 |
|
|
|
Join
SEA-AIDS
eForum!
SEA-AIDS
eCorrespondent
Special issue - covering 7th ICAAP |
|
FEATURES
HIV/AIDS in Asia Pacific – 7th ICAAP
Care and Treatment
'3 by 5'
ARV Access
Comprehensive Care
Political, Economic and Social Contexts
Civil Society
Multisectoral responses
GIPA
Culture, Gender and Sexuality
Women
Sex Work
MSM
Prevention and Epidemiology
Harm Reduction
Youth
Media
7th ICAAP KC On-site Reports
7th ICAAP Press Releases & Statement |
Editor's
note: |
|
This special edition of the
eCorrespondent features summary analyses
of the on-site conference coverage from
the Seventh International Congress on
AIDS in Asia and the Pacific (7th ICAAP),
which took place from 1st to 5th July
this year in Kobe, Japan. Health &
Development Networks (HDN) and its Key
Correspondent (KC) Team would like to
thank the 7th ICAAP Organising Committee
for their support in facilitating our
daily on-site conference coverage –
ICAAP News and HDN KC Reports
– which have been distributed widely to
help reach and hopefully benefit more
people.
A complete listing of the KCs who
contributed and links to all the KC
reports from the 7th ICAAP can be found
at the end of this edition. Please
forward this special edition of the
eCorrespondent to any colleagues and
friends who may be interested in this
important regional conference.
|
|
Upcoming events
|
|
Living 2005-08-13 The LIVING 2005
Conference,
originally scheduled for 9th to 13th
October 2005 in Lima, Peru, will now
take place from 12th to 16th March 2006…more
3rd
HIV/AIDS Programme Management workshop
is moved to September 2005
As a result of current political crisis
in the
Philippines, please be informed that the
3rd HIV/AIDS Program Management
workshop: Delivering Results has been
moved to 12th to 23rd September 2005. We
apologize for any inconvenience it might
have caused you as this is beyond our
control…more
National Bioethics Conference of Indian
Journal of Medical Ethics
The theme
of this first national conference, which
will take place in Mumbai, India from
25th to 27th November, will cover the
ethical challenges in health care:
global context, Indian reality…more |
|
In brief... |
|
HIV/AIDS in Asia Pacific – 7th ICAAP |
|
During the 7th ICAAP opening ceremony,
Dennis Altman, President of the AIDS
Society of Asia and Pacific (ASAP)
called for a "more coordinated and
integrated approach to building regional
partnerships between major
stakeholders," to create a "stronger
voice of civil society." Altman believes
by focusing on trying to engage
governments, businesses and
international agencies, we have
overlooked the "forgotten lessons of
involving the most affected groups in
policy-making." By building strong
region-wide associations and networks,
civil society can enhance governmental
responses, while holding them
accountable for any lack of commitment.
The closing ceremony reflected the sense
of apathy felt by some participants
during the conference. Instead of
building on the theme presented by
Altman during the opening ceremony,
Prasada Rao, Regional Director of the
UNAIDS support team for Asia-Pacific
reiterated that the region is running
out of time. He stated, "The most
important lesson may be that business as
usual is no longer an option." In many
ways, however, the 7th ICAAP was an
exercise in business as usual. There
were no major announcements, except the
World Health Organization's adding
methadone and buprenorphine to its
'essential medicines list', and no sense
of urgency.
One of the biggest disappointments of
the 7th ICCAP was the Japanese
government's failure to use its
international prestige and influence to
direct the world's attention to AIDS in
Asia during the conference. According to
Rao, "governments are probably more
aware now [of HIV/AIDS] than anytime in
the past, but merely being aware is not
enough." |
The day prior to the Kobe conference,
Japanese Prime Minister Koizumi
announced Japan will contribute an
additional US $500 million to the Global
Fund to Fight AIDS, Tuberculosis and
Malaria and called on other G8 members
to follow suit, while failing to mention
that there are now over 10,000 Japanese
living with HIV/AIDS, and his country
was hosting the 7th ICAAP. "Denial has
characterized Japan's responses to
HIV/AIDS from the beginning, I still
heard the same denial in the opening
ceremony," said Cheryl Overs of the
International HIV/AIDS Alliance.
UNAIDS believes present HIV/AIDS
responses in Asia have reached a
'tipping point.' Currently, there are
around 8.2 million people living with
HIV/AIDS in Asia, concentrated among
'vulnerable populations' - including sex
workers and their clients, injecting
drug users, young people and mobile
populations. The UNAIDS regional report
published immediately prior to the
conference identified several programme
barriers and constraints, institutional
obstacles, and recommendations for
governments, national HIV/AIDS
programmes and civil society.
