General Information about HIV

Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.

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General Information

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Basic Info on HIV.

Whether you are some one who would like to get involved in the field or whether you, a family member or a frined have been diagnosed as HIV positive - 'knowledge is power'. Sound scientific knowledge and information can help you to make better choices.

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HIV Timeline. 11/2016

Published by AVERT

AVERT has been at the forefront of the HIV response since 1986.

By sharing knowledge, we empower people to protect themselves and others from infection, reduce stigma and improve HIV programmes globally.

Our impartial information reaches thousands of people across the world every day and our partnership work helps to change the lives of those most in need in sub-Saharan Africa.

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7 Things You May Believe About HIV/AIDS That Turn out to be Wrong 20/4/2016

1. HIV is a death sentence

WRONG

HIV/AIDS is the deadliest pandemic in recent history: it has killed twice as many people as the first World War. But the progress made in a mere 30 years against the disease has been spectacular. Today, someone who takes antiretroviral drugs every day has a very low risk of developing AIDS and can live a long and fulfilling life.

… BUT ALSO, UNFORTUNATELY, RIGHT FOR THOSE NOT ON ARV…

if you’re unlucky enough to live in a place with poor access to lifesaving ARV. Over 75% of the people living with HIV in West and Central Africa - 5 million people - are not on ARV treatment and therefore condemned to a slow, painful and unnecessary death. The situation is even worse for the 730,000 HIV-infected children in the region: 90% don’t have access to ARVs. Urgent action is needed to change this situation.

2. HIV mostly affects gay men

WRONG.

It may be the case in Western countries, but not worldwide. In fact, the face of HIV globally today is a young woman. 59% of people living with HIV in Sub-Saharan Africa are women. In South Africa, girls age 15-19 are as much as eight times more at risk of HIV infection than their male counterparts.

IT’S TRUE that men who have sex with men are disproportionally affected by the pandemic. It’s also the case for sex workers or injectable drug users. This is the reason why the United Nations’ plan to combat HIV/AIDS puts a lot of emphasis on these most-at-risk groups. But still, 45% of all children who are born with the virus come from West and Central Africa. Why? Because their mothers did not have access to treatment

3. You cannot have a healthy baby if you’re HIV positive

WRONG

A pregnant HIV+ woman on optimal ARV treatment has less than 2% risk of transmitting the virus to her baby. This is fantastic news: thanks to ARVs, the number of children born with the virus worldwide has been cut by 60% since 2000 and last year Cuba became the first country to declare that it had completely eliminated mother-to-child HIV transmission.

But again, this victory depends on the availability of ARV treatment. In West and Central Africa, only 39% of HIV positive pregnant women are on treatment. This is why the number of children born with the virus in this region is so disproportionately high: whereas West and Central Africa accounts for 17.9% of the total number of people living with HIV in the world, it records close to half of the births of HIV-infected children.

Those babies are born with a disease that could have been prevented. And it’s all the more dramatic that 90% of the HIV positive babies in this region do not have access to pediatric HIV treatment either. Without treatment, about one-third of children living with HIV will not survive past their first birthday; half of them will not celebrate their second birthday and only one in five of these children will celebrate a fifth birthday.

4. Using condoms is the only way to avoid infecting your partner or getting infected by HIV

WRONG

For sure, using condoms is very effective in preventing HIV infection. But it’s not the only way.

Studies have shown that optimal treatment on ARV reduces the risk of transmitting the virus by 96% in couples in which one is HIV-positive. New drugs even allow HIV negative people to be protected against infection.

Promoting the use of condoms is an important tool against HIV, but people need a combination of prevention tools to choose from, to fit best with their situation. Offering ARV treatment for all is a key component to put the HIV/AIDS pandemic under control, and therefore, it’s a huge problem that so few people – less than 1 in 4 – have access to treatment in West and Central Africa. Without treatment for all who need it, everywhere, the chances of bringing the global pandemic under control are very slim. This is why MSF is calling for an urgent, ambitious catch up plan for countries with low coverage of ARVs.

5. The more HIV+ people in a country, the more AIDS-related deaths

WRONG

South Africa has, by far, the largest number of people living with HIV (6.8 million), and AIDS still takes a staggering toll in the country with 14,000 deaths a year. But as staggering as it is, this number remains below Nigeria’s, which has half the number of HIV+ people. Can you guess why? Again, it’s simple: Nigerians have far less access to ARVs than South Africans (22% versus 45% coverage of ARV).

Similarly, Guinea recorded roughly the same number of AIDS-related deaths in 2014 (3,800) as Swaziland (3,500). But Swaziland has twice the number of people living with the virus (210,000 versus 120,000) and the highest proportion of adults living with HIV worldwide (27.7%).

In short, in places where antiretroviral treatment is not widely accessible, people suffer and die proportionally more from HIV/AIDS.

6. The less HIV+ people in a country, the easier it is to fight the disease

WRONG

Logic suggests that the Democratic Republic of Congo (DRC), where ‘only’ 1.2% of its population is living with HIV, would be better able to provide ARV daily treatment than Malawi. After all, both countries are relatively comparable on paper in terms of GDP per capita[1] or human development index[2]. Yet Malawi has managed to put 50% of its HIV-infected population on ARVs. The DRC, less than 25%.

Doesn’t make sense? Well there are some explanations. If, as in the DRC, HIV is less visible in society, media and political agenda’s, it gets lost among many other health priorities. This is understandable. What is less understandable is the constant neglect by international actors of countries with low HIV prevalence like those in West and Central Africa.

7. Only rich, stable countries have the capacity to offer lifelong, daily treatment

WRONG

This seems to make logical sense; after all, even health systems in rich countries are already under strain to provide treatment for growing number of people with chronic conditions: diabetes, obesity… So imagine the situation in a country like Malawi that needs to provide daily HIV treatment for 10% of its adult population, even though it has six times less health workers than the bare minimum recommended by WHO.

In fact,  the most noteworthy progress against HIV/AIDS have been achieved in resource-poor countries. In fact, the introduction of ARVs in the 2000s was the single most important factor to increase life expectancy in Southern Africa.

MSF has even built experience over the years as to how to provide HIV care in conflict settings, for example in Yemen or CAR, to avoid making people double victims of both war and their HIV+ status. Continuing care is imperative even in the most challenging, unstable areas.

Just because a country has limited resources or a context is complicated or unstable doesn’t have to mean that people living with HIV cannot be provided with ARV treatment.

It is essential that none of us, anywhere, forget the most neglected victims of HIV/AIDS. For this reason, MSF is calling calls on donors, affected governments and UN agencies to develop and implement a fast-track plan to scale-up life-saving antiretroviral treatment in countries where ART coverage reaches less than one-third of the population, particularly in West and Central Africa.

The time is now.

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Global HIV/AIDS Timeline.

Published at Kaiser Family Foundation
13/07/2015


Introduction

On June 5, 1981, the U.S. Centers for Disease Control and Prevention (CDC) issued its first warning about a relatively rare form of pneumonia among a small group of young gay men in Los Angeles, which was later determined to be AIDS-related. While scientists believe that HIV was present years before the first case was brought to public attention, 1981 is generally referred to as the beginning of the HIV/AIDS epidemic. Since that time, tens of millions of people have been infected with HIV worldwide. The Global HIV/AIDS Timeline is designed to serve as an ongoing reference tool for the many political, scientific, cultural, and community developments that have occurred over the history of the epidemic.

Timeline by Year

View: 1981 | 82 | 83 | 84 | 85 | 86 | 87 | 88 | 89 |90|  91 | 92 | 93 | 94 | 95 | 96 | 97 | 98 | 99 |2000| 01 | 02 | 03 | 04 |05 | 06 | 07 | 08 | 09 | 10 | 11 | 12 | 13 | 14 | 15

1981

  • U.S. Centers for Disease Control and Prevention (CDC) reports first cases of rare pneumonia in young gay men in the June 5 MMWR. These cases were later determined to be AIDS. This marks the official beginning of the HIV/AIDS epidemic. CDC also issues report on highly unusual occurrence of rare skin cancer, Kaposi’s Sarcoma, among young gay men in the July 4 MMWR.
  • First mainstream news coverage of the CDC’s June 5 MMWR by the Associated Press and the LA Times on the same day it is issued. The San Francisco Chronicle reports on it the next day.
  • New York Times publishes its first news story on AIDS on July 3.

1982

  • U.S. CDC establishes term Acquired Immune Deficiency Syndrome (AIDS); refers to four “identified risk factors:” male homosexuality, intravenous drug abuse, Haitian origin, and hemophilia A.
  • Cases of AIDS now present in many states and its cause not yet known. See news report: ABC World News Tonight, October 18, 1982.
  • “GRID” or “gay-related immune deficiency” increasingly used by media and health care professionals, mistakenly suggesting inherent link between homosexuality and AIDS.
  • First U.S. Congressional hearings on AIDS held.
  • Gay Men’s Health Crisis, the first community-based AIDS service provider in the U.S., established in New York City.
  • City and County of San Francisco, working closely with San Francisco AIDS Foundation, Shanti Project and others, develops the “San Francisco Model of Care,” which emphasizes home- and community-based services for people with AIDS.
  • First AIDS case reported in Africa.

1983

  • The U.S. Public Health Service issues recommendations for preventing transmission of the infection through sexual contact and blood transfusions.
  • U.S. CDC clarifies its use of term “high risk group” and urges that it not be used to justify discrimination or unwarranted fear of casual transmission.
  • U.S. CDC adds female sexual partners of men with AIDS as fifth risk group.
  • The Orphan Drug Act is signed into U.S. law, providing incentives to drug companies to develop therapies for rare diseases.
  • In the September 9 MMWR, U.S. CDC notes that AIDS has not been spread through casual contact and declares that “AIDS is not known to be transmitted through food, water, air, or environmental surfaces.”
  • Dr. Luc Montagnier of the Pasteur Institute in France isolates lymphadenopathy-associated virus (LAV) — which he believed to be related to AIDS — and publishes findings. That same year, Dr. Robert Gallo of the National Cancer Institute in the U.S. successfully cultivates LAV (which he identified as HTLV-III) in lab and submits paper for publication proposing that a retrovirus causes AIDS.
  • The World Health Organization (WHO) holds first meeting to assess the impact of AIDS globally and begins international surveillance.
  • People living with AIDS (PWAs) take over plenary stage at a U.S. conference and issue statement on the rights of PWAs referred to as The Denver Principles.
  • National Association of People with AIDS (NAPWA) and Federation of AIDS Related Organizations form.
  • AIDS Candlelight Memorial held for the first time.

