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/