The International AIDS Conference
Washington, D.C, USA
What you should know about...
For those that couldn’t be there in person, we bring you a summary of the biggest themes on the HIV and AIDS agenda at this year’s International AIDS conference. In this newsletter we talk about some of the major issues that will be affecting the work of community-based HIV organisations.
The conference provided many opportunities for us to celebrate and learn about the progress that has been made in the field of HIV and AIDS over the last two years. But it also highlighted the continuing need for community-based programs like Stepping Stones to secure the human rights of people living with HIV and to continue to combat the stigma and discrimination faced by people living with HIV.
THE GLOBAL PLAN. The biggest focus of the International AIDS Conference 2012 was news about the progress of The Global Plan
What is it?
The Global Plan is a strategy launched in 2011 to try to reduce the number of new babies born with the HIV virus as a result of vertical transmission (ie transmission before, during or after their birth). The Global Plan provides a framework, which supports participating countries to tackle the barriers that prevent women from accessing peri-natal services. It is being rolled out in 22 “high priority” countries. These are countries that have the highest estimate of pregnant women who have HIV – you can see the full list of participating countries by clicking here.
What are the difficulties with the scale up of the Global Plan?
Many women with HIV and their supporters at the AIDS conference 2012 were talking about the potential negative impacts that a scale-up effort could have if a real commitment to a human rights framework, especially for mothers, is not upheld.
Increased stigma and discrimination for women living with HIV?
The Global Plan does not spell out the need for all HIV testing to be voluntary and confidential. It also overlooks the violence and stigma that an HIV diagnosis can still bring. People living with HIV, especially women, will lose out from treatment and care – and will stay away from health care settings - if issues of stigma and discrimination aren’t tackled alongside medical interventions.
The Global Plan claims it will support women’s empowerment through access to HIV prevention and treatment services, and sexual and reproductive health services. But this overlooks that many women – if tested positive – may face violence, abandonment and discrimination from their partners, family and communities. Health care services themselves can also often be dangerous places for people living with HIV. People with HIV can face discrimination or can be denied medical assistance (Hale and Vazquez, 2011). A recent report by the AIDS Legal Network and the Global Coalition on Women and AIDS highlights the other serious gender barriers that may prevent treatment access. Two further reports from the Asia-Pacific region highlight similar human rights abuses faced by women with HIV in ante-natal settings. Click here to access these reports in full.
More than anyone else women living with HIV want to protect their child and minimize the risk of transmission but their own health and wellbeing is just as important. Look at how the oxygen mask on an aeroplane can illustrate the need to care for the mother:
Coerced Sterilisation in Healthcare Settings
Coerced sterilisation is one shocking example of the violence that can happen to women living with HIV in healthcare settings. We heard several testimonies during the conference from women who have been sterilised WITHOUT THEIR CONSENT as a result of their HIV status. Many of these women, now unable to have children, lost their husbands; some were kicked out of their homes, all of them were robbed of their choice. CLICK HERE TO WATCH A SHORT VIDEO ABOUT COERCED STERILISATION HAPPENING IN KENYA: ROBBED OF CHOICE
How can Stepping Stones help?
The Stepping Stones Plus manual - a supplement to the original manual - can help to promote a holistic, community wide response to the different sexual and reproductive issues that affect women – and men. To see the full range of issues covered by the Stepping Stones Plus manual, click here. Like the original Stepping Stones manual, Stepping Stones Plus has a strong human rights framework. It educates people about their right to choice, confidentiality and respect when accessing healthcare services. It includes exercises about treatment support and adherence issues, gender-based violence, and HIV & Motherhood in the context of sexual and reproductive health and rights for people living with HIV.
CRIMINALISATION. Another big topic at the AIDS 2012 conference was the increasing criminalisation of HIV.
How can Stepping Stones help?
Despite the increasing number of laws that criminalise HIV, there are no research data at all that suggest that criminalising HIV transmission will prevent it. Instead, a UNAIDS policy on criminalisation suggests an expansion of proven HIV prevention programmes, such as Stepping Stones, that reduce stigma and discrimination against people living with HIV and other marginalised groups. Stepping Stones teaches us to take responsibility for our own health and the health of our communities. It supports each community to become a place where people living with HIV can feel safe, happy and accepted.