1984

  • U.S. Department of Health and Human Services (HHS) announces Dr. Robert Gallo of the National Cancer Institute finds that a retrovirus causes AIDS. Dr. Gallo and Dr. Luc Montagnier of the Pasteur Institute hold joint press conference in June announcing discovery that a retrovirus (identified as HTLV-III by Gallo and LAV by Montagnier; see 1983 entry) — later named Human Immunodeficiency Virus (HIV) — causes AIDS.
  • U.S. CDC states that abstention from intravenous drug use and reduction of needle-sharing “should also be effective in preventing transmission of the virus.”
  • San Francisco officials order bathhouses closed; major public controversy ensues and continues in Los Angeles, New York and other cities. See news report: ABC World News Tonight, November 23, 1984.
  • AIDS Action Council is formed by small group of AIDS service organizations from across the U.S.

1985

  • First International AIDS Conference held in Atlanta, hosted by U.S. HHS and WHO.
  • At least one HIV/AIDS case reported in each region of the world. First HIV case reported in China.
  • First HIV test licensed by the U.S. Food and Drug Administration (FDA); detects antibodies to HIV. Blood banks begin screening the U.S. blood supply.
  • Pentagon announces it will begin testing all new recruits for HIV and will reject those who are positive.
  • U.S. Public Health Service issues first recommendations for preventing transmission of HIV from mother to child.
  • Rock Hudson announces that he has AIDS and dies later this year. See news report:  ABC World News Tonight, October 2, 1985.
  • Ryan White, an Indiana teenager with AIDS, is barred from school; goes on to speak out publicly against AIDS stigma and discrimination.
  • First major play about the early days of the AIDS epidemic, “The Normal Heart” by playwright Larry Kramer, opens.
  • American Foundation for AIDS Research (amfAR) founded by Co-Chairs Mathilde Krim and Michael S. Gottlieb, and National Chair Elizabeth Taylor.
  • Project Inform founded to advocate for faster government approval of HIV drugs.
  • National AIDS Network (NAN) in the U.S. forms.

1986

  • President Reagan first mentions word AIDS in public.
  • National Academy of Sciences issues report critical of U.S. response to “national health crisis;” calls for $2 billion investment.
  • U.S. Surgeon General Koop issues Surgeon General’s Report on AIDS, calling for education and condom use.
  • Institute of Medicine report calls for a national education campaign and creation of National Commission on AIDS in U.S.
  • AZT, the first drug used to treat HIV/AIDS, begins clinical trials. See news report: ABC World News Tonight, September 19, 1986. 
  • First HIV cases reported in Russia and India.
  • 2nd International AIDS Conference held in Paris, France.
  • International Steering Committee for People with HIV/AIDS (ISC) created; becomes Global Network of People Living with HIV/AIDS (GNP+) in 1992.
  • Ricky Ray, a nine-year-old hemophiliac with HIV,  barred from Florida school; his family’s home burned by arsonists the following year.
  • Robert Wood Johnson Foundation creates “AIDS Health Services Program,” providing funding to hard hit U.S. cities; program is precursor to Ryan White CARE Act.
  • Informal distribution of clean syringes begins in Boston and New Haven.
  • First panel of the AIDS Memorial Quilt created.

1987

  • First antiretroviral (ARV) drug — zidovudine or AZT (a nucleoside analog) — approved by U.S. FDA.
  • U.S. Congress approves $30 million in emergency funding to states for AZT.
  • AIDS Coalition to Unleash Power (ACT UP) established in New York in response to proposed cost of AZT; the price of AZT is subsequently lowered.
  • President Reagan makes first public speech about AIDS; establishes Presidential Commission on HIV (Watkins Commission). See news report: ABC World News Tonight, April 1, 1987.
  • U.S. CDC launches first AIDS-related public service announcements, “America Responds to AIDS.”
  • U.S. CDC holds its first National Conference on HIV and communities of color.
  • U.S. FDA adds HIV prevention as a new indication for male condoms.
  • U.S. FDA creates new class of experimental drugs called Treatment Investigational New Drugs (INDs), which accelerates drug approval by two to three years.
  • U.S. FDA sanctions first human testing of candidate vaccine against HIV.
  • U.S. Congress adopts Helms Amendment banning use of federal funds for AIDS education materials that “promote or encourage, directly or indirectly, homosexual activities,” often referred to as the “no promo homo” policy.
  • U.S. adds HIV as a “dangerous contagious disease” to its immigration exclusion list; mandates testing of all applicants.
  • 3rd International AIDS Conference is held in Washington, D.C.
  • AIDS becomes first disease debated on floor of United Nations (UN) General Assembly. Assembly designates WHO to lead effort to address AIDS globally.
  • Global Programme on AIDS launched by WHO.
  • AIDS Support Organisation (TASO) forms in Uganda.
  • National Black Leadership Commission on AIDS, National Minority AIDS Council, and National Task Force on AIDS Prevention form in the U.S.
  • First issue of “AIDS Treatment News” published to provide HIV treatment information to community members.
  • “And the Band Played On: Politics, People and the AIDS Epidemic,” a history of the epidemic’s early years by Randy Shilts, published.
  • AIDS Memorial Quilt displayed on National Mall in Washington, DC, for first time.
  • Entertainer Liberace dies of AIDS.

1988

  • World AIDS Day first declared by WHO on December 1.
  • WHO reports AIDS cases increased 56% worldwide. See news report: ABC World News Tonight, January 8, 1988.
  • UNAIDS reports the number of women living with HIV/AIDS in sub-Saharan Africa exceeds that of men.
  • 4th International AIDS Conference is held in Stockholm, Sweden; International AIDS Society (IAS) forms.
  • Watkins Commission on AIDS presents report to President Reagan.
  • U.S. National Institutes of Health (NIH) establishes Office of AIDS Research (OAR) and AIDS Clinical Trials Group (ACTG).
  • U.S. FDA allows importation of unapproved drugs for persons with life-threatening illnesses, including HIV/AIDS.
  • ACT UP demonstrates at U.S. FDA headquarters in protest of slow pace of drug approval process.
  • The U.S. Health Resources and Services Administration (HRSA) awards 21 grants to plan for HIV/AIDS systems of care, laying groundwork for statewide programs later funded through Ryan White CARE Act.
  • U.S. Health Omnibus Programs Extension (HOPE) Act of 1988 authorizes use of federal funds for HIV/AIDS prevention, education, and testing.
  • U.S. Surgeon General Koop and U.S. CDC mail brochure “Understanding AIDS” to all U.S. households; first and only national mailing of its kind.
  • U.S. Justice Department says people with HIV/AIDS cannot be discriminated against. See news report: ABC World News Tonight, October 6, 1988.
  • Judge in Florida rules young girl with AIDS can only attend school if in glass enclosure. See news report: ABC World News Tonight, August 29, 1988.
  • U.S. CDC launches TV commercial campaign about AIDS awareness aimed at minorities. See news report: ABC World News Tonight, October 17, 1988.
  • Elizabeth Glaser, an HIV positive mother of two HIV positive children, and two friends form the Pediatric AIDS Foundation; later renamed the Elizabeth Glaser Pediatric AIDS Foundation.
  • First comprehensive needle exchange program (NEP) established in North America in Tacoma, Washington; New York City creates first government-funded NEP; San Francisco establishes what becomes largest NEP in the U.S.

1989

  • A foreign traveler with AIDS is not allowed into U.S. because he has AIDS. See news report: ABC World News Tonight, April 6, 1989.
  • U.S. Congress creates National Commission on AIDS.
  • U.S. CDC issues first guidelines for prevention of Pneumocystis carinii pneumonia (PCP), an AIDS-related opportunistic infection and major cause of morbidity and mortality for people with HIV.
  • Head of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), Dr. Anthony Fauci, endorses parallel track policy, giving those that do not qualify for clinical trials access to experimental treatments.
  • AIDS activists stage several major protests about AIDS drugs during year, including at the Golden Gate Bridge, the New York Stock Exchange, and U.S. headquarters of Burroughs Wellcome.
  • 5th International AIDS Conference (“The Scientific and Social Challenge of AIDS”) held in Montreal, Canada.
  • First “Day Without Art” organized by Visual AIDS to underscore impact of AIDS on the arts. See news report: ABC World News Tonight, December 1, 1989.
  • Dancer and choreographer Alvin Ailey dies of AIDS.
  • Photographer Robert Mapplethorpe dies of AIDS.

1990

  • Ryan White dies at 18. See news report: ABC World News Tonight, April 8, 1990.
  • Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 enacted by U.S. Congress. Provides federal funds for community-based care and treatment services; funded at $220.5 million in first year. See news report: ABC World News Tonight, April 9, 1990.
  • Americans with Disabilities Act of 1990 (ADA) enacted by U.S. Congress; prohibits discrimination against individuals with disabilities, including people living with HIV/AIDS.
  • U.S. FDA approves use of AZT for pediatric AIDS.
  • 6th International AIDS Conference (“AIDS in the Nineties: From Science to Policy”) held in San Francisco, CA. To protest U.S. immigration policy, domestic and international non-governmental groups boycott conference. The 1992 conference, scheduled to take place in Boston, moved to Amsterdam.
  • Kimberly Bergalis, of Florida, believed to have been infected with HIV by her dentist, causing major public debate.
  • First National Conference on Women and AIDS held in Boston.
  • “Women, AIDS and Activism,” developed by ACT UP’s Women’s Caucus, published, becoming the first book of its kind.
  • Pop artist Keith Haring dies of AIDS.

