HIV and the politics of fear

By Matthew Weait, Professor of Law and Policy (Birkbeck College, University of London, United Kingdom)

For the past decade or so I have been privileged to participate in, and contribute to, national and international policy initiatives concerned with the criminalization of HIV transmission, exposure and non-disclosure. The people involved in this work, paid and unpaid, have been tireless in their efforts to draw the attention of those with legislative power to the negative impact that punitive responses to people living with HIV, and to those in key populations, has had and continues to have on prevention efforts and on reducing HIV-related stigma and discrimination. They could not, I think, have done more. 

Yet punitive responses remain – a stubborn stain that refuse to be shifted (except for a few notable exceptions). Why is this so? Why, in an era in which effective treatment (where it is accessible and available) means that people living with HIV with an early diagnosis have a similar life expectancy to those without HIV, should people be so afraid of infection that they want to punish and imprison? And why is this even more apparent in countries where that treatment is indeed accessible and available (North America, Australasia and Europe)? It seems to me that the answer lies in an increasingly obsessive focus on the value of security and in a perversion of that value during the last twenty years.

There was a time when we accepted that our bodies were fragile, porous, weak – open to disease and infection. To be human was to be a much more vulnerable organism, more susceptible during accidents, childbirth, and illness. As biological, medical, and pharmaceutical sciences have developed, as we have come increasingly to believe that we are able to regulate, manage and master the pathological agents that threaten our physiological integrity. 

It is thus completely explicable that HIV – despite being a manageable, if serious, chronic illness – should be stigmatized to the point of criminalization. Explicable because it is a reminder – an embodied reminder – that we are mortal; that the fantasy we entertain about our bodies is merely that – a fantasy.  Any threat to this – including the person who fails to let us know that they are a potential source of infection, and the person whose virus might (but doesn’t) escape – is, quite literally, intolerable. 

HIV is an environmental fact. It coexists with humans. The humans in whom it is embodied suffer criminalization, stigma, and discrimination not because of HIV itself – it’s a virus (!) – but because HIV confounds us, challenges us, frightens us, forces us to acknowledge what being human really means. And these negative effects of HIV can, and will, only be eradicated (for as long as there is neither vaccine nor cure) if we learn from the experience and practice of those who have organized so hard to counter them: if we (re)learn the value of, and progressive political opportunities that come from, working together and with a certain degree of humility in the face of nature. 

If there is one legacy from HIV that we might wish to remember, I hope that it is the reaffirmation of what can be achieved – for ourselves and for others – through a politics that acknowledges the value of community rather than one that thrives on the fear of difference.

XXX

HIV Update: Rights in Action

By Kevin Osborne (IPPF)

Since the beginning of the epidemic, HIV has been at the crossroads of science, rights and moral values. All too often human-rights, tolerance, and acceptance are seen as ‘nice-to-haves’ but not ‘must haves’ as part of national and international responses to HIV. Yet studies have shown that failure to respect human rights undermines the return on investment. There is a financial as well as moral imperative to ensure that the efforts, attention and hard-earned currency invested in responding to HIV are as effective as possible.

There is an unconscionable economic, human and social cost of inaction on human rights. In my home country South Africa, a study by the Harvard School of Public Health found that the political inaction during the AIDS denialism of Thabo Mbeki’s government equated to 365,000 premature deaths. This included 330,000 South Africans who died for lack of treatment and the 35,000 babies who perished because of ineffective, incomplete or absent efforts to prevent the transmission of HIV from their mothers. In total, the economists found this was at least 3.8 million years of life, lost.

On a global scale, a recent study has also quantified the cost of inaction. A new investment framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for the prevention of HIV transmission.  The framework differentiates between (i) basic programme activities that aim to directly reduce HIV transmission, morbidity, and mortality; (ii) activities that are necessary to support the effectiveness and efficiency of these programmes (critical enablers); and (iii) investments in other sectors that can have a positive effect on HIV outcomes (synergies with development sectors). Human rights, tolerance and social inclusion are core principles at the heart of creating such an enabling environment. Scaling up and implementing   the new investment framework, would avert 12.2 million new HIV infections and 7.4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches.

