Friday, December 15, 2006

The two sides of opium

Afghanistan has a booming opium trade, which has increased seven-fold since 2002 and supplies an estimated 90 percent of the world's illegal heroin. Much of this goes to (or through) nearby Pakistan where injecting drug use is a main concern and HIV prevalence is rising. Recently, Pakistan's Health Minister expressed frustration at the Afghan government for not moving more effectively towards poppy eradication. The US eradication efforts since entering in 2002 have also been largely ineffective.

The WHO raises different concerns about Afghanistan's opium production: that it does not reach enough people worldwide for pain relieving purposes, causing a "world pain crisis". Opium is also the raw material for morphine. Developing countries as a whole only consume 6 percent of medical opioids yet by 2015 may have 10 million cancer cases. In the US, half of those suffering from chronic pain-most commonly AIDS and cancer patients-do not receive adequate pain relief. Pain relief worldwide is not only distributed unequally, but altogether insufficiently.

The Security and Development Policy Group (Senlis Council ), an international policy think tank with offices in Kabul, London, Paris and Brussels, has argued that the answer to Afghanistan's illegal drug trade is not poppy eradication, which: 1) deprives local farmers of a major source of income; 2) contributes further to the inadequacy of global pain relief; and 3) most likely will not eliminate the drug trade. Instead, it argues that the International Narcotics Control Board(INCB) license growing in Afghanistan. It is estimated that the price of buying the entire Afghan poppy crop would cost less than what the US is spending on eradication campaigns that have not worked.

The INCB's main function is to mediate exactly the dilemma that is presented in Afghanistan: balancing the medical needs of opioids while controlling illegal trafficking. The INCB has sent multiple missions to Afghanistan. They’ll outline their recommendations in their upcoming Annual Report to be released in February.

What will it say? Will it address only trafficking or also the need for more access to legal opiods?

Stay tuned.

Read more:
“There's a way to end Afghanistan's and the world's pain”

“Afghan drugs a worry as Pakistanis confront AIDS”

“Let a Thousand Poppies Bloom”

Thursday, December 07, 2006

Parallel messages, similar results

A recent New York Times editorial on the ineffectiveness of Phillip Morris’ anti-smoking ads bears more than a little resemblance to current debates about abstinence-only education for teenagers.

We’ve all seen the Phillip Morris ads saying, “Think, Don’t Smoke” and recent ads target parents, telling them to warn their children against smoking. In short, “just say no”.

A recent research study published in the American Journal of Public Health found that the ads have had no beneficial effect on teenagers and that those aimed at parents actually had an encouraging effect on teenagers.

The study found a direct relationship between exposure to the ads and likelihood of smoking in the past 30 days.

The New York Times observed that “their theme—that adults should tell young people not to smoke mostly because they are young people—is exactly the sort of message that would make many teenagers feel like lighting up.” The Times also noted that the goal of the ads is not actually to prevent smoking for a lifetime, but to put it off until adulthood, and that the ads have no mention of the fact that smoking is addictive or even harmful.

Likewise with abstinence-only education. Nearly two-thirds of US high school seniors have had sexual intercourse and there were 822,000 reported pregnancies among women 15-19 years old in the year 2000. While there is no evidence to show that abstinence-only classes changes this, there is evidence to show that education about contraception and sexually-transmitted infections reduces risk-taking and pregnancy among teens (see PP, Kaiser, ACLU, Guttmacher). And if the goals of abstinence-only programs are the same as the anti-smoking ads—to delay intercourse until adulthood (i.e. marriage)—then we will still have rampant ignorance about STIs, protection, and reproductive health.

While the motivations of the two campaigns may be different (those behind the Phillip Morris ads are looking to keep sales (i.e. smoking) up while “avoiding a governmental crackdown” and those preaching abstinence-only arguably do want to keep teens from having sex), each scenario, through the evasion of straightforward conversation and disregard for proven studies, threatens young people with bitter ends: lung cancer and AIDS.

Tuesday, December 05, 2006

Signs of a new Congress: Questioning the roots of US HIV/AIDS policy

The Boston Globe reported yesterday on some important questions that Democrats are asking about President Bush’s faith-based initiatives:

  • Have current faith-based initiatives violated the separation of church and state?
  • Did the Bush administration really give 98.3 percent of the faith-based foreign-aid money to Christian groups? How does this affect, among other things, our foreign relations?
  • What are the effects of such faith-based initiatives on our fight against AIDS?

Questions such as these are being articulated mainly by Representative Barbara Lee (D) from California and Representative William Delahunt (D) of Massachusetts.

Representative Lee is sponsoring a bill that would overturn a measure that requires that one-third of the money spent by the US government on AIDS prevention overseas go for "abstinence until marriage" programs. This is a $1 billion measure and many Democrats have suggested that the money could be better spent on other measures such as condoms. "When you look at what has been exposed and revealed, I think we have a factual basis to move forward with this," Representative Lee said.

Representative Delahunt, who will soon chair the International Relations subcommittee on Oversight and Investigation, said that if US-funded Christian groups work in Muslim-dominated countries, the effort could be "perceived to be proselytization and it can generate a harsh negative reaction that implicates and impacts in a negative way on America's image in the world and have significant consequence to our foreign policy goals."

Democrats are also attempting to repeal a measure that required US groups receiving faith-based funds to have a policy opposing prostitution. Many groups have said the pledge impedes their work with sex workers who are at high risk for HIV. Organizations have also raised a question of the constitutionality of the pledge as compelled speech. Two federal judges have ruled that the pledge is unconstitutional and the Bush administration has appealed these rulings.
Read more.

Regarding the AIDS fight, Representative Tom Lantos, the California Democrat who will chair the International Relations Committee in January, said, "Our global HIV/AIDS policy should be about saving lives…It is inconsistent with this goal to place ideologically driven restrictions on the implementation of efforts to prevent spreading the virus."

Thursday, November 30, 2006

HRW: World AIDS Day 2006: Ideology Trumps Action as Epidemic Worsens

Governments Must Respect Rights to Advance AIDS Fight

(New York, November 29, 2006) – Twenty-five years after AIDS was first identified, programs to fight the disease continue to be undermined by conservative ideologies and moralistic approaches, Human Rights Watch said ahead of World AIDS Day on December 1.

“The most effective approaches for preventing HIV/AIDS are not being used,” said Joe Amon, director of the HIV/AIDS program at Human Rights Watch. “Governments are refusing to adopt evidenced-based programs that respect individual rights, and are instead promoting ideological campaigns that make people more vulnerable to infection.” Human Rights Watch identified a number of examples from around the world affecting those most at risk of HIV infection, including youth, women, and injecting drug users.

  • In sub-Saharan Africa, a majority of young adults lack adequate knowledge of HIV transmission. Yet some governments emphasize “abstinence-only” approaches and promote inaccurate information about the effectiveness of condoms. For example, in Uganda the government promotes “virginity parades” and restricts the availability of condoms to youth while the epidemic – in a country once considered a “success story” – has worsened dramatically.
  • Women are increasingly recognized as the “face” of AIDS, but governments refuse to address the human rights abuses that cause their vulnerability. One in three women will face some form of gender-based violence in her lifetime, and studies have found that women who experience violence are up to three times more likely to become infected.
  • One in three new infections outside Africa affects injecting drug users. Few governments, though, are adopting such proven strategies as substitution therapy for drug addiction or the provision of clean needles. In Russia, where the epidemic is concentrated among injecting drug users, the government has refused to permit the use of methadone and has hindered the widespread availability of clean needles.
Six months ago, UN members signed a declaration recognizing that the protection and realization of human rights is essential in the global fight against AIDS. “The theme for this year’s World AIDS Day is ‘Keep the Promise,’” Amon said. “But unless governments adopt effective approaches that respect the rights of those most vulnerable to the disease, their broken promises will add up to millions more infected with HIV.”

