wiesen-Antin said the "challenge" in Sri Lanka is to keep the country's HIV prevalence low. About 35,000 people were displaced last year during conflict, the country's military has said, adding that it recently has resettled more than 100,000 people in the eastern part of Sri Lanka. "When people are displaced from their home, their usual system of justice sometimes does not exist," Wiesen-Antin said. She added that "under duress," some displaced people "resort" to commercial sex work, increasing the spread of HIV (Aneez, Reuters, 8/16). ICAAP will be held from Aug. 19 to Aug. 24 (Xinhua/People's Daily, 8/17).


Coalition launched in Colombo to promote male sexual health

By, People's Daily Online, August 23, 2007

A coalition aiming to address HIV- related vulnerabilities of men who have sex with men (MSM) in the Asia and Pacific region was launched here Wednesday at the 8th International Congress on AIDS in Asia and Pacific (ICAAP).

The Asia Pacific Coalition on Male Sexual Health (APCOM), a coalition of civil society groups, government representatives and the United Nations system, plans to increase investment and research, as well as promote individual rights of the MSM and transgenders.

"Male to male sex is being treated as if it does not exist. The reality is male to male sex occurs in all countries and cultures," said Prasada Rao, Director of UNAIDS Regional Support Team in Asia.

Despite evidence establishing male-to-male sex as one driving force of HIV transmission in Asia and Pacific region, relatively few MSM interventions strategically focus on prevention, treatment, care and support for MSM and transgender populations.

It is estimated by many groups, including UNAIDS (Joint United Nations Programme on HIV/AIDS), that targeted prevention programs reach less than 8 percent of the MSM although up to one third of all HIV cases in the Asia-Pacific region are transmitted via sex between males.

The ACPOM will identify and facilitate the provision of technical assistance, as well as convene governments, researchers, donors and civil society organizations to collaborate in initiating responses to prevent and treat HIV, improve sexual health, and reduce stigma and discrimination.

"We can only truly address the challenge of HIV, as well as confront stigma, discrimination, violence and social exclusion of MSM and transgenders, if we all work together in our collective, region wide struggle," stated Shivananda Khan, APCOM interim chair.

UNAIDS, UNDP (United Nations Development Programme) and UNESCO will support the APCOM as technical advisors.

Source: Xinhua


Tuesday, August 21, 2007

ASIA: "Seize the opportunities of hope"

By, IRIN PlusNews, August 20, 2007

The Eighth International Congress on AIDS in Asia and the Pacific (ICAAP) opened on Sunday in Colombo, the Sri Lankan capital, with speakers stressing the need for action to prevent a surge in the regional infection rate.

UNAIDS, co-sponsor of the congress, along with the AIDS Society of Asia and the Pacific (ASAP), recently revised its estimate of HIV-positive people in the region from 8.3 million to 5.4 million. Nevertheless, the epidemic in Asia and the Pacific is still increasing, with approximately one million new infections in the last two years.

J V R Prasado Rao, director of the UNAIDS regional support team in Asia, explained that the new figures were drawn from a combination of household and antenatal surveillance figures, whereas previous estimates had relied solely on tests of pregnant women.

"UNAIDS advocates looking at trends, not figures," Prasado Rao told delegates on Monday, "and the overall trends remain the same." Summarising these, he noted that HIV infections were rising in a number of countries, including China, Vietnam, Bangladesh, Nepal, Pakistan and Indonesia, but had declined in Thailand, Cambodia and several parts of India.

Pockets of despair

Economic growth and improvements in infrastructure have created greater wealth and mobility, but have also promoted HIV infections. Yet in most countries HIV infections remain largely confined to vulnerable pockets of the population, such as injecting drugs users, sex workers and their clients, and men who have sex with men.

"The challenge for Asia is to keep prevalence low," said Peter Piot, UNAIDS chief, in a statement read by his deputy director, Deborah Landey. Describing complacency by the region's leaders as misplaced, Piot cited dramatic increases in prevalence among men who have sex with men in China, and among married women in Papua New Guinea.