TREATMENT AS PREVENTION
This became the buzzword of the AIDS conference
But many people were worried and concerned by the way that the phrase was being used by policy makers, politicians and scientists.
What is it?
It is the idea that the Antiretroviral drugs, used to treat the HIV virus,
can also be used as a way to prevent HIV transmission to the wider population. It has been shown that long-term adherence to Antiretroviral drugs can reduce
the “viral load” of a person living with HIV – making it much less likely
that they will transmit the virus. This is great news – but to what extent should treatment be forced on people?
This is the name of a 'new treatment plan' option for people living with HIV as part of the wider "treatment as prevention" approach. Women who are diagnosed with HIV during pregnancy are the key group for the scale up of option B+. It means starting ARVs as soon as you are diagnosed as having HIV, and continuing with this medication for life. What this will mean is that people may start life-long ARV treatment just after they have been diagnosed - even if they are not sick and their own bodies do not yet need treatment because their CD4 count is still healthy (above 350 cells/µl). This treatment plan is attractive to policy makers and governments because it is seen as a cost-effective, “one size fits all” approach, it can protect against vertical transmission from mother to child, against other potential transmission to HIV negative sexual partners – and can protect the woman herself.
What are the problems with “Treatment as Prevention”?
We believe that the health and well being of the individual should always come first and foremost - based on the needs and choices of the individual. "Treatment including Prevention" is an alternative phrase, which puts more emphasis on the choice of the individual.
Problems with option B+ for pregnant women diagnosed with HIV
ARVs are wonder drugs. Yet they can also have many side effects including nausea, diarrhoea and depression. Taking ARVs when a woman is not feeling ill may lead to poor future adherence and issues of drug resistance if she does stop taking her medication. A recent international study has shown that there are widespread problems with ARV adherence during and after pregnancy for women anyway, for all the reasons we have described above. There are other issues that may make it very difficult for people to adhere, such as lack of enough nutritious food with which to take their drugs and the psychological stress of a HIV diagnosis, if no support is available. It can also feel very hard for a woman to take medication for herself if none is on offer for her partner or for their children if they are already sick, or if she is having to hide her medication, for fear of violence. All these issues and many more need to be considered carefully before Option B+ is rolled out. As one recent advocate has stated, “never fall in love with technology” without also paying careful attention to if, how and when people can best be supported to use it.
How can Stepping Stones help?
Stepping Stones Plus can help to educate people about current HIV issues such as including safe motherhood, possible issues facing "sero-discordant" couples, male circumcision, the female condom, voluntary and confidential counselling and testing, and other related issues. It can be useful in this context of 'treatment as prevention' because it covers the health, well being and rights of women living with HIV in all areas of sexual and reproductive health, as well as their children, partners and other dependents.
Members of the Stepping Stones Community of Practice at AIDS 2012
We were lucky enough to catch up with two members of our Stepping Stones International Community of Practice during the International AIDS Conference 2012 in Washington. We asked each of them to talk about their personal experiences of using Stepping Stones.
HIV/AIDS Thematic Manager,
Listen to Ellen talk about her experiences of implementing the Stepping Stones training package in Angola, Uganda and Tanzania with ACORD. She highlights the importance of resource provision and talks of the long term impacts of the Stepping Stones training package on a community.
Watch the video interview here.
Independent HIV/AIDS consultant & Project Manager
Elena talks to us about the roll out of the Russian adaptation of Stepping Stones in Siberia. She explainins how it has become a successful programme despite some initial problems.
Watch the video interview here.
"Any AIDS conference is a place where people could demonstrate their successes and best innovations to their colleagues, to know new technologies and strategies, to understand that they are not alone in their fight against this dangerous disease. But sometimes the conference looked like a vanity fair especially its scientific part that was as always the biggest. For me, the most interesting place at the conference was Global Village, a traditional space where people from NGOs around the world come together to share their ideas about the AIDS epidemic also through art, performances, and debates.
Elena Veselovskaya gives her impression of the IAC 2012
This conference, as usual, was a good opportunity for scientists to demonstrate their deep conviction that a developing a vaccine...At the same time, this conference gave its participants from Eastern Europe and Central Asia some feelings of inferiority, that their problems were not recognized by international community as important and interesting for such a big audience."