At the International AIDS Conference in Toronto last August, Human Rights Watch collected audio testimony from AIDS activists and individuals living with HIV worldwide, who present personal stories and perspectives on what is needed in the global AIDS fight. “Listen to their stories and you can begin to understand the impact of the AIDS epidemic and the failure of the world’s governments to address it,” Amon said. To hear the testimonies of AIDS activists and those living with HIV which Human Rights Watch recorded at the 16th annual International AIDS Conference, please visit: http://www.hrw.org/campaigns/aids/2006/toronto/audio.htm

For broadcast-quality audio interviews of other leading AIDS activists around the world, as well as a 30-minute radio program produced by Human Rights Watch for the International AIDS Conference, please visit: http://www.hrw.org/campaigns/aids/2006/toronto/audio2.htm

Tuesday, November 28, 2006

Chinese Release Detained AIDS Activist

On November 24th, Dr. Wan Yanhai, an advocate for AIDS patients in China and founder of the AIZHIXING Institute, was taken in for questioning by the Beijing police and detained for 48 hours. His detention forced the cancellation of a planned workshop, “Blood, Safety, AIDS, and Legal Human Rights”, which planned to focus on the rights of people infected with HIV/AIDS through blood transfusions. After Dr. Wan cancelled the workshop, he was released.

Dr. Wan has been detained before. In 2002, he was in police custody for four weeks after posting information on the internet about unsafe blood exchanges that were contributing to the rising incidence of AIDS in the province of Henan. He was charged with “illegally leaking state secrets.” Upon his release, Dr. Yanhai declared, “If this incident helps attract more concern and support for victims of AIDS and their families and children here in China, then it can be considered an opportunity we should grasp.''

The detention of Dr. Wan by the Chinese authorities on the eve of World AIDS Day emphasizes the restrictions on the rights of people living with HIV/AIDS in China. A press release by the Network of Chinese Human Rights Defenders (CRD) states that the Beijing police have been working to block villagers living with HIV/AIDS from entering the city—whether to visit or to express grievances to the government—in part as preparation for the 2008 Olympics.

UNAIDS reported in its 2006 annual report that the epidemic in China has reached more than 650,000 individuals. In contrast to most regions, the epidemic began in rural areas and spread to the cities, perhaps explaining why awareness has remained low and stigma has soared. Nearly half of the people living with HIV in China are believed to be infected from injecting-drug use. In some provinces such as Henan, one percent of pregnant women are found to be HIV-positive. UNAIDS also cites blood and plasma donations as a contributing factor to the epidemic, the issue that Dr. Wan has focused on. HIV-positive persons find little protection or help—the UNAIDS report estimates that “almost one in three (30%) health professionals in Yunnan Province…said they would not treat an HIV-positive person.”

Dr. Wan’s work continues to drawn attention to not only the discrimination facing people living with HIV/AIDS in China, but also the denial of the civil and political rights of those fighting on their behalf. Learn more about his work:

Human Rights Watch talks with Dr. Wan (7/2006)

Network of Chinese Human Rights Defenders press release (11/27/06)

“China Frees AIDS Activist After Month of Outcry” (9/21/02)

“China Now Set To Make Copies of AIDS Drugs” (9/7/02)

“China's Top AIDS Activist Missing; Arrest Is Suspected” (8/29/02)

Tuesday, November 21, 2006

Update on the AIDS Epidemic

UNAIDS and the WHO released the yearly report on HIV and AIDS. The 94-page report, "AIDS Epidemic Update: December 2006", estimates that 4.3 million new HIV infections occurred worldwide this year and that about 2.9 million people died of AIDS-related illnesses.

Annotated Life: Why Blog?

Blogging, social networking and activism

Friday, November 17, 2006

Site to check out

An anonymous AIDS Combat Zone reader leads us to AIDS: Remember me?, a site put up by the European Commission to encourage dialogue about HIV/AIDS. It's being done in conjunction with an event in Brussels, Belgium on the eve of World AIDS Day to screen new HIV commercials and select a favorite. Other areas of the site to check out include a contest encouraging you to write your own HIV/AIDS 60 second TV spot (European Union nationals only) and a vlog (video blog) you can participate in. This is the citizen-driven web at its finest!

Monday, November 13, 2006

New York Times: Needles, AIDS, China

To the Editor:

In "China's Muslims Awake to Nexus of Needles and AIDS", Howard French shows one bright spot in China's war against the AIDS epidemic: in Xinjiang, authorities are beginning to offer methadone to drug users.

However, the article does not show an uglier piece of the picture. Every year, authorities around the country also forcibly detain thousands of drug users in prisons, "treatment centers" in name only. As a researcher at Human Rights Watch, I visited one such facility and interviewed detainees from others. Under Chinese law, police may sentence individuals to three to six months --sometimes, longer-- in these prisons, without trial. Detainees are kept in unclean, overcrowded cells. They get no counseling. They are compelled to take part in forced, unpaid labor, working long hours on farms or in sweatshops that profit the prisons. Chinese sex workers also face similar detention.

As interviewees told me, all this punitive approach accomplishes is to marginalize those at high risk of HIV infection and drive them underground, away from authorities and any program that could teach them about HIV and how to prevent its spread. China should abolish these fake "treatment centers" and replace them with real ones.

Sara Davis
Executive Director
Asia Catalyst

Thursday, November 09, 2006

Online course regarding rights

Online Course – Introduction to Human Rights

http://rightstraining.fahamu.org/ocw/Courses_listing

Fahamu has a vision of the world where people organise to emancipate themselves from all forms of oppression, recognise their social responsibilities, respect each other’s differences, and realise their full potential. Fahamu supports human rights and social justice in Africa by:

• Supporting social justice advocacy through innovative use of information and communications technologies • Stimulating debate, discussion and analysis • Distributing news and information • Developing training materials and running distance-learning courses.

Fahamu focuses primarily on Africa, although we work with others to support the global movement for human rights and social justice.

Fahamu has developed a wide range of courses for human rights and social justice organisations, including courses on investigating and reporting on human rights violations, conflict prevention, prevention of torture, fundraising, financial management and others. Fahamu has extensive experience in developing and running distance-learning and workshop based courses internationally.

Fahamu is the first NGO partner in the OpenCourseWare Consortium. The first course being made available is Introduction to Human rights which was written by Richard Carver.

Wednesday, November 08, 2006

WHO Names New Director-General

Dr. Margaret Chan was nominated for the position of WHO Director-General. The World Health Assembly will meet on Thursday, November 9th to review the nomination. More on the WHO website. The news release is pasted below:

Dr Margaret Chan nominated to be WHO Director-General

8 NOVEMBER 2006 GENEVA -- Dr Margaret Chan of China was nominated today by the Executive Board of the World Health Organization for the post of Director-General. The Director-General is WHO's chief technical and administrative officer.

The nomination will be submitted to the World Health Assembly, which will meet for a one-day special session on Thursday, 9 November to appoint the next Director-General.

The procedures for the current nomination and election process were decided following the sudden death of Dr LEE Jong-wook, WHO Director-General, on 22 May 2006. At its meeting on 23 May, the WHO Executive Board agreed on an "accelerated process" for electing a Director-General.

On Monday the Executive Board, chaired by Dr Fernando Antezana Araníbar of Bolivia, selected a short list of five candidates. Yesterday the Board interviewed the five candidates and today selected Dr Margaret Chan as its nominee.

Dr Chan is a well-known public figure because of her record of leadership in fighting disease first in Hong Kong, and more recently at WHO. During her nine-year tenure as Director of Health, Dr Chan confronted the first human outbreak of H5N1 avian influenza in 1997 and successfully defeated Severe Acute Respiratory Syndrome (SARS) in Hong Kong in 2003. She also introduced primary health care 'from the diaper to the grave' with a focus on health promotion and disease prevention, self-care and healthy lifestyles. In 2003, she joined WHO and rose to the position of Representative of the Director-General for Pandemic Influenza as well as Assistant Director-General for Communicable Diseases. Now 59, Dr Chan obtained her Medical Degree from the University of Western Ontario in Canada and a public health degree from the National University of Singapore.

The WHO Executive Board is composed of 34 Members who are technically qualified in the field of health. The main functions of the Board are to give effect to the decisions and policies of the World Health Assembly, to advise it and generally to facilitate its work.

The countries represented on the current Executive Board are: Afghanistan, Australia, Azerbaijan, Bahrain, Bhutan, Bolivia, Brazil, China, Denmark, Djibouti, El Salvador, Iraq, Jamaica, Japan, Kenya, Latvia, Lesotho, Liberia, Libyan Arab Jamahiriya, Luxembourg, Madagascar, Mali, Mexico, Namibia, Portugal, Romania, Rwanda, Singapore, Slovenia, Sri Lanka, Tonga, Thailand, Turkey and the United States of America.

Dr Anders Nordström, appointed by the Executive Board as Acting Director-General of WHO in May, will continue in this role until a new Director-General takes office.