Sri Lanka, which is hosting the conference with its 2,500 delegates from 70 countries, has an HIV prevalence below 0.1 percent, one of the lowest in the region, but President Mahinda Rajapaksa said this was no reason "to pat ourselves on our backs".

Despite the presence of factors often conducive to fuelling epidemics, such as a large migrant worker population and a protracted conflict, the president described Sri Lanka's strict policies on illegal drugs and alcohol consumption as key to its success in keeping infections low.

Emphasis on universal coverage

About 235,000 people in Asia are receiving antiretroviral treatment: around 20 percent of those who need it. Given that most countries in the region have adequate resources and manageable numbers of people requiring treatment, Prasado Rao of UNAIDS challenged delegates to push harder to achieve the goal of universal coverage.

Prevention efforts were also lagging and, according to Prasado Rao, overly skewed towards the general population when the need was for programmes focused on the most vulnerable groups.

He also warned that over-dependence on external funding was likely to create problems for the future sustainability of anti-AIDS efforts in most countries.

While urging governments to expand their health budgets, Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, asked them to view HIV/AIDS not just as a health problem, but as a development issue requiring the mobilisation of all sectors.

"This conference is being held at a historic moment in the life of the epidemic in this region," Peter Piot said in his statement, "because there is still hope ... but we must seize these opportunities of hope."


Thursday, June 07, 2007

South Africa: Durban Aids Conference Opens

By, Anso Thom, Health-e (Cape Town), June 6, 2007

While South Africa has taken "giant leaps" by reaching consensus on a national response to HIV/AIDS for the next five years, the biggest challenge is its implementation, Deputy President Phumzile Mlambo-Ngcuka told the third national AIDS conference at its opening last night.

"I don't want to talk on stage about the plan. I want to go around and monitor implementation," said Mlambo-Ngcuka.

The deputy president said she was looking forward to the conference's recommendations, but she chastised the conference organisers for not giving health minister Manto Tshabalala-Msimang a more prominent role in the conference.

"The minister has withdrawn from the conference because of the place you gave her on the programme. You can't put someone who is the custodian of the department of health in a panel," said Mlambo-Ngcuka.

"I also don't think you are making the deputy minister of health's position easy by the way you are deploying her."

Tshabalala-Msimang was due to address this morning's plenary session while her deputy, Nozizwe Madlala-Routledge is to address tomorrow's plenary session.

UNAIDS Executive Director Dr Peter Piot said the AIDS conference could mark a turning point for South Africa. "If South Africa can achieve its aims, the country will be well on the way to leading Africa into a new phase in the AIDS response," he said.

Piot said the country's prevention of mother to child transmission programme was missing a major opportunity to integrate health services into the regular health system. "This should be a simple thing to do, but only 30 percent of pregnant women have access to these (PMTCT) services.

He added that it was vital to "change to higher gear on tuberculosis (TB) control".

"The emergence of extremely drug resistant TB strains is a dramatic wake-up call - if we don't factor and integrate TB into everything we do, we will get nowhere."

Piot ended that South Africa had a better chance than any other country in the region to deliver on AIDS. "If you can't, who can?"

Graca Machel called on every person in the country to take "personal responsibility" for speaking to friends and family about HIV and the importance of having an HIV test.

"We need to build a social movement around the struggle against AIDS," said Machel.


Thursday, August 31, 2006

Staying alive with HIV: ACW at IAC

ACW Campaign, August 31, 2006

The International AIDS Conference (IAC) recently took place in Toronto, Canada (13-18 August), bringing together more than 26,000 delegates from across the world.

At the conference, the AIDS-Care-Watch (ACW) campaign joined its partners and other treatment activists in demanding for greater access to antiretroviral treatment (ARVs).