The significance of human rights in the response to HIV has been integral from the very beginning. Due to the link between HIV and traditionally sensitive issues, the epidemic has brought into the open differing values and attitudes related to human sexuality and behaviour. As the spotlight shines away from HIV and specific sources of funding are opened up to incorporate other diseases and health systems strengthening, there is a risk that addressing these rights could falter. With an ever-increasing focus on numbers and scales (which are both important) it is imperative that rights – which are often difficult to quantify – are not jeopardized, forgotten, or simply taken for granted.

For IPPF, putting rights into action by upholding the sexual rights of all and addressing HIV-related stigma are key priorities for our work. Practical measures such as ensuring that our workplace is a stigma-free environment and providing stigma-free services in all of our clinics, go a long way in maintaining a rights-based approach in everything we do.

XXXX

Integrating services to increase men’s uptake of services

By Joelle Mak, Research Fellow (London School of Hygiene and Tropical Medicine, United Kingdom)

It is well documented that men’s use of health services in general, and sexual and reproductive health (SRH) services in particular, is much lower compared to women’s. Despite recognizing the need for male involvement in SRH, men are still engaged predominantly to improve women’s health rather than their own health and results in very little increase in men’s uptake of SRH services [3,4].

One approach that may work better is to integrate different health services. Integration of services allows clients to receive more services in a single visit. Variations of integration models mean that some services are provided by the same health care worker, or in the same consulting room or at the same facility. In general, integration of services is expected to produce benefits for both clients and service providers through improvements in the quality, uptake and efficiency of services [5,6].

Reviews synthesizing the evidence-base of SRH and HIV service integration identified studies primarily from low-income settings and found largely positive results across various outcome indicators including: increases in uptake of HIV testing, reduction in STI incidence, increases in condom use and improvements in quality of care [7-10], although a lack of vigorous evaluation and analysis that accounts for confounders reduces the possibility to draw firm conclusions. Many evaluations focus on female-orientated facilities or departments, such as family planning, ante or post-natal care, or maternal and child care which have little relevance for men. A consistent finding in different settings was that of substantial missed opportunities by service providers to address other SRH issues when clients present to clinics.

As part of the Integra Initiative (www.integrainitiative.org), different models of service delivery for integrated SRH and HIV services are being evaluated. Two rounds of cross-sectional household surveys have been conducted in Kenya and Swaziland. These will be analyzed to explore changes in service uptake among men and women as well as changes in the levels of demand for integrated services. It is anticipated that these findings will contribute to our limited knowledge about whether integrated services can improve men’s and women’s uptake of SRH services.

The potential to enhance male involvement in HIV services - an example from Swaziland

By Joshua Kikuvi, Fieldwork Coordinator, Swaziland (Integra Initiative)

At one of the Integra Initiative sites in Swaziland (King Sobhuza II Public Health Unit), there exists the potential of increasing men’s access to HIV services in a high HIV prevalence setting. The facility is located on the outskirts of an urban industrial zone, and offers both maternal and child health (MCH) services as well as dental, STI and dermatological services. All clients presenting themselves for any of these services are asked to state their HIV status (if known). Regardless of their status, basic HIV and STI counselling is offered to all clients before referral to the ART department for more comprehensive counselling (and testing, if the client consents).

Although the facility caters predominantly to women and children, there is a huge potential to use these services to create linkages that strengthen integration of HIV services with other curative and preventive services. These can be creatively tailored to promote male involvement in say, family planning and couples testing in such service packages as antenatal care, prevention of mother to child transmission and antiretroviral treatment, so that when women use these services, they also encourage their partners to seek healthcare. These baby steps towards integration of HIV and other services could improve men’s access to sexual reproductive health and HIV services.

References listed in the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

Perceptions of positive parenting

By Jon Hopkins, HIV Officer (IPPF Central Office)

“If I was an HIV negative father, my worries on my own self or on my life and my medicines would have been less. It can happen with any disease, but the stigma attached with HIV deepens the impact and stresses you out. The worry for the future of your children increases multi-fold. It increases one’s responsibilities multi-fold too” Father living with HIV, India 

In 2011, IPPF supported qualitative research in nine countries to document the perspectives and experiences of young people living with HIV accessing standalone or integrated sexual and reproductive health (SRH) and HIV services. Young people living with HIV were interviewed in each country including young men and women under the age of 30 some of whom were men who have sex with men (MSM), sex workers, transgender people and migrant workers.