For more information contact:
Christine McNabActing-Director, WHO Communications Department
Telephone: +41 22 791 4688Mobile phone: +41 79 254 6815E-mail: mcnabc@who.int

Iain SimpsonTeam leader, News and AdvocacyWHO, Geneva
Telephone: +41 22 791 3215Mobile phone: +41 79 254 3215E-mail: simpsoni@who.int

Fadéla ChaibCommunications OfficerWHO, Geneva
Telephone: +41 22 791 3228Mobile phone: +41 79 475 5556E-mail: chaibf@who.int

Tuesday, November 07, 2006

Candidates for WHO Director-General Respond to Questionaire

PEPFAR Watch has posted the answers to the questionaire put forward by civil society partners to the candidates for Director-General of the WHO. Read what several candidates said about critical issues such as HIV/AIDS, TB, and sexual and reproductive health.

Yesterday, the Executive Board of the WHO announced in a news release that the short-listed candidates are: Ms. Elena Salgado Méndez, Dr. Kazem Behbehani, Dr. Margaret Chan, Dr. Julio Frenk, and Dr. Shigeru Omi.

Monday, November 06, 2006

Abstinence Forever

USA today reports that the federal government is targeting unmarried adults up to age 29 as part of its abstinence-only programs because unmarried women in the 20-29 year age group are having children.

But really, why stop at 29? I bet there are 30 year old women, even perhaps 35 and 40 year old unmarried women having sex, and having babies too.

I don't know if it was taken out of context, but Wade Horn, assistant secretary for children and families at the Department of Health and Human Services, was quoted in the article as saying: "The message is 'It's better to wait until you're married to bear or father children,' " Horn said. "The only 100% effective way of getting there is abstinence."

The only 100% effective way of getting "there" - meaning to be married with children? - is abstinence??? Has HHS decided to totally abandon evidence, and pursue its ideological goals untethered to data? The article goes on to say:

The revised guidelines specify that states seeking grants are "to identify groups ... most likely to bear children out-of-wedlock, targeting adolescents and/or adults within the 12- through 29-year-old age range." Previous guidelines didn't mention targeting of an age group.

"We wanted to remind states they could use these funds not only to target adolescents," Horn said. "It's a reminder."

Last year, 46 states applied for the federal abstinence-education money, to fund programs in schools, neighborhood clubs and faith-based organizations.

Hmmm, so if HHS is telling states they can target 29 year olds with abstinence messages, how will they do that: schools? probably not. Neighborhood clubs? doubtful. Faith-based organizations? Bingo.

Wednesday, October 25, 2006

Access to pain relief

There have been important recent developments in the Drug Enforcement Administration regarding their policies on opium-based prescription drugs such as OxyContin. Before September, strict regulation by the Drug Enforcement Administration required physicians to limit prescriptions to a 30-day supply. Physicians who exceeded the required amount have faced investigation, arrest, and persecution as "drug dealers". A new proposal, subject to 60 days of public comment starting in early September, would allow doctors to prescribe up to a 90-day supply without fear of prosecution. Doctors that exceed this new limit will be subject to prosecution. Their cases will be identified on the DEA's new webpage, "Cases Against Doctors".

Marc Kaufman of the Washington Post has been following this, along with many others. Useful links to his articles (available on the PRN website) and more below:

http://www.usdoj.gov/dea/pubs/pressrel/pr090606.html
http://www.usdoj.gov/dea/concern/oxycontin.html
http://www.painreliefnetwork.org/article_detail_T6_R214.html
http://www.painreliefnetwork.org/article_detail_T6_R288.html
http://www.mercurynews.com/mld/mercurynews/living/health/15453353.htm
http://www.stopthedrugwar.org/chronicle/452/dea_proposed_rules_to_ease_pain_prescribing_restrictions
http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-14520.pdf

Tuesday, October 24, 2006

Questions from Civil Society to All Nominees for WHO Director General

These questions were proposed to all WHO Director Nominees. Stay tuned--we will post their responses as they come.


1. Global commitments have been made to universal access to HIV/AIDS prevention, care, treatment and support. For example, the African Union (AU) Common Position commits to doing everything possible to achieve 80% coverage of adults and children in need of antiretroviral treatment (ART) by 2010. Do you support the establishment of similar targets for other regions? How, specifically, will the World Health Organization (WHO) contribute to reaching these goals in Africa and in other regions?

2. The promotion of basic human rights is essential to the global response to HIV/AIDS. Medical and public health approaches to the epidemic must address basic human rights concerns at all levels, yet tension often exists between public health and human rights communities. In what specific ways do you see WHO responding to human rights concerns as a fundamental aspect of public health and medical approaches to prevention, treatment and care across the board?

3. How, specifically, will you ensure that the involvement of civil society--including people living with HIV/AIDS and vulnerable groups—is a priority at all levels of decision making, from the setting of funding, policy, and programmatic priorities through the design, implementation, monitoring and evaluation of prevention, care, treatment, and support programs? For example, a major concern for civil society right now is the development and dissemination of new guidelines by WHO for provider-initiated testing without adequate concern either for basic human rights principles and/or adequate transparency and accountability in the consultation process to develop these guidelines. How will you ensure adequate global consultation, comment, and critique on issues of voluntary counseling and testing versus provider-initiated testing and by what means will you include civil society actors in monitoring and accountability in these areas?

4. How will WHO tackle the challenges of TB/HIV co-infection, and move to help countries achieve universal access to the full WHO-recommended package of 12 collaborative TB/HIV activities in all health systems, particularly in countries with high HIV burden? How will WHO address the increasing epidemics of MDR- and XDR-TB?

5. The advancement and protection of sexual and reproductive rights are crucial in the response to HIV/AIDS. Gender inequality, gender-based violence and discrimination fuel the spread of HIV among women, girls, LGBT and other populations and are both cause and consequence of the spread of HIV infection and other urgent public health problems. How will WHO deal with these issues specifically as integral to all of the work of the organization and health systems under your tenure and as integral to the response at every level of law, policy, and health practice within member countries?

6. Specific populations are particularly vulnerable in the epidemic, including those already marginalized by social stigma and widespread discrimination and routinely denied their basic human rights. These groups include, among others, intravenous drug users (IDUs), commercial sex workers (CSWs), gay, lesbian and transgender persons, men who have sex with men (MSM), and undocumented migrants. Rather than promoting their basic human rights, governments often seek instead to criminalize and further marginalize these groups. How—specifically--will WHO work to protect the right to health for all these groups? How can WHO, for example, help advance the rights of IDUs, CSWs, MSM, and others as an integral part of an effective global response to the HIV/AIDS epidemic, especially in countries where these rights are not protected? By what means will WHO seek to ensure effective and adequate services are made available to those in prison settings? How will WHO work to advance rights-based public health approaches over efforts to further marginalize and/or criminalize vulnerable groups?

7. The world continues to fail in delivering on universal access to an essential package of AIDS commodities that includes: antiretroviral medicines (for both treatment and prevention of HIV infection); drugs to treat and prevent tuberculosis, hepatitis C, sexually transmitted infections (STIs) and other co-infections; HIV testing kits and other diagnostic technologies; home-based care kits and related essentials; breast milk substitutes; male and female condoms, substitution treatments; and clean injecting equipment. In what ways will WHO lead in filling these gaps?

8. All prevention interventions must include complete and accurate evidence-based information about HIV/AIDS prevention and treatment at the level of the individual. “Conscience clauses” and “opt-outs” can not trump the rights of individuals to fully informed choices and consent. How will you seek to bridge the increasing ideological divide undermining access to comprehensive prevention interventions worldwide? Prevention and treatment must also be linked in meaningful ways: Today, for example, only a small share of pregnant women living with HIV have access to services for the prevention of mother-to-child transmission, and few of those accessing PMTCT have sustained access to treatment for themselves. In what ways will WHO help to bridge these and other gaps?

9. How do you envision WHO’s work with generic producer countries and less developed country governments without manufacturing capacity to set precedents for the use of TRIPS flexibilities including compulsory licenses for export of first- and second-line anti-retrovirals?

10. UNAIDS estimates that the world needs to provide between $20 billion to $22 billion by 2008 to fund a comprehensive response to HIV/AIDS. How will WHO work with donors, multilaterals (GFATM, UNAIDS, World Bank), and countries around the world to assure the necessary resources are mobilized and deployed? How will you work to end the unnecessary institutional friction in Geneva between UNAIDS and WHO and to ensure that GTT recommendations on harmonization and alignment of multilaterals are implemented?