In addition, ACW called for national governments, international agencies, donors, and others to call for urgent interventions to address the following care and treatment priorities:

***Reducing HIV-related stigma, especially in the health care setting
***Greater efforts to integrate tuberculosis (TB) and HIV services
***Increased availability to drugs to treat/prevent opportunistic infections

To read ACW Position’s on these issues, please go to:

Stigma and HIV

TB and HIV

Cotrimoxazole Prophylaxis

Wednesday, August 16, 2006


Speech by Dr Peter Piot, UNAIDS Executive Director, XVI International AIDS ConferenceToronto, 13 August 2006

Friends and colleagues,

Once again we have come together to address our common cause—AIDS.Throughout this week, we must remember that we all share that one common cause which needs all of our collective strengths more than ever.

I bring you the greetings from UN Secretary-General Kofi Annan, and his conviction that this conference can be a milestone in the world’s response to AIDS—a response that he has made his personal priority.

We are at a time of great hope and great opportunity because we have achieved more in the past five years than in the previous twenty.

But, as the theme of this conference “Time to Deliver” points out, we still have a lot to deliver.

Although the scope of our successes is clearly inadequate, we are seeing real results in terms of lives saved because of effective prevention and access to treatment.

Building on this foundation, we have our first and perhaps only opportunity to move the AIDS response into entirely another league, where we build on our emergency actions and put in place a long-term sustainable response.

This is how our gathering this week can be a milestone, a turning point in the AIDS response.

But, we must acknowledge that long-term sustainability does not mean five or tenyears, but twenty-five years and more.

We must anticipate the future in our planning and action because for generations to come ours will continue to be a world living with HIV.

The sheer growth in the size of the epidemic reflects that fact that we have so much more to do, particularly around prevention and engaging the world’s growing youth population.

We will set ourselves up for demoralization and indeed for failure if we base our strategies on wishful thinking that the end of AIDS can be achieved any time soon.

Tragically, the end of AIDS is nowhere in sight.

Friends, because of all that we have painfully learned in the past 25 years, the agenda of what we need to do over the next 25 is now clear.

First and foremost, we must maintain the exceptionality of AIDS on political agendas.

Yes, we must normalize AIDS as a disease, so that it is thought of and handled as just another disease, with no stigma. And yes, we must team up much more closely with wider development efforts, so that the AIDS response is put at the core of development agendas, not outside.

But let us not confuse these with the need to maintain the exceptionality of AIDS in politics and public policy.

The end of AIDS exceptionality would spell the end of protected funding for antiretroviral therapy, of commitment to harm reduction for injecting drug use, of sex education in schools, of billions for the AIDS response, of the Global Fund and USPEPFAR, of Presidents and Prime Ministers leading national AIDS efforts.

So, first and foremost, we must keep AIDS exceptionally high and exceptionally visible on political agendas year after year. The real threat is too little recognition –not too much! – that AIDS is an exceptional crisis and worsening threat.

Second, we must ensure that no credible national AIDS plan goes unfunded – now or in the decades ahead.

How will we close this gap of billions? And how will we ensure that commitments are made for a decade at a time, not for one fiscal year?

The lives of hundreds of millions depend on full funding for needed HIV prevention.

And, the lives of the 40 million people living with HIV today depend on maintaining full and unbroken funding for universal access to HIV treatment.

These challenges of sustaining funding demand the engagement of the best minds of our times. I am profoundly encouraged that Bill and Melinda Gates, among others,have taken on the AIDS response as their personal cause.

Third, to get to real success, we must make the money work.

This means accelerating the current scaling up of all HIV services from investment in systems to strengthening community capacity. Keeping people alive and well through providing antiretroviral therapy is one critical investment in capacity.

This means ensuring that the money is working for those who are most vulnerable.By this I mean, among others, men who have sex with men, injecting drug users, sexworkers and orphans.

This means ending fragmentation of AIDS efforts, which has huge costs in lives and money.

