Global Public Health Goals Thwarted
OFFICIAL PRESS RELEASE: DAY 6
FOR
IMMEDIATE RELEASE
Global Public Health Goals Thwarted By Human Rights Violations, Gender Inequality And Stigma
More than 24,000 Participants from 194
Nations
Contribute to Success of Conference
Mexico City [8 August 2008] As the XVII International
AIDS Conference drew to a close, HIV experts from around the
globe highlighted the dramatic negative impact that stigma
and the denial of human rights, including gender inequality,
continue to have on the effectiveness of HIV treatment and
prevention scale up. Fear of violence, discrimination and
unwarranted prosecution prevent many people living with or
at risk for HIV from seeking testing and treatment, and
drive others to place themselves at risk for infection.
“The voices of those who bear the brunt of this pandemic have been loud and clear in Mexico City this week,” said Pedro Cahn, International Co-Chair of AIDS 2008 and President of the International AIDS Society and Fundación Huésped in Buenos Aires, Argentina. “If the world does not heed the call to ensure the human rights and dignity of every person affected by HIV, we will not achieve our goal of universal access.”
“Those most at risk, including injection drug users, men who have sex with men and sex workers, as well as women and youth, must never be seen simply as patients or prevention targets,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008 and Head of the Molecular Virology Unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Coordinator of the Clinical Care Committee of CONASIDA, Mexico’s National AIDS Council. “Their experiences and contributions are central to the development and implementation of effective programmes. As we strive for universal access we must once and for all commit to the ideal that every life is worthy of respect.”
Speakers in the final plenary session underscored the connection between public health and human rights, and also addressed the intersection of HIV and Tuberculosis (TB).
Confronting TB/HIV In the Era of Increasing anti-TB
Drug Resistance
Tuberculosis is the leading cause of
death among people living with HIV in Africa and a major
cause of death elsewhere. At least one-third of the 33
million people living with HIV worldwide are co-infected
with TB, and these individuals have up to a 15% risk of
developing active TB every year.
Dr. Chakaya Jeremiah (Kenya), Chief Research Officer of the Centre for Respiratory Diseases Research at Kenya Medical Research Institute, gave an overview of the challenges presented by the dual epidemics of HIV and TB. To reduce the burden of TB in people living with HIV, he urged the HIV community to take greater responsibility for implementation of the 3 “I”s recommended by the World Health Organization. The three “I”s include: intensified case finding; isoniazid preventive therapy; and TB infection control. Jeremiah noted good progress being made to decrease the burden of HIV in TB patients through HIV testing of TB patients and the initiation of preventive therapy for HIV-positive TB patients.
Jeremiah also profiled the emerging threats of multidrug-resistant and extensively drug-resistant TB (MDR/XDR-TB). The experience with XDR-TB in South Africa paints a bleak picture with very poor patient outcomes. According to Jeremiah, both MDR/XDR-TB are the consequence of sub-optimal TB control and inadequate infection control practices in health care settings.
HIV Prevention Lessons from Community Experiences in
Concentrated Epidemics
In his plenary remarks, Bruno
Spire (France) identified reducing stigma, combating
prevention fatigue, and diversifying HIV testing as key
steps to prevent sexual transmission of HIV in concentrated
epidemics. Spire proposed a “triple therapy” strategy to
combat stigma and discrimination rooted in evidence of
stigma’s negative impact on HIV risk reduction. The
strategy includes fighting for better acceptance of people
living with HIV (PLHIV), improving laws and policies to
protect those most vulnerable to infection, and implementing
prevention programmes that incorporate community
mobilization and peer support. He cited examples of female
sex worker mobilization efforts in India, Chile and France,
and an initiative to mobilize men who have sex men in
Africa, as important examples of this successful strategy.
Spire is President of AIDES, France’s primary
nongovernmental HIV organization, and a researcher at the
French National Institute for Medical Research.
To combat prevention fatigue, Spire called for pragmatic solutions for those who do not consistently use condoms, including risk reduction programmes adapted to individual and community needs. He pointed to data showing that access to antiretroviral therapy and perceived good health have a positive impact on consistent condom use among people PLHIV. Spire also emphasized the importance of a variety of HIV testing approaches. This includes routine testing with opt-out options, which Spire said demonstrates higher rates of HIV detection, as well as increased access to voluntary counseling and testing, particularly in community settings. In addition to facilitating earlier access to care, learning one’s HIV status enables earlier adoption of safer behaviors. Spire noted that rates of unprotected intercourse are more than 50% lower among those who know their HIV status.