Further analysis has been done on the results of the survey in Sudan, Mexico and India. Interesting gender differences can be seen in the perceptions of parenthood among young people living with HIV, with a greater concern that HIV status affected parenting choices more for men than women. In all three countries, a majority of respondents felt that being HIV-positive affected a man’s role as a father. The reasons given were that men had a greater sense of responsibility towards their children as their primary role was providing social and financial security and this was affected by being HIV-positive (see figure 1).

The importance of male involvement can be clearly seen in these findings. Young men and young women living with HIV see the importance of male involvement when considering their own parenting choices. This shows that attention, support and services need to focus not only on the sexual and reproductive health and choices of young women, but also on men and their dreams and desires of fatherhood. 

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

Masculinity as a barrier to SRH and HIV services

By Hayley Thomson, Research and Policy Officer (Sonke Gender Justice Network, South Africa)

As HIV testing and treatment services become more widely available across the world, it is becoming apparent that fewer men than women are accessing them. For example, in South Africa, according to 2010-2011 data, men represented only 30 per cent of those who tested during a national, and widely publicized, HIV counselling and testing campaign. Despite this, very few efforts are made to specifically target men to increase their uptake of testing and treatment services. Some policymakers and service providers may feel that the only barrier to men accessing services is men themselves, and that it is more important to focus energy on providing services to women. While it is obviously necessary to ensure services are available to women, it is unhelpful to assume that there is nothing that can be done to encourage men to access testing and treatment services. We should also not overlook the fact that men’s access to HIV and SRH services benefits women. 

Men are shown from a young age that clinics and hospitals are female spaces – staffed by women and attended by women. From the onset of menstruation women are encouraged to prioritize their health, attend annual check-ups, go for pap smears, and so on. It is acceptable for girls and women to discuss such female health issues with their mothers and other female relatives and friends.  What do we do to encourage men and boys to prioritize their health?

To be considered a man, men are also taught from a young age that they need to be strong and in control. As South African President Jacob Zuma recently expressed in an interview when discussing his childhood, "You could not afford to be a coward or they would tell you that you have to cook like a girl, instead of eating the food that is cooked by the girls". Any behaviour that does not conform to this hegemonic notion of masculinity runs the risk of being labelled as unmanly, feminine, or even ‘gay’. Within our social hierarchy men have more power than women, but heterosexual men have more power than homosexual men, therefore in order to be accepted as a ‘real’ man, boys are conditioned to realize that any behaviour that could elicit the label of being ‘gay’ should be avoided. Going for medical check-ups, getting tested or seeking treatment, just doesn’t fit in with this masculine ideal – it seems weak, it involves asking for help, making oneself vulnerable, and therefore could be viewed as womanly. It is clear that men’s uptake of HIV and SRH services are a far more complex issue than a question of individual choice.

There is much that needs to, and can, be done to enable and encourage men to access SRH and HIV services. Interventions focussing on these issues have been shown to effectively increase men’s support for their partner’s SRH and improve the health of men, women and children. Sonke Gender Justice Network, along with their partners and other CSOs, worked hard to ensure that South Africa’s National Strategic Plan on HIV, STIs and TB 2012-2016 acknowledged the need to address men’s health-seeking behaviour and masculine gender norms [Available here]. Sonke, along with their MenEngage partners, also conduct policy advocacy work to address this issue throughout the region.

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

HIV Update: Engaging men & boys

By Kevin Osborne (IPPF)

Men have their own specific sexual and reproductive health needs, and these needs are as diverse as men are. Addressing gender inequities in health, promoting sexual and reproductive health and rights, and preventing HIV and gender-based violence is not possible without efforts to directly engage all men and boys.

HIV has highlighted that ‘getting to zero’ is not possible without reaching and involving men and boys in HIV and sexual and reproductive health (SRH) programmes. Men are often poorly served by existing SRH and HIV services and are reluctant to use them, which has direct implications for their well-being and that of their partners and children. Some men feel that they must live up to gender stereotypes by proving their masculinity, which can contribute to an unwillingness to seek help, information or treatment.