1991

  • NBA legend Earvin “Magic” Johnson announces he is HIV-positive and retires from basketball.
  • U.S. CDC recommends restrictions on practice of HIV-positive health care workers; U.S. Congress enacts law requiring states to take similar action.
  • Housing Opportunities for Persons with AIDS (HOPWA) Act of 1991 enacted by U.S. Congress. Provides housing assistance to people living with AIDS through grants to U.S. states and local communities.
  • 7th International AIDS Conference (“Science Challenging AIDS”) held in Florence, Italy.
  • ICASO (International Council of AIDS Service Organizations) forms as global network of non-governmental and community-based organizations.
  • Red ribbon introduced as international symbol of AIDS awareness at Tony Awards by Broadway Cares/Equity Fights AIDS and Visual AIDS.
  • Lead singer of band Queen Freddie Mercury dies of AIDS.

1992

  • AIDS becomes number one cause of death for U.S. men ages 25 to 44.
  • U.S. FDA licenses first rapid HIV test, which provides results in as little as ten minutes.
  • 8th International AIDS Conference (“A World United Against AIDS”) held in Amsterdam, the Netherlands; would have taken place in Boston but was moved due to U.S. immigration ban.
  • International Community of Women Living with HIV/AIDS (ICW) founded.
  • Teenager Ricky Ray, whose home was torched because he and his siblings were HIV-positive, dies of AIDS. See news report: ABC World News Tonight, December 18, 1992.
  • Mary Fisher and Bob Hattoy, each HIV-positive, address the Republican and Democratic National Conventions, respectively.
  • Tennis star Arthur Ashe announces he has AIDS.

1993

  • U.S. President Clinton establishes White House Office of National AIDS Policy (ONAP).
  • U.S. CDC initiates HIV prevention community planning process for local distribution of federal prevention funding.
  • U.S. CDC expands case definition of AIDS to reflect fuller spectrum of the disease, including adding conditions specific to women and injection drug users.
  • U.S. FDA approves female condom for sale in U.S.
  • U.S. Congress enacts NIH Revitalization Act, giving the OAR primary oversight of all NIH AIDS research; requires NIH and other research agencies to expand involvement of women and minorities in all research. President Clinton signs HIV immigration exclusion policy into law as part of the same law.
  • Women’s Interagency HIV Study (WIHS) and HIV Epidemiology Study (HERS) begin; both major U.S. federally-funded research studies on women and HIV/AIDS.
  • First annual “AIDSWatch” — hundreds of community members from across U.S. converge in Washington, D.C. to lobby Congress for increased AIDS funding.
  • 9th International AIDS Conference is held in Berlin, Germany.
  • “Angels in America,” Tony Kushner’s play about AIDS, wins Tony Award and Pulitzer Prize for Drama.
  • “Philadelphia,” film starring Tom Hanks as a lawyer with AIDS, opens in theaters, becoming first major Hollywood movie on AIDS.
  • Ballet dancer Rudolf Nureyev dies of AIDS.
  • Tennis star Arthur Ashe dies of AIDS.
  • Leading advocate for women with AIDS in prison Katrina Haslip dies of AIDS.

1994

  • AIDS becomes leading cause of death for all Americans ages 25 to 44; remains so through 1995.
  • U.S. Public Health Service recommends use of AZT by pregnant women to reduce perinatal transmission of HIV; based on “076” study showing up to 70% reduction in transmission.
  • U.S. FDA approves oral HIV test, first non-blood based antibody test for HIV.
  • NIH issues guidelines requiring applicants for NIH grants to address “the appropriate inclusion of women and minorities in clinical research.”
  • 10th International AIDS Conference (“The Global Challenge of AIDS: Together for the Future”) held in Yokohama, Japan.
  • Author of “And the Band Played On” Randy Shilts dies of AIDS. See news report: ABC World News Tonight, February 22, 1994.
  • Pedro Zamora, a young gay man living with HIV, appears on the cast of MTV’s popular show, The Real World; dies later in the year at age 22.
  • Co-founder of Pediatric AIDS Foundation Elizabeth Glaser dies of AIDS.

1995

  • First protease inhibitor, saquinavir, approved in record time by the U.S. FDA, ushering in new era of highly active antiretroviral therapy (HAART).
  • U.S. CDC issues first guidelines for prevention of opportunistic infections in persons infected with HIV.
  • U.S. CDC issues report on syringe exchange programs (SEPs). The National Academy of Sciences concludes SEPs are effective component of a comprehensive HIV prevention strategy.
  • U.S. President Clinton establishes Presidential Advisory Council on HIV/AIDS (PACHA).
  • First White House Conference on HIV/AIDS held.
  • First National HIV Testing Day held on June 27; created by the National Association of People with AIDS (NAPWA).
  • Olympic Gold Medal diver Greg Louganis discloses he is living with HIV; announcement leads to public debate regarding disclosure of HIV status. See news report: ABC World News Tonight, February 23, 1995.
  • Rap artist Eric Wright (Eazy-E of NWA) dies of AIDS.

1996

  • 11th International AIDS Conference (“One World, One Hope”) held in Vancouver, Canada; highlights effectiveness of HAART, creating a period of optimism. See news report: ABC World News Tonight, July 8, 1996.
  • UNAIDS (Joint United Nations Programme on HIV/AIDS) begins operations; established to advocate for global action on epidemic and coordinate HIV/AIDS efforts across UN system.
  • IAVI (International AIDS Vaccine Initiative) forms to speed the search for effective HIV vaccine.
  • Brazil begins national ARV distribution; first developing country to do so.
  • Number of new AIDS cases diagnosed in U.S. declines for first time in history of epidemic.
  • HIV no longer leading cause of death for all Americans ages 25-44; remains leading cause of death for African-Americans in this age group.
  • ABC News poll on public attitudes towards AIDS. See news report: ABC World News Tonight, February 1, 1996.
  • Time Magazine names AIDS researcher Dr. David Ho as its “Man of the Year.” See interview with Dr. Ho: ABC World News Tonight, February 1, 1996.
  • The Levine Committee, a blue ribbon advisory panel, calls for overhaul of NIH AIDS research, including stronger role for OAR and increased support for vaccine-related and investigator-initiated research.
  • U.S. FDA approves viral load test, a new test that measures the level of HIV in the body.
  • U.S. FDA approves first HIV home testing and collection kit.
  • U.S. FDA approves first HIV urine test.
  • U.S. FDA approves first non-nucleoside reverse transcriptase inhibitor (NNRTI), nevirapine.
  • U.S. Congress reauthorizes Ryan White CARE Act.
  • AIDS awareness ad campaigns target larger public, not only those at high risk. See news report: ABC World News Tonight, July 8, 1996.
  • Former heavyweight boxing champion Tommy Morrison announces he is HIV-positive.

1997

  • AIDS-related deaths in U.S. decline by more than 40 percent compared to prior year, largely due to HAART.
  • U.S. President Clinton announces goal of finding an effective vaccine in 10 years and creation of Dale and Betty Bumpers Vaccine Research Center.
  • U.S. FDA approves Combivir, a tablet combining two ARV drugs, making it easier for people living with HIV to take medication.
  • U.S. Congress enacts FDA Modernization Act of 1997, codifying accelerated approval process and allowing dissemination of information about off-label uses of drugs.

1998

  • First large-scale human trials (Phase III) for an HIV vaccine begin.
  • Despite earlier optimism, several reports indicate growing signs of treatment failure and side effects from HAART.
  • U.S. HHS issues first national guidelines for use of antiretroviral therapy in adults.
  • U.S. HHS Secretary Shalala determines needle exchange programs to be effective and do not encourage use of illegal drugs, but Clinton Administration does not lift ban on use of federal funds for such purposes.
  • U.S. Supreme Court, in Bragdon v. Abbott, rules that Americans with Disabilities Act covers those in earlier stages of HIV disease, not just AIDS.
  • Ricky Ray Hemophilia Relief Fund Act of 1998 enacted by U.S. Congress, authorizing payments to hemophiliacs infected through un-screened blood-clotting agents between 1982 and 1987.
  • Minority AIDS Initiative created in U.S., after African-American leaders declare “state of emergency” and Congressional Black Caucus (CBC) calls on U.S. HHS to do the same.
  • 12th International AIDS Conference (“Bridging the Gap”) held in Geneva, Switzerland.
  • Treatment Action Campaign (TAC) forms in South Africa; grassroots movement pushes for access to treatment.
  • Global AIDS and human rights activists Jonathan Mann and Mary Lou Clements-Mann killed in plane crash.

1999

  • First human vaccine trial in a developing country begins in Thailand.
  • U.S. President Clinton announces Leadership and Investment in Fighting an Epidemic (LIFE) Initiative to address the global epidemic; leads to increased funding.
  • U.S. Congressional Hispanic Caucus, with the Congressional Hispanic Caucus Institute, convenes Congressional hearing on impact of HIV/AIDS on Latino community.
  • Founder of National Task Force on AIDS Prevention Reggie Williams dies of AIDS.

2000

  • 13th International AIDS Conference (“Breaking the Silence”) held in Durban, South Africa; first time held in developing nation; heightens awareness of the global pandemic.
  • U.S. National Security Council and UN Security Council each declare HIV/AIDS a security threat.
  • G8 Leaders acknowledge need for additional HIV/AIDS resources during Okinawa Meeting.
  • Millennium Development Goals, announced as part of Millennium Declaration, include reversing the spread of HIV, TB, and malaria as one of 8 key goals.
  • UNAIDS, WHO, and other global health groups announce joint initiative with five major pharmaceutical manufacturers to negotiate reduced prices for AIDS drugs in developing countries.
  • U.S. Congress enacts Global AIDS and Tuberculosis Relief Act of 2000, authorizing up to $600 million for U.S. global efforts.
  • U.S. President Clinton announces Millennium Vaccine Initiative, creating incentives for development and distribution of vaccines against HIV, TB and malaria.
  • U.S. President Clinton issues Executive Order 13155 to assist developing countries in importing and producing generic forms of HIV treatments.
  • U.S. President Clinton creates first ever Presidential Envoy for AIDS Cooperation.
  • U.S. CDC forms Global AIDS Program (GAP).
  • U.S. CDC reports that among men who have sex with men in the U.S., African-American and Latino cases exceed those among whites.
  • U.S. Congress reauthorizes the Ryan White CARE Act for the second time.
  • U.S. HHS approves first state 1115 Medicaid expansion waivers for low-income people with HIV in Maine, Massachusetts and District of Columbia; in 2001, Massachusetts becomes first state to enroll new clients.