11. Finally, what is your vision of the role of WHO in promoting needed research and development on HIV, TB, malaria, and other global killer diseases to ensure that health-related Millenium Development Goals are met and that new generations of more effective diagnostics, treatments, and vaccines, including a vaccine and ultimate cure for HIV/AIDS, are developed?

Thursday, October 19, 2006

Kennedy and Waxman urge U.S. to promote access to healthcare in its trade practices


In recent letters to Secretary Michael Leavitt (Health and Human Services) and Comptroller General David Walker (Government Accountability Office), Senator Kennedy and Representative Waxman remind the Administration of its obligations under the Trade Act of 2002. Under this act, the U.S. is obligated by law to respect the commitments made under the TRIPS and Public Health, commonly known as the 'Doha Declaration'.

Kennedy said:
“In this era of HIV epidemics, avian flu outbreaks, and other public health threats, it is essential that we promote good health and access to medicines in every country”.

Waxman chimed in, perhaps more pointedly:
“We have to recognize that the Bush Administration’s single-minded pursuit of intellectual property protections for drug companies can have potentially devastating consequences for the public health in developing countries”.

Kennedy and Waxman also asked the government to retract its demand for the World Health Organization to withdraw its 2005 report, "The Use of Flexibilities in TRIPS by Developing Countries: Can They Promote Access to Medicines?, that identifies barriers that trade agreements impose on public health policies. Waxman said, “We need more analysis of the implications of our policies, not less”. One point the WHO report made was:
“…the U.S. policy, by focusing exclusively on the interests of its export industries, may lead to very restrictive interpretations of the flexibilities contained in international agreements to the detriment of public health needs in developing countries”.


Links to:
Letter to the Honorable David M. Walker in the Government Accountability Office
Letter to the Honorable Michael O. Leavitt, Secretary of Health and Human Services


Tuesday, October 17, 2006

ONDCP: Misconstruing evidence on needle exchange programs.

The ONDCP (Office of National Drug Control Policy) has a blog called “Pushing Back” which recently featured an interview with Dr. David Murray, an ONDCP policy analyst and “expert” on needle exchange. The blog entry was entitled “What’s Wrong with Needle Exchange Programs?”

In the interview Dr. Murray claims that recent research about the programs’ effectiveness in lowering HIV infection has been inconclusive, and that their effect on continued drug use is unknown. These claims form the basis of the Federal Government’s refusal to fund needle-exchange programs. Dr. Murray says that endorsing needle exchange programs conflicts with the “primary burdens for any public health intervention” which are to:

“…produce the effect that they intended to produce, that they do not introduce harmful unintended consequences, and that they are demonstrably superior to other interventions that could produce better outcomes”

Ok, let’s look at these criteria:

1) produce the effect that they intend to produce –

Murray cites a recent Institute of Medicine report , and says that evidence concerning the effect of these programs on HIV infection is “limited and inconclusive”. However, the report specifically says:

“a large number of studies and review papers…show that participation in multicomponent HIV prevention programs that include NSE [needle and syringe exchange] is associated with a reduction in drug-related HIV risk behavior, including self-reported sharing of needles and syringes, unsafe injection and disposal practices, and frequency of injection.”

2) do not introduce harmful unintended consequences –

Dr. Murray also misrepresents the IOM report when discussing the effects of needle exchange on drug use itself. While Dr. Murray says that evidence on this is “inconclusive”, the IOM report says:

“the few studies that have examined the unintended consequences of programs that include NSE found no evidence that they lead to more new drug users, more frequent injection among established users, expanded networks of high-risk users, changes in crime trends, or more discarded needles in the community.”

3) are demonstrably superior to other interventions that could produce better outcomes –

Dr. Murray states: “The single most important point, however, is that there is a superior intervention that reduces the risk of disease transmission and that reduces the danger from the drugs themselves -- that intervention is drug treatment.”

Drug treatment is clearly essential, but why should it be only drug treatment, and what is ONCDP doing to make treatment more available worldwide? UNAIDS estimates that there are now 13 million injecting drug users worldwide. Where drug treatment is available at all, it is often ineffective or punitive. In Russia, with an estimated two million IDUs, “treatment” is often restricted to medically managed withdrawal. Prescription medication to reduce cravings for illegal opiates (substitution treatment) is illegal. Across Asia, many drug users are confined to centers that are more like prisons than health care facilities, and that offer little or no psychosocial or medical support.

It’s one thing for the Federal Government to decide not to fund needle exchange programs and leave it up to the states. It’s quite different for them to misconstrue the evidence of their important role in battling HIV-infection. The Institute of Medicine is not alone in its findings. In 2002 Surgeon General David Satcher issued a report to Congress that concluded:

“After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs . . . are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.”

Additional organizations that support needle-exchange programs as effective tools for protecting the public health of communities include:

American Academy of Pediatrics
American Bar Association
American Foundation for AIDS Research
American Medical Association
American Public Health Association
Association of State and Territorial Health Officials
National Alliance of State and Territorial AIDS Directors
New York Academy of Medicine

Tuesday, October 10, 2006

Omololu Falobi: the loss of a great activist

Human Rights Watch mourns the death of its Nigerian colleague Omololu Falobi, 35, a multiple-awards winning journalist and human rights activist. Falobi died unexpectedly on October 5th, leaving behind his wife and two young children.

Human Rights Watch spoke with Falobi in July 2006 about his work and his hopes for the impact of journalism on the AIDS epidemic.

Falobi was the founder/executive director of Journalists Against AIDS (JAAIDS) Nigeria. At the 15th International AIDS conference in 2000, he won the International AIDS Society's Young Investigator Award. The same year, he was named the winner of the Highway Africa Award for Innovative Use of New Media, an award that recognizes outstanding and innovative use of the Internet in African journalism.

In 2001, he was appointed an Ashoka Fellow in recognition of his outstanding and innovative approaches to 're-engineering society'. In recognition of this advocacy on HIV/AIDS in Africa, he was selected as the African NGO representative on the board of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2004 and 2005. More recently, he helped in convening the African Civil Society Coalition on HIV and AIDS, which serves as an umbrella movement for organizations involved in HIV and AIDS advocacy and campaigns on the continent.

“His individual leadership, his longtime commitment to pushing for Africa's own community leadership over its epidemic, his example of how journalists can be stronger social activists, his vision and championing of the Nigeria E-Forum (the only HIV/AIDS-focused listserve of its type and breadth in Africa), and his ability to draw other activists together for positive change have inspired and motivated people from around the globe into action - including me. His legacy speaks for itself...but his departure from us leaves a great void.” –Ron MacInnis, the Director of Health Journalism at Internews

More tributes to Omololu at: http://omololu-falobi.blogspot.com/



Friday, October 06, 2006

New report:Sterile injecting equipment and opiate substitution for IDUs

The Institute of Medicine recently published Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence (2006), highlighting research that found that access to sterile injecting equipment and opiate substitution treatment effectively reduces the spread of HIV among injecting drug users (IDUs). Outside Africa, UNAIDS estimates that nearly one in three HIV infections is due to injecting drug use, yet HIV prevention services reach only 5 percent of the world's injection drug users. The report highlights this alarming fact by focusing on China, Thailand, and Russia and calls on governments to take immediate action to curb HIV among IDUs.

Unfortunately, there is a stark absence of a human rights framework. The article fails to hold governments accountable to adopting effective policies, saying for example "...HIV prevention interventions for IDUs should be tailored to local circumstances and implemented in a culturally appropriate manner". Too often "cultural norms" have been used as an excuse for horrendous rights abuses against individuals who use drugs. In order to effectively apply the research presented by IOM's scientists, a rights-based approach is necessary to overcome local stigma and discrimination.

Wednesday, October 04, 2006

Alert to CHAMP’s new monthly bulletin

The Community HIV/AIDS Mobilization Project has started a monthly bulletin focusing on AIDS in jails and prisons. Each issue will outline a case-study of an advocacy campaign. The first issue, published in June 2006, focuses on the movement around AB1677 which advocated for the distribution of condoms in California prisons (this bill was, unfortunately, vetoed over the weekend).

Check it out at:
http://www.champnetwork.org/media/prisonissue1.pdf

AIDS adding to 'brain drain'

There are many factors contributing to the ‘brain drain’, or the loss of skilled professionals from developing countries. AIDS adds another layer to this: Lancet in August 2006 wrote that, alarmingly, “Death is depleting the ranks of health professionals more rapidly than recruitment abroad”.