Service providers have often focused on reaching women and girls, and clinics and services are often perceived as ‘female-only’ spaces. It is important to develop services that meet men’s specific SRH needs and that are more appealing and accessible to them. Encouraging men to attend as partners and integrating services are some ways to achieve this.

It is vital that all service providers have a good understanding of the SRH issues of different men, as not all men are the same! Younger men, older men, men living with HIV, men who have sex with men, married men, and others, all have additional or slightly different SRH needs. A wide range of SRH-related services should be offered to address issues from HIV and other sexually transmitted infections - to positive prevention, non-communicable conditions (such as male-specific cancers), sexual dysfunctions, family planning, and parenting choices. Service providers should also be able to refer clients to related services, such as harm reduction, mental health and/or other social services.

Men and boys are already changing their attitudes and practices towards sex, relationships, their own health, and their dreams and desires of fatherhood. Men can be fathers, brothers, partners, and friends. For all men we need to ensure our efforts continue to value, support and better serve them in all of these different roles.

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

AIDS 2012: Sexual rights are human rights

By Tewodros Melesse (Director-General, IPPF)

A mysterious ‘slimming’ disease appeared while I was doing community-based reproductive health work in Africa. Nobody knew what it was or where it came from. Some people even wondered if it was the food. People thought that those who were affected were cursed. Of course this disease is now what we know as AIDS. My passion for this issue still comes from seeing how people reacted to the disease all those years ago – and witnessing the fear associated with the virus. But we must not forget that this is very much a disease that affects an individual, and everyone has their own story. 

After all these years, HIV is still a challenging public health issue. Why is this different to the challenges of other health issues like cancer? In essence it’s because HIV, like other STIs, is related to sexuality. With HIV, your sexuality often becomes public. The stigma and discrimination towards people living with HIV goes beyond being infected with a virus. Society makes judgements such as a person infected with HIV must be promiscuous or assumed to be homosexual. 

As HIV is mostly transmitted sexually, IPPF should strive for a comprehensive approach connected to sexuality. This includes providing age-appropriate comprehensive sexuality education, as knowledge and awareness are still key to prevention. Clinics, too, need to provide information and give advice as well as services. 

We need to recognize that HIV is here. HIV needs to be normalized, as it is a part of our society. This can be done through education, cross-cutting services and mainstream activities. 

We also need to keep up the momentum, although no longer seen as an immediate ‘death threat’ because of the greater access to life saving treatment (ARVs), society and politicians still need to respond. HIV is still a tragedy. From history, we have witnessed diseases that have almost disappeared, yet have come back, with greater strength. Is this because people become too complacent? ARVs have been a great advancement, but we must continue our collective prevention efforts in a comprehensive, integrated way, if we are to create a world with ‘zero new HIV infections, zero discrimination, and zero AIDS-related deaths’. 

Download the AIDS 2012 issue of the IPPF HIV Update newsletter:http://www.ippf.org/resources/publications/HIV-Update-newsletter

AIDS 2012: Key message 04

Defend social justice as a key part of the sexual rights agenda 

During the last half-century, many international declarations have proclaimed health care to be a fundamental human right. Yet, a human rights approach to health and HIV is still a long way off. The very principles of human rights, including bodily integrity, informed consent and freedom from coercion, should guide policy development and practice. Addressing risk and vulnerability to ill-health also requires spotlighting the inequalities – social, economic, and political – that drive the epidemic. For AIDS to be truly over, efforts need to be refocused on both actively promoting and vigorously defending human rights, equality and social justice. 

1. Stand up to HIV-related stigma 

Stigma attaches itself not only to individuals but also to specific social contexts, and can be linked to HIV status, sexual orientation, gender, race and/or religion. HIV-related stigma continues to hinder the uptake of essential prevention, treatment and care services. Stigma often reinforces power inequalities between providers and clients, contributes towards social marginalization, and is one of the most pervasive structural drivers of vulnerability to HIV. 

IPPF established IPPF+ in 2008 as part of our HIV Workplace Policy to connect staff and volunteers living with HIV across the Federation, and ensure supportive and stigma-free work environments. 

