HIV Update: Learning Lessons

By Kevin Osborne (IPPF)

Keeping abreast of all the latest developments and ensuring that our organizational response to HIV remains proactive requires that we must carefully and consistently apply the lessons that have been learned. But how do we apply these important lessons across the Federation?

While the HIV epidemic continues to be one of the most challenging health and development issues confronting the world today, it has acted as a catalyst for wider social transformation. From spotlighting the importance of gender equality and the necessity of the human rights aspects of health, to galvanizing the united power of activism – it has been transformative. And the latest data from UNAIDS shows some reason for cautious optimism, with evidence that new HIV infections have fallen to the lowest levels since the peak of the epidemic in 1997.

With new scientific advances, greater recognition of key populations at higher risk, and a tangible commitment to the SRH and HIV linkages agenda, we need to constantly renew our learning and adapt our response. This should be based on honest and critical reflection; systematic strengthening of our organizational capacity to respond to new trends and ensuring that strategic lessons are applied and shared.

As information is updated and new trends slowly emerge, we need to review and utilize this information to better inform our response. And we have a clear role to play in this, as demonstrated by the recent global IPPF survey to determine the involvement of Member Associations (MAs) in national processes of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was conducted in an effort to increase the number of proposals linking sexual and reproductive health and HIV (see page 3). With the news that the Global Fund has both cancelled Round 11 and has adopted a new strategy, this survey could help shape our ongoing engagement.

The end of a calendar year provides an opportunity for reflection on our own response. Recent IPPF data suggests a ten-fold increase globally in the HIV-related services provided by IPPF Member Associations between 2005 and 2010. Even with this impressive increase in service provision, it is important to assess these achievements critically. While the responsibility for this success is not equally shared across all MAs and regions; the framework for increased global action on linking SRH and HIV has been established. One of the key lessons for the Federation is, that by strengthening our collective HIV competency capacity, we have a reservoir of untapped potential to significantly increase our range of HIV-related services along the prevention-to-care continuum, and ones which go beyond just health services.

IPPF’s strategy of concentrated HIV capacity building for a select number of Member Associations, has demonstrated success that must now be shared. Working together on this can only lead to increased cumulative action and answers.

Love
Kevin

Download the December issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+28.htm

Older and Wiser

By Rachel Albone, HIV and AIDS Policy Advisor (HelpAge International, United Kingdom)

HelpAge International has been implementing programmes addressing the needs of older people affected by HIV for 10 years. As the work of HelpAge initially focussed on mitigating the impact of the epidemic on older carers, Rachel Albone, HIV and AIDS Policy Advisor, gives her perspective on the changing importance for supporting older people living with HIV:

While supporting older carers remains central to HelpAge International’s work, we like others, have been witnessing a shift in the epidemic with an increasing number of older people living with HIV. In 2005, UNAIDS estimated 7 per cent of people living with HIV worldwide were aged 50 and over. While a more up to date global estimate is not available due to the focus on 15-49 year olds, where data is being collected, significant increases are being seen. Recent data shows 14 per cent of people living with HIV in sub-Saharan Africa are aged 50 and over. By 2015 at least 50 per cent of those with HIV in the US will be in this age group.

Despite these increases, the response to HIV remains largely restricted to the 15-49 year age group. Policies and programmes rarely include older people or their need for access to services and support. HelpAge is working in east and southern Africa to raise awareness of the impact of HIV in and on older people and to support older people to live positively.

Prevention, treatment, care and support programmes must be age sensitive and address older people’s specific needs. Our approach is one of peer education and support. We establish peer support groups for older people living with HIV, providing psycho-social support, advice on adherence, and support to mitigate the impact of epidemic. We also recognize the need for improved access to bespoke counselling services for older people. With an ever increasing number of older people living with HIV, what we need and want to see is a policy and programme response that is fully inclusive of the needs of older people.

For more information on HelpAge International: http://www.helpage.org 


Article from IPPF HIV Update newsletter - Issue 27: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

David Kato Vision & Voice Award

By Tewodros Melesse (Director General of IPPF) 

On 26 January 2011, the world was deeply shocked and saddened by the news of David Kato’s murder. As the Litigation & Advocacy Officer with Sexual Minorities Uganda (SMUG), David campaigned tirelessly for human rights and particularly for the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people across Africa. And this campaigning work had lead him to work on a number of initiatives with the HIV team at IPPF on a number of occasions.

In recognition of his life and courage, and the continued struggle of LGBTI individuals around the world, I am pleased to announce the call for nominations for the David Kato Vision & Voice Award. IPPF - along with other partners - established this award to be presented annually to an individual who demonstrates courage and outstanding leadership in advocating for the sexual rights of LGBTI individuals, particularly in environments where they face continued rejection, marginalization, isolation and persecution. Nominations for the award can be submitted until 1 November 2011 and are accepted for any individual whose leadership and life work has directly contributed to addressing the sexual rights of LGBTI people in their community. The award recipient will be announced on Human Rights Day (10 December 2011) and will be invited to attend part of the IPPF Donors’ Meeting at the end of January 2012 to collect the award.

If you know someone in your community who is particularly deserving of this award, I strongly encourage you to submit a nomination. For further information and to submit a nomination, please visit the award website: http://www.visionandvoiceaward.com/.  

 

50 Plus – the experiences of older people living with HIV

By Lisa Power, Policy Director (Terrence Higgins Trust, United Kingdom)

As treatments for HIV improve in both quality and accessibility, people are living longer with the virus. In some countries, provided their HIV is diagnosed in good time and treatment provided, people can now hope to live well into old age. The over 50s is the fastest growing group of people living with HIV. But what quality of life can they look forward to, and how can it be improved?

