HIV as you've never seen it before

Luke Jerram's glass microbiology sculptures. He has a show on at the Smithfield Gallery from the 22nd September to the 3rd October, 10am-6pm, and the launch is the 22nd September 6-8pm.

Hat-tip, once again, to Chris Blattman.

IRIN: UNEP report says HIV/AIDS and climate change should join forces

A new report by the United Nations Environment Programme (UNEP) and UNAIDS, IRIN reports, seeks to join the global activist forces in the fight against climate change and HIV/AIDS. So far, both threats have known separate responses, but climate change may very well have many impacts that could worsen the HIV/AIDS situation in the developing world.

The biggest threat - already present in many parts of the world - is food insecurity caused by more intense and widespread droughts, and other extreme weather events such as flooding.

The authors also speculate that competition for increasingly scarce resources brought on by climate change, such as water and grazing, may heighten the risk of conflict and migration, and deepen gender and social inequities - all factors with the potential to fuel the spread of HIV.

Academic article: Caring for People with HIV: state policies and their dependence on women's unpaid work

Women's unpaid care work is a feature of life in sub-Saharan countries, where nearly 67% of PLWHA live and where 75% of all AIDS deaths occurred in 2007. Women comprise 58% of adult HIV infections and tend to be more adversely affected because of their primary caregiving role.

Increasing reliance on home-based care to supplement an overstretched health system fails to acknowledge the cost on the patient, the carer and the wider family, including financial resources, time resources, and opportunity costs. For women, this means time taken away from paid work, unpaid household chores, and agriculture. For girl children, caregiving is at the expense of school work, leisure activities and important social development activities - including HIV prevention activities. In many cases, particularly when heading a family as a result of being orphaned, many girls cannot go to school at all, renouncing their right to education - affecting their potential income and career choices, and ability to play a role in wider society.

Policies should be developed to recognise these effects and take into consideration the needs of women and girl children carers, including the right to education. An option might be to see care work as a professional career option which would allow girls, women and workers to progress and develop. This would create a pool of trained, qualified professionals who are adequately compensated. Finally, challenging the assumption and strong cultural traditions that mean caring is women's work, not men's, would lay the foundation for a more equal sharing of care responsibilities.

Citation: Makina, A. (2009) Caring for People with HIV: state policies and their dependence on women's unpaid work, in Gender and Development, Vol 17, No. 2, July 2009 pp309-319

Summary by Laura.

IDS Bulletin: how to respond better to AIDS

Reaping the benefits from the free 40 day full access to IDS (see previous post), this post draws your attention to a study by Stuart Gillespie from last year on Poverty, Food security, HIV vulnerability and the impact of AIDS in sub-Saharan Africa. The study concludes that

While the poor are undoubtedly hit harder by the downstream impacts of AIDS, in a variety of ways, their chances of being exposed to HIV in the first place are not necessarily greater than wealthier individuals or households. There is strong evidence that socioeconomic and gender inequalities condition the spread of HIV, while AIDS-related disease and death increases these inequalities – a potentially vicious cycle. [...]
If you are a person living with HIV and you are poor, it will be harder for you to sustainably access antiretroviral therapy; it will be harder to find and pay for treatment for opportunistic infections which (if you are malnourished) will usually be more severe, and it will be harder to ensure any medical treatment is complemented by a diverse and reliable diet. At the household level, poverty will worsen the impacts of other livelihood stresses and shocks, and close down options for effectively responding. At the end of the line, it is women and children who are the most vulnerable.

How to improve the AIDS response?

• pay more attention to the drivers of transmission within different social groups, with special attention to the vulnerabilities of women and children
• enhancing local capacity and improving livelihood strategies will increase the resilience of vulnerable households

AlertNet: Clinton and drugmakers announce cheaper HIV drugs

Reuters reported that

Former U.S. President Bill Clinton and drugmakers Pfizer and Matrix Laboratories Ltd announced a deal on Thursday to lower the cost of treatments for patients with drug-resistant forms of HIV/AIDS.
Second-line antiretroviral therapies and a drug used to treat tuberculosis for those with drug-resistant HIV/AIDS will be made available at a reduced cost and in more convenient regimens, saving as many as hundreds of thousands of lives in the developing world, Clinton said.

UNAIDS: Global economic crisis expected to disrupt HIV prevention and treatment programmes

A new report from UNAIDS and the World Bank, released on July, 6th, indicates that in 22 countries in Africa, Europe and Central Asia, the Caribbean, and Asia and Pacific, HIV prevention and treatment programmes may face disruption this year.

Reports from agency staff in 71 countries indicate that eight countries are already facing shortages of antiretroviral drugs or other disruptions. Together, these countries are home to more than 60% of people worldwide receiving AIDS treatment.

However, there is a lot of uncertainty regarding the extent to which these programmes will be affected, as the effects of the crisis are still to impact most of the governments’ budgets that support AIDS treatment. In particular North Africa, Latin America, the Middle East and most of Asia appear to be less vulnerable to the economic crisis’ impact.

According to the report,

much is at risk: increased mortality and morbidity, unplanned interruptions or
curtailed access to treatment, with increased risk of HIV transmission, higher
future financial costs, increased burden on health systems and reversal of
economic and social development gains.

The report recommends the following actions:

Use existing funding better―especially in countries facing cuts in their national AIDS response budgets, governments and aid agencies should provide technical support to reallocate resources from low- to high-impact prevention and treatment programmes. All countries should seek ways to make programmes more efficient and more cost-effective.

