AIDS Care Watch at the IAC2006

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

AIDS: THE NEXT 25 YEARS

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.
Recommendations
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
    children.
  • 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

www.aidscarewatch.org or email: info@aidscarewatch.org
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
Recommendations
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.

Recommendations

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