Criminalization of HIV is Costing Lives and
Increasing Suffering
According to Edwin Cameron (South
Africa), Justice of the Supreme Court of Appeal of South
Africa, the enactment of laws that criminalize transmission
of or exposure to HIV has become so widespread, and criminal
prosecutions so frequent, that they have become a crisis in
efforts to deal rationally and effectively with HIV. Citing
examples from locations as diverse as the United States,
Sierra Leone and Singapore, Cameron highlighted the
irrational nature of these laws and their ineffectiveness in
achieving their purported goal of preventing the spread of
HIV. Rather, they radically increase HIV stigma and become
barriers to testing and treatment. Prosecutions often single
out already vulnerable groups such as sex workers, men who
have sex with men and, in European countries, black males.
Women are especially victimized by these laws, which expose
them to assault, ostracism and further stigma.
Cameron stated that one of the outcomes of AIDS 2008 should be a major international pushback against such misguided criminal laws and prosecutions. He urged delegates — strengthened in their resolve to fight against stigma and discrimination — to return home committed to persuading lawmakers and prosecuting authorities of the folly and distraction of criminalization.
Roadmap
for Action on Women, Girls and HIV/AIDS
Citing violence
against women as both a cause and consequence of HIV
infection, Zonibel Woods (Canada) of the Ford Foundation
highlighted the fear of violence from partners as a reason
that some women do not seek treatment for HIV. Woods
declared that providing access to treatment cannot be
divorced from ensuring a woman’s right to live free from
violence, and that attempts to scale up HIV treatment, while
ignoring stigma and discrimination, will not work. For real
progress, the legal and policy environment to address
violence against women must be strengthened along with the
commitments to invest in, enforce, monitor and evaluate such
policies.
Confronting gender-based violence is one of three priorities in Wood’s roadmap for responding to HIV in women. She also outlined the importance of ensuring women’s right to sexual and reproductive health, and investing in women’s organizations so that women can participate effectively in decisions that affect their lives. Policies and budgets must support the full range of reproductive health services, including quality pregnancy and delivery care, and access to contraception. In addition, research and investment in technologies that put control of prevention in women’s own hands also remain critical. In closing, Woods welcomed the recent decision by the Global Fund to Fight AIDS, TB and Malaria to invest in gender transformative programs. However, she emphasized that success in this regard depends on the engagement of women’s organizations in setting in-country priorities, and the inclusion of experts in gender equality and women’s empowerment funding on proposal review panels.
Conference Closes With Rapporteur Reports, Calls to
Action
At the Closing Session, delegates heard summary
remarks from AIDS 2008 Co-Chairs, Dr. Pedro Cahn and Dr.
Luis Soto Ramirez, as well as from community
representatives. Global Fund Executive Director Dr. Michel
Kazatchkine gave a closing keynote address following a taped
transmission from the official conference hub held at the
Nelson Mandela School of Medicine of the University of
KwaZulu Natal in Durban, South Africa. Incoming IAS
President, Dr. Julio Montaner, Director of the BC Centre for
Excellence in HIV/AIDS and Founding Co-Director of the
Canadian HIV Trials Network, gave an inaugural address,
followed by remarks from OXFAM Ambassador and singer Annie
Lennox. To conclude today’s Closing Session, Mexico City
Mayor Marcelo Ebrard and Local AIDS 2008 Co-Chair Luis Soto
Ramírez officially transferred the International AIDS
Conference glass globe from Mexico City to Vienna, Austria,
the host of AIDS 2010. Accepting the globe for Vienna were:
Sonja Wehsely, Executive City Councillor for Public Health
and Social Affairs; Frank Amort, from Aids Hilfe Wein; and
AIDS 2010 Local Co-chair Brigitte Schmied, from the
Otto-Wagner Hospital.
With more than 24,000 participants from over 190 countries, AIDS 2008 was the second largest in the history of the International AIDS Conference, and the first to be held in Latin America. The conference theme, Universal Action Now, emphasized the need for continued urgency in the worldwide response to HIV/AIDS, and for action on the part of all stakeholders.
During the conference, a team of 50 rapporteurs prepared written summaries of conference sessions to record what was discussed and identify next steps on a range of issues. Prior to the Closing Session, chief rapporteurs from eight topic areas presented weekly summaries. All reports and summaries are available online at www.aids2008.org.
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