Address urgent funding gaps―countries with a high reliance on external funding for HIV should strengthen collaboration between national authorities and major international funders to identify and address impending cash-flow interruptions and arrange bridge financing as necessary to avoid cash-flow interruptions.

Monitor risks of programme interruption―a simple warning system could be established to anticipate and minimize treatment interruptions. A key component of such a system would be to carry out regular surveys to identify “vulnerable” countries and provide tailor-made financial and policy assistance.

Plan for an uncertain environment―the uncertainty that many respondents note calls for contingency planning: contingency plans could consider changes that could be made to ensure continued access to treatment and realistic expansion plans, and to maintain the most effective, highest priority prevention activities under alternative potential funding scenarios. The report recommends that resource mobilization strategies include sources of finance that can be sustained over the long term.

Alertnet: New HIV/TB research centre at KZN University

The University of KwaZulu-Natal (UKZN) in South Africa will host a new research centre dedicated to exploring ways of controlling the HIV/tuberculosis co-epidemic.

Read more on Alertnet.

UNAIDS : NEW DIRECTOR AND DIRECTION

On his first country visit, the new Executive Director of UNAIDS, Mr Michel Sidibé outlined his vision and priorities for UNAIDS in the township of Khayelitsha in South Africa. Speaking to community and political leaders, Mr Sidibé praised the resilience and perseverance of the community working together to achieve goals in the face of incredible challenges.

Sub-Saharan Africa remains the region most heavily affected by HIV worldwide, accounting for two thirds (67%) of all people living with HIV and for three quarters of AIDS deaths in 2007. The nine countries in southern Africa continue to bear a disproportionate share of the global burden-35% of HIV infections and 38% of deaths due to AIDS.

Like other regions of the world, southern Africa is feeling the effects of the global economic crisis. Mr Sidibé stressed the need for follow through on domestic and international investment commitments to meet 2010 country targets.

Most countries have set universal access targets for 2010 that are ambitious and reach real people. For countries to reach the specific targets they have set, an estimated investment of US$ 25 billion will be required in 2010, which is US$ 11.3 billion more than is available today.
For further info see UNAIDS WEBSITE.

ICRC: HIV Field Guide

The field guide is designed to assist the ICRC in responding to HIV as an integral part of its core health activities. It provides:

• guidance and decision-making tools to help delegations decide what to do in response to HIV among specific populations in a given context;
• guidance on how to integrate HIV into core health activities.

Annex 1 contains a series of Action Guides that summarize information on key topics and options for action. These need to be read in conjunction with more detailed technical resources, references to which are provided in each Action Guide. The guide is also designed to help delegations find strategic entry points to respond to HIV as part of the work they do in a given setting and, over time, to build the whole organization’s capacity to respond to HIV as an integral part of its work.

Downloadable as a PDF from the ICRC website.

New data and information on Children and AIDS

UNICEF Children and AIDS:Third Stocktaking Report

The phrase ‘know your epidemic and response’ has become extremely important in the response to HIV and AIDS. But to better serve children, knowing your epidemic and response must be paired with 'know your children'. This Third Stocktaking Report examines data on progress, emerging evidence, and current knowledge and practice for children as they relate to four programme areas, and it calls for several focused, concrete, achievable actions that can significantly improve prospects for children and women and help nations move towards their goals.

Children and AIDS: Country Fact Sheets, 2008
A companion volume to Children and AIDS: Third Stocktaking Report, 2008, with statistical data for 157 countries and territories.

ICASA: 15th International Conference on AIDS and STIs in Africa: “Africa’s Response: Face the facts”

For more than two decades, the African continent has participated in the fight against AIDS and provided potential solutions to the numerous challenges posed by this epidemic.

However, even as the fight continues, it is important to stop and evaluate these many initiatives, in order to recognize their contributions, successes and ambitions, as well as to acknowledge their weaknesses and shortfalls. It is time to take stock of political commitments, unfulfilled promises and actions and practices employed in the fight against HIV/AIDS.

At ICASA 2008, International and African experts will evaluate the current state of the HIV and STI epidemics with regard to science, communities and leadership.

In addition, the conference will broach topics concerning other, equally important infectious diseases such as tuberculosis, malaria and hepatitis.


Addressing the vulnerability of young women and girls to HIV in southern Africa
HIV Data

3 December 2008

On the opening day of ICASA 2008, a new regional report is launched by UNAIDS Executive Director Dr Peter Piot that looks at the vulnerability of women and girls in Southern Africa to HIV.

Dr Peter Piot addresses the launch of the UNAIDS RST report on vulnerability of women and girls in Southern Africa.
Credit: UNAIDS/Jacky D. Ly
Almost two-thirds of all young people with HIV live in sub-Saharan Africa where about 75% of all infections among young people aged 15 to 24 years are among young women.

Responding to the need to understand why young women and girls living in countries in this region are so vulnerable to HIV infection, UNAIDS and the Reproductive Health and HIV Research Unit of the University of Witwatersrand in South Africa convened an expert technical meeting in June 2008.

The meeting agreed four specific sets of actions at community and country levels that are grounded in national strategies and are context specific. The four key actions are:

Mobilize communities for HIV prevention, with strong male involvement, to design relevant strategies and messages about the causes, consequences of and solutions to young women and girls’ vulnerability
Expand access to high quality, well-integrated essential sexual and reproductive health and prevention services, while mobilising demand for and use of them.
Develop and ensure adequate technical and financial resources for implementation of national strategies that address the structural drivers of vulnerability.
Strengthen country capacities for epidemiological and behavioural surveillance, priority research, and monitoring coverage and impact of prevention responses to generate information to improve decision-making.