Intervention programmes have to regain
their focus and concentrate on
vulnerable populations. Rao continued,
"Interventions have to cover at least
60-70% of the vulnerable groups."
As well as the UNAIDS report: A Scaled
but response to AIDS in Asia and the
Pacific (http://www.unaids.org),
the conference also saw the release of
three parallel reports: Monitoring the
AIDS Pandemic's (MAP) Drug Injection and
HIV/AIDS in Asia; Sex work and HIV/AIDS
in Asia; and Male-Male Sex and HIV/AIDS
in Asia (http://www.mapnetwork.org)
which highlight some of the latest
epidemiological and behavioral
surveillance data on the region.
|
|
Care and Treatment |
|
'3 by 5' |
ARV Access |
|
Prior to the 7th ICCAP, the WHO released
the report "Progress on the Global
Access to HIV Antiretroviral Therapy."
The report, announced that the 3 by 5
programme will most likely fail to meet
its goal of providing antiretroviral
(ARV) drugs to 3 million people in
resource-poor countries by the end of
2005. However, there are reasons to be
hopeful. The number of people in Asia on
ARVs increased from 55,000 to 155,000 in
the past 12 months, and globally, US $27
billion is available or pledged for
HIV/AIDS the period 2005-2007.
Jack Chow, Assistant Director General of
WHO, stated, "If we build this chain of
concerted action: resources such as
finances, connected to expertise with
strategy, in turn connected to our
implementing partners and communities
living with the virus, it is translated
into clear results in terms of the
numbers of people on treatment." He
continued, "Clearly, we have a long way
to go."
The report went on to list numerous
challenges in scaling up ARV
availability. For example, ARV scale-up
has been slowest in many of those
countries where HIV is concentrated in
the most vulnerable and marginalized
groups, such as injecting drug users
IDUs and sex workers. Many of the
successful pilot programs that reach
these groups are run by non-governmental
organisations and faith-based groups.
Jim Kim, Director of WHO's HIV/AIDS
Department stated, "The key now is to
move from the very many pilot projects
that are out there into integrated
programmes that are controlled at a
central level by the national AIDS
authorities."
Another challenge put forward by Dr A.M.
Zakir Hussian, Managing Director of
Partners in Health and Development (PDH)
is that poor and developing countries do
not have the health care infrastructure
for ARV scale-up. At King George's
Medical University, a key centre for
managing a free ARV roll-out programme
in Uttar Pradesh (India), only one staff
member is familiar with ARV treatment
protocols, he claimed. |
Inadequate ARV coverage indicates that a
comprehensive package of other
readily-available treatment and care
options should be urgently provided to
keep people with HIV alive. Dr G.E.
Ravindran, Country Director for the
Catholic Medical Mission Board (CMMB) in
India says that 90 percent of his
patients in need of ARVs cannot access
them. However, Ravindran says, "with
good nutrition and prompt treatment of
infections, especially common
HIV-related infections, with treatments
that are already available," many of his
patients survive.
Dr Zakir Hussain asked, "If [3by5]
hasn't met the goals on time then should
we keep our eyes shut or rather take
lessons form this so that something can
be done fast enough to keep people who
need ARVs alive?"
Along with the rapid scale-up of ARV
underway in Asia-Pacific, will come the
"inevitable growth of drug resistance
and the need for second-line ARV
therapy." Dr Quraishi, Director-General
for the National AIDS Control
Organization said. Currently there are
sufficient first-line ARVs, he observed
but "the problem will come when we need
second-line drugs…I'm personally very
worried about the second-line drugs."
Much of the developing world has
depended on India to provide low-cost,
generic first-line ARVs. However,
India's revised patent law "will end the
largely unrestricted copying of ARV's,"
including second-line ARVs. The patent
law was revised in order to meet the
condition for India's entry into the
World Trade Organization.
Apparently, China and Brazil are capable
of filling the production gap left by
India. Surie Moon, who works for
Medecins Sans Frontiers Access to
Essential Medicines Programme in
Beijing, believes there is not doubt
China can fill this role. "Chinese
producers are already making the raw
materials for a wide array of
second-line drugs," she said.
China's Vice Health Minister, Wang
Longde, reaffirmed, "China made
commitments when it joined the WTO, and
China will keep its word" not to break
the patents on ARV production. He added,
"China is currently in negotiations with
pharmaceutical companies about
second-line drugs."