The UK’s 50 Plus research, done by Terrence Higgins Trust (THT), MBARC and Age UK for the Joseph Rowntree Foundation, surveyed 410 older adults with HIV – one in twenty of all those with HIV in the UK. They found that HIV systematically disadvantages those infected across their lifetime in three key areas – health, financial and social wellbeing. Older people with HIV, as a group, have twice as many other long term conditions (on top of their HIV); they are less economically active and less likely to have savings for old age; they are less likely to have their own home; they have significant levels of social isolation and poor mental health and considerable fears for the future. Not everybody ends up alone and in poverty, by any means, but some do and many others are disadvantaged across their lifetime in ways that could be changed, with proper planning and support.

These findings echo similar research in the US and the Netherlands, which suggests that whatever your health and social care systems, some of these problems will occur. For all these studies, people over 50 with HIV were a mixed group of the long term and more recently diagnosed. Obviously, those diagnosed longer ago - when everyone expected to die and many stopped work and spent their savings, and when many people saw their friends and partners die - had the greatest problems with health, wellbeing and poverty but even those more recently diagnosed were often disadvantaged in comparison with their peers.

With HIV, however well you start off, you may encounter stigma and ill-health that leads to broken relationships, lessens employment opportunities and damages your ability to provide for the future. At THT, we believe this means we need to change our services, not only to support those currently over 50 who are in greatest need, but also to work with younger people and those more recently diagnosed to minimise the problems they may face as they age with HIV. We need to help people stay in work or get back to it; manage their money and plan for the future; guard against social isolation and poor mental health; live healthy lives to reduce co-morbidities and improve quality of life.

One of the important aspects of this research is that it was undertaken at every stage with the close involvement of older people with HIV; on the advisory panel, as community researchers, as writers and as communicators of the findings. In the West, our elders are often neglected and survey respondents reported experiencing as much stigma around age as HIV. But older people with HIV are an enormous resource for the future.

The full report of A national study of ageing and HIV (50 Plus) is available at: http://www.tht.org.uk/binarylibrary/peoplesexperienceofhiv/50-plus-final-report.pdf

Article from IPPF HIV Update newsletter - Issue 27: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

HIV Update: Ageing with HIV

By Kevin Osborne (IPPF)

With increasing availability and options of effective antiretroviral treatment, people living with HIV are living longer and the population of people who are HIV positive is steadily growing older. Ageing is an inevitable process for us all, but what are the consequences of long-term HIV infection and treatment?


The face of HIV has altered dramatically over the past decade. A combination of earlier diagnosis, ART treatment adherence, and awareness of healthier lifestyle options translates into a drastically increased life expectancy for many people living with HIV. Globally, many people have now been living with the virus for over twenty years – some because they were born with HIV and others because they are long-term survivors of the epidemic. This unchartered territory raises many new and important issues about how long-term HIV infection and treatment affects the natural ageing process.

As people living with HIV grow older, they will have a unique set of clinical and psycho-social needs that need to be addressed in a more sustained and systematic manner. In the United Kingdom a recent study specifically investigated the needs, concerns and characteristics of people aged 50 and over who are living with HIV. Beyond health-related issues, a number of other challenges including financial and social wellbeing should increasingly be taken into consideration.

Many questions related to how older age affects the natural progression of HIV infection and the body’s response to long term treatment still remain unanswered. Clinicians and health practitioners are increasingly confronted by additional issues - from managing the expected and routine issues facing the over 50s living with HIV to dealing with some of the consequences of long-term ART use and resistance. It is clear that both providers and clients are entering a new phase in holistic health for people living with HIV.

As more people are living longer and healthier lives with HIV, IPPF Member Associations will have to find creative and innovative ways of meeting their sexual and reproductive health needs - from providing additional psycho-social support; strengthened integration with other health and care services for older adults to forging new partnerships with organizations specifically working with older adults.

Download the September issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+27.htm

New release: Love, Life and HIV Toolkit

The Love, Life and HIV Toolkit – developed by IPPF, UNFPA, Young Positives and the Global Coalition on Women and AIDS – aims to develop a greater understanding of some of the issues facing young people living with HIV today. It is available in English, French and Spanish and includes:

• A 28 minute film. Young people living with HIV from the Dominican Republic, India, Mexico, Russia, South Africa and Swaziland talk about a host of issues that affect their lives. The film is split into six themes: 1. facing stigma; 2. accessing services; 3. finding love; 4. having a family; 5. being supported; and 6. getting involved.
• A session plan to accompany each of the films themes. Each session includes adaptable discussion starters and activities, take home points summarizing the session, and links to further resources to enable users to maximize the potential learning in the stories shared in the film.
• Handouts with further information on each of the themes. These can be used by educators and trainers when preparing to lead sessions or can be given to participants as resource materials.

Limited hard copies of the film can be ordered from info@ippf.org. The resource pack is available from http://bit.ly/lovelifehiv.  

World Hepatitis Day

Today, the 28th of July, is World Hepatitis Day to recognize the need to further raise awareness of chronic hepatitis B and C around the globe and to advocate for policy change to improve health outcomes for people affected by viral hepatitis. Together, hepatitis B and C affect one in 12 people worldwide and approximately one million people die from these viruses every year (World Health Organization).

The 2011 theme for World Hepatitis Day is ‘This is hepatitis... Know it. Confront it. Hepatitis affects everyone, everywhere.’ This inclusive theme emphasizes the scale of viral hepatitis and helps combat the stigma often associated with hepatitis B and C by conveying the fact that these viruses do not discriminate.

Hepatitis simply means inflammation of the liver and can be caused by a wide range of things. One of the most common causes of chronic (long-term) hepatitis is viral infection, which can be transmitted sexually. Hepatitis B and C are two such viruses and approximately 500 million people around the world are currently infected with chronic hepatitis B or C. Unlike hepatitis C, hepatitis B can be prevented through effective vaccination.