2001

  • June 5 marks 20 years since first AIDS case reported.
  • UN General Assembly convenes first ever special session (UNGASS) on HIV/AIDS.
  • UN Secretary-General Kofi Annan calls for a global fund, a “war chest”, to address AIDS, during African Summit on HIV/AIDS in Abuja, Nigeria.
  • Newly appointed U.S. Secretary of State, Colin Powell, reaffirms U.S. statement that HIV/AIDS is a national security threat.
  • World Trade Organization announces “DOHA Agreement” to allow developing countries to buy or manufacture generic medications to meet public health crises, such as HIV/AIDS.
  • Generic drug manufacturers offer to produce discounted, generic forms of HIV/AIDS drugs; several major pharmaceutical manufacturers agree to offer further reduced drugs prices in developing countries.
  • First National Black HIV/AIDS Awareness Day in U.S.
  • First National HIV Vaccine Awareness Day in U.S.
  • See news report for current state of HIV treatment and vaccine research: ABC World News Tonight, June 25, 2001.

2002

  • HIV is leading cause of death worldwide among those aged 15-59.
  • Global Fund to Fight AIDS, Tuberculosis and Malaria begins operations; approves first round of grants later this year.
  • 14th International AIDS Conference (“Knowledge and Commitment”) held in Barcelona, Spain.
  • UNAIDS reports that women comprise about half of all adults living with HIV/AIDS worldwide.
  • U.S. National Intelligence Council releases report on “next wave” of epidemic, focused on India, China, Russia, Nigeria, and Ethiopia.
  • U.S. FDA approves OraQuick Rapid HIV-1 Antibody Test; first rapid test to use finger prick. OraQuick granted Clinical Laboratory Improvement Amendments (CLIA) waiver in 2003, enabling test to be performed outside of laboratory, allowing more widespread use.
  • See news report on impact of HIV/AIDS on African Americans: ABC World News Tonight, July 7, 2002.

2003

  • President Bush announces President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative to address HIV/AIDS, TB, and malaria in hard hit countries.
  • G8 Evian Summit includes special focus on HIV/AIDS; new commitments to the Global Fund announced.
  • WHO announces “3 by 5” Initiative, intended to bring treatment to 3 million people by 2005.
  • Government of South Africa announces new antiretroviral treatment program.
  • William J. Clinton Presidential Foundation secures price reductions for HIV/AIDS drugs from generic manufacturers to benefit developing nations.
  • First National Latino AIDS Awareness Day in U.S.

2004

  • PEPFAR begins first round of funding.
  • UN Secretary-General Kofi Annan compares war on terror to war on AIDS. See news report: ABC World News Tonight, July 13, 2004.
  • UNAIDS launches Global Coalition on Women and AIDS to raise the visibility of epidemic’s impact on women and girls.
  • Group of Eight (G8) nations call for creation of “Global HIV Vaccine Enterprise,” a consortium of government and private sector groups designed to coordinate and accelerate research efforts to find an effective HIV vaccine.
  • 15th International AIDS Conference (“Access for All”) held in Bangkok, Thailand; first time held in Southeast Asia.
  • Global Fund to Fight AIDS, Tuberculosis and Malaria holds first ever “Partnership Forum” in Bangkok, Thailand; 400 delegates participate.
  • U.S. HHS announces expedited review process by U.S. FDA for fixed dose combination and co-packaged products; to be used by the U.S. in purchasing medications under PEPFAR.
  • U.S. FDA approves OraQuick Rapid HIV-1 Antibody Test for use with oral fluid; oral fluid rapid test granted CLIA waiver.
  • See news report on HIV/AIDS in China: ABC World News Tonight, July 12, 2004.

2005

  • United Kingdom hosts G8 Summit at Gleneagles; focus on development in Africa, including HIV/AIDS.
  • World Economic Forum’s Annual Meeting in Davos, Switzerland includes focus on addressing HIV/AIDS in Africa and other hard hit regions.
  • UN General Assembly convenes high-level meeting to review progress on targets set at 2001 UNGASS on HIV/AIDS.
  • WHO, UNAIDS, U.S. Government, and Global Fund to Fight AIDS, Tuberculosis and Malaria announce results of joint efforts to increase availability of antiretroviral drugs in developing countries. An estimated 700,000 people had been reached by the end of 2004.
  • U.S. FDA grants “Tentative Approval to Generic AIDS Drug Regimen for Potential Purchase Under the President’s Emergency Plan for AIDS Relief”, marking first ever approval of an HIV drug regimen manufactured by a non-U.S.-based generic pharmaceutical company, under U.S. FDA’s new expedited review process.
  • First Indian drug manufacturer (Ranbaxy) gains U.S. FDA approval to produce generic antiretroviral for PEPFAR.
  • First National Asian and Pacific Islander HIV/AIDS Awareness Day in U.S.

2006

  • June 5 marks quarter century since first AIDS case reported.
  • United Nations convenes follow-up meeting and issues progress report on the implementation of the Declaration of Commitment on HIV/AIDS.
  • Russia hosts G8 Summit for first time (in St. Petersburg); HIV/AIDS is addressed.
  • First Eastern European and Central Asian AIDS Conference (EECAAC) held in Moscow, Russia.
  • 16th International AIDS Conference (“Time to Deliver”) held in Toronto, Canada.
  • U.S. CDC releases revised HIV testing recommendations for health-care settings, recommending routine HIV screening for all adults, aged 13-64, and yearly screening for those at high risk.
  • U.S. Congress reauthorizes Ryan White CARE Act for third time.
  • First National Women and Girls HIV/AIDS Awareness Day in U.S.
  • First National Native HIV/AIDS Awareness Day in U.S.

2007

  • President Bush calls on Congress to reauthorize PEPFAR at $30 billion over 5 years.
  • WHO and UNAIDS issue new guidance recommending “provider-initiated” HIV testing in health-care settings.
  • WHO and UNAIDS recommend “male circumcision should always be considered as part of a comprehensive HIV prevention package.”

2008

  • U.S. Congress reauthorizes PEPFAR for an additional 5 years at up to $48 billion; the legislation ends the statutory HIV travel and immigration ban.
  • UN General Assembly convenes UNGASS follow-up meeting and issues progress report on implementation of Declaration of Commitment on HIV/AIDS.
  • 17th International AIDS Conference (“Universal Action Now”) held in Mexico City; first time held in Latin America.
  • U.S. CDC releases new HIV incidence estimates for U.S., showing that the U.S. epidemic is worse than previously thought.
  • First National Gay Men’s HIV/AIDS Awareness Day in U.S.

2009

  • U.S. President Obama launches the Global Health Initiative (GHI), an effort to develop a comprehensive U.S. Government approach to addressing global health in low- and middle-income countries, with PEPFAR as a core component.
  • Obama Administration officially lifts HIV travel and immigration ban by removing final regulatory barriers to entry; to take effect in January 2010. Leads to announcement that International AIDS Conference will return to U.S. for first time in more than 20 years, and be held in Washington, D.C., in 2012.
  • U.S. President Obama calls for first-ever National HIV/AIDS Strategy for U.S.
  • U.S. Congress eliminates long-standing statutory ban on use of federal funding for needle exchange in U.S., with caveats.
  • First National Caribbean American HIV/AIDS Awareness Day in U.S.

2010

  • Removal of U.S. HIV travel and immigration ban officially begins.
  • Large international clinical study (iPrEx) shows daily dose of combination antiretroviral pill reduced risk of acquiring HIV among men who have sex with men and transgendered women who have sex with men.
  • South African researchers announce results of clinical trial CAPRISA 004 showing that use of microbicide gel reduced risk of HIV infection among sexually active women.
  • 18th International AIDS Conference (“Rights Here, Right Now”) held in Vienna, Austria; focus is on human rights as a critical part of HIV response.
  • UN convenes a summit to accelerate progress toward the 2015 UN Millennium Development Goals.
  • Obama Administration releases first comprehensive National HIV/AIDS Strategy for U.S.
  • U.S. President Obama signs comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law, which provides new health insurance coverage opportunities for millions of individuals in U.S., including people with HIV. Provisions of law to be implemented in coming years.

2011

  • June 5 marks 30 years since first AIDS case reported.
  • Large multinational study of serodiscordant, mostly heterosexual, couples (HPTN 052) shows early treatment of HIV-infected person greatly reduces transmission to negative partner.
  • UN General Assembly convenes meeting to review progress on HIV/AIDS; adopts new Political Declaration on HIV/AIDS.
  • Obama Administration announces goal of AIDS-free generation, highlighted in speeches by Secretary of State Clinton and President Obama.
  • U.S. Congress reinstates decades-long ban on federal funding for needle exchanges only two years after eliminating the same ban.
  • U.S. CDC releases new HIV incidence estimates for U.S.
  • U.S. HHS launches 12 Cities Project, focusing resources on areas with the highest HIV/AIDS burden in the country.
  • AIDS activist and actress Elizabeth Taylor dies.

2012

  • XIX International AIDS Conference held in Washington, D.C., marking first time conference held in U.S. since 1990.
  • U.S. FDA approves OraQuick In-Home Test, first rapid test using oral fluid that can be bought over-the-counter; results of which are obtained at home.
  • U.S. FDA approves the use of Truvada (emtricitabine/tenofovir disoproxil fumarate) for reducing risk of HIV infection in uninfected individuals at high risk, marking the first HIV treatment to be approved for pre-exposure prophylaxis (PrEP).

2013

  • UNAIDS reports that since 2005, deaths related to AIDS have declined by almost 30%.
  • WHO releases new guidelines recommending earlier use of antiretrovirals, calling for treatment to begin when CD4 cell count falls below 500 cells/mm3, a change from the previous standard of 350 cells/mm3; also includes recommendations related to antiretroviral therapy for children under 5 with HIV, pregnant and breastfeeding women with HIV, and HIV-positive persons with uninfected sexual partners.
  • Article published in the New England Journal of Medicine details case of an infant thought to be cured of HIV by starting HAART 30 hours after birth.
  • U.S. Secretary of State John Kerry marks the 10th anniversary of PEPFAR.
  • U.S. Preventative Services Task Force gives routine HIV screening an A grade, indicating “there is high certainty that the net benefit is substantial.”
  • U.S. Congress passes HIV Organ Policy Equity (HOPE) Act, allowing HIV-infected organs to be donated to persons who are already living with HIV.