2. Neutralize gender inequalities 

Gender dynamics can both cause and counteract the structural drivers for HIV and the power inequalities in which HIV transmission thrives. Globally, women and girls make up more than half of all people living with HIV. Increasing recognition is now given to the different rights-based family planning and sexual health needs of men and boys (including men who have sex with men), as well as recognizing the crucial role they play as partners. Transgender people are often disproportionately affected by HIV and other sexually transmitted infections (STIs) and should be part of the global conversation on issues related to the gender dimensions of the epidemic. 

IPPF implements projects that support empowerment for women and girls and safeguards family planning choices for all men and women, regardless of HIV status, age or sexual orientation. We provide services to men and boys in their own right, to protect their sexual health and rights, and also engage men as partners. 

3. Catalyze supportive livelihoods for all 

Poverty is a root cause of ill-health leading to a lack of access to the means to sustain life and services needed to maintain good health. Ensuring people - especially young women and girls - are economically empowered and have livelihoods that allow choice, dignity and the means to live a fulfilling life are key priorities for action. 

IPPF purposefully facilitates and links income generating opportunities for young women and girls and their families in economically marginalized communities and invests in capacity development and peer-counselling opportunities for people living with HIV as part of our SRH response.

Download the AIDS 2012 issue of the IPPF HIV Update newsletter:http://www.ippf.org/resources/publications/HIV-Update-newsletter

AIDS 2012: Key message 03

Strengthen the integration between SRH and HIV services 

The importance of linking SRH and HIV is widely recognized. The majority of HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding. The risk of HIV transmission and acquisition can be further increased due to the presence of certain STIs. In addition, sexual and reproductive ill-health and HIV share root causes, including poverty, limited access to appropriate information, gender inequality, cultural norms and social marginalization of the most vulnerable populations. The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to SRH and HIV prevention, treatment, care and support. Linkages between core HIV services and core SRH services in national programmes are thought to generate important public health benefits. Yet, integration of SRH services into HIV services and vice versa is still often provided on an adhoc basis. In addition, perspectives on linkages need to consider the structural and social determinants affecting both HIV and SRH. 

1. Ensure SRH and HIV services are integrated for all clients regardless of HIV status, age, gender, sexual orientation or social-economic status 

Integrated SRH and HIV services increase access to and uptake of key services, especially among poor, marginalized, socially-excluded and vulnerable populations, such as women and girls, people living with HIV and key populations, including men who have sex with men, sex workers, transgender people and people who use drugs. 

91% of IPPF Member Associations currently have strategies to reach people particularly vulnerable to HIV such as women and girls, key populations and people living with HIV.

2. Position efforts to eliminate mother to child transmission of HIV within a broader framework of maternal, child and neonatal health 

A bold new commitment has emerged through a ‘Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive’ which aims to reduce the number of new HIV infections among children by 90% and reduce the number of AIDS-related maternal deaths by 50%. 

77% of IPPF Member Associations that provide services are currently providing services to prevent mother-to-child transmission of HIV. 

3. Strengthen data collection systems to measure integrated service delivery 

There is no “blueprint” to integration. An appropriate level and type of integration depends on a variety of factors including the nature of the HIV epidemic and the size and scope of existing services. Clear operations research and systems for routine data collection are needed in order to plan for and support the scaling up of optimal integrated SRH and HIV services. 

IPPF supports the development of indicators on SRH and HIV linkages and promotes the findings of the Integra Initiative research on delivering integrated services in high and medium HIV prevalence settings.

Download the AIDS 2012 issue of the IPPF HIV Update newsletter:http://www.ippf.org/resources/publications/HIV-Update-newsletter

AIDS 2012: Key message 02

Create an enabling HIV policy and legal environment 

The law is a critical element of our response to HIV and public health. It can narrow the divide between vulnerability and resilience; between access and uptake; between rhetoric and action. But in many countries, punitive laws and policies continue to hinder access to comprehensive SRH and HIV information and services, in particular for those most vulnerable to and affected by HIV. Over sixty countries have laws that specifically criminalize HIV transmission or exposure; over seventy that criminalize same-sex sexual activity; over one-hundred deem sex work to be illegal; and over one-hundred still have laws that do not recognize equal inheritance rights for women. Whether it is understanding the damaging effects of the criminal law, or ensuring that the benefits of SRH-HIV integration are realised, there is a need to overcome this gap between what works and the policy and legal environment. 