As viral hepatitis is transmitted in similar ways as HIV, coinfection is a growing concern. In people living with HIV, infection with viral hepatitis can lead to more serious complications, such as more rapid liver damage. Coinfection can also complicate the treatment of HIV infection. It is important for people living with HIV to be tested for viral hepatitis and take steps to prevent infection.

Hepatitis is a global problem and by working together we can deliver change in prevention and access to testing and treatment.

For more information about HIV and hepatitis, including prevention, diagnosis and treatment: http://www.aidsmap.com/Hepatitis-and-HIV/cat/1508/

For more information about World Hepatitis Day, including campaign materials in different languages: http://www.worldhepatitisalliance.org/Home.aspx

UN HLM on AIDS: IPPF Key Message 04

Renew the political commitment to HIV

Recognizing the long-term benefits that have accrued from investing in HIV programmes, governments, international donors and the private sector need to re- commit to meeting the international targets, goals and accountability. Nuanced political commitment to HIV for this new millennium needs to be prioritized.


Rationale: In the last decade the HIV response has been transformed by increased political commitment and a dramatic increase in resources. Progress has been made towards the Millennium Development Goal (MDG) target for HIV, which is to have halted and begun to reverse the epidemic by 2015. At a global level, the epidemic is stabilizing. According to the 2010 UNAIDS Global Report, the number of new HIV infections declined by 16 per cent from an estimated 3.1 million in 2001 to 2.6 million in 2009. Improved access to services to prevent mother-to-child transmission has reduced the number of infants infected with HIV from 500,000 in 2001 to 370,000 in 2009. New interventions and emerging technologies, including male circumcision and pre-exposure prophylaxis, have the potential to further enhance HIV prevention efforts, if implemented at sufficient scale.

Current gaps to address:

• Close the funding gap: The funding gap - the difference in the amount of money needed and the amount actually allocated - was $7.7 billion in 2009, compared to $6.5 billion in 2008. Funding is a shared responsibility. Donor and recipient countries must meet their commitments and be held accountable. International donors should ensure full funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and develop additional innovative financing mechanisms to ensure the long-term sustainability of the response. 
• Continue to scale up access to treatment: An estimated 10 million people who need treatment do not have access to ART. In 20 African countries, more than 80 per cent of treatment depends on donor funding. A recent survey showed that eight countries already face shortages of antiretroviral drugs and a further 22 countries - accounting for more than 60 per cent of people on treatment worldwide - expected an adverse impact on treatment programmes in the future. 
• Commit to a sustainable long-term response: HIV continues to be an exceptional epidemic and thus require an exceptional response. It is still a major threat to health and development and an effective response to HIV is critical to achieving all of the other MDGs. HIV spending is a down payment on a healthy future, yielding immense benefits for future generations, reducing human suffering and averting the large economic and development costs associated with the epidemic.
• Plug the condom gap: Condoms are a critical element of any HIV prevention strategy and are the only dual protection method available for the prevention of HIV, STIs and unplanned pregnancies. Yet, the gap between the number of condoms needed and the number of condoms available for HIV prevention and family planning is high.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm 

UN HLM on AIDS: IPPF Key Message 03

Uphold the rights of people living with HIV

HIV prevention programmes need to be ‘fit for purpose’ by ensuring they are rights-based, evidence-informed and support people living with HIV to live longer and healthier lives. ‘Treatment as Prevention’ should become an integral part of the HIV response and efforts need to be scaled up to increase access to HIV testing, adherence counselling and treatment.


Rationale: Increasing the impact of prevention programmes is essential to preserve the long-term sustainability of treatment initiatives and prevent the epidemic from further undermining the gains made across the broader development agenda. ‘Traditional’ prevention programmes have mostly targeted those people who are HIV negative and have promoted a wide range of behaviour change strategies. While this is crucial, they have largely ignored both the needs and important role of people who are living with HIV. The ‘Positive Health Dignity and Prevention’ movement has highlighted the need to promote an approach that goes beyond health related services and includes other interventions to deal with issues of disclosure, sexuality, drug use, and laws – all within a human rights approach. Key approaches in a ‘positive prevention’ strategy include protecting their sexual and reproductive health and avoiding other sexually transmitted infections; delaying HIV disease progression; and promoting shared responsibility to protect their sexual health and reduce the risk of HIV transmission.

Current gaps to address:

• Promote positive prevention: PLHIV are a diverse group and have the right to live enjoyable and fulfilling sexual and reproductive health lives. Resources should be utilized to address the prevention needs of PLHIV and promote ‘treatment as prevention’ options. 
• End the criminalization of HIV transmission: There are over 60 countries that have HIV-specific criminal laws. The criminalization of HIV transmission or exposure weakens HIV prevention efforts and marginalizes people who are already vulnerable to HIV infection. Awareness needs to be raised about issues relating to the criminalization of HIV transmission or exposure. 
• Invest in evidence-informed programmes: The epidemic’s continued expansion stems from the frequent failure to apply proven prevention strategies tailored to the current realities of local epidemics, as well as the chronic and continuing underinvestment in evidence-informed prevention strategies. Funding needs to be increased for evidence-informed and rights-based prevention strategies that promote and support long-term social change to facilitate HIV prevention or that address the societal or structural factors that increase vulnerability.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

UN HLM on AIDS: IPPF Key Message 02

Mention the ‘unmentionables’

Create enabling environments to reduce stigma and discrimination and protect human rights through the removal of punitive laws that criminalize key populations that are particularly vulnerable to HIV, such as sex workers, men who have sex with men, transgender people and people who use drugs. Without specifically mentioning the groups of people that are particularly vulnerable to HIV infection, they are all too often ignored or sidelined in HIV responses.