“UNAIDS Technical Meeting on Young Women in HIV Hyper-endemic countries of Southern Africa” was launched on the opening day of ICASA 2008, Dakar.

Participants at the meeting included regional researchers; representatives of national AIDS councils, government departments and the Southern African Development Community; and members of the eastern and southern Africa United Nations Regional AIDS Team. Participants were selected for representation across high-level policy, social and scientific research and programming expertise related to women, girls and HIV, from all countries of southern Africa.

Andy Seale, Senior Regional Adviser for Advocacy and Communications with UNAIDS Regional Support team for Eastern and Southern Africa, said: “A major acceleration in social mobilization, service scale-up, increased resources and better surveillance is needed to successfully address the vulnerabilities explored at the meeting. Actions are needed at all levels from the state level to actions at community, family and individual level.”

The outcomes of that meeting are reflected in a new publication launched by UNAIDS in Eastern and Southern Africa on 1 December 2008 that outlines the experts’ conclusions, recommendations and needed sets of action.

“UNAIDS Technical Meeting on Young Women in HIV Hyper-endemic countries of Southern Africa” also includes a number of the background technical papers which were commissioned for the meeting.

Southern Africa context explored

On the opening day of ICASA 2008, a new regional report is launched that looks at the vulnerability of women and girls in Southern Africa to HIV.
Credit: UNAIDS/Jacky D. Ly The papers explore some of the factors that are driving the current epidemic in southern Africa. These include the practice of age disparate and intergenerational sex; biological vulnerability of young women; economic empowerment; education and gender-based violence. A final paper examines the complex interaction between environmental factors and individual choices, behaviours and community norms.

Improved analyses of these factors will enable appropriate and evidence-informed responses to these specific challenges that increase vulnerability of young women and girls in the region.

Social transformation

Meeting participants called for a social movement to address the drivers that contribute to the risk of HIV infection in the region. Addressing human rights violations, harmful social norms, weak community and leadership capacities are seen as some of the fundamental steps to tackle the vulnerability of young women and girls to HIV in southern Africa.

JHA: Understanding the Effect of the Tsunami and Its Aftermath on Vulnerability to HIV in Coastal India

In 2006, Oxfam commissioned the Swasti Health Resource Center in Bangalore, India, to study whether the 2004 tsunami and its aftermath increased vulnerability to HIV infection among affected residents of coastal India. Researchers found that such vulnerability did indeed increase in most of the 30 communities studied, primarily because the physical, social, and psychological conditions after the tsunami led to a significant increase in unprotected sex with non-regular sexual partners, especially among people living in temporary shelters. The research team recommends measures that government, local NGOs, and international aid groups can take to minimize the risk of HIV infection among displaced people after major disasters.

Read more on the JHA website.

UNAIDS:Understanding HIV transmission for an improved AIDS response in West Africa

“West Africa HIV/AIDS epidemiology and response synthesis”

On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.

The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.

Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.

The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.

The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.

For more information, see the UNAIDS website.

“Know your epidemic. Know your response”

The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.

Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.

The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.

British Red Cross podcast for World AIDS Day

In honour of World AIDS Day, a new podcast on the work of British Red Cross peer educators in Scotland and their link with peer educators in Nepal is up on our external website.

Other podcasts include episodes on the aftermath of Cyclone Nargis in Myanmar, and child soldiers in Sierra Leone.

A message from Bernard Gardiner, Federation HIV Unit Manager

World AIDS Day has become the traditional day throughout the world to say the right things about HIV, BUT the real test comes on every other day of the year when we need to DO the right things to keep the promises. Good intentions and hope are not a method. Promises have to be followed up with specific targets, and monitoring to ensure those targets are met.

Two years ago on World AIDS Day the previous Secretary General launched the Federation's Global Alliance on HIV, and committed the Federation to doubling the amount of HIV work by 2010.

In the late 1990s the Federation was spending only about CHF 3 million each year on HIV work. Last year we pushed past CHF 45 million, meaning we are on track to keep our promise. 80 National Societies are now members of the Global Alliance on HIV, detailed plans and costings of exactly how each will double HIV work, and how Zones will support national society capacity building, can be seen on the Federation's website.

Our resource mobilisation target for 2010 is CHF 270, which is more feasible today as global HIV funding has increased from millions to billions of dollars. To stay on track to meet our target the Secretariat has to put intensive effort into supporting National Societies to access Global Fund to Fight AIDS TB and Malaria and other funding sources at the country level. The reality of HIV funding architecture is the 'country driven approach' - most donor support is dispersed at country level. The Global Alliance on HIV means national societies have technically credible plans and budgets to take to the table in country, and donors are taking the Federation's standardised approach as a signal the Federation is serious and organised.

Some resource mobilisation opportunities still exist at Zone and Global levels, and these must also be maximised.

So in summary, we are now in a position where we have a clear platform for co-operation (the Global Alliance on HIV), specific plans and budgets, and improved resource mobilisation. We need to build on this hard work and success, to DO MORE and DO BETTER. We aim to fully deliver this promise to double the Federation's HIV work by the end of 2010.

The banners hanging in the IFRC Geneva Secretariat's foyer today are an adaptation of the current 'Stop AIDS. Keep the Promise' materials of the World AIDS Campaign, and address key elements of how we will deliver over the coming year. These designs will be made available to all national societies for use throughout 2009.