Fourth, to get to real success, we must accelerate and sustain scientific innovation in developing microbicides, next-generation drugs, and vaccines.

A top priority is to immediately double funding for microbicide research and development.

At the same time, we must put in place the mechanisms and agreements to ensure universal access to all life saving essentials – not just for the immediate future but forthe long term.

Fifth, we must begin to make real headway in addressing the drivers of this epidemic, especially the low status of women, homophobia, HIV-related stigma,poverty and inequality. It’s time that we get serious about protecting and promoting human rights and reflect it in our budget allocations.

An AIDS response that is not as embedded in advancing social justice as in advancing science is doomed to failure.

As I’ve seen over and over again in Africa and Asia, if people living with HIV are too poor to eat well or continue to face stigma and hatred, universal access to HIV treatment will forever remain a pipe-dream.

And if women and sexual minorities are subjected to violence and oppression, their ability to negotiate safe sex and have access to HIV prevention and care will forever remain wishful thinking. Young people are also, all too often, denied access to life saving prevention services.

Finally, but crucially, we must build the very broad coalition needed to realize such an ambitious agenda over not just this generation but the next generations too.

We need a far broader coalition – drawing in science, government, people living with HIV, civil society, faiths and business.

We need a far more united coalition, united by a commitment to saving lives, even if we may have differences on tactics. We must spend our energy on fighting this epidemic, not on fighting each other. Surely one of the main lessons of these past 25 years is that when we are united we win, when we are divided, AIDS wins.

Friends, we are at a time of great opportunity and great hope.

Because of all that we have achieved, we now have the opportunity to build longterm sustainability onto our current crisis management efforts.

We must plan and act not just for today but for the next 25 years. With every ounce of our intelligence, innovation and determination, we must advance both social change and science in the fight against AIDS.

To reiterate my key points: We must ensure that adequate funds are made available;We must make the money that is mobilized work for those who need it; We must accelerate scientific innovation; We must address in new and more aggressive ways, the social drivers of this epidemic; and, we must work in concert—as a coalition of genuine partners with genuinely shared goals.

Finally, and most importantly, faced with this exceptional crisis, we have no choice but to act in exceptional ways.

Thank you.