Rationale: All too often human rights is seen as a ‘soft option’ that is difficult to measure. However, experience shows that human rights need to underpin a response to HIV. Stigma and discrimination continues to limit access to essential services for people living with HIV and individuals particularly vulnerable to infection — young women and girls, men who have sex with men, transgender people, people who use drugs and sex workers. Multiple legal and socio-cultural barriers continue to prevent or discourage these groups from accessing and using healthcare services. Being among the most marginalized and discriminated against populations in society, they are often ‘hidden’ and are rarely involved in the formation and implementation of HIV policies, programmes and services to meet their specific needs. Any sustainable response to HIV must remove these punitive laws and address the other social drivers of the epidemic.

Current gaps to address:

• Increase access to services for MSM: Globally, MSM are often denied access to basic health services due to the criminalization of sex between men, homophobia amongst healthcare workers and isolation due to stigma and discrimination. Recent studies have found high levels of HIV prevalence among men who have sex with men in Africa, ranging from 10 per cent to 43 per cent. It is imperative that restrictive laws and policies are repealed and healthcare workers are sensitized so access to vital SRH and HIV information and services for MSM can be improved.
• Repeal punitive discriminatory laws and policies: Nearly three decades after the epidemic was first identified, stigma, discrimination, and punitive laws and policies continue to undermine efforts to prevent new infections. Key populations are reluctant to seek services in contexts where their behaviour is against the law. Such punitive and coercive policies are both counterproductive from a public health perspective and antithetical to the human rights basis of effective prevention.
• Scale up gender transformative programmes: Gender transformative programmes aim to change gender norms and promote relationships between men and women that are fair and just. A ‘gender argument’ has often been used to establish and enhance women’s participation and rights but some groups of women, such as women who use drugs and female sex workers, are often overlooked. Programmes to support these women and girls who are particularly vulnerable to HIV also need to also be scaled up. 

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

UN HLM on AIDS: IPPF Key Message 01

Maximize existing synergies between HIV and associated responses to improve the lives of young women and girls

Scale up the linking of sexual and reproductive health and HIV, using prevention of mother to child programmes as a key entry point to strengthen maternal, newborn and child health services and expand access to a wider range of sexual and reproductive health services.


Rationale: The majority of HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding; and the risk of HIV transmission and acquisition can be further increased due to the presence of certain sexually transmitted infections (STIs). Prevention of mother to child transmission (PMTCT) is a key proven entry point for strengthening both HIV services and maternal, newborn and child health (MNCH) services. However, these two programmes frequently tend to run in parallel, missing the opportunities to ensure more women and their partners have access to a wide range of sexual and reproductive and HIV-related services, including family planning and unintended pregnancies among HIV positive women.

Current gaps to address:

• Make better use of proven strategies: Stakeholders in the response must significantly intensify their efforts to prevent new infections by making better use of proven strategies. Stakeholders should make a solid commitment to ending paediatric HIV transmission; promoting early infant diagnosis; and optimising the health of mothers living with HIV and their families.
• Optimize integrated services: To ensure that HIV services are effective and properly delivered within an MNCH setting, there is a need to better understand how to ensure that services can be effectively integrated in resource-poor settings and reach out to poor and marginalized women, especially those living in rural and remote areas. 
• Putting women at the centre of PMTCT programmes: Women need to be put at the centre of any PMTCT programme by promoting primary prevention among women of reproductive age and encouraging women to know their HIV status. There also needs to be increased attention to the contraceptive methods and family planning options offered to women living with HIV.
• Involve male partners: While most interventions have been focusing on ensuring women access to health care during the time of pregnancy, more needs to be been done to involve their male partners in health-related decisions. Increasing male involvement in PMTCT services may increase the chances of male partners practicing safer sex with, and providing support to their female partner when they learn their HIV status.

Read all of IPPF's key messages for the 2011 UN High Level Meeting on AIDS in the June issue of the HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

HIV Update: HIV. Now more than ever.

By Kevin Osborne (IPPF)


Thirty years since the United States Centers for Disease Control issued its first warning about a rare form of pneumonia among a small group of young gay men, ten years since the landmark United Nations General Assembly Special Session on HIV and AIDS, and five years since the political commitments towards universal access to prevention treatment, care and support: the AIDS response is at a crossroads.


Leaders from government and civil society will gather at the 2011 UN General Assembly High Level Meeting on AIDS in New York from the 8-10 June to review the progress and chart the future course of the global AIDS response. Efforts made over the past decade are now having an impact: global and country action is making a tangible difference as universal access to HIV prevention, treatment, care and support has increased. While not all the inspirational targets have been met, this trend is an encouraging sign of what collective and focused action can accomplish.

However, ‘AIDS fatigue’ is becoming a worrying reality. In particular, political and financial commitment is stalling and many of the hard-won gains are under serious threat. It is vital that the 2011 High Level Meeting on AIDS re-commits to overcoming the remaining barriers to an effective country-owned, sustainable, and accountable HIV response. Now, more than ever, a strengthened response to HIV should not falter. Intensified action to address the prevention and treatment needs of pregnant mothers and their children (including early infant diagnosis) should be prioritized. Linking resources to the realities of the epidemic to meet the needs of men who have sex with men (MSM), sex workers and their clients, and people who use drugs should be guaranteed. Advocacy action on creating an enabling policy environment that supports HIV responses should be promoted and, in light of the ‘game-changing’ results from the recent ‘treatment as prevention’ trial, prevention options need to be scaled-up. Until gaps like these are adequately addressed, much work remains to be done in a unique partnership between governments, civil society and the private sector.