Felicita Hikuam came to the Secretariat four years ago from Namibia Red Cross to develop our colourful 'Come Closer - you cannot get HIV by being a friend, kissing, hugging, playing, talking etc' anti-stigma campaign, and then went on to work for World AIDS Campaign. She suggested IFRC develop its own version of World AIDS Campaign materials focusing on how the IFRC will keep its promises over the coming year.

The first banner highlights our Global Alliance on HIV platform to DO MORE and DO BETTER. The Global Alliance approach is all about PARTNERSHIP, and how we can achieve much more by working together.

The second banner highlights our key 'added value'. National Society volunteers mobilise the community, usually the community where they live. The 'Partner' theme captures the spirit of this mobilisation work. The main job of National Societies is to support these volunteer change agents to DO MORE and DO BETTER. The Secretariat needs to advocate more strongly and convince donors and governments of the value of this work, and of the need to fund community systems strengthening.

The 3rd banner represents the foundation of our HIV work, partnership with PLHIV.

UNAIDS and IFRC will this month sign a new three year UNAIDS Collaborating Centre Agreement, to partner with the Global Network of PLHIV (GNP+) to reduce stigma and discrimination. The agreement includes work to improve how the needs of PLHIV are met in humanitarian situations. To maximise co-ordination, the Secretariat focal point person for this Collaboration will be co-located in the Principles and Values Department with the Gender expert. This, combined with Secretariat support to the newly formed network of Red Cross and Red Crescent staff and volunteers living with HIV, and the Human Resources Department's HIV in the Workplace programme, will mean we move closer to keeping our promise to make IFRC a better home for PLHIV.

HIV is something that touches us all, personally and professionally. We can DO MORE and DO BETTER, and by our actions show real leadership in the global HIV response.

Thank you for all you do to help the Federation to deliver its promises. I hope today that you feel proud to be part of this collective effort. You make the difference - thank you!

A message from Alyson, our HIV and AIDS advisor

Dear Colleagues,

Today, 1 December 2008 marks the 20th anniversary of World AIDS Day. In a report by UNAIDS it is clear that since 1988, efforts made to respond to the epidemic have produced positive results. However, there are still huge outstanding needs and consequent efforts required by all of us to reduce HIV. Please take the time to read through this message today and consider what we can do to make a difference.

This year’s theme is “Lead – Empower – Deliver”. Designating leadership as the World AIDS Day theme for 2007 – 2008 highlights both the political leadership needed to fulfill commitments that have been made in the response to AIDS – particularly the promise of universal access to HIV prevention, treatment, care and support by 2010 – and celebrating the leadership that has been witnessed at all levels of society.

This year WAD activities are being held across the Territories, for example:

• South East Territory are holding a conference to launch their HIV project where workshops will be held on Anti stigma, HIV awareness and Sexual health .The conference will also include personal statements from young people.
• Northern Territory is running a number of events up to and during WAD week. This includes a Universal Children’s day conference where peer educators raised awareness of their work throughout the year, through displays and discussions. The Mayor of Liverpool and Hollyoaks stars, will join young British Red Cross volunteers and Liverpool school children to celebrate Universal Children’s Day and gain awareness of HIV and AIDS

Many of the National Societies that we are working with are holding different events with their volunteers, staff and partners across their countries. This aims to demonstrate their commitment to increase awareness of HIV and reduce discrimination.

Some key facts on the AIDS epidemic which we should consider in planning and implementing our work:

• An estimated 33 million people were living with HIV in 2007. There were 2.7 million new HIV infections and 2 million AIDS-related deaths last year.
• The rate of new HIV infections has fallen in several countries, but globally these favourable trends are at least partially offset by increases in new infections in other countries.
• Globally, women account for half of all HIV infections—this percentage has remained stable for the past several years.
• The global percentage of adults living with HIV has levelled off since 2000. In virtually all regions outside sub-Saharan Africa, HIV disproportionately affects people who inject drugs, men who have sex with men and sex workers.
• Prevention
• In the last two years, good progress has been made in the prevention of mother-to-child transmission of HIV, but more work is urgently required with only 33% of pregnant women living with HIV receiving antiretroviral treatment to prevent mother-to-child transmission in 2007.
• The scaling up of HIV prevention programmes globally is paramount.
• For people most at risk, since 2005 we have seen a tripling of HIV prevention efforts focused on sex workers, men who have sex with men and people who inject drugs.
• The number of new HIV infections continues to outstrip the advances made in treatment numbers—for every two people put on antiretroviral drugs, another five become newly infected.

Treatment

• Nearly 3 million people were receiving antiretroviral treatment in low- and middle-income countries at the end of 2007. This represents 31% of estimated global need and a 45% improvement over 2006.
• Globally, treatment coverage is higher for women than men.
• But children are not benefiting equally as adults. In sub-Saharan Africa, children living with HIV are about one third as likely to receive antiretroviral therapy as adults.
• Increases in treatment have been extraordinary in many countries.
• After decades of increasing mortality, the annual number of AIDS deaths globally has declined in the past two years, in part as a result of greater access to treatment.
• The cost of providing HIV treatment will continue to increase – as some of those on treatment currently need to access second and third line treatment regimens, and as delayed access makes disease management more complex for the estimated 30 million HIV-positive people worldwide who have never been on treatment.
• Most countries have policies providing free antiretroviral drugs—however many patients have to pay ‘out-of-pocket’ costs such as diagnostic tests, treatments for opportunistic infections and transportation, items which can be quite considerable depending on local contexts.

