HIV/AIDS in Honduras

Honduras is one of the poorest countries in Latin America and one of the hardest hit by HIV/AIDS. The adult prevalence rate is estimated at 1.5 percent. Only Belize, with a prevalence of 2.5 percent, has a higher prevalence in all of North, Central, or South America, according to UNAIDS.

I would like to highlight a couple places that are hard at work to curb the epidemic and improve the lives of Hondurans living with HIV and AIDS.

In 1995, Siempre Unidos ("Always United") formed as the first self-help group for persons living with HIV/AIDS in Honduras. Its scope expanded over the years and it now follows the mission of providing life-saving outpatient medical treatment, social support, and education to people living with HIV/AIDS in Honduras. It receives help from the Global Fund, the Episcopal Church, and the Honduran government and now provides free anti-retroviral treatment to hundreds of people living with AIDS in San Pedro Sula. It continues to hold support group meeting once a week for over 100 people and also provides employment opportunities for HIV-positive women at its sewing factory, SiempreSol.

Fundacion Llaves began in 1999 to assist people living with HIV/AIDS in Honduras who were unable to obtain adequate information about their condition. Upon realizing that most of the information in Honduras pertained to prevention, Fundacion Llaves’ primary mission became to disseminate information for people living with HIV/AIDS—about health, the treatment options, and human rights. To this end, Fundacion Llaves reaches out to the press, the government, and the community to raise awareness. They publish a magazine called “Llaves” and a weekly radio program “Aprende del VIH/SIDA y Gana” (Learn about HIV/AIDS and Gain). With only 8 people, the organization has made significant gains for Hondurans living with HIV/AIDS.

Update: Dr. Gao will travel

Earlier today, Chinese officials finally granted AIDS activist Dr. Gao Yaojie permission to travel to the United States next month to accept her award from Vital Voices, reported the AP/New York Times (http://www.nytimes.com/aponline/us/AP-China-AIDS-Whistleblower.html).

For the last week, Dr. Gao has been confined to her home in the Henan Province by Chinese officials pressuring her not to travel to the US. The 80-year-old doctor has been instrumental in exposing the harsh realities behind China's AIDS epidemic, which the Chinese government would rather leave hidden. After heavy pressure from international groups during Dr. Gao's detention, the Chinese government reportedly told the US embassy: "We will abide by her decision to come."

Read more about the Chinese government's efforts to cover up the detention itself:
"China Covers Up Detention of AIDS Doctor", February 16th, http://www.nytimes.com/2007/02/16/world/asia/16china.html

Intensive course in Health and Human Rights

Intensive Course in Health and Human Rights:
June 18-22, 2007 Boston, Massachusetts

Learn How to Incorporate a Human Rights Framework Into Your Professional Activities

Presented in Collaboration with:

• The Boston University School of Public Health, Department of Health Law, Bioethics and Human Rights
• The Harvard School of Public Health, Department of Population and International Health

This rigorous 4.5-day program helps a wide range of professionals acquire the skills and knowledge they need to successfully incorporate a human rights framework into their daily activities. Participants will acquire a basic understanding of both the history and present status of international human rights and international humanitarian law as they apply to public health practice. The faculty will show participants how to:

· Analyze the human rights dimensions of public health policies and programs
· Access international mechanisms and procedures to further the human rights of persons whose health status is threatened

About the Program:

Expert faculty members create a dynamic learning environment in which a large body of material can be covered in a short amount of time.

The program progresses from general to specific topics:

· Basic Concepts of Health and Human Rights
· Application of the Human Rights Framework to Public Health Policies and Programs
· Skills for Putting the Health-Human Rights Linkage into Practice
· Institutional Settings for Linking Health and Human Rights
· The Way Ahead: Making the Health-Human Rights Linkage Work

Program Format:

Small group settings provide further opportunity for direct interaction with the faculty and with your fellow participants. Repeated offerings allow you to attend more than one session of interest. The individualized attention you receive in the Intensive Course in Health and Human Rights will help you formulate your strategy for implementing newly acquired knowledge and skills in your professional work as well as provide invaluable networking support.