In advance of this meeting, it is important to reflect upon the current gaps and our niche within the global response to HIV. This month's issue of HIV Update highlights the four key messages that IPPF delegates at the High Level Meeting will be promoting in our work with and in country delegation teams. Currently, the IPPF Member Associations in the following countries have already been invited to be part of their official country delegation teams: Belgium, Belize, Djibouti, Mali, Mauritania, Rwanda, Swaziland and Sweden. Our continued focus on the human rights approaches inherent in all prevention, treatment and care responses underpins all aspects of the epidemic and remains a much needed voice in the global arena. Words matter and actions count. While politics may eventually dictate the final negotiated outcome of the High Level Meeting; it is imperative that we raise our voices and strategically strengthen our actions.

Download the June issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+26.htm

Tribute to David Cairns MP

The International Planned Parenthood Federation (IPPF) is deeply saddened by the news of the death of David Cairns  - Member Parliament in the United Kingdom and Chair of the UK All-Party Parliamentary Group on AIDS.

David was an outspoken supporter of the rights of people living with HIV, including through active involvement in IPPF’s work against stigma, discrimination and criminalization of people living with HIV.

He reached out to and showed his support for a wide range of people, demonstrating his passion for ensuring that human rights are not withheld from people living with HIV, people who are gay or lesbian, and people living in countries or circumstances less fortunate than his own.

David was a visionary parliamentary leader whose work on HIV will not be forgotten. He used his position to engage with diverse communities of people living with HIV in the United Kingdom to learn about the realities of life with HIV in this country, and actively advocated for enabling policy environments both in the UK and internationally. Recently, he eloquently expressed his concern about laws that criminalize transmission of HIV and how they are used to single out and stigmatize people living with HIV.

Our thoughts are with David’s partner, family, friends and colleagues at this time. David’s leadership, intuitive understanding of the issues and passion for human rights will be greatly missed.

A memorial service will take place on Wednesday, 18 May at 8pm at St Mary's Church, Clapham Common in London. In David's memory, please support the campaign against homophobia in Uganda with a donation to Sexual Minorities Uganda (SMUG): http://uk.virginmoneygiving.com/DavidCairnsMemorial

Reaching MSM and other LGBT people across the Federation

Despite increasing acceptance of sexual diversity, lesbian, gay, bisexual and transgender (LGBT) people around the world continue to experience social exclusion, prejudice, and violence as a result of discrimination on the basis of sexual orientation and gender identity. Today, May 17th, marks the International Day Against Homophobia and Transphobia - the anniversary of the World Health Organization's decision to remove homosexuality from its list of mental disorders in 1990.

The fear or dislike of homosexuality and differing gender identities in others or oneself and the assumption that heterosexual relationships are the norm create stigma and discrimination in society. This societal homophobia is deepened in countries where laws exist that criminalize same-sex relationships. In 2011, 76 countries around the world still consider homosexuality illegal.

Homophobia and transphobia have a profound impact on many aspects of the lives of LGBT people, including sexual and reproductive health (SRH). Many LGBT people find it difficult to openly access the SRH and other health services they need due to fear of being identified as being LGBT or due to the real or perceived negative attitudes of the service staff. Across the Federation, there are many outstanding examples of IPPF Member Associations reaching out to men who have sex with men (MSM) and other LGBT people in an effort to more effectively meet their SRH and HIV needs.

Cameroon

The Cameroon National Assocation for Family Welfare (CAMNAFAW) is providing stigma-free SRH and HIV services for the LGBT community in a country where homosexuality is punishable by law. In recent years, stigma and discrimination has been fuelled by homophobic reporting in the local media to publicly denounce homosexuality, resulting in the persecution of many homosexuals. To overcome this and to reduce the vulnerability faced, CAMNAFAW initiated a project to build trust and provide safe spaces where LGBT individuals could receive non-judgemental counselling, support and sexual health information. CAMNAFAW is one of the few voices in Cameroon championing the rights of sexual minorities, and produced a film showcasing the project.

Macedonia

The Health Education and Research Association (HERA) developed a national report card on the current situation of HIV prevention among MSM in collaboration with Equality for Gay and Lesbians (EGAL), a national LGBT organization. The report card was developed through a review of SRHR and HIV policies and programmes; interviews with various stakeholders; and community focus groups with MSM. Most importantly, this report card is being utilized as an advocacy tool providing recommendations for future actions to enhance HIV prevention for MSM. Although sex between men is not illegal in Macedonia, there is no specific legislation to protect MSM from discrimination; therefore a main recommendation was to include sexual orientation as a non-discrimination clause in the law.

Peru
Instituto Peruano de Paternidad Responsible (INPPARES) has created a safe environment in its clinics to cater for the needs of MSM and other LGBT people, especially those who are young. Young people continue to have limited access to sexual health services in Peru. With an emphasis on freedom of expression on issues of sexual diversity, young LGBT individuals are equipped with the confidence and skills to express their views more openly, to respond to intolerant and hurtful comments, and to be more assertive when communicating with their families and with acquaintances. INPPARES also works to raise institutional and political awareness of sexual diversity, which has had a significant impact internally on staff awareness and openness. This is an important achievement in a country where conservatism prevails.

China

The China Family Planning Association (CFPA) is promoting sexual health among MSM in three cities of Gansu Province, northwest China. Although sex between men is not illegal in China, many MSM keep their sexuality hidden due to the stigma they might otherwise face, making it particularly challenging to reach them with information and support. One of the primary components of this project is peer educator recruitment, training and outreach. Peer educators conduct outreach in bars, shower centres, and other venues frequented by MSM to disseminate condoms, lubricant, HIV and sexual health information, and health service referral cards. The project supports MSM in making informed decisions with an emphasis on personal choice.