Treatment advocates view the
treatment-related intellectual property
(TRIPS) contingency, a WTO accord which
allows countries to supersede existing
drug patients in the name of pubic
health, as a "key tool" to lower the
cost and make ARVs universally
accessible. Thomas Cai, a Chinese PLWHA
activist warned, "If China doesn't
produce second-line drugs it could be
the same as 5 years ago, when I started
my first treatment [in China]. We had to
pay over US $1,000 a month." |
|
Comprehensive Care |
|
Inadequate ARV coverage indicates that a
comprehensive package of other
readily-available treatment and care
options should be urgently provided to
keep people with HIV alive. Dr G.E.
Ravindran, Country Director for the
Catholic Medical Mission Board (CMMB) in
India says that 90 percent of his
patients in need of ARVs cannot access
them. However, Ravindran says, "with
good nutrition and prompt treatment of
infections, especially common
HIV-related infections, with treatments
that are already available," many of his
patients survive.
Dr Zakir Hussain asked, "If [3by5]
hasn't met the goals on time then should
we keep our eyes shut or rather take
lessons form this so that something can
be done fast enough to keep people who
need ARVs alive?" |
|
Political, Economic and Social Contexts |
|
Civil Society |
Multisectoral responses |
|
Rather than focusing on the discouraging
announcement that WHO's '3 by 5'
programme will not achieve its targets
by the end of 2005, ICAAP participants
instead promoted discussion on how to
strengthen efforts to stop the spread of
HIV in Asia-Pacific. Out of this
discussion came two contrasting points
of view.
The first stresses the importance of
top-level political commitments. Nimal
Siripala De Silva, Minister of Health in
Sri Lanka stated, "Success stories
relating to the fight against HIV/AIDS
clearly demonstrate the role played by
the political leadership in the
implementation of successful prevention
programmes." |
A multisectoral response to HIV/AIDS is
seen as a crucial ingredient for a
successful national HIV/AIDS response,
but one sector often overlooked is the
military. During the satellite session –
HIV/AIDS and Uniformed Services –
several representatives from
Asia/Pacific army and police units,
along with the US Army, gave
presentations on the role of HIV/AIDS
prevention in the their militaries.
According to UNAIDS, "The implications
for national security are clear: a
military force that is sick and dying
will not be as effective – or as
disciplined – as one that is healthy". |
|
On the other hand, Periasamy Kousalya,
coordinator of the Positive Women's
Network of South India called for more
grassroots initiatives. She identified
the lack of treatment information and
the denial of health care services as
the key barriers to effective treatment.
She believes that building local
bottom-up organizations and a "critical
mass of community leaders" is the most
effective way to create change.
In the context of the "Three Ones,"
civil society involvement in national
and regional AIDS responses has been
minimal at best. According to Balwant
Singh, Director of the Indian-based
HIV/AIDS Alliance, "Overall, civil
society's involvement in the
development of the Three Ones has been
extremely limited. Civil Society has the
responsibility to work more effectively
together, and other actors need to learn
how to work well with [civil] society."
Dr Bijan Nassirmanesh, director of the
Iranian NGO Persepolis,
went further to say, "This is the time
for some big organizations…to come
forward and say 'we failed' and ask for
help from civil society….It seems like
honesty, not a very technical point."
Government's lack of trust and control
of funding are barriers to full
participation of civil society groups.
Meng Lin, a Chinese PLWHA, claimed,
"There are few opportunities for us to
express our ideas and act on them. There
are people and organizations that
support us, but they also are
controlling and limiting us – we cannot
make our own decisions or control our
own work because they don't trust us."
In a joint statement by civil society
groups attending ICAAP, NGOs called
current treatment and care efforts an
"abysmal failure," and called on
governments in Asia-Pacific to scale-up
care, treatment and prevention efforts.
The statement read, "The current gap in
all kinds of HIV/AIDS prevention,
treatment and care provision in the
region represents a common failure to
meet the key government commitments we
have highlighted." AIDS Campaign Watch
(ACW) Campaign Manager Abigail Erikson,
said, "we are trying to form a critical
mass of organizations that are asking
these questions…we need voices, we need
to have a groundswell from the bottom."
|
GIPA
|
|
After more than a decade when
governments pleaded to make GIPA
(greater involvement of people living
with HIV/AIDS [PLWHA]) a fundamental
principle in their AIDS responses, the
role of PLWHA is still insufficient. An
example was the lack of attendance of
the GIPA session at ICAAP, in which only
50 people attended in a space meant to
accommodate up to 2000 people. While
there was a lot of discussion on large
international organizations and
governments merely using PLWHAs to add
value to their reports, Marcel van
Soest, Executive Director of the World
AIDS Campaign, asserted that NGOs and
PLWHAs need to organize into a unified
and coordinated voice. "Such leadership
and organization are rare, however, and
NGO networks often deteriorate into
dead-end discussions or bickering."