Tuberculosis and HIV

• Tuberculosis remains a leading cause of death for people living with HIV in low- and middle-income countries.
• While tuberculosis incidence has declined globally in recent years, the number of cases continues to increase in areas heavily affected by HIV or drug-resistant TB.
• Despite the availability of affordable treatments for tuberculosis, only 32% of TB cases in people living with HIV received both antiretroviral and anti-tuberculosis drugs—the greatest need for dual treatment is in sub-Saharan Africa.
• Efforts to prevent, diagnose and treat tuberculosis must be scaled up in HIV care settings

Source: Report on the global AIDS epidemic 2008, August 2008 (UNAIDS/WHO next plan to publish an AIDS Epidemic Update in 2009).

Many regards,
Alyson

World Aids Day: 1st December 2008

• UNAIDS launches AIDS Outlook: a new report that provides perspectives on some of the most pressing issues that will confront policymakers and leaders as they respond to the challenges presented by AIDS in 2009.
• The World AIDS Day calendar;
  
• A press release from this morning;

  National HIV prevention programmes can become more successful using combination prevention approaches—this will help make the money work effectively during tough economic times

• From the Federation website: HIV still with us, not defeated yet...
• As in previous years, the World AIDS Campaign has produced a wide variety of campaign materials to be used by individuals and organizations that want to campaign on World AIDS Day and host commemorative events.
  

See after the jump for a list of related events.

• The Cara Trust: World AIDS Concert with Choir from London Gay Men’s Chorus
  Date: Saturday 29th November
  Time: 12.45pm-1.30pm
  Place: St Pancras Church, Upper Woburn Place, Euston
  RSVP: 02072436147 E: mail@caralife.com
• Steering the response to HIV through the changing global financial environment - leadership and collaboration
  Date: 1st December 2008
  Time: 2.45pm to 5pm
  Place: Overseas Development Institute, 111 Westminster Bridge Road, London SE1 7JD
  RSVP on ODI website.
  Chair: Simon Maxwell, Director, ODI
• The Food Chain - Feeding the Fight against HIV: 20th Anniversary and World AIDS Day reception
  Date: 1st December
  Time: 5pm
  Place: The South African High Commission, Trafalgar Square, London WC2N 5DP
  RSVP: (limited places) info@foodchain.org.uk 020 7354 0333
• The Cara Trust: World AIDS Day Evensong
  Date: 1st December
  Time: 5pm
  Place: Westminster Abbey
  RSVP: 02072436147 E: mail@caralife.com
• Where next for New HIV Prevention Technologies? Briefing and Drinks reception
  Date: 2nd December 2008
  Time: 3-5pm
  Place: Royal Society, 6-9 Carlton House Terrace, London, SW1Y 5AG
  RSVP: whalleya@interactworldwideorg
• HIV & Health Systems Strengthening: Opportunities for Achieving Universal Access by 2010.
  Date: 4th December
  Time: 12-2pm Place: Attlee Suite, Portcullis House, House of Commons
  Chair: Rt Hon Francis Maude MP, Vice-Chair of The All Party Parliamentary Group on AIDS
  RSVP: katy@aidsconsortium.org.uk

IFRC: 'War, poverty, HIV' and hope

Juan Manuel Suez del Toro, President of the International Federation of Red Cross and Red Crescent Societies.

Humanitarian organizations seeking funds for relief operations in Africa face an acute dilemma. If we stress the suffering of Africans who lack food or health care, who struggle against floods, drought and possibly famine, who flee war and communal violence, we risk reinforcing the image of Africa as a "basket case", beyond help. If we take the purely positive approach, the donors - whose resources are scarce and with the global financial crisis becoming more so - are unlikely to respond.

Hunger again stalks parts of Ethiopia while the food-security situation in Zimbabwe is widely regarded as the worst ever. Both countries are the focus of major - but so far poorly covered - appeals for funding by the Red Cross Red Crescent¹. In 2008 conflict simmered in eastern Democratic Republic of the Congo, Somalia and Darfur and flared anew in Burundi, Chad and Mali; there was serious communal violence in Ghana and South Africa - all reported in the western media, which also picked up on other "negative" stories like piracy in Somali and Nigerian waters, the persecution of albinos, and xenophopic violence.

But has this depressing portrayal of Africa as a "chamber of horrors" becomes a self-fulfilling prophecy, smothering the good news that also exists in increasing quantities? Is it now, in itself, an obstacle to progress, making the world turn away from Africa in despair? It's far too early to say HIV in Africa is beaten, but could it have peaked?

Read more on Alertnet.

XVII International AIDS Conference 2008 Mexico City

Update - conference information now available online!

Archived, online coverage of the XVII International AIDS Conference (AIDS 2008) is now available from kaisernetwork.org, the official webcaster of AIDS 2008.

In partnership with the International AIDS Society, kaisernetwork.org has prepared the following online coverage:

• Webcasts, transcripts and slide presentations of the opening and closing sessions, all plenary sessions, and over 75 other sessions and press conferences;
• English- and Spanish-language audio podcasts of more than 80 sessions;
• Narrated video highlights of conference developments;
• News summaries of conference developments and newly-released studies in the Kaiser Daily HIV/AIDS Report; and
• Interviews with newsmakers and journalists summarizing conference developments.

Updates from British Red Cross Advisors!