India

The Family Planning Association of India (FPA India) has increased access to a combination of HIV prevention and SRH services for MSM in a number of clinics. Clinic staff received sensitization training on sexuality issues, and the SRH needs of MSM. A male drop-in centre was established to provide a safe space for MSM to receive information on various issues. Better known for their work in family planning and maternal and child health, MSM were initially hesitant to enter such centres. However, in partnership with local MSM organizations, the clinics are now known within the community as a stigma-free service. The clinics are also another option for men who do not feel comfortable utilizing MSM-specific services and provide the opportunity to bring their sexual partners, including female partners.

Syria

The Syrian Family Planning Association (SFPA) is providing youth-friendly HIV and SRH services in established youth centres throughout the country. Due to the high level of stigma and discrimination in the country, this project does not directly target MSM, but aims to provide an environment accepting of all young people. This has enabled some young men to feel confident and free to discuss issues related to their sexual orientation with the centre’s educators and counsellors. In an effort to attract other young MSM, these young people were encouraged to attend a peer education training workshop and to bring along their friends to the centre. In a society that treats homosexuals as criminals, this is an important first step to build confidence with this marginalized group.

For more information on the International Day Against Homophobia and Transphobia: http://www.dayagainsthomophobia.org/

Dr Robert Carr: Moments and Memories

IPPF commemorates the life of Dr Robert Carr—colleague, friend and human rights champion—and will honour his legacy

The global fight against HIV has generated many champions over the last 30 years, and the world has sadly now lost one of its true defenders of human rights—Dr Robert Carr—someone who stood up for those who were often overlooked by many or living in the margins of society. Robert was a man of absolute integrity whose honesty and passion for the greater acceptance of the rights of vulnerable people in the world often cut through the hypocrisy. Robert still had much more to contribute through his advocacy on sexual rights, his role as the civil society co-chair of the Global Coalition on Women and AIDS and on the Board of the Global Forum on MSM and HIV, and his endless championing of issues facing gay and other men who have sex with men around the world. He has gone too soon, but his legacy will no doubt continue to inspire action and commitment in these important areas for many years to come. His spirit will hopefully inspire a new generation of leaders to take up the issues he so fiercely defended.

For many of us at the International Planned Parenthood Federation (IPPF) what started out as a strong working relationship turned into a formidable friendship and camaraderie. Robert had that unique ability to ‘blur the edges’; connect with different kinds of people and link people together. From the Caribbean to Canada to Kuala Lumpur below are some thoughts and reflections from colleagues and friends.

“Robert worked tirelessly for HIV in the Caribbean. It’s like the light of a star has gone out. Collectively we need to ensure that his insights and vision continue to be present in our work. His spirit will inspire us to pay attention to the unnoticed, spotlight what may sometimes be invisible, and persevere with his efforts to serve the most vulnerable communities at home and around the world.”
--Dr Jacqueline Sharpe, President and Chairperson of the Governing Council

"We are grateful that Robert came into our lives at the time that he did. His understanding and mastery of the sexual rights concerns of our Caribbean sub-region has brought our work to the attention of many allies. It is important that we continue the important advocacy work that he begun, or we would have allowed his legacy to die with him."
--Dona Da Costa Martinez, Executive Director, Family Planning Association of Trinidad and Tobago

“Robert Carr was a longstanding colleague and friend of IPPF. His commitment to vulnerable people around the world—through his wisdom as a leader, his insight as a mentor, and his humility as a peer—was inspiring, and will be greatly missed by all.”
--Dr Gill Greer, Director General

“Outspoken, exuberant, passionate, spirited and always smiling, Robert had the same approach to life as he did to his work. And he lived each day to its full. Personally, I have a lost a dear friend and comrade. And the world has lost one of its greatest defenders of social justice.”
--Kevin Osborne, Senior Advisor HIV

“Rob was a powerful and unstoppable force with a strong commitment to human rights. He will heat a debate and always find ways to name the elephant in the room – he was not shy to talk about the need to stop the double standards and hypocrisy that permeates some of our work. He was a person of principles and integrity – and the sweetest man and dearest friend on earth! Working with Rob was amazing. His spirit and fierce determination will be with us forever. Rest in peace dear Rob.”
--Ale Trossero, Director of Programmes, East Asia and the Pacific Regional Office

“When I first met Robert Carr in London it was a night that was filled with loads of laughter, brilliant conversation, passionate debate and inclusion – but he called it "field work." I was dazzled. He became my friend and confident and to many people at an event in Toronto last year one phenomenal dance partner. Dance on Mr Carr!”
--Alastair Hudson, Stigma Index Team: United Kingdom

“I remember Robert as a person of the utmost integrity, yet full of laughter and fearless to speak his mind about issues passionate to him.”
--Daniel McCartney, HIV team

“With his sharp wit and incisive perceptiveness, Robert had a way of saying the unexpected and often illuminating the unspoken. I first met Robert at one of his many conference presentations, where he showed a news photograph of two men being ushered away from a shop into a police van, amid a violent onslaught from a small crowd. At first glance, the image appeared to show a prejudiced, destructive and pessimistic scene in Jamaica for gay men. Yet Robert spoke of the picture as a great sign of hope—of progress in Jamaica. The police in the photo were ‘serving and protecting’ gay men, rather than joining in or even initiating the violence. I have learnt mountains from Robert, and although we have many more mountains to go in terms of overcoming the issues he fought so passionately for, each step will be all the stronger, wiser and more determined for having known him.”
--Lucy Stackpool-Moore, HIV team

Gay men and other MSM: The right to sexual and reproductive health

By George Ayala and Mohan Sundararaj – The Global Forum on MSM & HIV (MSMGF)

EVERY human being must enjoy the right to sexual and reproductive health, and that includes gay men and other men who have sex with men.