Lancet cites studies
from the Joint Learning Initiative and the WHO showing that the median age at death of HIV-positive professionals in Zambia is 38 years old. Over a decade, the deaths of nurses accounted for a 37 percent nurse vacancy rate.

The article promotes providing heightened access to HIV/AIDS care for civil servants in countries severely affected by AIDS. Granting them normal access creates delays and absenteeism, and does nothing to lessen stigma. Focusing on care for HIV-positive health professionals, the article argues, would do more to extend the survival of HIV-positive patients than banning recruitment abroad.

Uganda and Namibia are cited as nations that are taking steps to care specifically for civil servants with HIV.



Frank Feeley (2006) “Fight AIDS as well as the brain drain” The Lancet 368 (August):435.

Tuesday, October 03, 2006

Lancet on Maternal Mortality

From time to time we’ll include issues related to health and human rights that go beyond HIV/AIDS.

In an upcoming issue of the British medical journal Lancet are a couple of articles which advocate for increasingly focused approaches to the problem of maternal mortality.

In 2000, the Millennium Development Goals proposed to reduce maternal mortality by two-thirds by 2015. An article in this week’s Lancet says that this will best be done by adopting a “core strategy of intrapartum care based in health-centres”. The authors contend that not enough international attention has been directed towards maternal health and that the international donor community should “channel funds through sector-wide support”.


But in a related comment, researchers from University College London call the argument a “one-size-fits-all” strategy and suggest instead that maternal health policies be “context-specific” and community-based. Just strengthening the health services will have little effect on poor people who may not have access to the health centers, the Comment says
.

Human Rights Watch recently reported on women turned away from care in Burundi, and imprisoned after giving birth for failing to pay their hospital fees
. This report shows that clearly we must act both to strengthen the availability of appropriate, quality care, and the accessibility of it.

Kristof’s “The Deep Roots of AIDS”

Nicholas Kristof searches for the roots of HIV [Op-Ed, “The Deep Roots of AIDS”, September 19] and finds them in poverty and gender inequality. He tells the story of a man in Cameroon who falls ill and eventually dies of AIDS. The family, unable to gather the funds to pay for consistent treatment, is now destitute: the man’s wife is alone and disenfranchised, his daughters have dropped out of school and have few choices ahead of them.

Yet Kristof’s solution isn’t to address the root causes he identifies—poverty and gender inequality—but to promote routine HIV testing. Expanding testing programs alone will not ensure antiretroviral treatment for the lower-class. It will not end violence against women, which helps fuel the epidemic, nor will it diminish the lure of sugar-daddies to pay school fees or put food on the table.

In preaching abstinence until marriage and fidelity, the U.S. program on AIDS has turned a blind eye to these issues. We do need a more aggressive approach to the global AIDS crisis, but it must be built around protecting human rights, empowering women and girls, and expanding access to antiretroviral drugs. Only then will people seek HIV testing - and be able to do something about the result.

Monday, October 02, 2006

Report from New York City: the immigrant experience and HIV/AIDS

Over the last 3 decades, the growth and diversification of New York City’s immigrant population has mirrored the growth in the HIV epidemic.

Michele Shedlin and her colleagues in a recent study examined this concurrence, locating a gap in public health research. They state:

Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders.

Seeking to examine the impact of migration on health risks and disparities, the study focuses on Hispanic, West Indian, and South Asian immigrants to New York City. A complicating factor of great consequence is that since September 11th, 2001 data on immigrants in NYC have gotten scarce as the individuals have been more reluctant to identify themselves, fearing stigma or even deportation.

The study, published in the Journal of Urban Health as part of its “HIV perspectives after 25 years”, examined the three immigrant groups in different scenarios, involving in depth interviews and assessments. The contacts were made through hospitals, social workers, health officials, and outreach workers. The researchers found that, among an array of other hardships, immigrants are more than twice as likely as citizens to have no health insurance and knew less about HIV infection and protective measures.

The articles states boldly, “the success or failure of this city’s response to its HIV epidemic…will likely revolve around the adequacy of our responses to the challenges posed by our city’s vital and growing immigrant communities.” It calls for more studies of its kind, heightened communication, and more partnerships in order to achieve more informed HIV/AIDS prevention and care.

“Immigration and HIV/AIDS in the New York Metropolitan Area” Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 83, No. 1 (43-58)

Needle Exchange Debates

Progress in New Jersey

New Jersey has long prohibited the distribution of hypodermic needles in government-sanctioned programs and is the only state in the union still to do so. Now, 4 in 10 cases of HIV infections in New Jersey result from injecting drug use with contaminated needles. 14 years after the legislation was first introduced, lawmakers are reviewing a bill that finally appears to have enough support to win passage. The bill would allow needle-exchange programs and even Governor
Jon Corzine has expressed support.

The New York Times reported on this story (September 25):
http://www.nytimes.com/2006/09/25/nyregion/25needles.html


US AIDS policy: Still hostile to Evidence and Rights

On an international front, American officials withdrew their support for needle exchange programs at the WHO’s Asia-Pacific conference last week. They submitted last-minute proposals to a resolution calling for universal access to HIV/AIDS treatment that, in Peter Hodgson’s view, New Zealand’s Health Minister, would have watered down the resolution. He said “[the U.S.] position is that if they have needle exchanges then people will use needles more and use intravenous drugs more…I think it is demonstrably wrong”.

“Demonstrably wrong” pretty much says it all.

The Associated Press reported on this story in the IHT (September 25):
http://www.iht.com/articles/ap/2006/09/22/asia/AS_MED_WHO_Asia_AIDS.php

An urban structural intervention to fight AIDS

In the response to AIDS we need to keep reminding ourselves that it’s not all about individual behaviors.

For example, an AIDS and Behavior article from September 2005 targets housing as a promising structural intervention to reduce the spread of AIDS. The first study of its kind, it collaborated with a national, multi-site evaluation of HIV/AIDS service delivery projects that focused on providing services to low income HIV positive people. The projects were located all over the U.S. in primarily urban settings. Angela Aidala and colleagues then took the data and focused on the correlation between three variables: drug risk behavior and sex risk behavior (dependent variables), and housing status (independent variable). The researchers traced change in individuals’ risk behavior over time as housing status changed. They found that there is a strong association between housing status and HIV transmission; moreover, this association occurs on a gradation, with the homeless at greater risk than the marginally housed, and with both groups at greater risk than the stably housed.

The researchers outline a next step that is needed for action: “data must be produced to show that the provision of housing not only causes a profound reduction in HIV risk-taking but that the risk reductions are so substantial that this is a cost-effective strategy to fight the spread of AIDS in the United States.”

So what’s being done and why aren’t we doing more?

Here’s one model we should be looking at more closely:

Housing Works is a minority-controlled, community-based, not-for-profit corporation providing housing, health care, advocacy, job training, and vital supportive services to homeless New Yorkers living with HIV and AIDS: http://www.housingworks.org/aboutus/index_more.html

Aidala, Angela, J. Cross, R. Stall, D. Harre, and E. Sumartojo “Housing Status and HIV Risk Behaviors: Implications for Prevention and Policy”. AIDS and Behavior, Vol. 9, No. 3, September 2005 (251-265)

Thursday, September 28, 2006

South Africa: Allocation of resources

South Africa has the highest number of people living with HIV in Africa, and rivals only India for the most in the world.

Activists have long pushed for – and had great success – demanding greater access for everyone to antiretroviral drugs in South Africa. But the question is still sometimes raised – how can a scarce resource (antiretroviral drugs) be ethically and most effectively distributed?

As shown by recent reports on the KwaZulu-Natal Province by David P. Wilson, James Kahn, and Sally M. Blower in the Proceedings of the National Academy of Sciences and by Prof Gita Ramjee of the Medical Research Council of South Africa, there are different priorities that could guide allocation strategies.

The article in the PNAS focuses on the urban-rural divide. Using a model that predicted the consequences of three drug allocation strategies in different areas between 2004 and 2008, the researchers argue that the most effective strategy for preventing additional cases of HIV infection would be to prioritize distribution to urban populations. The authors acknowledged the ethical problems in such a strategy, but stated that given an opportunity to treat 500,000 people by 2008, “if the government health policy officials in KwaZulu-Natal wish to apply the utilitarian principle (and minimize the epidemic), our results show that they should allocate all drugs to Durban”.