• Some Good News from Zimbabwe!

Feedback from the International Aids Conference 2008 Mexico City
4 August 2008
Today at the IAC08 researchers from the Imperial College London and Harvard University confirmed the recently documented decline of HIV Prevalence in Zimbabwe.Using robust epidemiology data it was shown that HIV Prevalence in adults aged 15- 49 peaked around 1997/8 at 29.3% then levelled off and declined most significantly in the period 2001 to a current level of 15.6%. This represents a 50% reduction in 6 years and the aversion of an estimated 660,000 new infections.

Zimbabwe is the first country in the region to experience such a significant decline. Not only is this good news for Zimbabwe but also significant for the surrounding countries in the region that are experiencing similar generalised epidemics but as yet have not experienced such trends.

The question is how has this been achieved in Zimbabwe? Is it a demonstration of the natural course of the disease or as a result of major prevention successes in behaviour change in the country?

The mathematical modelling does indeed suggest that this trend of sharp incline, plateau and decline is thought to be the expected norm for the course of the disease and goes some way to explaining the decline; but cannot explain the extent of the decline and therefore must also look to possible behaviour change to explain further the trends.

With use of population based and cohort studies this was the question understudy. Key findings show that whilst mortality certainly has contributed to some decline, migration even in the levels recently seen in Zimbabwe has not significantly contributed.

What is more important is to consider which factors have contributed to a decline in HIV incidence. The studies clearly show that whilst condom use is relevantly high this has remained relatively consistent over the time period 1999-2005 and would have little impact on the decline. Significantly however, is the reported decline in the number of sexual partners of men in this period of 6 years, which also seems to mirror the maturation of the disease when high levels of mortality are experienced in the communities and families. As people see the reality of the disease this appears to impact their behaviour.

This of course can only result in change of behaviour such as reduced number of sexual patterns if there is understanding of HIV transmission routes, which suggests that the general HIV and Aids information available in Zimbabwe has been to some level been understood and used. This was mapped against the National HIV prevention programme interventions in Zimbabwe, which in fact show to be the general HIV response approach seen across the region.

Of course the special context of Zimbabwe in the last decade has been the rapid economic decline and the affect on both rural and urban communities. Certainly this has seemed to play some part in the reduction of sexual partners simply as men report they are unable to afford to socialise as they did, take additional girlfriends or pay for sex. Ironically of course in times of hardship more women are turning to transactional sex for source of additional incomes, but report that ‘business is slow’. HIV is of course a dynamic disease and some men reported certainly they would have more ‘girlfriends’ again once they have overcome the current economic problems!

The clear conclusion of the research suggests the decline can be attributed to a combination of factors; - certainly a reflection of the natural course of the disease plus some change in sexual norms including significant reduction of sexual partners, and additionally influenced by the economic downturn and possibly significantly influenced by the community response as the disease reaches a critical point in the community.

But why Zimbabwe and not the surrounding neighbouring Southern African countries? Is it good news for the region? Well possibly - it is possible that Zimbabwe is simply the earliest in the epidemic and that other countries may follow similar decline in years to come. The research is not there to make these country comparisons as yet. (No examination made of any studies made of the effect of role out of ARV on the prevalence decline).

• HIV, Nutrition, Food Security and Livelihoods (including microfinance)

Feedback from the International Aids Conference 08 Mexico City
8 August 2008
1) Supporting quality and delivery of integrated home based care
A satellite session held on HIV food security and livelihoods presented by RENEWAL/FAO/WFP discussed what progress has been made in furthering our understanding on the interactions between HIV, food security and livelihoods and how to respond to this at scale.

The session highlighted how we may be underestimating the impact of the increase in food prices on people’s behaviour and on nutrition and the need to respond to the 3 concurrent epidemics:
· HIV
· TB
· Malnutrition

Studies from Swaziland and Malawi July 2008 demonstrated an increase in risky sexual behaviour as food prices increase.

Also transport costs to collect vital antiretroviral treatment (ART) were placing greater demands on families who at times had to choose between continuing their ART and buying food.

Labour challenges in food security and livelihoods programmes were discussed and the need to ensure more collective actions at community level.

Nutrition counselling within care and support programmes for people living with HIV was highlighted as an area that requires further implementation.

In a further session on the HIV, Nutrition and Food Security, researchers of the University of KZN , AMPATH/USAID , and UNAIDS re-emphasised the importance of nutrition as part of management of HIV. Outlined the increased nutritional requirements of the PLWHIV; and understanding of HIV in weakening household food security.

Conclusions were reached that there is a need for balance of nutrition interventions as therapeutic care for PLWHIV with a strategy for maintaining long term food security of household in long term HIV programming as part of care and support package which is relevant and responsive to PLWHIV, households and communities; and which also contributes to psychosocial well-being as well as nutrition needs. There is Need to develop further partnerships of FS in public health and HIV response with a balance of interventions including micro finance, cash transfers, skills building, community projects leading to increase in income/savings or access to loans and strengthened FS.

If we grasp the issue FS can be part of the combination prevention strategy in increasing access to food, income, health services, treatment, care and well being; and reduce vulnerability that may contribution to increase risk behaviours (such as transactional sex) or weakened immunity.