Gay men and other men who have sex with men (MSM), estimated to comprise about 5-10 per cent of the world’s population, have been historically excluded from health and HIV-related programme, policy or financing discussions. They face homophobia and a range of structural challenges that undermine their ability to realize health to the fullest level possible. In every country truthfully collecting and reporting HIV and health data, gay men and other MSM consistently record higher HIV prevalence rates or poorer health outcomes when compared to adults in the general population. Moreover, gay men are seldom, if ever, meaningfully engaged in the design of health and HIV responses meant for gay men. This has left a health sector that is weakly equipped to effectively cater for a population that continues to shoulder a disproportionate HIV and AIDS burden.

Sexual and reproductive health: a holistic approach

Sexual and reproductive health (SRH) of gay men and other MSM cannot be viewed as the mere absence of disease. It encompasses their physical, emotional, mental and social well-being in relation to their sexuality.

‘Coming out’ – a process through which gay men come to terms with their sexuality, which may or may not include revealing their sexual identity to others is therefore integral to mental health. Gay men who realize self and social acceptance, find it easier to seek sexual healthcare or speak candidly to a primary care provider about their sexual health needs. The integration of gay men with mainstream society can thus provide a more equitable and less biased health delivery platform from which they can access targeted HIV prevention, treatment, care and support services and other health interventions.

Gay men and other MSM have unique health needs

The accrual of compelling evidence over decades has led the international scientific community to increasingly regard homosexuality as a normal variation within the spectrum of human sexual expression. But rejection of gay men can begin at home with family members, and can often be compounded by societal ostracism. In many cases, this leads to isolation, abuse, violence or sometimes murder. In over 70 countries, sex between consenting adults of the same gender is considered a criminal offence. Broader society and national governments have failed to recognize gay men’s rights to privacy, non-discrimination and a decent life, fuelling prejudice against them at every level. It is in this context that gay men and other MSM attempt to navigate their HIV and health needs.

Research has shown that these individuals reliably bear higher rates of depression, anxiety, chronic stress, suicidal thoughts, and substance use. Fearing rejection, they may delay seeking health services including mental health care. In some contexts, gay men and other MSM are subjected to sexual abuse, physical harassment, rape and violence and therefore are robbed of any control over their own bodies. Consequently, they are unable to readily access screening services for sexually transmitted infections (STIs), including HIV or necessary prevention information, condoms and lubricants.

Core principles to working with gay men and other MSM

A sound approach to addressing the SRH needs of gay men and other MSM must take into account a broad set of issues and principles.

Principles of practice have long been deliberated by AIDS service providers and advocates, but are often overlooked in policy discussions in favour of a narrow focus on scientific evidence in substantiating HIV-related interventions and SRH programme strategies. The following are some important core principles of practice:

1. The imperative of reducing STI and HIV infection rates should not impinge on personal freedoms.
2. All people, including MSM and MSM living with HIV, deserve the same level of support, health care, support services and political rights as anyone else.
3. All people, including MSM and MSM living with HIV, are entitled to a fulfilling and satisfying sex-life.
4. All people, including MSM and MSM living with HIV, have the right to be self-determining.
5. All people, including MSM and MSM living with HIV, deserve to be free from rape, violence and discrimination and are entitled to adequate legal recourse when these rights are violated.
6. HIV prevention programs and SRH services should not take a singular focus on risks but rather leverage the strengths, resources, competencies, social connections, capacities, and resiliency that are already present in gay men and other MSM and their communities.
7. Pleasure, gender, satisfaction, intimacy, love, and desire are key concepts in a fuller understanding of sex and sexuality among gay men and other MSM and should be included when formulating more meaningful research, programmatic, and policy responses.
8. Researchers, prevention practitioners, and policymakers should consider structural, situational, and contextual factors in understanding HIV risk and in developing sexual health interventions tailored to the specific needs of gay men and other MSM.

Additional resources are available from the Global Forum on MSM & HIV (MSMGF) website: http://www.msmgf.org/

Article from IPPF HIV Update newsletter - Issue 25: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+25.htm

HIV Update: Sex between men

By Kevin Osborne (IPPF)

Since its debut in the early eighties, HIV continues to disproportionately affect men who have sex with men (MSM). Despite some policy gains made over the past years, MSM still experience serious challenges when trying to access HIV prevention, treatment, care and support services. And much of this has to do with the prevailing culture of stigma and discrimination.

In every country in all regions of the world, relationships and consensual sex occurs between men. Yet in over 70 countries criminal penalties currently exist for same-sex acts between consenting adults, including imprisonment and death. Even in countries where consensual sex between men is not illegal, MSM are among the most marginalized and discriminated against in society. Individuals are often targets of exclusion and violence on account of their real or perceived sexual orientation. This reality was underscored earlier this year with the tragic loss of David Kato in Uganda. And despite being at a greater risk of HIV infection, MSM are too often overlooked in national responses with few, if any, targeted resources provided.

The existence of punitive laws also makes it very difficult for MSM to openly access health services, and more needs to be done to effectively serve their sexual and reproductive health (SRH) and HIV needs. In recognition of this need, IPPF has recently entered into a partnership with the Global Forum on MSM & HIV (MSMGF) – a network promoting the health and human rights of MSM worldwide – to scale up our collective efforts. IPPF’s Sexual Rights Declaration clearly stresses that every human being has the right to sexual and reproductive health - including gay men and other MSM - and our lead article by MSMGF calls for this right to be honoured.