2014

  • Child thought to be HIV-free tests positive for HIV, a disappointing setback in the quest for a cure.
  • 20th International AIDS Conference (“Stepping up the Pace”) held in Melbourne, Australia.
  • Major coverage reforms under the U.S. Affordable Care Act go into affect, impacting health coverage for many people with HIV in U.S.

2015

  • Findings from Ipergay and PROUD studies show PrEP to be effective in reducing HIV incidence among gay men.
  • Findings from “Strategic Timing of AntiRetroviral Treatment” (START) study released; show starting antiretroviral treatment early improves health outcomes for people with HIV.
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Stages of HIV Infection

From AIDS.gov

 Stage 1Stage3

 

WHAT are the stages of hiv infection?

HIV infection has a well-documented progression. If you are infected with HIV and don’t get treatment, HIV will eventually overwhelm your immune system. This will lead to your being diagnosed with Acquired Immune Deficiency Syndrome (AIDS).

However, there’s good news: when used consistently, antiretroviral therapy (ART) prevents the HIV virus from multiplying and from destroying your immune system. This helps keep your body strong and healthy by helping you fight off life-threatening infections and preventing HIV from progressing to AIDS. In addition, research has shown that taking ART can help prevent the spread of HIV to others. (Read more about HIV treatment.)

Below are the stages of HIV infection. People may progress through these stages at different rates, depending on a variety of factors.

acute infection stage

Within 2-4 weeks after HIV infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, fatigue, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection.

During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 cells to replicate and destroys them in the process. Because of this, your CD4 count can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.

It is important to be aware that you are at particularly high risk of transmitting HIV to your sexual or drug using partners during this stage because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission.

For more information, see NIH’s Guidelines for the Use of ART in HIV-1-Infected Adults and Adolescents: Acute and Recent (Early) HIV infection.

clinical latency stage

After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no HIV-related symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)

During the clinical latency stage, the HIV virus continues to reproduce at very low levels, although it is still active. If you take ART, you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster.

It is important to remember that people in this symptom-free stage are still able to transmit HIV to others, even if they are on ART, although ART greatly reduces the risk of transmission.

If you have HIV and you are not on ART, then eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.

Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. However, if you are taking ART and maintain a low viral load, then you may enjoy a near normal life span. You will most likely never progress to AIDS.

Factors Affecting Disease Progression

People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful diet, exercise, and not smoke.

Time between HIV infection and AIDS

Factors that may shorten the time between HIV and AIDS:

  • Older age
  • HIV subtype
  • Co-infection with other viruses
  • Poor nutrition
  • Severe stress
  • Your genetic background

Factors that may delay the time between HIV and AIDS:

  • Taking antiretroviral therapy
  • Staying in HIV care
  • Closely adhering to your doctor’s recommendations
  • Eating healthful foods
  • Taking care of yourself
  • Your genetic background

By making healthy choices, you have some control over the progression of HIV infection.

To learn more, see CDC’s Living with HIV.



As noted above, when used consistently, ART prevents the HIV virus from multiplying and from destroying your immune system. And there are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure HIV itself. The earlier you detect your HIV infection and start treatment, the better.

But not everyone is diagnosed early. Some people are diagnosed with HIV and AIDS concurrently, meaning that they have been living with HIV for a long time and the virus has already done damage to their body by the time they find out they are infected. These individuals need to seek a healthcare provider immediately and be linked to care so that they can stay as healthy as possible, as long as possible. Use the HIV Testing and Services Locator to find an HIV provider near you.

 

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The Body

 The website of The Body is an excellent source of information about all aspects of the virus and Aids.

 

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Facts for Life. What You and the People You Care About Need to Know About HIV/AIDS.

 American Foundation for AIDS Research

2006.

This FAQ from the American Foundation for AIDS Research reviews some of the most common questions people have about how HIV is transmitted, who is most at risk, and what HIV testing is all about. It's a particularly helpful resource for HIV-negative people in need of a quick education on what steps they do - and don't - need to take to protect themselves from HIV.

Download PDF, 16p, 748.40 KB

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Glossaries (What Does this Word Mean?)

Many organisations provide lists of what all the difficult terms mean.
  • The AEGIS online glossary is available here
  • If you want something you can download, or order by email, try the AIDSInfo glossary here.
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Treatment and Emergency Assistance

HIV Treatment Primer. (ACRIA) The world of HIV treatment can be intimidating: dozens of meds, lab tests, medical terms and differing opinions.Whether you’ve just been diagnosed with HIV, have known for a while, or are helping a friend with HIV, the good news is that you can learn enough to make informed decisions without becoming an infectious disease specialist. Download (972KB)

TAC's Treatment Literacy Materials as well as useful materials from other organisations.

More detailed information and resources about treatment are available here.

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Treatmant Facilities in South Africa

TAC provides a list of post-exposure prophylaxis facilities obtained from the South African Police Services.

TAC's list of Health facilities where antiretroviral treatment is available.

TAC's list of Some doctors who treat people with HIV.

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Why Is HIV So Difficult to Combat? 25/7/2016

Published by CIDRESEARCH

AIDS was first clinically observed in a patient in 1981. Today, more than 37 million people are estimated to be living with HIV. Tragically, more than 39 million people are estimated to have died from the disease.

In these intervening 35 years, billions of dollars and many brilliant minds have been dedicated to finding a cure for the disease. Despite these great efforts, no such cure exists today.

Why?

Imagine if an arsonist had set fire to the local firehouse. How can anyone come to the rescue when the very equipment required for the fight is set ablaze? This is exactly the challenge we face with HIV.

In a cunning display of viral fitness, HIV has evolved to target cells of the immune system, attacking our body’s emergency response team serving to fight off invading organisms. These immune cells—macrophages, dendritic cells, and T cells—express a protein on their surface called CD4, which plays a critical role in immune system communication and happens to be hijacked by HIV, allowing the virus to gain entry and manipulate the immune system during infection. As more and more CD4 cells become infected, they begin to die off.

"We know more about HIV today than ever before, and our pace of progress is unprecedented."

On top of this, HIV can even kill uninfected immune system cells, a phenomenon we are just beginning to understand. This is why HIV is named the “human immunodeficiency virus”. When the immune system is damaged, it is treacherously difficult for your body to fight against HIV or other opportunistic infections.

But wait, it gets worse.

During the first 10 days of infection, a single strain of HIV is estimated to mutate more times than all of the known strains of influenza have mutated—in all of human history. Immunologists have trouble designing a vaccine to target all circulating strains of flu in a given season. By comparison, we can see how making a vaccine against HIV must be orders of magnitude more challenging.

Under these circumstances, even small signs of progress are encouraging, such as with the most successful HIV vaccine trial to date, RV144. Participants who received the vaccine were ~30% less likely to become infected with HIV than those who received the placebo, but many have questioned whether this result was statistically significant.

Antiretroviral drugs block various stages of the virus life cycle. We may not have a great vaccine yet, but, thankfully, antiretroviral drugs have saved many people from dying and made HIV a manageable disease in the US and other developed nations. Antiretrovirals block various stages of the virus life cycle.

In the past few years, physicians have started prescribing these drugs to people who don’t have HIV, but who are at risk for contracting the virus in the future. This has proven to be a highly effective strategy called PrEP, short for pre-exposure prophylaxis. Unfortunately, due to the high mutation rate of HIV, PrEP is not a perfect prevention method.

In fact, a case study was reported just this February at the Conference for Retroviral and Opportunistic Infections, where a patient on PrEP became infected with a strain of HIV that was resistant to the cocktail of the three antiretrovirals he was taking. Tens of thousands of at risk individuals are now on PrEP, so the fact that this is the first documented case of failure despite the patient’s adherence to his Truvada prescription, means that, in general, these drugs are extremely effective at stopping the virus from replicating in infected and uninfected people.

Unfortunately, these drugs do not provide a cure and require people to take pills every day for the rest of their lives in order to have a chance to remain healthy. Human error and real-life factors (time, money, access to healthcare) come critically into play in this model. One can begin to picture why this prevention and disease management strategy is difficult to enact and sustain for the long term, particularly when considering that 95 percent of people living with HIV reside in developing countries. For these reasons more than a million people are still dying from HIV every year.

The good news is we know more about HIV today than ever before, and our pace of progress is unprecedented. Researchers at our institute and around the globe are working toward cures that would bypass the need for antiretrovirals.

Much effort has been directed at harnessing broadly neutralizing antibodies, which have been identified in some individuals with HIV and observed to help counteract several strains of the virus. If we are able to design vaccines that direct our immune system to produce these antibodies prior to coming in contact with the virus, we could stop HIV in its tracks.

"During the first 10 days of infection, a single strain of HIV mutates more times than any strain of influenza—in all of human history."

Another exciting immune-modulating strategy under exploration is vectored immunoprophylaxis, a clever approach that uses a harmless virus (a vector) to deliver molecules that prevent infection from pathogens, such as HIV. Using this strategy, scientists have demonstrated that a synthetic molecule they designed could efficiently block infection in a primate model of HIV. This molecule tightly binds to HIV because it looks like CD4, the main cellular receptor required for HIV entry. Once bound to the molecule, HIV is neutralized and ‘locked out’ from any cell it tries to enter. The really exciting news is that this vector-delivered molecule appears to work even better than any known broadly neutralizing antibody.

Researchers are also eagerly exploring gene therapy strategies to modify a patient’s immune system. In addition to binding CD4, HIV attaches to a coreceptor called, CCR5, which allows HIV to “unlock the door” at the cell surface. Since naturally occurring mutations in CCR5 make people resistant to HIV, scientists have been using new genetic engineering tools as “molecular scissors” to make precise changes in the DNA coding regions for CCR5. Essentially, this involves taking out person’s immune cells, cutting out a piece of CCR5, and then putting the HIV-resistant cells back into the immune system.

The virus can’t get in once you change the locks on the door.