Source: CRIN - Child Rights Information Network

Tuesday, August 08, 2006

HIV and Tuberculosis: Turning the tide against TB and HIV co-infection

Current State of Affairs
At the United Nations (UN) General Assembly special session on HIV/AIDS (2001), the leading infectious cause of death among people living with HIV (PLHIV) – tuberculosis (TB) – was not on the agenda. The resulting Declaration of Commitment on HIV/AIDS did not even include the word ‘tuberculosis’.
It did, however, assert that by 2003 national governments would: “... in an urgent manner make every effort to provide progressively and in a sustainable manner, the highest attainable standard of treatment for HIV/AIDS, including the prevention and treatment of opportunistic infections…”
New strategies and tools are urgently needed to tackle the challenge of TB/HIV co-infection. The WHO recommended collaborative TB/HIV activities must be accelerated, and research stepped up to deliver a new generation of effective drugs and diagnostics to keep co-infected people alive. Closer coordination between national TB and HIV programmes and services is vital. TB and HIV accelerate each other’s progression. PLHIV infected with TB have much greater chances of developing active disease than HIV negative people, even at high CD4 counts.
Even where the DOTS strategy is available, current diagnostic tests fail to detect active TB among 60-80% of people with HIV due to the predominantly smear negative pulmonary or extrapulmonary nature of TB in PLHIV. Although recent studies have shown that, in some settings, over three-quarters of people presenting at TB clinics may be co-infected with HIV, only a small fraction of people with TB are also tested for HIV.
An even smaller proportion enter antiretroviral (ARV) treatment. In some countries, people with HIV-associated TB disease experience up to 33% mortality during the first two months of TB treatment. Rifampicin, a cornerstone drug in TB combination therapy, has adverse interactions with HIV treatment regimens containing nevirapine or protease inhibitors. Further, the current TB vaccine used to prevent childhood TB may not be safe for children with HIV.
Building on closer integration of TB and HIV programmes in the short-term, our best hope for turning the tide against TB and HIV co-infection lies in the full implementation of WHO recommended TB/HIV collaborative activities and the development of new diagnostic tests, drugs, and vaccines that can identify co-infected individuals and provide them with fast, effective and affordable treatment, or prevent TB infection altogether.
The AIDS-Care-Watch campaign calls upon national governments, international agencies, donors, and advocacy groups to explicitly recommend and commit to specific actions and investments that will generate:
  • Universal access, by 2010, to the full WHOrecommended package of 12 collaborative TB/HIV activities in all health systems – public and private – and in a decentralised fashion at primary care levels.
  • Better TB diagnostic tests for use in resource-poor settings that are rapid and effective for diagnosing pulmonary and extrapulmonary TB disease in people with HIV, including
  • New drugs that shorten TB treatment duration and are safe for use in people being treated for HIV.
  • Greater availability and systematic provision of drugs such as isoniazid and cotrimoxazole to prevent/treat TB and other opportunistic infections among PLHIV, including HIV-infected children.
  • A TB vaccine safe for use in PLHIV to prevent undue suffering and death among those at high risk.
  • Greater support for engagement by civil society organisations – including people living with or recovered from TB and PLHIV – in the design, implementation and evaluation of TB/HIV policies and services.

TURNING THE TIDE AGAINST TB AND HIV CO-INFECTION- This document has been adapted from a civil society position paper produced by Health and Development Networks, Treatment Action Group, OpenSociety Institute, TB Alliance, and the World AIDS campaign for the 2006 UNGASS review meeting, June 2006.

The AIDS-Care-Watch campaign is a global initiative with the goal of reducing the number of HIV-related deaths in 2006. The campaign has over 400 non-governmental and civil society partners. For more information about the campaign and its partners, please go to or email:
ACWPosition IAC August 2006
HIV and Tuberculosis

Monday, August 07, 2006

Universal access to cotrimoxazole prophylaxis:An essential life-extending treatment for people living with HIV and TB

Current State of Affairs
Cotrimoxazole – also known as Bactrim or Septra – is a wide spectrum antibacterial drug that is highly effective in treating and preventing common opportunistic infections (OIs) among adults and children living with HIV and/or tuberculosis (TB). The drug is widely available and affordable in most settings, costing just $0.0022/dose to $0.0047/dose in the international market1.
Since March 2000, cotrimoxazole use has been recommended by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS)
as a life-extending treatment for people living with HIV(PLHIV). In 2004, the WHO, UNAIDS, and the United Nations Children Fund (UNICEF) also recognized the vital role of cotrimoxazole prophylaxis in saving the lives of infants and children exposed to/infected with HIV in a joint statement calling the drug “a crucial potentially life saving intervention…” Yet, despite these provisional guidelines on its use, most countries have not widely implemented cotrimoxazole as a priority, life extending treatment.
Last year, the WHO convened an expert consultation to revisit the issue of cotrimoxazole prophylaxis for adults and children. At the meeting, new recommendations were drafted and experts advised the WHO to develop clear and consistent messages on the need and value of cotrimoxazole prophylaxis, and to provide technical assistance to countries to increase its use. In addition, it was recommended that regional and global targets should be developed to monitor
access to the drug. To date, none of these recommended actions have been taken, nor have revised guidelines been published.
Despite the proven effectiveness of cotrimoxazole in extending the lives of people with HIV and TB, access to this simple, cheap, life-extending treatment is low, especially in the Asia-Pacific region. Furthermore, people living with HIV and TB are not always aware of the benefits of cotrimoxazole. For example, a survey on cotrimoxazole use among PLHIV conducted by the AIDS-Care-Watch Campaign (June 2006), found that awareness of the drug varied significantly . One respondent from Bolivia reported: “People who are in networks of [people living with HIV/AIDS] are [aware of the potential benefits of cotrimoxazole], those who are not, are left to the good will and knowledge of medical doctors who are often not trained in HIV, not even basic [care and treatment].”2
People living with HIV and TB in poorer parts of the world are often challenged by a variety of infectious diseases, which place them at greater risk of developing HIV-related opportunistic infections. The AIDS-Care-Watch Campaign strongly recommends a set of urgent actions to increase availability of drugs to treat and prevent OIs, in particular:
WHO: Should immediately publish revised guidelines on cotrimoxazole prophylaxis for children and adults, and set time-bound regional and global targets for universal access to cotrimoxazole prophylaxis.
Government bodies: Should integrate WHO guidelines on cotrimoxazole prophylaxis and treatment for adults and children into national AIDS-related care policies and guidelines.
Health care settings: Medical services should actively increase availability and systematic provision of cotrimoxazole to children and adults exposed to and/or living with HIV and/or TB, in accordance with international and national treatment guidelines.
1 According to the international drug price indicator guide, 2005
2 ACW Campaign 2006 Survey on Cotrimoxazole, June 2006 Universal access to cotrimoxazole prophylaxis: An essential life-extending treatment for people living with HIV and TB