Paul Toh, from Singapore-based Action
for AIDS and former "GIPA Advisor" for
UNAIDS-Thailand, pointed out another
"key barrier" is the lack of money
coming into the communities. He stated,
"It's a top down approach where money
goes through governments, not directly
to groups…this has to change before GIPA
will work.
|
|
|
|
Culture, Gender and Sexuality |
|
The issue of gendered migration, and
migrant women's health and social rights
is fairly new on the 'globalization'
agenda. While safeguarding the migrants'
right and health in Asia has been on the
agenda of the past few ICAAPs, female
migrants' rights have received little or
no attention. Sharuna Verghis stated,
"Bereft of citizenship, nationality and
livelihoods, migrant women are also the
ones who have the least right, and no
platform to ask for their rights."
According to Marina Mahathir, President
of the Malaysian AIDS Council, women
living with HIV are often "invisible to
the general population." She continued,
"women are discriminated against and the
ones who are young and unmarried have to
bear the double burden of this
discrimination…women cannot even talk
about sex or sexuality." Mahathir
believes Islam offers hope for women in
Asia -Pacific. "Islam offers
flexibility. For example, there is no
outright ban on contraception as in the
Catholic Church. Even harm reduction is
acceptable in certain 'emergency'
situations," she explained.
The Female Health Foundation and the
United Nations Population Fund
(UNFPA)hosted a meeting to discuss how
to overcome resistance to the use of
female condoms in Asia-Pacific. Like
harm reduction, female condoms work.
Patty Weisenfeld of the Female Health
Foundation stated, "Female condoms are
relatively new in the region and it will
take time to build both demand and
political commitment to ensure
sustainable and affordable supplies are
widely available." |
During an interview with Cheryl Overs,
of the International AIDS Alliance, she
stated there are three changes in the
nature of sex work that should be noted:
1) is the shift from formal to informal
sex work; 2) sex workers have a high
attrition rate; and 3) is the use of new
technologies, such as the internet and
other communication devices. Overs
believes these developing
characteristics mean AIDS prevention
activities should continue to target sex
workers, scale-up targeting male clients
and change the structure of sex work
that will decrease the demand for unsafe
sex.
Mr Andrew Hunter and Ms Maria from the
Asia Pacific Network of Sex Workers
believe conference organizers and
participants were negligent in ignoring
the "scientific evidence about what
works in HIV prevention with sex
workers" and failing to address issues
facing today's sex workers.
|
|
MSM |
|
Over the course of the conference there
were numerous satellite sessions,
discussions sessions and numerous
research papers and posters displays
focusing on the cultural, political and
legal challenges to HIV/AIDS prevention
that men who have sex with men (MSMs)
face in individual countries. Missing
from most of these discussions was the
issue of gay leadership and region-wide
coordination on various issues such as
the sexual health needs of HIV-positive
men, the spread of HIV across borders as
Asia's gay population become more
mobile, facilitating comprehensive,
regional prevention and research
projects, and coordinating a unified,
region-wide responses to current urgent
situations such as the targeted assault
on Nepalese gay men by Nepal's police
forces. Close to one-tenth of the 7th
ICAAP participants were reportedly MSM.
Nevertheless, the UNAIDS report: A
Scaled but response to AIDS in Asia and
the Pacific failed to identity MSM as an
especially vulnerable population.
|
|
Prevention and Epidemiology |
|
With a large number of symposia and
poster presentations, some participants
see the 7th ICAAP as giant step forward
in harm reduction in Asia. Government
officials now promote condom use,
prevention of sexually transmitted
infections (STIs), needle exchange and
methadone treatment without "having to
wipe away sweat from their foreheads."
Government responses from Pakistan and
Iran have been credited with this new
general attitude. For example, Iran
recently amended their anti-narcotics
law to refer to drug users as patients
and not criminals.
On the eve of the ICAAP, WHO announced
that is had finally added methadone and
buprenorphine to its list of essential
medicines. Dr. Peter Piot, Executive
Director of UNAIDS stated, "This is
important. Nations who want to provide
methadone in their programmes will now
have easier access."