1. Repeal punitive discriminatory laws and policies
Stigma and discrimination continue 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. Punitive laws that criminalize key populations and HIV-specific criminal laws weaken HIV prevention efforts, undermine human rights, and foster stigma and discrimination. 

IPPF‘s campaign ‘Criminalize Hate Not HIV’ raises international awareness on how the criminalization of HIV transmission hinders the HIV response. 

2. Advocate for supportive policies that actively link HIV with sexual and reproductive health and rights 

Research shows that the integration of SRH and HIV services provides an effective way to more efficiently use scarce economic and human resources. Yet, this hinges on a ‘tipping point’ at which more investment will be needed to ensure that efficiency gains are made and services not over strained. 

IPPF advocates for national level policies and financing that support the integration of services. Since 2008, IPPF and partners have supported the rollout of the Rapid Assessment Tool for SRH and HIV Linkages in 43 countries. 

3. Act on policies that work

Significant efforts and resources are placed on the development of ‘new’ policies and procedures – while many sound policies are insufficiently acted upon. Male and female condoms are the only dual protection method available for the prevention of HIV, STIs and unintended pregnancies. Yet, the gap between the number of condoms needed and the number of condoms available is enormous. Similarly, addressing the family planning needs of HIV positive women from a rights-based perspective is a critical component of the elimination of mother-to-child transmission strategy that needs to be scaled up. 

IPPF provided over half a billion condoms (511,320,000) between 2009 and 2011. 

Download the AIDS 2012 issue of the IPPF HIV Update newsletter:http://www.ippf.org/resources/publications/HIV-Update-newsletter

AIDS 2012: Key message 01

Develop a renewed vision of political commitment to HIV 

Over the past twenty years political commitment to HIV has been a necessary ingredient of ensuring that the AIDS rhetoric is met with concrete and tangible action. The importance of wide ranging political commitment cannot be under estimated, and the indicators of this commitment have over time spurned much needed AIDS action. New and innovative ways of demonstrating, measuring and showcasing political commitment need to be developed in order to ensure that the hard won HIV gains made over the years do not evaporate. It is critical that a new cadre of political and institutional leadership on HIV is nurtured. A unique combination of bold action to address the structural drivers of the epidemic; sustained and predictable investment and the re-engagement of essential sectors that have as yet – despite well versed words – not addressed HIV are some of the parameters that need to be galvanized.

1. Guarantee predictable and defined financing

Recognizing the long-term benefits accrued from investing in HIV programmes, governments, international donors and the private sector need to re-commit to international funding targets and goals. Financing for HIV should be predictable, defined and ensure the long-term sustainability of the response, including through innovative financing mechanisms. It is essential that funding for HIV is an increasingly balanced mixture of national and other resources, while successful results-driven mechanisms should continue to be a feature of the AIDS landscape. International donors should ensure full funding, for example of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

IPPF supports the work of the GFATM by ensuring that eligible Member Associations are actively engaged in national GFATM processes for stronger linkages between HIV and sexual and reproductive health. 

2. Access = Life 

Access to life-saving medicines is a human right. Global trade and drug licensing processes must enable access to medicines for all. An estimated 10 million people who need treatment do not have access to antiretroviral treatment (ART). In 20 African countries, more than 80 per cent of treatment depends on donor funding. Eight countries already face treatment shortages; while a further 22 countries expect problems in the future. This accounts for more than 60 per cent of people on treatment worldwide.

67% of IPPF Member Associations provide a comprehensive range of HIV services integrated into SRH services, including provision of or referrals to ART. IPPF MAs also promote access to stigma-free health care services for people living with HIV, hard to reach communities, and key populations. 

3. Re-engagement of all key sectors on HIV 

Increasing a global, regional and national response to HIV requires a multi-sectoral strategy with a number of vital sectors (beyond health) providing sustainability and longevity to the demands of the epidemic. For a number of reasons, interest has begun to wane and the HIV response from a number of these sectors is being called into question.

IPPF continues to pioneer, strengthen and expand our response to HIV through an integrated model of service delivery and advocacy on HIV and SRH issues.