In the midst of all this progress, we must continue pushing on basic research. Could treatments such as vectored immunoprophylaxis ever be applied on a large scale in places like sub-Saharan Africa, where in some regions more than 80% of the population is HIV-positive? The truth is we don’t yet know how this cutting-edge technology will impact the future of medicine. Perhaps solving HIV/AIDS on a global level will require a combination of approaches; a great vaccine, a breakthrough in drug design, or a new immunotherapy paradigm could be just around the corner.

As Nelson Mandela once said, “It always seems impossible, until it’s done.”

 

We may not have a cure yet—but with sound science, we always have hope.

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35 Things You Might Not Know About HIV. 1/6/2016

Published by POZ

 

A look at some science-based facts about HIV that may surprise you as we mark the 35thanniversary of the official start of the AIDS epidemic.

June 5, 1981. The Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) detailed five recent cases of homosexual men in Los Angeles diagnosed withPneumocystis carinii pneumonia (PCP), two of whom had died. All five men had also experienced cytomegalovirus (CMV) and candidal mucosal infections.

 

July 3, 1981. The New York Times published a short article titled “Rare Cancer Seen in 41 Homosexuals,” reporting on a subsequent MMWR that focused on gay men, largely in New York City and the San Francisco area, who developed often swiftly fatal cases of Kaposi’s sarcoma (KS).

HIV, which had been slowly and silently spreading throughout the 20th century from its origins in Western Africa, had finally begun to rear its ugly head on a grand scale.

The AIDS epidemic had officially begun.

 

To say that much has changed since those early terrifying days of the epidemic is a categorical understatement. AIDS would bring out the best and the worst of society, exposing and fueling deep-seated, often institutionalized hatred toward gays and other disenfranchised demographics, while bringing to their feet a heroic new order of activists and scientists.

 

Often at fierce odds with one another, these two latter forces would eventually come to work more symbiotically as they fought for a common goal: to combat a plague that threatened to annihilate vast swaths of the human race.

 

Today, 35 years into the epidemic, an estimated 36.9 million people are living with HIV worldwide. About 17 million of them are on antiretroviral (ARV) treatment as of 2015. Twenty-nine individual ARVs have been approved since Retrovir (zidovudine, or AZT) was approved in 1987. And scientists are fast at work developing potential vaccines and cures for the virus.

 

To mark this milestone, POZ has culled together 35 science-based facts about the HIV epidemic, many of which may surprise you. Click on any of the hyperlinks for more information.

 

HIV Origins:

  1. “Patient Zero” is a myth. In an attempt to boost sales of his 1987 book chronicling the early AIDS epidemic, And the Band Played On, journalist Randy Shilts and his editor colluded to fabricate the story that the French Canadian flight attendant Gaëtan Dugas was almost single-handedly responsible for the initial spread of HIV throughout the United States. Recent genetic research has further debunked the myth. 

HIV Care & Treatment:

  1. Starting HIV treatment early improves quality of life, compared with delaying until the immune system deteriorates—at least for those with generally good health.
  2. However, even those on ARVs whose virus is fully suppressed still have a lower quality of life than their HIV-negative counterparts.
  3. ARVs may still benefit those who have experienced triple-drug-class treatment failure.
  4. You may not need quarterly HIV checkups. Recent research suggests that if HIV is suppressed, you can probably get away with only annual CD4 testing. Another study found that twice-yearly doctor’s visits may be all that’s needed to control the virus.
  5. Non-AIDS-related conditions pose a significant threat to people with HIV, including psychiatric, liver, cancer, kidney and cardiovascular conditions. ARVs can protect against these outcomes, especially psychiatric and kidney conditions.
  6. Common cancers are more fatal among people with HIV than among their HIV-negative counterparts.

Hepatitis C Virus (HCV):

  1. Hepatitis C is a much more prevalent virus than HIV. The CDC estimates that 1.2 million people are living with HIV in the United States (recent research suggests that this is an overestimate, however).Estimates of hep C’s prevalence vary, with the CDC putting the figure between 2.7 million to 3.9 million, while other estimates suppose that as many as 5 million to 7 million U.S. residents are infected with the virus. Hep C is also the biggest killer among all infectious diseases in the United States.
  2. Sexual transmission of hep C among men who have sex with men (MSM) apparently dates back decades. Research suggests that such transmissions are becoming increasingly common, with HIV-positive MSM at much higher risk than their HIV-negative counterparts.

Cure:

  1. Timothy Ray Brown, the only person on earth officially cured of HIV, does have some company, if you broaden the definition of “cure.” There are various people scientists consider in a state of HIV“remission” following early treatment of the virus.
  2. A great deal of research is being conducted in the HIV cure arena, and there have been many promising developments of late, but most scientists agree that a cure is many years, if not decades, off. Meanwhile, twice in the last three years, the United Kingdom’s The Telegraph has falsely reportedthat a cure for the virus was imminent, each time leading to a rash of erroneous reports in other media outlets.
  3. No, soy sauce does not treat or cure HIV, despite fanciful media reports suggesting the contrary.
  4. No, pot does not treat, prevent or cure HIV, despite fanciful media reports suggesting the contrary.

Women:

  1. A parasite may be to blame for high HIV rates in African women.
  2. HIV-positive transgender women are less likely than their cisgender counterparts to have their virus under control.

Prevention:

  1. Awareness of pre-exposure prophylaxis (PrEP) among MSM is rising, although actual widespread use of Truvada (tenofovir/emtricitabine) use among HIV-negative MSM is apparently limited to a few cities.
  2. We may see a long-acting injectable version of PrEP, administered every eight weeks, in 2020.
  3. People on HIV treatment often overestimate how infectious they are, despite increasing evidence thattransmitting the virus with an undetectable viral load is extremely unlikely.
  4. Gay men are using condoms less these days, but their use varies based on context. It’s not a simple matter of guys always or never using condoms; there’s a lot of nuance in between.
  5. There is no apparent link between states’ HIV criminalization laws and condom use among MSM in those states. Arguably, such laws do not have a public health benefit.
  6. Since 1999, there has been only one confirmed case of someone acquiring HIV through occupational exposure—a laboratory technician who was stuck by an infected needle in 2008.
  7. Behavioral factors don’t explain why black MSM have such disproportionately high HIV rates. Overall, black MSM engage in comparable rates of condomless sex, have fewer sex partners and engage in less drug use during sex.
  8. Only one in five sexually active high school students have had an HIV test.
  9. A considerable proportion of HIV transmissions among MSM occur within ongoing sexual partnerships.
  10. Scientific understanding of exactly how well condoms prevent HIV is shaky. Such research is stymied by the need to rely on self-reports of condom use.
  11. HIV superinfection apparently doesn’t affect disease progression. A decade ago, fears of superinfection (acquiring a second infection of the virus) and “superbug” HIV fueled considerable, ultimately unnecessary hysteria.
  12. As death rates continue to drop among people with HIV, life expectancy is approaching normal for many of those on ARVs, especially those who don’t smoke or abuse drugs and are not coinfected with hepatitis B or C viruses (HBV/HCV). However, the average life expectancy for those in HIV care is still about 14 years below that of their HIV-negative counterparts.
  13. Even very early HIV treatment may not reverse the immediate damage to the gut caused by the virus’s initial assault.
  14. HIV may be evolving into a weaker virus.

Substance Use:

  1. Even one or two drinks a day can be harmful to people with HIV, whose threshold for safe alcohol use is lower than for HIV-negative individuals. Also, HIV-positive people get a buzz from drinking on less alcohol.
  2. Falsely believing that booze and HIV meds are a toxic mix, many people purposefully skip ARV doses while drinking. Similarly, many will actually increase their risk of harm to themselves by intentionally missing ARV doses while using drugs.
  3. People on HIV treatment double their risk of death by smoking. Furthermore, smokers with well-controlled HIV lose far more years of life to cigarettes than to the virus.

The State of the Epidemic:

  1. HIV prevalence among MSM varies widely by city and state, with Southern MSM hit especially hard.For example, an estimated 11 percent of young black MSM in Atlanta contract HIV each year.
  2. The annual HIV diagnosis rate has dropped 19 percent over the past decade, and the rate among MSM, after years of increases, has started to level off.
  3. The U.S. HIV population may be smaller and more virally suppressed than long presumed. At the same time, viral suppression rates are increasing steadily among HIV-positive Americans.

 

 

 

 

 

 


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27 Things Everyone Needs to Know About HIV. 17/11/2015

Published by HIVPLUSMAG

In the first few weeks after finding out you are HIV-positive, you’ll have a lot of basic questions and you’ll need some straightforward answers to help stay healthy, protect yourself and others, and move forward with what should be a long, happy life.

1. Is it possible I got a false positive on my HIV test?
When your initial test comes back positive (unless you’ve done the at-home test) you should be offered a confirmatory test, basically a second test to make sure you’re HIV-positive. The likelihood of two false positives is extremely rare. If you took the at-home test, it’s a good idea to go to a doctor or clinic to do the second test. Sadly, false-negative test results can happen too, so if you come up positive and your partner comes up negative, be cautious and have your partner retest. According to AIDS.gov, the likelihood of a false negative depends on when you might have been exposed to HIV and when you took the test: “It takes time for seroconversion to occur. This is when your body begins to produce the antibodies an HIV test is looking for—anywhere from two weeks to six months after infection. So if you have an HIV test with a negative result within three months of your last possible exposure to HIV, the CDC recommends that you be retested three months after that first screening test. A negative result is only accurate if you haven’t had any risks for HIV infection in the last six months—and a negative result is only good for past exposure.”
 
2. How did I get HIV?
This is a question you’ll get asked exhaustively, but right now you’re probably just asking yourself. The bottom line is that the main risk is having unprotected anal sex or (for women) vaginal sex or sharing needles with an infected person. It’s possible but quite a bit less likely that you got it from oral sex. The CDC says it’s also possible to acquire HIV through exposure to infected blood, transfusions of infected blood, blood products, or organ transplantation, “though this risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.”
 
3. Can “tops” get HIV?
Actually, there’s some truth to the assumption that male “tops” (insertive partners in anal sex) get HIV less. The insertive partner in both anal and vaginal sex is less likely to contract HIV—in the case of anal sex, tops have 86 percent reduction in transmission, according to a 2012 study—but that still means tops can get HIV from sex.  
 