Responses should be therefore:
· Target those who are food insecure and those nutritionally at risk, which includes people living with HIV
· Integrated to include care and support, water and sanitation, livelihoods
· Gender sensitive- evidence from Ethiopia food for work programmes highlights significant increase in school enrolment for boys but not girls – need to consider in design of programmes
· Long term and built on community response
· Include range of activities including access to nutritional food, nutritional knowledge, agricultural and livelihood skills

Challenges may be:
· Including appropriate exit strategies
· Cash transfers appropriate in stable economies

2) Micro-finance

Presentations at a Poster Session discussed that a large body of research, experience and understanding of micro-finance exits in the development field and in most countries. It is generally accepted that micro-finance programmes can mitigate against the affects of destitution though it is less evident that micro-finance schemes can mitigate GBV or have preventive effects against HIV.

Important not to expect too much – micro credit is about credit!

Key points are:
§ General accept that Microfinance can uplift households and reduce financial pressure. May be particular important to PLWH households to support increase access to services
§ Microfinance not necessarily prove to reduce transmission of HIV but contribute to welfare of households and individuals well being and health, and links to community gains and involvement
§ Work in partnership with those that know Microfinance – knoweldge and experience exits in almost all countries.
§ Consider involvement of volunteers and community based health workers in the microfinance scheme as part of community engagement and also their well being and support.

• Comprehensive Combinations: Key findings from the Mexico IAC 2008

Feedback from the International Aids Conference 2008 Mexico City
4 August 2008
To more effectively prevent and respond to HIV “Combination HIV prevention at scale with combination care, support and treatment for life within universal primary health care, education and support for all is the minimal action required”.

Currently each year an estimated 1 million people are started on antiretroviral treatment (ART) but 2.7 million people are newly infected, we are not keeping pace with the HIV pandemic.

There is a window of opportunity and vulnerability to HIV – increasing evidence highlights need for rapid point of care, diagnosis and treatment of HIV and Tuberculosis, (TB) including multiple drug resistance (MDR) TB, plus ongoing care and support.

ART has been a major success but only as a disease suppressant- like insulin for diabetes and anti inflammatory for rheumatoid arthritis- a cure still required.

Further details below highlight what combination HIV prevention and care, support and treatment include such as prevention of mother to child transmission (PMTCT), male circumcision, palliative care, care for OVC, TB, HIV in emergencies and in conflict and post conflict, responding to HIV and violence and service delivery. These are all areas for BRC to further consider in future support to HIV programming, which require discussion and action. Immediate points to follow are included within.

Further details are provided on separate papers on HIV and food security and livelihoods, male circumcision and the success of the HIV response in Zimbabwe.

Combination HIV prevention improves life
Proven prevention methods which need to be used include primary prevention through behaviour change communication, life skills linked to education and support, positive prevention, prevention of mother to child transmission (PMTCT), male circumcision, condom use, harm reduction. Not ABC approach !
· Need a combination of biomedical, behavioural and structural interventions using non-judgemental harm reduction approaches
· Countries need to develop evidence driven context-specific national HIV prevention strategies which are better coordinated
· Need to embrace the political, economic and social determinants of risk and not focus on individual behaviours
· Need further research on effectiveness of antiretroviral therapy (ART) in prevention- pre exposure prophylaxis (PreExpP), microbicides, treatment of common infections and vaccines (Ref SCIENCE 28.07.08)
· Need to know where infections will happen
· Need to diversify HIV testing approaches- include opt out, remove barriers, stigma and increase access across communities
· Need to become more effective against stigma as stigma and discrimination increase risky behaviour, decreases uptake of HIV testing and willingness to disclose.
(For further info see special issue www.thelancet.com HIV prevention August 2008)
Prevention of mother to child transmission (PMTCT)
· Some increase in prevention of mother to child transmission to 23 % globally (only 1:10 infants receiving ART within PMTCT) and access to ART for children but coverage and quality remains unacceptably low – Nigeria and Ethiopia below 10% (UNAIDS 2007).
· In 2007 estimated 2.1 million children younger than 15 years were living with HIV. More than 90% of these children had been infected through mother to child transmission.
· Although an increasing number of countries have PMTCT programmes only 18% of pregnant women in low and middle income countries received a HIV test in 2007 and coverage remains low, 11% in West and Central Africa and inadequate in many countries with only 33% of women accessing the most effective regimen of a combination of two or three antiretroviral drugs.
· Globally 80% women have at least 1 antenatal contact but only 50% have skilled care at delivery – need to offer support for PMTCT at first contact and during delivery at minimum.
· Barriers to uptake include negative attitudes from HCWs, poor access to services and poor services, stigma and discrimination and fear of HIV testing and disclosure. Limited male involvement – study S Mamman Uni KZN, SA.