Download the AIDS 2012 issue of the IPPF HIV Update newsletter: http://www.ippf.org/resources/publications/HIV-Update-newsletter

HIV Update: The Politics of AIDS

By Kevin Osborne (IPPF)

AIDS is multi-faceted and above all deeply political. Since the epidemic was identified in the early eighties, activism and advocacy has been driven by a complex mix of politics, power, and personalities. Nearly four decades on, the current political commitment to HIV is under question.

On the eve of the XIX International AIDS Conference in Washington, D.C., it is perhaps a good time to reflect on the nature of political commitment to this epidemic: what does it mean? Do we have it? What does it look like? Potentially rewarded for ending its entry restrictions on people living with HIV this is the first time in twenty-two years that the conference has been held in the USA (the 6^th International AIDS Conference was held in San Francisco in 1990). While this is in many ways a victory for sound policy and for the rights of people living with HIV to travel freely, government restrictions on the entry of sex workers and people who use drugs will make it difficult or impossible for those who identify as belonging to these groups to attend this conference.

“Turning the Tide Together” – the unifying theme of the AIDS Conference – highlights the fact that linked policy, activism and sound human-rights based practise should form the backbone of a sustained response. Held at both a time of global austerity and in the backyard of one of the most powerful and influential HIV players in the global response, this conference needs to be an urgent clarion call for renewed political commitment to HIV.

Ahead of this conference that will bring together a unique balance of scientists, activists, programmers and policy makers, it is important for us to reflect on IPPF’s commitment towards addressing some of the current gaps in AIDS response.

IPPF remains committed to ensuring that our specific niche response - linking our work on HIV to broader sexual and reproductive health and rights issues - will remain relevant, realistic and robust. We owe that to ourselves, our stakeholders, and to every client.

Download the AIDS 2012 issue of the IPPF HIV Update newsletter: http://www.ippf.org/resources/publications/HIV-Update-newsletter

Search for a new condom slogan

Have a great idea for a new slogan promoting condom use? If so, you could see it in print on our condom packs around the world!

Since 2005, IPPF Member Associations have distributed an estimated 1 billion condoms worldwide. That's a lot of condoms! To celebrate this acheivement, we are looking for a new, creative slogan to print on our male condom packs.

Use your creativity and literary flare to come up with a new slogan promoting condom use, and you could see your slogan on our new IPPF condom packs. Share your idea with the world on the IPPF Facebook page!

Why condoms?

Male and female condoms are the only dual protection method available for the prevention of unintended pregnancies and sexually transmitted infections, including HIV. When used consistently and correctly, condoms are also one of the most effective methods. Yet this proven strategy seems to have increasingly been de-prioritised in the global and different national agendas. It is time for a stronger condom movement, one which focuses on pleasure and creates demand for both male and female condoms, as well as lubricant.

As a global service provider and leading advocate of sexual and reproductive health and rights for all, IPPF has a key role to play to ensure that every sexually active person has access to good quality condoms, is motivated to use them, and has the knowledge to do so correctly. 

To read more about this effective and proven strategy, read a previous blog post on condoms: http://ippfaids2010.blogspot.co.uk/2010/10/hiv-update-condoms.html

The Global Commission on HIV and the Law: Building Resilient HIV Responses

By Mandeep Dhaliwal (UNDP) and Emilie Pradichit (Global Commission on HIV and the Law)

Law is a critical element of our response to HIV and public health. It can bridge the divide between vulnerability and resilience. Much in the same way that HIV has exposed health and social inequalities; it has magnified weaknesses in the rule of law that the world can no longer afford to ignore.

Legal frameworks can be powerful tools for countries struggling to control their epidemics. The last three decades have given rise to contentious legal debates on HIV-related issues (e.g.: criminalization of HIV transmission, exposure and non-disclosure; legal restrictions on needle and syringe distribution in the US, on methadone in Russia, versus legal comprehensive harm reduction in Australia). The last few years have seen an insurgence of punitive laws and practices related to drug use, HIV transmission and exposure, sex work, and same sex sexual relations. There is also a growing body of evidence on the relationship between HIV and violence against women. There is enough variation in legal responses to HIV around the world to highlight the need to rigorously examine the impact of different legal environments on HIV outcomes. This is why the Global Commission on HIV and the Law (The Commission) was created: to examine the impact of law on HIV responses and to catalyze action at the country level, to create legal environments which protect and promote human rights.