The biggest problem with the study is that it only looks at preventing infections through 2008. Imagine if we did the same study with a global perspective in 1990 and only looked at infection through 1992. What would our conclusions have been – only to focus programs in Western countries and ignore Asia, Eastern Europe and Africa because they would prevent fewer cases? Didn’t we make that mistake once already?

The Medical Research Council’s study on KwaZulu-Natal focuses on women and revealed alarming HIV prevalence ranging from 38 to 66 percent. The social factors that cause this prevalence are timeless and bridge the urban-rural divide. MRC cites as factors the taboos surrounding sex and promiscuity and the treatment of boys as “demigods…exempt from apology for unfaithfulness”. The existence of AIDS is routinely denied and women are often forced to engage in unprotected sex.

MRC’s research adds complexity to the discussion of allocation strategies. While perhaps treating only people in urban areas would yield fewer infections in the short term, it would do nothing to lower the stigma surrounding AIDS or empower women economically or in their relationships. These social factors stretch across the urban-rural divide and will continue to be a driving force behind AIDS unless tackled directly.

Links to articles:
http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyID=2006-09-12T131530Z_01_N11215210_RTRUKOC_0_US-AIDS-SOUTHAFRICA.xml&archived=False

http://www.irinnews.org/report.asp?ReportID=55634

Voices of HIV/AIDS

The HIV/AIDS Program at Human Rights Watch would like to draw attention to a recent addition to the website: over a dozen stories from courageous individuals intimately involved in the fight against AIDS. Human Rights Watch collaborated with Making Contact to produce a 30 minute program featuring the voices of AIDS activists rarely heard in the mainstream media. All this is available at Human Rights Watch's HIV/AIDS Program webpage.

2006 Awards for Action on HIV/AIDS and Human Rights

Gareth Williams, a leading AIDS activist and voice for the rights of sexual minorities in Jamaica and the English-speaking Caribbean, is the recipient of the 2006 International Award for Action on HIV/AIDS and Human Rights. Stella, a Montréal-based support and information group organized by and for sex workers, is the recipient of the Canadian Award. Both are presented by the Canadian HIV/AIDS Legal Network and Human Rights Watch.

Williams spearheads an emergency support program that provides material care and support for victims of homophobic violence. He also played a key role in encouraging community members to share their stories with researchers for the 2004 Human Rights Watch report, Hated to Death: Homophobia, Violence, and Jamaica’s HIV/AIDS Epidemic: (
http://hrw.org/reports/2004/jamaica1104/).

Stella serves women, transvestites and transsexuals. The group maintains an ongoing presence in sex work venues, including streets, escort agencies, massage parlours and strip bars.

Until human rights are at the center of AIDS policy and program decision-making, we must continue to thank courageous and tireless advocates for human rights, whose bravery in the face of personal risk, benefits us all. To this end, in 2002, the Canadian HIV/AIDS Legal Network and Human Rights Watch established the Awards for Action on HIV/AIDS and Human Rights to recognize excellence and long-term commitment to work that has a direct impact on HIV/AIDS and human rights issues. An award is presented annually to one Canadian and one international recipient. The 2006 Awards will be presented on September 28th in Gatineau, Quebec (
www.aidslaw.ca/awards).

Wednesday, September 27, 2006

CDC recommends routine testing: Ignores stigma?

The Center for Disease Control and Prevention revised their recommendations on September 22 regarding HIV testing. Now, the CDC urges that all teenagers and most adults receive HIV tests as part of routine medical care. Further, it advocates dropping previous guidelines of pre-test counseling and signed consent forms.

This proposal prioritizes expansive testing over efforts to inform people about high-risk behavior. A study of AIDS cases in 33 U.S. states between 2001 and 2004 showed that over 60 percent of HIV cases are due to male-to-male sexual contact or injection drug use (MMWR 54(45); 1149-1153). The heterosexual partners of MSM and IDUs must also be considered in this statistic. Education and counseling about high-risk behavior is crucial to curbing the epidemic. In the case that people engaged in risky behavior test negative, without counseling there is little motivation to change that behavior or change in risk perception.

Dr. Julie Gerberding, the disease control agency’s director, said, “People with HIV have a right to know that they are infected so they can seek treatment and take steps to protect themselves and their partners.'' But what exactly is the CDC doing to facilitate these steps? People cannot take steps on their own without counseling about their status and guidance through the system. The CDC might take on a leadership role in funding needle exchanges and comprehensive sex education in schools, for example.

The New York Times called the move “a sharp break from the early days of the AIDS epidemic, when the stigma and fear of social ostracism caused many people to avoid being tested”. In fact, stigma around AIDS and sex is still very much alive in the United States. Education policies around abstinence both exemplify and exacerbate this stigma. They affirm the destructive stance that those infected have failed to adhere to moral policies.

http://www.nytimes.com/2006/09/22/health/22hiv.html?hp&ex=1158984000&en=1cb8ad4909b01b0f&ei=5094&partner=homepage

HIV Perspectives after 25 years

The Journal of Urban Health recently put together a series entitled “HIV Perspectives after 25 years”. The articles in the issue include:
  • immigration and HIV in New York City
  • integration of HIV prevention activities into the medical care setting
  • conceptual articles about structural intervention
  • the importance of funding prevention as well as vaccine research
  • the devastating effect of HIV/AIDS on children.

The series serves well to show not only how many issues the epidemic affects but also how vast the field of study has become.

While there is no article that explicitly touches on the relationship between human rights and HIV/AIDS, the concept of structural intervention is featured prominently. The articles advocate approaches to public health that alleviate the burden of blame on individuals. Pinning blame on individuals can obstruct the right to health.

The authors state, “[structural interventions] locate the cause of public health problems in contextual or environmental factors that influence risk behavior…rather than in characteristics of the individuals who engage in risk behaviors”.

The authors define four important types of structural interventions in HIV prevention: community mobilization, integration of HIV services, and economic and education interventions.

These articles can be found at:
Journal of Urban Health, Bulletin of the New York Academy of Medicine (2006) Vol. 83, No.1

Report from New York City: the turbulent history of HIV/AIDS education

The HIV/AIDS curriculum of public schools in New York State and New York City has been the subject of important debate for much of the 25 years since the start of the AIDS epidemic – and each twist and turn of the debate has reflected wider debates occurring about AIDS.

Since 1987, the New York State Education Commissioner Regulations have required that every board of education in the state provide education on HIV/AIDS to students K-12. The content of that education has varied, since it’s dependent on the current Chancellor and political context. For example, in 1991 Chancellor Joseph A. Fernandez proposed distribution of free condoms in schools. This was the subject of fierce controversy over the next year and finally passed with fear mongers suggesting that there would be a big increase in sexual behavior.

A decade later, movement in the public school curriculum regarding HIV/AIDS education was initiated by Scott Stringer, then NYS Assembly member (now Manhattan Borough President), who, in 2003, wrote a comprehensive report entitled “Failing Grade: Health Education in NYC Schools” (
http://www.assembly.state.ny.us/member_files/067/20030622/index.html). In “Failing Grade” Stringer criticizes the vast discrepancy between local mandates for health education and actual practices. The report found that the majority of districts violate New York City’s minimal mandates on health education; often this is simply out of ignorance of the mere existence of regulations.

The need for more sex education is clear—New York City is still the American epicenter of HIV/AIDS (New York City accounts for 15.5 percent of all AIDS cases in the U.S. and more than half of high school students identify as sexually active. The Guttmacher Institute, in a report entitled, “Facts on Sexually Transmitted Infections in the United States” released in August 2006 cited, “although teens and young adults represent only 25% of the sexually active population, 15–24-year-olds account for nearly half of all STI diagnoses each year” (
http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf).

In November 2005, Chancellor of the NYC Department of Education, Joe Klein, issued a revised curriculum on HIV/AIDS. The new document prioritizes reducing the stigma around people with AIDS, stating as one of its key goals that it will “enable [students] to feel comfortable around people with HIV/AIDS”. To the teachers, it says: “It is important to clarify that it is risk behavior they should avoid, not the people who have AIDS”. It suggests homework to encourage greater parental involvement.