Tariq Zafar, of the Asia Harm Reduction
Network (AHRN) believes the current
coverage of harm reduction programmes is
insufficient and urgently needs to be
expanded. He stated, "The time of pilot
programmes is over." To address the
complicated needs of IDUs, Zafar has
been advocating the use of IDUs as a
resource. "We know what doesn't work. So
instead of floundering over and over
again, its time to involve the drug
users and ask them what they need." Dr
Bijian Nassirmanesh, Director of
Persepolis and an Executive member of
AHRN said, "Scaling up means picking up
to the same pace that the epidemic is
taking."
The reports released by Monitoring AIDS
Epidemic (MAP) also showed that IDUs are
not confined to a small social group.
Rather, the MAP reports "presented data
and graphs to show that men who have sex
with men also buy sex from women, women
sex workers inject drugs and injecting
drug users often by sex from women."
|
Studies show factors including
traditional gender roles, poverty,
migration, human trafficking, war and
civil disturbances contribute to
increasing of young contracting HIV.
During a satellite session, co-sponsored
by the United Nations Children's Fund
(UNICEF), Family Health International
(FHI) and Save the Children (UK), on
children affected or orphaned by
HIV/AIDS in Asia' it was reported the
number of children living with HIV/AIDS
is approximately 120,000, of which
34,000 are in need of ARVs.
It was also shown that the number of
pregnant women needing access to of
mother-to-child HIV prevention (PMCTC)
interventions throughout Asia is about
155,400. Dr Tim Brown (East-West Centre)
stated the main route of HIV
transmission to children is via the male
clients of sex workers who infect their
wives. A strong community involvement is
needed as part of a continuum of care
for children affected or orphaned by
HIV/AIDS.
Regarding young people, hosts of the
award-winning Malaysia TV program '3R'
(Respect, Relax, Respond) also showed
that young people need information
regarding sexual health and safe sex
skills in order to be responsible for
their sexual behavior. |
|
Media |
|
The media has the responsibility to
provide private sector leadership and
the public with accurate HIV/AIDS
prevention information. Yu Sasamoto, CEO
of Music Television (MTV) Japan,
admitted that many opportunities for
private sector leadership and
partnership have been missed in Japan
because so many Japanese still view
HIV/AIDS as 'taboo'. Head of a Japanese
NGO participating in ICAAP stated the
media had not "admitted the fact that
their reporting on the first HIV case in
1998 programmed the public to associate
HIV/AIDS with fear and something
sinful." |
|
7th ICAAP Press Releases & Statement |
7th ICAAP KC On-site Reports |
|
PR: 2,400 Participants from 45 Countries
– Outlook for HIV/AIDS Prevention and
Treatment in Asia and the Pacific
…more
PR: Expanded harm reduction practices
will reduce HIV epidemic and its impact
in the Asia Pacific region
–
Asian governments and other institutions
have been too slow in providing services
to protect people using drugs from HIV
infection, despite evidence stressing
that injecting drug use is one of the
major driving factors behind the
region’s epidemics…more
PR: AIDS drug access increasing in the
Asia and the Pacific, but future care
needs daunting for region's health
systems
–
Recent progress in delivering
antiretroviral (ARV) drugs to people
living with HIV/AIDS in Asia and the
Pacific has been impressive. But the 8.2
million people living with HIV in the
region present a major future care need
that national health systems are not
ready to absorb in the coming years…more
PR:
Six million
HIV infections can be averted in the AP
region in the next five years if
prevention services are rapidly expanded
–
Without immediate and extraordinary
action on AIDS, the Asia Pacific region
will see 12 million new HIV infections
in the next five years. If urgent
measures are adopted, that number can be
cut in half…more
Statement: Civil Society Statement to
National Governments in the Asia Pacific
region–
The following statement presents the
outcome of several meetings involving
civil society organisations that took
place during the 7th International
Conference on AIDS in Asia and the
Pacific, held in Kobe, Japan, 1-5 July,
2005…more
|
The following is a complete listing of
all the KC on-site reports from the 7th
ICAAP conference.
|
|
Special Acknowledgement to the HDN Key
Correspondent (KC) Team |
|
HDN would like to thank the following
Key Correspondents for their hard work
and commitment in preparing the 7th
ICAAP reports.
HDN Key Correspondent Team
-
Aruna Jagath Hewapathirane (Sri
Lanka)
-
Celina D'Costa (India)
-
Edmund Settle (China)
-
Ishdeep Kohli (India)
-
Jamie Uhrig (Thailand)
-
Nenet Ortega (The Philippines)
-
Nipaporn Intong (Thailand)
-
Odilon Couzin (China)
-
Zofeen T. Ebrahim (Pakistan)
To contact the HDN Key Correspondent
Team, please write to:
correspondents@hdnet.org |
© 2004 China AIDS Survey
Monterey, California
|
