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

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)

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

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

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

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.

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)

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)

Graying of AIDS" Photo-essay

According to Time magazine "More Americans are living with HIV into middle age and beyond, but they are often ignored by doctors and society. Six people share their stories about surviving with HIV". They have put together very interesting photoessay titled as The Graying of AIDS .