However, it also includes revisions to the health education curriculum that are not necessarily a step in the right direction. The document incorrectly labels abstinence as 100% effective, which does nothing to reduce stigma around sex. The changes include adjustments to the free condom distribution program, instituted in 1991. Now, all parents and guardians have the option of prohibiting their children from the taking advantage of the program: “their children’s identification numbers are placed on a list to ensure that they will not participate”.

This amendment violates the often-stated goal of universal access to prevention that vulnerable teenagers need and will lead only to further delay in effectively addressing HIV/AIDS among adolescents. Plus, really, how hard will it be for a kid whose parents haven’t objected to pick up condoms for a kid whose parents have?

Uganda: Another approach to testing

The debates around HIV testing often focus on the false dichotomy between Voluntary Counseling and Testing (dismissed as the old “failed” approach, despite never having been adequately funded, and working remarkably well in many places with lots of interest but still small overall percentages of populations being tested) and Routine Provider Initiated Counseling and Testing (where patients can, supposedly, opt-out). Routine testing has been promoted even where there are no links to care and support services or to medical treatment.

A recent project in Uganda shows an alternative, more comprehensive, approach. A pilot project conducted by Home-Based AIDS Care combines testing and counseling and, perhaps most notably, takes place in homes. People involved with the Home-Based AIDS Care project overwhelmingly opted to get tested, received counseling whether HIV positive or not, and experienced less stigma from their community. They also were guaranteed access to clinical care and antiretroviral therapy if needed.

The study found that, three months after the diagnosis, there was “substantial increase among positive social events, such as strengthened relationships and community support, and no increase in negative events”. This is likely due to the attention and affirmation that both HIV-positive and -negative individuals in the community received.

Importantly, this technique is considered “operationally feasible” from a financial perspective. This stems in part from targeting entire households which often house several individuals with HIV. Additionally, it promises to be sustainable: as stigma within the community lessens as a result of the counseling, there could be a move towards heightened comfort with methods of protection and earlier testing and treatment.

Uganda is perhaps more able to succeed in these types of programs because they have a long history directly addressing stigma and supporting grassroots initiatives. Other countries in sub-Saharan Africa may have less success, but it is good to see a model of what might be possible.

http://www.aidsmap.com/en/news/1AD39BE5-74F6-4038-9668-4332C712DF1F.asp?type=preview

Monday, August 21, 2006

A Successful Conference Concludes

The XVI International AIDS Conference - attended by more than 24,000 scientists, activists and government officials from 180 countries - ended Friday August 18 with demands for national governments and the international community to mobilize the political will critically needed for progress in the fight against HIV/AIDS.

Over seven days conference speakers exposed the complex mosaic of epidemics - social, economic, political and medical - which feed the global AIDS crisis, calling for the international community to address the disease’s many drivers. The need for scaled-up prevention and increased access to drugs took center stage throughout the week with near universal agreement that appropriate scientific knowledge and adequate means exist to stem the spread of HIV/AIDS; what is less clear however, is the G8’s commitment to funding and national governments’ willingness to exert decisive leadership.

The success of harm reduction strategies, advancements in microbicide development, and the centrality of human rights (and their many violations) all got significant attention throughout the Conference. PMTCT and Harm Reduction were repeatedly sighted as two of the most effective but underutilized tools in the HIV prevention toolbox. Likewise there was significant emphasis on the need for comprehensive HIV/AIDS care including family-wide nutrition supplements and expanded support for orphans.

“ABC” - the Abstinence, Be Faithful, Condomize campaign vigorously supported by the United States came under severe attack spurring demands that donors drop conditions with HIV/AIDS funding. Speakers ranging from the UN’s Stephen Lewis to ActionAids International’s Beatrice Were argued that the ABC strategy ignores on-the-ground realities and fails to address women’s powerlessness in sexual relationships in many countries. Bill and Melinda Gates and Bill Clinton kept women and girls at the forefront, focusing on microbicide development as a means to increase women’s control over their sexual safety.

Throughout the week activists directed delegates attention to the need for generic ARVs whose production is not governed by free-trade agreements, pharmaceutical companies or intellectual property patents.

Greater inclusion of all groups - PLHA, youth, MSM, transgendered peoples and others - at all levels of AIDS programming, as well as continued efforts for diverse regional conference coverage must be given greater attention in the coming years for the most effective prevention, care and treatment programs to be developed.

The conference was undoubtedly a success with critical issues addressed in diverse forums at every level of leadership. The question now is how the international community can sustain momentum built during the conference and create mechanisms for holding governments accountable to funding pledges and the Millennium Development Goals, which promise universal access to prevention and care by 2010.

Thursday, August 17, 2006

Relections on the Conference

Yesterday we asked people how they are feeling about the XVI AIDS Conference, what they will take away from it, and if they think the most important issues are being tackled.

Here are some of their responses:

“People are talking more on prevention and microbicides and new results studies, but they have to think about positive people also, is their a response ready for preventing this HIV infection, to reduce this epidemic? Positive people, even I am positive people, I changed my behaviors. I have learned good knowledge and I have a good experience to share with others. It is important for me to be able to share this experience and this knowledge because I am able to prevent the spread of this disease. I can give some other faces to this epidemic. Whatever they are thinking about this prevention, they have to involve the positive people also in their programs."
- Asha, India


"I don't think there could ever have been another factor that brought so many people together for a common cause. We've all wished for a long time for an end to injustice and a healing for humanity and in such a bizarre way this virus is giving us that opportunity because we are now dependent on people in our society that we have turned our backs on in our world. We depend on sex workers and IDUs to help us combat this and understand it. I think this amazing to mobilize that wisdom and that dignity... There isn't a corner on the globe that isn't affected by this and it's an incredibly uniting movement."
- Les Dolyn, Jasper, Alberta


"This is my first International AIDS Conference. It's a huge conference, really amazing and there are many people from many parts of the world. It is really worthwhile to be here - I learn how people from African countries, from Central Asia, how they are facing AIDS challenges, including stigma and discrimination and lack of access to ARV and other supporting services. I am really happy to be here. There are issues we are not talking about here, but I am more happy to see that people are expressing their concerns here, openly, whereas we cannot do the same thing in the country because countries contexts will be difference, political leaders will have different priorities than AIDS, but here we in AIDS so we can talk about that."
- Bobby, Nepal



"The conference is very good, it's has been a huge job on the part of the organizers of the conference. It's a great time for people to come together to talk about their work and their opinions and their solutions to the issues of AIDS around the world. But there is not enough representation on Latin America, I am from Colombia, there is not enough representation of the governments and very few sessions on Latin America which is leaving Colombia in a critical situation similar to the one Africa is facing."
- Domingo Garcia, Colombia

"I think one issue that is not being addressed sufficiently at this conference is the issue of access to treatment. We now have the case where India must become TRIPS compliant and so because of that it many not be able to supply future drugs because now India grants patents on pharmaceutical products. We have TRIPS plus provisions being signed in the free trade agreements where the TRIPS flexibilities available are now being limited through the FTAs. So we have a situation where we are looking at least potentially access to second-line drugs being very difficult if not nearly impossible. I think this at this conference though the issue is being addressed, it is not at the forefront and to me its the most important issue right now - what are we going to do for cheaper generics on second line ARVs - taking into considering what's happened in India as well as the current trend on property rights in bilateral trade agreements."
- Singita, United Kingdom

Wednesday, August 16, 2006

Rural Africa: Still forgotten?

I came to the 2006 International AIDS Conference wearing many hats. In addition to writing for three online publications (this one, Time To Deliver, and AIDS Combat Zone) I'm also a CHAMP activist, an SGAC member, a USF Global Health student, a Peace Corps nominee, and a concerned global citizen. The driving force behind my participation in these causes has long been my concern over the impact of HIV in the developing world, particularly sub-Saharan Africa. That being the case, I came to the 2006 IAC with the hope of attending sessions that would better prepare me for my upcoming Peace Corps placement and subsequent career in global health, and also allow me to better communicate African issues to my blog audiences.

Even with the tremendous size of the conference, only a handful of sessions and workshops are dedicated to topics that can be applied to rural Africa. I've only been able to attend one so far, a very interesting workshop and discussion on incorporating traditional medicine into an HIV program. I hope to be able to attend several more like it before the conference is over, but I don't have nearly as many options as I had originally hoped.

The implied message is that Africa, despite being home to more than half of the world's people with HIV and AIDS, still isn't an important part of the global response to HIV. If the leaders of AIDS movements around the world are serious about reversing the spread of HIV in Africa, we are going to need to see more direct attention paid to the situation in Africa at global meetings such as this one. By bringing Africa out of the shadows of discussions about HIV, we can finally begin to reverse the African AIDS epidemic.