Over the last eighteen months, the Commission, led by the United Nations Development Programme (UNDP) on behalf of the UNAIDS family, has looked at the relationship between legal responses, human rights and HIV and developed actionable, evidence-informed recommendations for effective HIV responses. Based on an analysis of where the law could transform the AIDS response and send HIV epidemics into decline, the Commission has focused on four areas:

1. Laws and practices which criminalize those living with - and most vulnerable to - HIV;
2. Laws and practices which sustain or mitigate violence and discrimination lived by women;
3. Laws and practices which facilitate or impede access to HIV-related treatment; and
4. Issues of law pertaining to children and young people in the context of HIV.

One of the Commission’s key contributions is its evidence on issues of HIV and the law. The Commission has examined public health and legal scholarship, as well as evidence on the impact of legal environments on the lives of people living with and vulnerable to HIV. Perhaps the most compelling evidence came from the Commission’s seven regional dialogues, held from February to September 2011. To inform its deliberations, the Commission received 644 submissions from 140 countries. 40 per cent of the submissions were from Africa and over 70 percent of the submissions described the daily reality of stigma, discrimination, marginalization, verbal and even physical abuse experienced by people living with HIV. 60 percent of the submissions noted human rights violations lived by women, including barriers to sexual and reproductive health and equal inheritance and property rights. 50 per cent of submissions highlighted the negative health and human rights impact of criminal laws. Submissions also highlighted issues such as the negative impact of laws on age of consent which don’t recognise the evolving capacity of the child and prevent young people from accessing HIV and health services and the problems posed by the current intellectual property regime and trends in intellectual property enforcement, such as free trade agreements, which are impeding the scale up of life sustaining treatment.


Building a movement for enabling legal environments

The regional dialogues in Africa, Asia-Pacific, Caribbean, Eastern Europe and Central Asia, High Income Countries, Latin America and the Middle East created policy space for frank, constructive multi-stakeholder dialogue between those who influence, write and enforce laws, and those experience its impact. Through these dialogues, the Commission heard from over 700 people living with HIV, sex workers, men who have sex with men, transgender people, people who use drugs, police and prison officials, ministers of justice and health, public health officials, parliamentarians, judges and religious leaders. The dialogues have been crucial for identifying how the law can advance health and human rights, for example: where police cooperation with community workers has increased condom use and reduced violence and HIV infection among sex workers; where effective legal aid has made notions of justice and equality real for people living with HIV and contributed to better health outcomes; where advocates have creatively used traditional law in progressive ways to promote women’s rights and health; where court and legislative actions have introduced gender-sensitive law on sexual assault and recognized the sexual autonomy of young persons; where governments have provided harm reduction and HIV infection rates among people who use drugs have dropped. The good practice and constituencies mobilized through these dialogues are vital resources for creating legal environments which support effective HIV responses.

Even before the Commission has launched its final report, country level action on improving legal environments is emerging. For instance, Fiji recently chose to not criminalize HIV transmission and lifted HIV-related travel restrictions; in Guyana, a Select Parliamentary Committee chose not to criminalize HIV transmission; the first ever judicial sensitization on HIV and the law took place in the Caribbean; national dialogues on HIV and the law have been held in Papua New Guinea, Belize, Panama and Nepal; and in Moldova and Kyrgyzstan, patent laws are being reviewed. At the Asia Pacific High-Level Intergovernmental Meeting on HIV which took place in February 2012, several governments announced their intentions to review and reform punitive legal approaches towards key populations. The Commission’s work has also influenced the report of the Commonwealth Eminent Persons’ Group which includes a recommendation for the removal of punitive laws blocking effective HIV responses.

The Commission’s final report will be launched at a global dialogue in July 2012. Undoubtedly, the report will emphasize the necessity for an honest appraisal of prejudice, fear and false morality which have confounded the AIDS response for decades. The Commission’s messages and recommendations will form the basis of the next generation of HIV responses, where governments and citizens approach HIV as an issue of health, development and social justice.

All research and submissions will be available on the Commission website when the final report is launched. All Regional Dialogue materials are already available on the Commission’s website. For more information, visit www.hivlawcommission.org.

Article from the March issue of the IPPF HIV Update newsletter: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+29.htm