Care, treatment and support
· ART - Challenges to retention 1 in 3 people who start ART are not in care – receiving ART – after 3 years – Nathan Ford MSF SA advised only 60% of clients are continuing to be part of ART programme after 24 months. Reasons include client’s fear of disclosure, costs, negative attitudes by care provider and access to programme – need to consider model of delivery of programme and support such as RCRC community based volunteers.
· Still reaching only 30 % of those in need of treatment – Q do we have the capacity to reach and treat for life everyone who requires ART
· Management of ART related side effects is part of the model of comprehensive care
· According to WHO research gaps March 2008 decision when to start ART still based on personal opinion, general view from conference need improved diagnostic facilities and treatment for HIV globally, start treatment earlier with improved treatment regimes for most people in developing countries.
· What is the optimal non ART care and support package and need for guidelines regarding this (i.e. CHBC minimum standards).
· Palliative care regarded as a key component of care – discussed principles and relevance of palliative care in HIV response. Clear pain and symptoms experienced by people living with HIV and also suffering from TB and other related conditions. Palliative care includes supporting adherence to treatment and also psycho social and spiritual support- improves overall patient care
· Task shifting – resource poor countries don’t or will not simply have the human resources of healthcare workers to implementation to scale. Need to consider alternative health systems management
· More than 50 countries in the world still do not have access to opioids.
· Opioids are not available in rural areas and in home care in most countries.
· Support for palliative care should be in national health plans- guidelines for CHWs available (includes RCRC module).
· Recommended adapting WHO definition to define palliative care services nationally
· Joint declaration and statement of commitment on palliative care and pain treatment in human rights- see www.hospicecare.com/resources/pain_pallcare_hr/
· Also further info from pain and policy studies group Uni Wisconsin in USA
Orphans and vulnerable children (OVC)
· SAfAIDS has produced children’s ART and TB treatment literacy pack targeted at 6-12 years olds in recognition that children are being marginalised from their own treatment literacy. The pack includes booklets for children and activities plus manual for carers and parents/ caregivers- AL requested pack suggested adaptation and use within support groups for OVC
· CRS produced paediatric counselling course –AL follow up
· Recommended policies programmes and funding must be redirected to provide support for children to and though their families. IN generalise epidemics HIV clusters in families, strengthening the capacity of families through systematic public sector initiatives has been identified globally as one of the most important strategies of building an effective response for preventing and mitigating the impact of the epidemic on children.
· Need to reconsider policies to develop comprehensive and integrated family-centred services. Need to address not just children but also family’s health basic material needs, psychosocial support and development.
· More attention is required for social protection for poor families, Households afforested by HIV and AIDS experience a worsening of their socio economic status, suggested loss of at least 25% average household income.
· Critical additional resources including income transfers should go direct to those most affected by HIV and AIDS- includes advocacy and support for universal social security support grants plus programmatic interventions targeted to vulnerable households. The interventions should be regarded as an entry point to large scale integrated national responses characterised by access to essential services, such as health and education, social welfare an social justice, enabled by basic income security.
Tuberculosis TB
· 2 million cases of TB have been missed due to the missed opportunity to offer testing to people who undertake HIV testing
· The number of TB cases has tripled in the high HIV prevalence countries in the last two decades
· TB is the leading cause of death among people living with HIV in Africa and a major cause of death elsewhere.
· WHO recommendation - the three I’s for TB/HIV –Isoniazid preventive therapy, intensified case finding for TB and infection control must be urgently implemented to reduce the burden of TB among people living with HIV.
Caring for Carers
· Highlighted globally we are not caring for health care workers, who are not accessing HIV and TB testing and diagnosis
· Health care workers (and RCRC volunteers) involved in care should know the symptoms of TB and be given counselling and health screening annually for TB and HIV. All should be encouraged to know their status.

HIV in conflict and post conflict
· Research paper UNHCR March 2007 highlighted concerns regarding protection and increasing HIV among internally displaced persons (IDPs) in DRC with particular risks to women. Access to HIV prevention services including behaviour change communication, information education and communication, condoms and HIV testing were limited resulting in low levels of knowledge and high risk behaviours. Recommendations from the study included:
o Supporting community based structures and gender sensitive approach
o Prevention activities should address points above
o Increased support to improve basic health facilities and services, including HIV testing and support
o Implementation of the IASC guidelines
· Kenya – following the civil conflict a study undertaken from Jan – June 2008 found 7.500% increase in sexual violence in Nairobi. Highlighted need for increased support and counselling in gender based violence, rape, trauma and HIV. Lessons from the conflict highlighted need for HIV emergency preparedness plan to be developed by all stakeholders and include people living with HIV and community organisations, consider community support and ongoing access to essential antiretroviral treatment.
HIV violence and women
· WHO multi country study 2005 domestic violence and women’s health- Ethiopia 16% of young women forced to have first sex/60% women interviewed suffering from intimate partner violence
· IMAGE – CBO supporting microfinance for women – recently invited to SA regional HIV meeting SARAWO/Sister ACT and Girl Child network Zimbabwe all promoted as effective supporting organisations in this area.
· Although limited biological evidence re violence and HIV Charlotte Watts – LSHTM - study microfinance and women in SA found in SA women with violent partners 50% more likely to have HIV and UNAIDS in Tanzania x 10 more likely
Harm reduction
· Despite UNGASS recommendation in 2005 for access to prevention to include harm reduction programmes only 78 countries known to have programmes.
· Continued moral and religious beliefs negating services offered and increasing stigma and discrimination
HIV and criminalisation
o Recent Acts in Sierra Leone and Zimbabwe increase risks to women living with HIV. Similar laws are being passed in other African countries – handout available.
Service delivery
· Need for improved leadership and management
· Serious implementation bottlenecks – even if we had effective vaccines and microbicides how would we be able to deliver?
Countries and even districts are working in isolation – unable to effectively respond through this “ cottage industry” approach.

Kenya RC on Reuters Alertnet, via IRIN

NAIROBI, 15 October 2008 (IRIN) - Fatma Swalleh, 24, lost her mother, the only parent she had ever known, six years ago to HIV/AIDS. Watching her mother indulge in heavy drinking while denying her status made Fatma's life miserable, but the responsibility of caring for her three younger siblings and bedridden mother strengthened her resolve to volunteer to care for HIV patients.

Fatma is now a HBC volunteer for Kenya RC. Read more on Alertnet.