Protests at the conference

Activists from around the world are gearing up for creative actions throughout the rest of the conference aimed at pushing world leaders to deliver on promises now. On Tuesday AIDS activists staged at least three protests throughout the convention center bringing attention to pharmaceutical companies and the vital importance of generic drugs. Honoring India's Independence Day, activists marched throughout the Exhibition Hall with posters in the colors of the Indian flag and called pharmaceutical companies and national government to quit trying to patent life-saving ARV drugs. India which has long been a producer of generic drugs is under particular attack both because it supplies ARV's to only about 10,000 of the 700, 000 Indians who need them and because the country is set to relinquish independent, generic production of AIDS drugs at the end of 2006. Activists chanted "Big Pharma Quit India," "Time to Deliver" and "Life Before Profits" and hundreds of delegates rushed to take photographs while pharmaceutical company employees looked on with growing distress as the marched gathered more and more participants. In a related event activists took over pharma giant Abbott's booth at the entrance to the exhibition hall postering the area with signs demanding that Abbott lower its prices for second-line treatments (currently far more expensive than first-line treatments) and make them available throughout the world. Abbott Laboratories Inc. produces Kaletra, the biggest selling of a class of HIV drugs known as protease inhibitors.

Wednesday HIV/AIDS activists will take to the streets, the exhibit hall and the media room to demand leaders deliver on promises and increase attention to traditionally disenfranchised high-risk populations. The day kicks-off with a direct action outside the U.S. Embassy before moving back to the convention center where medical students will call on international governments to fund more health care practitioners in the global south. At ten activists are planning on re-taking Abbott's booth though they were warned in advance by conference activists liaisons that they may be met with security. At noon harm reduction advocates will join Toronto residents on the street outside the South Building to bring attention to the long-muted demands of IDUs and their advocates for expanded harm reduction services. Immediately after activists are planning to stage a theatrical performance where Uncle Sam shoots poorer countries in the back in the skywalk and pressrooms to demand an end to patents and ARV-related Free-Trade Agreements. Additionally, Korean activists are planning an action in the Global Village to bring attention to the need for affordable ARVs in the eastern Asia.

Stephen Lewis and Paul Farmer

Stephen Lewis, U.N. Special Envoy for HIV/AIDS to Africa, issued a call Tuesday at the close of his remarks on nutrition, for activists to take on all international institutions simultaneously with raucous, tenacious and well-crafted demands for global justice. Speaking on a panel entitled "Food and Nutrition in Care and Treatment Programs in Developing Countries" Lewis and fellow luminary Dr. Paul Farmer urged advocates, organizations and multilateral agencies to demand that government promises – such as those made at UNGASS in June – become reality rather standing as empty promises year after year. Lewis highlighted the symbiotic nature of hunger and HIV/AIDS particularly in Sub-Saharan Africa and the Caribbean while Farmer gave specific examples of the relationship between economic insecurity, lack of food and consumptive diseases. Farmer charged that HIV/AIDS advocates must get better at dispelling the notion that essential wrap-around services for HIV/AIDS patients are "gold plated." Ensuring that hungry patients have food to eat, that thirsty patients have water to drink, and that their children go to school, he argued, must be understood by world powers to be critical to HIV/AIDS treatment provisioning. Arguing that trade barriers and free trade agreements have created a "paradox of tragedy – the coexistence of gluttony and starvation" while devastating local agricultural production, Farmer and Lewis urged western activists in particular to continue demanding global economic, political and social justice and fair trade agreements from their leaders.

Tuesday, August 15, 2006

Audio interview with Masias Cowper on forming relationships when living with HIV

Masias Cowper who’s been HIV positive for 13 years discusses her status and the problems of disclosure that continue to exist and the forming of new relationships. She talks about disclosing her status to her family which she describes as "the worst thing ever". It took her 6 months and when she did disclose to her partner the reaction was violent and negative even though it was he who was the source of the infection. Slowly she began to come out to her family and her workplace despite being fired from her job. "five years after my diagnosis was five years of recovery" - recovering her rights as a woman, to love, to be reproductive, to be respected, to be in a relationship, have a job, participate in her community.

Lisa Power of UK's Terrence Higgins Trust points out that for anyone with a a long term illness, building a new relationship is extremely difficult. People do not or are not able to deal with the long term illnesses of others. Often they are just not prepared to make the necessary effort to learn about that illness whether it be cancer or parkinsons. HIV is particularly difficult because of the stigma attacked to the illness which is largely based on ignorance as "public understanding lags behind the reality".

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Harm Reduction In a Long Overdue Spotlight

Harm reduction - a set of practical strategies that reduce negative consequences of drug use - is finally getting the attention it deserves at this year's International AIDS Conference. Eastern European and Central Asian Harm Reduction and Injection Drug User (IDU) advocates took center stage yesterday with more than 10 session being held on topics ranging from HIV/Hepatitis C to related human rights violations to on-the-ground tactics for reducing discrimination and stigma against IDUs. Outside of Africa injection drug use currently accounts for 1 in 3 new HIV infections; worldwide, 13 million people living with HIV were infected through injection drug use. In Eastern Europe and Central Asia harsh discrimination and stigma against IDUs continues to marginalize HIV + people while denying them critical medical care, treatment programs and social services. As of the end of 2004, 36,000 IDUs worldwide receive ARVs, 30,000 of whom reside in one country - Brazil.

Talking today with harm reduction advocates from Indonesia, Thailand, Russia and Ukraine, denial of medical services to IDU's consistently emerged as one of their major concerns. Stories abounded of doctors routinely turning away drug users from medical centers and hospitals. Ukraine is currently home to one of the world's fastest growing HIV epidemics. Yet HIV+ IDUs are routinely subject to human rights abuses by health practitioners and police, which force these highly vulnerable populations underground or "into the shadows" in their efforts to avoid criminalization, persecution and prison. A Ukrainian activists talked at length today about the forced testing which Ukrainians are subjected to in health care facilities. Once found to be positive, men and women are frequently forced to sign a statement acknowledging their criminal liability and then turned out to the streets without treatment.

HRW covered many of these issues in a report earlier this year entitled "Rhetoric and Risk: Human Rights Abuses Impeding Ukraine's Fight Against HIV/AIDS". You can find it online at: in at http://hrw.org/reports/2006/ukraine0306/.

IDU advocates, activists and PLHA's also highlighted the relationship between HIV and Hepatitis C, a disease which many claim has been ignored by doctors, scientists, and national governments. Around the world, more than 500 million people are infected with Hepatitis C (HCV) but treatment is available for one percent of infected people. And, even for those who are on treatment often critical information on interference between ARV and HCV drugs is limited or non-existent forcing many people who start the treatment to drop it once unexpected side affects begin. Tomorrow look for interviews with Russian AIDS activists from FrontAIDS, a dynamic movement fighting for access to treatment, adherence and community mobilization across Russia.

Monday, August 14, 2006

ARV production and government responsibilities

Anand Grover, the co-founder of the Mumbai Lawyers Collective HIV/AIDS Unit, delivered a speech on the second day of the conference titled "Human rights and Social Vulnerabilities," in which he expressed concern about the availability of inexpensive generic drugs in five to ten years with India's agreement to comply with the Agreement on Trade -Related Aspects of Intellectual Property Rights (TRIPS) regarding product patents. Lives in Focus had interviewed Grover in Mumbai earlier about this subject and asked what alternatives there are to Western pharmaceutical companies imposing licenses on Indian generic drug makers and why the Indian government itself does not begin production of the drugs. Listen to his thoughts on the subject in this podcast.

25 years of AIDS, Global Voices

Human Rights Watch and Making Contact collaborated on a radio show - “25 years of AIDS, Global Voices”, which presents the voices of activists and people living with HIV/AIDS from South Africa, India, Ukraine, Uganda, Nigeria, US, and more.

The show will air on more than 200 radio stations in the US, Canada, South Africa and Ireland.

To have truly effective AIDS programs that respond to the needs of those at risk and infected with HIV it's important that voices from the front lines are truly heard. In the program, people talk about discrimination, about struggling to learn that they are HIV positive, and about fighting for their rights to be respected. We will be posting the show at our HRW campaign page, and it will also be available at Making Contact: http://www.radioproject.org/.

The show is personal and powerful. Check it out.