4. Does being HIV-positive mean I also have AIDS?
Absolutely not. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage of HIV disease. HIV is the virus that causes AIDS, but for most people, proper treatment and regular medical care to keep your immune system strong will prevent you from ever developing AIDS. Remember, an HIV-positive test result means only that: You have HIV.
 
5. Am I going to die?
No, probably not anytime soon. There can always be complications, just as there are with any chronic condition (like diabetes, for example), but generally, with current medications, people with HIV are living near-normal lifespans. You will be susceptible to the same medical conditions that affect all people as they age, and some experts say that people with HIV will experience some of these conditions associated with aging (like osteoporosis) sooner because of the lifesaving antiretroviral drugs you need to take. 
 
6. How do I answer when people ask, 'Can you get HIV from...'?
Let’s start with how it is not transmitted. Since the virus cannot survive outside the body, you cannot get it from toilet seats or shared cups or utensils. You can’t get it from kissing or from spit, since it’s not transmitted in your saliva. It is also not transmitted in sweat or urine. You can’t get it from a swimming pool, hot tub, sauna, mosquito or rodent bites, tattoos, or ear/body piercings. Only four bodily fluids are known to carry HIV in quantities concentrated enough to infect another person: blood, semen, vaginal fluids, and breast milk. According to the Centers for Disease Control and Prevention, it is one of these fluids from an HIV-positive person that has to come in contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream (from a needle or syringe) for HIV transmission to possibly occur. 
 
7. Who is at higher risk of HIV infection?

 

Across all ethnicities, in the U.S. the group most affected by HIV infection is gay and bisexual men and other men who have anal sex with men (but for some reason don’t identify as gay or bi, dubbed MSM). Transgender women, especially women of color, are at a significantly higher risk as well, though exact numbers aren’t known because in many studies they are included, erroneously, in the MSM category. Black and Latino men and women and injection drug users have higher risk rates, but of course anyone (straight, gay, black, white, whatever) who has unprotected anal or vaginal sex is at risk.
8. Does this mean I have to stop having sex?
No, not unless you want to. But we encourage you not to stop. Orgasms can be wonder drugs in themselves: They help you sleep, boost your immunoglobulin levels (which fight infections), and reduce stress, loneliness, and depression. There are ways to protect yourself and your partner, however, including consistent condom use, PrEP, serosorting, and keeping your viral load undetectable.  One tip: If you use lube during vaginal or anal sex, avoid two ingredients: polyquaternium and polyquaternium-15, both types of polymers, which may increase the possibility of HIV transmission.
 
9. What about oral sex?
It is far less common but possible to transmit HIV through oral sex, especially if you are a man and you ejaculate into someone else’s mouth. If you have HIV and your partner performs fellatio on you but you do not ejaculate in that person’s mouth, you have an extremely low chance of passing HIV to them. HIV transmission through “fellatio without ejaculation can happen, but it is exceedingly rare,” says Thomas Coates, Ph.D., a professor of medicine and director of the University of California, San Francisco, AIDS Research Institute and the Center for AIDS Prevention Studies. “It’s not ‘no risk,’ but it’s relatively low-risk.” When ejaculation occurs during fellatio, the risk of HIV transmission rises; researchers debate what the rate of transmission is but most estimates are between 1 and 10 percent, but you lower that to almost no risk if you pull out for the money shot. And if you are a woman, having someone perform cunnilingus on you is extremely low-risk as long as you are not menstruating.
 
10. What is “Treatment as Prevention?”
A couple of large-scale studies, on both gay and straight couples in which one was HIV-positive, showed that a person taking medication that reduces the amount of virus in their blood (that’s their “viral load”) to an undetectable level has only a 4 percent chance of passing HIV along to their partner, even if they do not use condoms. Any poz person will tell you one of the most frightening parts of being poz is the concern about infecting others; if you get yourself healthy enough and stay that way with an undetectable viral load, you actually make yourself safer to your partners than if you use only condoms.
 
11. What is PrEP?
Right now PrEP refers to Truvada, a combo pill that’s given in one particular configuration to people with HIV and in another configuration to people trying to prevent HIV. In the latter, it’s taken daily to prevent infection and has been approved for use in anyone at high risk (your partner would be considered high-risk now that you are poz). PrEP is extremely effective when taken correctly, but doctors still recommend you use condoms for added protection. (And make no mistake here: no, your partner cannot just take your Truvada if that’s what you’re prescribed; the different combination in your pill’s formulation won’t work and could do them great harm.)
 
12. Can I still have kids?
Yes. If you’re a woman who is positive, medications can make it so you have less than a 1 percent chance of transmitting HIV to your unborn child. If you’re a man, your sperm will need to be “washed” of HIV and then inseminated into your partner, wife, or surrogate. The main difference for couples is that you’ll need a specialist who deals with HIV, fertility, and insemination. PrEP has also recently been prescribed by doctors off-label to prevent transmission during intercourse when couples are trying to conceive as well. If you want to adopt or foster parent, there are some new protections for HIV-positive parents-to-be that ensure you can’t be discriminated against.
 
13. I already have kids. How do I tell them?  
Many parents worry that telling their kids might place a burden on the children. Mental health professionals say the decision about whether to tell your kids depends on many factors, including how perceptive they are (if there are medicine containers all around, kids will ask about them), how discreet you need to be (asking kids to keep your status a secret is a heavy burden), and how strong you can be for them (some kids will be angry or overly clingy, worried you’ll be dying). For most people, telling their children is the right thing to do. Before you do, learn everything you can about HIV. Your kids have been perfecting the “why” questions since they were 2 years old; this is a moment when there will be a lot of whys and hows. Your doctor or counselor might have ideas about groups or advocates for children, who can also talk to the kids or be a support team for you and the offspring as you go through the coming-out process. Then, says Mark Cichocki, a nurse educator at the University of Michigan’s HIV/AIDS Treatment Program and the author of Living With HIV: A Patient’s Guide, talk in a quiet space, be honest, trust your kids to handle it, and let them express their emotions fully (remember, kids can experience a range of feelings, including guilt, fear, rage, and rejection). This process may take more than one day—it’s the beginning of a conversation in which you should be honest, age-appropriate, and willing to offer both answers and assurances. Kids can impress us with their ability to understand and assimilate information; you just need to have it ready for them. After the crying and talking is done, take them out for ice cream so they remember that this is just another thing that your family will tackle together.
 
14. What is a serodiscordant couple?
Serodiscordant simply means one of you has HIV and one of you doesn’t. Some gay couples use the term “magnetic couples” to mean the same thing. There’s very little research on how successfully serodiscordant, or mixed, couples cope with the complications of HIV. According to TheBody.com, an online HIV resource guide, “research of this nature tends to measure the most negative aspects of positive/negative couplings, telling us primarily how HIV complicates our lives. It tells us very little about the rewards, the discovery of inner strengths, the emotional ties, the opportunities for developing better communication skills, or the joy generated when a mixed-status couple does create a happy, strong, fulfilling relationship.”
 
15. So how do we handle being a serodiscordant couple?
What you need to know if you’re a mixed couple is that you can have a happy and healthy relationship, but like all relationships, it requires work and commitment, because love does not conquer all. The HIV-negative partner may want to talk to his or her physician about PrEP; you should talk with yours about achieving an undetectable viral load. Both reduce the likelihood of you transmitting the virus to your partner. Couples might also want to see a counselor who specializes in coping with HIV. Many HIV-positive people fear spreading the disease to their partners, making sex fraught with tension. Many HIV-negative partners encounter disrespect from friends and family members when the other partner’s status is revealed. A counselor can help you work through those kinds of issues and communicate to each other your anxieties, fears, and needs.
16. How many of my previous sexual partners do I need to tell about my diagnosis?
This is kind of a murky area, with debate between activists and public policy experts. You will be asked to notify, or have the health department notify, anyone you have had sex with or shared needles with since your last negative HIV test or, if you’ve never had one, the most recent sex partners (say, in the last year). Your partner(s) will need to be tested now and, if the test is negative, again in three months (the window period between infection and when it actually shows up on a test). According to the New York Department of Health, how far back in time known partners should be reported is determined on a case-by-case basis depending on such factors as the approximate dates when you believe you were exposed and became infected and how willing (or able) you are to dig up those names and contact info, with the priority on current and recent partners. The federal Ryan White Care Act requires states to make a good-faith effort at notifying current spouses and anyone who has been the HIV-positive person’s spouse within the last 10 years. Therefore, spouses within the last 10 years, if known, should be notified, unless you’ve had a negative HIV test result since then. Do know that public health departments and clinics are not supposed to pressure you for this information and they cannot withhold your test results or penalize you in any way for not divulging this info. 
 
17. How much do I need to tell my dentist and other health care workers offering me nonsurgical treatment? 
All health care professionals use “universal precautions” to prevent the transmission of blood-borne diseases like HIV and hep C to and from patients, according to Robert J. Frascino, MD, of the Robert James Frascino AIDS Foundation. An expert for TheBody.com, Frascino says he’d recommend disclosing your status to your dentist, though, so that he or she could be on the lookout for HIV-specific problems in the mouth. “Health care professionals, including dentists, are trained to look for certain conditions more closely if they know you have an underlying medical problem, be that diabetes, cancer, HIV or whatever,” he writes. “Why would you not advise your dentist of your HIV status? If you feel that dentist would discriminate against you for being HIV-positive, that’s not the office you want to be treated in anyway, right? Being HIV-positive is not something to be ashamed of. It’s a viral illness.” The same is true for other health care providers: You don’t have to tell them, but it’s in your best interest and best health to do so.
 
18. What will change for me in my everyday life now that I’m positive?
With proper treatment, being HIV-positive is a manageable, chronic condition like lupus, diabetes, or asthma. But it’s a chronic condition nonetheless. Unless you had other health conditions prior to diagnosis, you’ll likely see a physician more than you did before because it’s vital that you monitor your health closely. Regular visits with your HIV health care provider will keep you up to date on everything concerning your health. Speak with your doctor about changes that need to be made to your diet, exercise regimen, and use of alcohol, prescription medicines, and recreational drugs. If drugs were a factor in your transmission (there’s a link between crystal meth use and HIV transmission, for example), your doctor might recommend rehab. You may tire more easily, be more prone to infections, have medical side effects you didn’t have before. But hands down, the biggest change in your daily routine will be taking medication, if you and your doctor decide this is the best treatment option for you. HIV medication requires strict adherence to the prescribed daily dosage, and the drugs often have side effects. Open communication with your doctor will ensure that you are fully equipped to handle the changes in your life.
 
