HIV and the Law

via the Global Commission on HIV and the Law

The end of the global AIDS epidemic is within our reach. This will only be possible if science and action are accompanied by a tangible commitment to respecting human dignity and ending injustice.

Law prohibits or permits specific behaviours, and in so doing, it shapes politics, economics and society. The law can be a human good that makes a material diff erence in people’s lives. It is therefore not surprising that law has the power to bridge the gap between vulnerability and resilience to HIV.

We came together as a group of individuals from diverse backgrounds, experiences and continents to examine the role of the law in eff ective HIV responses. What we share is our abiding commitment to public health and social justice. We have listened with humility to hundreds of accounts describing the eff ects of law on HIV. In many instances, we have been overwhelmed by how archaic, insensitive laws are violating human rights, challenging rational public health responses and eroding social fabric. At other times, we have been moved by those who demonstrate courage and conviction to protect those most vulnerable in
our societies.

Many would say that the law can be complex and challenging and is best left alone. Our experience during this Commission has shown us a very different perspective. We have been encouraged by how frank and constructive dialogue on controversial issues can sometimes quickly lead to progressive law reform, the eff ective defence of legislation or better enforcement of existing laws. Even in environments where formal legal change is a slow and arduous process, we have witnessed countries taking action to strengthen access to justice and challenge stigma and discrimination.

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Misconceptions surrounding HIV problematic in India

via The Times of India

Twenty-five years after the first case of HIV/AIDS was reported in the country, experts say the main target in the fight against the disease is misconceptions. After releasing the 13th Behaviour Surveillance Survey Round XIII for 2011, experts in the field said that awareness among the public had gone up but awareness without misconception was low.

Many believe that healthy-looking people have a good immune system and may not test positive for HIV/AIDS. Doctors have been trying to tell people that antiretroviral drugs - the medicines of choice for HIV/AIDS - will only keep the viral load low, but many assume they are safe after taking them. "We require schemes to target misconceptions. Only awareness without misconceptions will strengthen the fight against HIV," said AIDS Prevention And Control (APAC) project director Dr Bimal Charles.
Dr Charles said that in the surveys, people had said cleaning the vagina with vinegar or having sex with monkeys would keep out the infection.

The annual survey report, by APAC project along with Tamil Nadu State AIDS Control Society (TANSACS) and USAID, has been prepared since 1996. The survey is conducted among high-risk groups like female sex workers, gays and injecting drug users and bridge population groups such as truckers and migrant workers.

With a sample size of 5,000, the field work was done in November and December 2011 across 15 towns in Tamil Nadu. The results showed a significant improvement in the behaviour among targeted groups where NGOs were working.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Migrant population bears highest burden of HIV in India

via The Times of India, by Kounteya Sinha

Migration is fuelling India's HIV epidemic. National AIDS Control Organisation's latest figures show that besides high risk populations like sex workers, the highest burden of HIV is among migrants - 3.6%, which is 10 times the HIV prevalence among the general population.

With migration rates increasing, the prevalence will only get worse. According to the 2001 census, 30.1% of the population was considered to have migrated (314 million) - a considerable increase from 27.4% in 1991. NACO has, therefore, identified 108 railway stations - which are both source and destination of migrants travelling in search of work. These are now the focus of the country's anti-HIV fight.

Red Ribbon Express (RRE), which chugs out of Delhi on Thursday, will stop at most of these 108 identified stations to test migrants for HIV besides carrying out counselling and spreading anti-HIV messages. During it's year-long journey, RRE will traverse through 23 states, cover 30,000 km and stop at 162 stations.

Speaking to TOI, a NACO official said, "Migrants are one of the major focus areas this time with the RRE. Last year, RRE stopped at 152 stations and reached out to 8 million people directly. This time, around 30-40 stops will be to mainly address migrants."

NACO has identified 122 districts with high out-migration across 11 states which are on priority for starting up community level interventions. Another 75 important transit locations have been identified across these 122 districts from where these migrants usually board long distance trains/buses to reach their destinations.