Addressing HIV-related stigma in health care settings

Five years ago the United Nations (UN) General Assembly held a special session on HIV and AIDS that resulted in the “Declaration of Commitment on HIV/AIDS (2001)”. The Declaration made a specific commitment to reduce the social stigma associated with HIV:

By 2003, [we shall] ensure the development and implementation of multisectoral national
strategies and financing plans for combating HIV/AIDS that address the epidemic in forthright terms; confront stigma, silence and denial; address gender and age-based dimensions of the epidemic; eliminate discrimination … 1

Despite this commitment, health care settings are where many people living with HIV (PLHIV) still experience some of the worst HIV-related stigma. The three driving forces behind this insidious form of stigma are:

Morality: Health care workers often moralise and judge people’s behaviours based on existing prejudice among others in society: religious institutions, the media, and the general public. By legitimising moralistic stances with respect to PLHIV, health care workers often deny people the proper care they need and deserve.

Helplessness: Clinical helplessness colours health care workers’ reactions to PLHIV. This operates on several levels. First, not only are they powerless to cure HIV, health care workers are often unable to alleviate the psychological and physical pain of PLHIV. Second, many are not trained to provide emotional support to PLHIV. Thirdly, health workers in heavily-affected settings have to deal with the impact of HIV in their own communities.

Fear: HIV-related stigma is more pronounced in countries with a weak health infrastructure. In such settings, health care workers must face their daily fear of acquiring HIV because of inadequate access to universal precautions such as gloves, sharps disposal, post-exposure prophylaxis (PEP) and safe blood collection kits. Like others, they may be reluctant to test themselves for HIV. This may consequently be projected onto PLHIV.


National governments, international agencies, health workers, advocacy groups donors, and others should endorse and call for urgent interventions to address the three driving forces behind stigma among health workers, namely:

  • Codes of ethics and professional conduct in health care provision must be put in place, with sufficient forms of redress for professional violations
  • Practical and attitudinal HIV-related training for all health care providers should be encouraged, especially in light of calls to expand the health care workforce in resource-poor settings.
  • Universal precautions should be promoted in order to reduce health care workers’ fear of infection, as well as availability of supplies (gloves, sharps disposal etc). Voluntary counselling and testing, care and support for health care providers need to be promoted.
  • Provision of PLHIV-friendly health services, including voluntary counselling and testing, and care and support services must be scaled up. PLHIV must be involved in developing, managing and evaluating such services.

1 UNGASS DoC (2001) paragraph 37