Learn more at: http://sph.bu.edu/index.php?option=com_content&task=view&id=556&Itemid=692#Program%20Fee

Update: Global Fund names Executive Director

The Global Fund selected Michel Kazatchkine to replace Richard Feachem as its Executive Director. Kazatchkine has spent much of the last 20 years working on HIV/AIDS, both as a physician and as the leader of an AIDS research agency. Feachem's term ends on March 31, 2007.

Read more about the Global Fund's selection and Professor Kazatchkine:
Global Fund
Boston Globe
Agence Nationale de Recherches sur le SIDA

AIDS doctor detained by Chinese officials

Dr. Gao Yaojie, a 79-year old Chinese doctor who has been internationally recognized for her fight against the spread of HIV, has been detained by Chinese officials since Thursday, February 1st. Dr. Gao was scheduled to arrive in the US this week to accept an award from Vital Voices. As of Feb 6, Dr. Gao has been under house arrest in Zhengzhou with no access to modes of communication.

Dr. Gao spent her retirement traveling around Henan Province, spreading information about AIDS and distributing medicine. She was instrumental in exposing how a blood-selling program in central China infected thousands of people with HIV in the 1990s. She was been nominated for a Nobel Prize and has been awarded several international prizes, such as the Jonathan Mann Award for Global Health and Human Rights in 2001, and she was nominated for a Nobel Prize in 2005.

Dr. Gao has been repeatedly prohibited from traveling abroad. This time, according to news reports and AIDS activists within China, Henan officials went to her house to warn her not to travel to the US where, in addition to accepting her prize from Vital Voices, she was scheduled to hold meetings with politicians and advocacy groups in Washington.

Dr. Gao has taken extraordinary risks to expose the scope of the AIDS epidemic in China. Although China has received increasing accolades from the international community for frankly addressing AIDS, her detention is a sad illustration that speaking openly and honestly about the epidemic is still threatening to officials within China.

More information on Dr. Gao Yaojie’s detention:
International Herald Tribune
Globe and Mail
Reuters

More information on Dr. Gao:
TIMEasia.com: Asian Heroes
PBS (1/3/07): China from the Inside
Women of China (12/12/05): “Gao Yaojie: a Crusader for AIDS Prevention”
China Daily (7/14/05): 108 Chinese grassroots women in race for Nobel
AFP (3/7/04): “China's AIDS whistleblower Gao Yaojie vows to continue helping sufferers”
The Peking Duck (2/26/04): “China's leading AIDS activist Gao Yaojie publicly honored”
Dr. Gao Yaojie: “My AIDS Prevention Journey” (5/1/01)

Other information on AIDS in China
Human Rights Watch’s Report: “Restrictions on AIDS Activists in China”
ABC News: “Stigma and Discrimination Fuel Spread of AIDS in China”
Letter to New York Times re: ''China's Muslims Awake to Nexus of Needles and AIDS''
Kaiser Network (1/06): “Estimated Number of HIV-Positive People in China Is 650,000”

Update: Global Fund Executive Director

Three finalists for the position of Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria have been announced. Richard Feachem, who has been the Executive Director since 2001, will be replaced by either Michel Kazatchkine, France's HIV/AIDS ambassador; David Nabarro, a British national now leading the United Nation's efforts to fight avian flu; or Alex Coutinho, executive director of the AIDS Support Organization in Kampala, Uganda.

The Boston Globe followed up on this story.

Boston Globe: Global Health Organization prepares to name leader

WASHINGTON -- The next leader of a global organization that fights major infectious diseases, including AIDS, may come from a group that includes the former health minister of Mexico, France's AIDS ambassador, the former leader of UNICEF, and several leaders of the World Health Organization, according to a list of names obtained by the Globe.

The board overseeing the organization, Global Fund to Fight AIDS, Tuberculosis and Malaria, failed to select a new executive director last November and now hopes to name one at a meeting in Geneva early next month.

Read this article at: http://www.boston.com/news/nation/articles/2007/01/09/global_health_organization_prepares_to_name_leader/

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”

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.

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

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.

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?

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/

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.

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).

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