Studies on the relationship between migration and HIV conducted by NACO in three popular migration corridors - Ganjam-Surat, Darbhanga-Delhi and Azamgarh-Mumbai - threw up shocking findings. It showed that two to four times more number of informal workers had non-regular partners or visited sex workers with only 25% using condoms. Around 5% male migrants and 13% female migrants reported sexually transmitted infections, nearly double the national average.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Treatment alone will not win war against HIV

via Cape Argus, by Sipokazi Fokazi

If South Africa is to win the battle against HIV/Aids it cannot rely solely on treatment, and must explore prevention strategies that would target those most at risk, including women and children, a Cape Town scientist and HIV researcher has cautioned.

Professor Linda-Gail Bekker, head of the Desmond Tutu HIV Centre, at UCT, said although the effect of HIV treatment was starting to show with the number of deaths beginning to even out, the country would not win the battle with treatment alone.

Bekker was speaking during a meeting hosted by the Microbicide Media and Communication Initiative, an advocacy group that gathers research in microbicides by a range of organisations.

She warned that reliance on treatment would at some stage become unaffordable and unsustainable.

Finance continued to be a problem for many countries, and paying for antiretroviral drugs was becoming expensive.

“Given the financial difficulties, countries will somehow have to come up with plans on how to bring infection levels down.”

The focus needed to be on strategies that achieved behavioural change.

One of the most important things for South Africa was knowing its epidemic – who was most at risk, who was passing HIV to whom, and where the epidemic was concentrated.

UNAids information was that four population groups remained at risk: men who had sex with men, commercial sex workers, prisoners, and intravenous drug users.

In South Africa, young women and pregnant women could be added to that list.

Bekker suggested targeting, directing and tailoring prevention interventions to reduce infection rates.

“You need to know where most of your infections are occurring, and then to work out how best to intervene. I believe it has been a mistake to think one size fits all,” she said.

One area in which South Africa could start shutting the door was in the mother-to-child transmission of HIV.

“We need to wipe out paediatric infection.”

South Africa could not afford to allow transmission of the virus from mother to child.

“If we don’t prevent this, those children will need treatment for the rest of their lives and it will be expensive for the country. We can bring our mother-to-child HIVinfection rate to below 1 percent.”

Researchers had made great strides in HIV prevention studies, particularly in the field of microbicides.

Bekker said it was important that prevention packages be tailored to population groups that were most at risk.

Such strategies would have to take into account biomedical, behavioural and structural components.

“We are in a very exciting period where a whole range of biomedical technologies are showing partial but significant efficacy. Combinations of these prevention technologies in the future will give people options.”

Among the most promising interventions being researched by the Desmond Tutu HIV Centre and its partners was a rectal microbicide, for those practising anal sex. The proposed study would be carried out here and in other places around the world.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Gates Foundation’s AIDS Program in India Has Made Uneven Progress Over 8 Years

via The New York Times, by Donald G. McNeil, Jr.

A large and costly AIDS prevention program that the Bill and Melinda Gates Foundation pioneered in India eight years ago has had mixed results, according to a preliminary analysis published on Monday in The Lancet.

 

The foundation spent $258 million on the program from 2003 to 2008. It has since put in $80 million more, but is shifting responsibility to the Indian government.

The program, called Avahan, focuses on high-risk groups, like drug addicts, gay and bisexual men, and prostitutes and their clients, including truckers. It pays for education campaigns, safe-sex counseling, syringes, condoms and treatment for other venereal diseases. (Above, a sex worker at a prevention meeting.)

When the program began, it was assumed that India, with its huge population and government officials reluctant to discuss the problem, would quickly surpass South Africa as the country with the most AIDS cases. A 2007 household survey allayed those fears; the epidemic had stayed largely within the risk groups. India is now thought to be in third place, behind Nigeria.

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An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India

via BMC Public Health, by Vandana Gurnani, Tara S Beattie, Parinita Bhattacharjee , Cfar Team, H L Mohan , Srinath Maddur, Reynold Washington, Shajy Isac, B M Ramesh, Stephen Moses and James F Blanchard

Abstract

Background:

Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists.

Methods:

Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008.

Results:

The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress >90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs.

Conclusions:

Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]