Our work with MSM has increased considerably over the last five years. In 2005, 25 per cent of IPPF Member Associations had specific strategies for MSM, and by 2009 this had increased to 45 per cent, with some outstanding examples. While much still remains to be done to meet the SRH and HIV needs of MSM and their partners, IPPF Member Associations are uniquely placed to provide much-needed services – including access to stigma-free clinical services, high-quality condoms and water-based lubricant, specific risk reduction strategies, and appropriate referrals for care and support. Working in partnership with regional and country level MSM organizations and networks will help shape and strengthen both our work and our collective voice to address the sexual and reproductive health and rights of MSM.

Article from IPPF HIV Update newsletter - Issue 25: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+25.htm

What do I do if I am living with HIV and…

Ahead of International Women's Day on the 8th of March, IPPF has published a new informative booklet and poster for young women living with HIV. The booklet and poster answers questions raised by young women living with HIV about dating, relationships, sexuality, and parenthood.

It offers information to help young women to have a healthy, happy, and sexually fulfilling life and to decide on issues relating to sexual and reproductive health. The booklet covers the following topics:

What do I do if I’m living with HIV and...

...I want to date or be in a relationship?
...I want to tell my partner or my family that I am living with HIV?
...I want to protect my partner from HIV and other STIs?
...I want to practise safer sex?
...I want to get pregnant?
...I want to protect my baby from HIV?
...I do not want to get pregnant?
...I want to end a pregnancy?
...I want further support?

Like all people, there is a lot of diversity among young women living with HIV. We hope this guide provides information that is useful in helping young women decide how to best look after their sexual and reproductive health.

To download the booklet and poster: http://www.ippf.org/en/Resources/Guides-toolkits/What+do+I+do+if+I+am+living+with+HIV+and.htm

Girls Decide: Nomvelo's journey, Swaziland

On 16 February, IPPF launched Girls Decide at the first screening of the Girls Decide film series. The films and publications are part of a larger initiative that aims to highlight the centrality of girls’ and young women’s sexual and reproductive lives for both individual and global development, and aims to ensure that girls’ and young women’s sexuality and pregnancy-related issues are effectively addressed by adopting policies and practices that work for girls.

The Girls Decide films share the stories of six girls from around the world in their journeys to make informed decisions about sex, pregnancy, abortion and relationships. They show how Member Associations of IPPF fulfil their commitment to young people’s sexual and reproductive rights through the provision of quality youth-friendly services.

The films are all based on true stories and were developed through a participatory process with young women from each of the six countries. The main characters are portrayed by actors. All interviewees are practising health professionals and community leaders.

One film shares the story of a girl in Swaziland. Nomvelo was born with HIV and she is interested in taking her relationship with her boyfriend further, but does not feel confident about how to talk to him about her HIV status. The Family Life Association of Swaziland, an IPPF Member Association, provides support to girls and young women living with HIV to lead positive and healthy lives.

IPPF believes that all girls and young women living with HIV have the right to experience their sexuality in healthy and positive ways. They also have the right to date, to be in relationships, to marry, to access sexual and reproductive health services and information, to have children and to decide if, how and when to disclose their HIV status.

To see the other films and for further information on the Girls Decide initiative: http://www.ippf.org/en/What-we-do/Adolescents/Girls+Decide.htm

I love you. A universal language.

Valentine’s Day is about love, irrespective of gender, sexual orientation or HIV status.

In many countries, laws exist that do not allow people to express love without fear of persecution or violence. Laws that criminalize HIV transmission and exposure, and those that criminalize behaviours and practices associated with HIV transmission, have a profound impact on the lives of people.

Even on Valentine's Day, people living with HIV and people most vulnerable to HIV infection - including women, men who have sex with men, transgender people and sex workers - will experience stigma, discrimination and violence.

Everyone has the right to love – love does not discriminate.

Be conscious this Valentine’s Day.

Criminalize Hate Not HIV is part of a growing campaign to raise awareness about issues relating to the criminalization of HIV transmission. For more information: http://bit.ly/criminalization.

There must be a silver lining

By Lucy Stackpool-Moore

Any day is a sad day for the world when senseless violence takes the life of a kind, compassionate human being. Yesterday was no exception, when David Kato, the litigation and advocacy officer for SMUG (Sexual Minorities Uganda) was killed in his home in Kampala.

David was a friend, and worked closely with IPPF on a number of occasions over the last two years. He spoke about the law and human rights at the Vienna International AIDS Conference.  Just a few months ago, David, representing Africa, provided an important perspective at a meeting of the UK Consortium on AIDS and International Development about barriers to universal access of HIV care & support. He made sure that due attention was given to this issue for all people, including those from sexual minority groups.



David Kato speaking at IPPF satelitte session in Vienna. Placard he created read "AIDS 2010 demands withdraw of the Ugandan Anti-Homosexuality Bill in its entirety now!"



At times like this we must look for inspiration and compassion and hope, and we must find the silver lining hiding in even the darkest of thunderclouds. I was reminded of the great Archbishop Desmond Tutu’s humane and wise comment about homophobia in March 2010—which he called ‘a step backward on human rights’ in Africa:

“Hate has no place in the house of God. No one should be excluded from our love, our compassion or our concern because of race or gender, faith or ethnicity -- or because of their sexual orientation… It is time to stand up against another wrong.

Gay, lesbian, bisexual and transgendered people are part of so many families. They are part of the human family. They are part of God's family. And of course they are part of the African family. But a wave of hate is spreading across my beloved continent. People are again being denied their fundamental rights and freedoms…

These are terrible backward steps for human rights in Africa. Our lesbian and gay brothers and sisters across Africa are living in fear…The wave of hate must stop… Exclusion is never the way forward on our shared paths to freedom and justice.”

IPPF is deeply shocked and saddened by the news of David Kato’s murder. Our thoughts are with David’s family and friends and colleagues at SMUG (Sexual Minorities Uganda). We have lost a friend, a colleague, a committed human rights activist and a generous and compassionate human being.