19. Will being HIV-positive affect my ability to have gender confirmation surgery, plastic surgery, or gastric bypass surgery? What about hormone treatments?
Short answer: No. There was thought to be heightened risk from surgery, but a study published in 2006 in The Journal of the American Medical Association compared surgery data for both HIV-positive and HIV-negative patients and found that the two groups had the same level of complications from surgery. Moreover, medical workers are better educated about HIV than they once were, and the fear of positive patients has eroded. But you may still have to work harder to find a surgeon who has worked with HIV-positive patients, or if you’re transgender, a doctor who can work with both your HIV specialist and your reassignment surgeon.
 
20. Do I need a special doctor for my HIV-related issues?
Yes. It is important to find a health care provider who specializes in HIV medical service right away. Sometimes your HIV testing center will recommend someone, or you can also ask your primary health care provider. Finding an HIV specialist who fits your needs is a huge first step after being diagnosed as positive. That person will literally be your lifesaver.
 
21. In between doctor visits, are there symptoms I should be on the lookout for?
Regular appointments with your HIV specialist are absolutely necessary. It is also necessary that you monitor your body on your own. There are certain signs and symptoms to look out for and a few health factors that should be constantly monitored. According to Rose Farnan, RN, and Maithe Enriquez, RN, authors of What Nurses Know…HIV/AIDS, you should pay special attention to certain symptoms: diarrhea, weight loss or loss of appetite, trouble or pain when swallowing, white patches or sores in or around your mouth, long-lasting fever, a new cough, shortness of breath, headaches, dizziness, blurred vision, or difficulty remembering things. It can be hard to distinguish whether these symptoms are just passing or a more serious issue, but keeping track of your body’s patterns will greatly benefit your health. Farnan and Enriquez suggest keeping written records of weight and other factors that can change over time. Also, do know that medications affect each person differently. While side effects are rarely severe, if you have any side effect longer than a few weeks, don’t just assume you have to just put up with it; ask your doctor about it.
 
22. How do I prevent myself from getting sick?
Because your immune system’s strength will fluctuate, it is even more important to always keep clean. It sounds basic, but it’s a big help if you simply wash your hands and encourage others around you to do the same, especially before and after you eat, after using the toilet, and if someone around you is sick. Maintain healthy eating habits (there are HIV specialist nutritionists, and your doctor can refer you to them if needed) and start or keep up a regular exercise routine as well (even if it’s just walking 30 minutes a day). Smoking, drinking, and recreational drug use all compromise your immune system, so find ways to cut back on (or ideally, stop) these activities. Don’t forget to keep tabs on your emotions, because mental health is as crucial as physical health. HIV is a chronic condition that comes with a lot of baggage because of cultural stigma. You’ll feel it, and it’ll take a while to get used to it. An HIV-friendly therapist can help you build resiliency at this difficult time. You’ll need a strong support system that can include your doctor, friends, and family, plus new friends you meet in your support groups along the way. But do not hesitate to reach out, because a positive outlook will be one of your greatest allies.
 
23What if I can’t afford my meds?
Thanks to health care reform, you can now get your own  health insurance and if you can't afford it, the federal government has subsidies for those who make less than 400 percent of the federal poverty level (under $46,000 annually). If you already have health insurance, and the co-pays are too high for you, you can reach out to your state’s department of public health and contact the drug manufacture to get help cover the costs. If you still can’t afford health insurance, you may qualify for Medicaid.  The AIDS Drug Assistance Program (ADAP) can also help uninsured or underinsured people pay for their HIV medications (learn more about the ADAP program here).
 
24. If for some reason I’m bleeding, do I need to worry about people who are helping me?
This probably depends on the situation, but often the answer is no. HIV is rarely transmitted in a household between family members (outside of sex and IV drug use, of course). And, if, for example, you got hurt playing football or duking it out at the gym, it’s “highly unlikely that HIV transmission could occur in this manner,” according to the University of Rochester Medical Center. “The external contact with blood that might occur in a sports injury is very different from direct entry of blood into the bloodstream which occurs from sharing needles or works.” The same goes for blood on a Band-Aid or a nosebleed or a cut finger, says Lisa B. Hightow-Weidman, MD, MPH, an associate professor of medicine in the Department of Infectious Diseases, University of North Carolina-Chapel Hill, and an expert for TheBody.com. “There is no risk of getting HIV from blood that has been sitting outside of a human body. Even if the [person bleeding] was infected, HIV begins to die once it leaves the body and becomes unable to infect anyone else.”
One caveat: If you’ve been in a serious auto or other accident, the emergency medical techs who are helping you should be using universal precautions, but it’s always good for your own health to tell them you’re HIV-positive (it’s illegal for health workers to refuse you care based on your status, per the federal Americans With Disabilities Act).
 
25. Do I have to tell my boss I have HIV, and can I be fired if my boss finds out I have HIV?
You absolutely do not need to tell your boss you have HIV. And you can’t legally be fired unless you have limitations on what you can do and your employer has made every effort to accommodate them. The Americans With Disabilities Act requires employers to make “reasonable accommodation” to the known physical or mental limitations of employees with disabilities (including HIV infection/illness). That doesn’t mean all employers understand the ADA; violations happen all the time, but if you do get fired, you have legal recourse. And certainly, if you have no symptoms that require you to have accommodations, then you can’t be let go because of your status. And under federal nondiscrimination laws your boss or prospective employer cannot require you to take an HIV test either.
 
26. What if I’m in the military?
First, you should know you are not alone. According to UNAIDS, HIV rates are higher among members of the military compared with the general population.  The Department of Defense military demographics suggest  210,000 enlisted men and women are HIV positive. While testing positive for HIV disqualifies someone from being accepted into the U.S. military, those who are already in the military may be able to continue serving. You will be evaluated to determine if your are still fit for duty. Those fit for duty can continue to serve but must “conduct themselves in such a way as to not infect others.” Because it's the military, you should also know “How to Stay Out of Jail If You're HIV-Positive and in the Military." 
 
27. How do I find support centers or support groups near me?
Each state has its own toll-free HIV and AIDS hotline, and Project Inform has the full list at ProjectInform.org/hotlines. If you call Project Inform’s HIV Health InfoLine, which is (800) 822-7422, you can talk to nonjudgmental people (in English and Spanish) who will listen to you, share their experiences, offer you accurate information about HIV, and help you navigate health care obstacles and talk to doctors about your concerns.
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What is AIDS? A Manual for Healthworkers

World Council of Churches

Revised 2003

A basic manual for health care workers to learn about AIDS.

Any parts of this book, including the illustrations may be copied, reproduced, or adapted to meet local needs, without permission from the author or publisher, provided the parts reproduced are distributed free or at cost – not for profit.

Download PDF, 33p., 326.80 KB.

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Basics About Living With HIV.

Basics about living with HIV - especially when you are newly diagnosed is available on the NAM website.
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FAQs and Myths About HIV and AIDS.

THIS DOCUMENT IS PART OF THE CABSA/WORLD VISION TRAINING MANUAL

“CHURCHES, CHANNELS OF HOPE”.
 
PLEASE CONTACT THE CHRISTIAN AIDS BUREAU
FOR MORE INFORMATION ON THIS TRAINING PROGRAMME
– CABSA, PO BOX 16, WELLINGTON. 6543, TEL: 021 873 0028021 873 0028 -
The following questions and myths will be addressed in this section:
  • Is AIDS a myth?
    • MYTH ONE: HIV does not cause AIDS. AIDS is just a new name for old diseases
    • MYTH TWO: AIDS can occur without HIV
    • MYTH THREE: Seropositivity to HIV can be widespread without AIDS.
    • MYTH FOUR: The validity of AIDS epidemiological research is questionable because HIV testing is unreliable.
  • Does HIV cause AIDS? Where did this debate originate that was picked up by South Africa’s President Mbeki? How should we think about it? How do we answer people who do not believe that HIV causes AIDS?
  • What effect will AIDS have on fertility?
  • What is the possibility of developing an AIDS vaccine?
  • How are potential vaccines tested on humans?
  • How effective is the condom at preventing STD’s and sperm penetration?
  • There have been rumours of naturally occurring holes in latex that are big enough for HIV to pass through. Is this true?
  • I want to use a condom, but my partner does not. How do I negotiate for safer sex?
  • What is the female condom?
  • How effective is the female condom?
  • Is there a difference in the rate of HIV transmission between circumcised and uncircumcised men?
  • What is the risk of HIV transmission from oral sex?
 
The first part of this section takes a look at myths relating to HIV as the cause of AIDS:
Q Is AIDS a myth?
A There are many reasons why people may subscribe to myths or conspiracy theories about disease. AIDS, in particular, is a disease that lends itself to the perpetuation of myths and to different forms of denial. For example, myths that deny the existence of AIDS can respond to people's emotional needs or to a desire to reassure themselves that they can avoid changing their behaviour. HIV is often transmitted through behaviours that are essentially private. Also, visible symptoms of the disease only appear after many years, making it easier for people not to accept that HIV will eventually cause AIDS. Then again, the idea of re-examining the evidence regarding the causes of AIDS may provide hope that if a cause other than HIV is identified, a cure might more readily be found. Below is a list of deceptions.
Seven Deadly Deceptions
Here is our list of the major denialist arguments. As noted above, the problem is not unorthodox ideas, but their immediate translation into personal medical advice, usually to tell patients to reject all medical care for HIV or AIDS, as well as suggesting that safer sex and other infection-control precautions can be ignored. So for each of the seven points, we include the corresponding action item. We are continually amazed at how casually sheer speculation gets translated into life-and-death decisions.
1. HIV is harmless (or does not exist), and AIDS is not contagious - so sexual and other precautions are unnecessary.
2. The HIV test is unreliable - so don't get tested.
3. AIDS drugs are poisons, pushed by doctors corrupted by the pharmaceutical industry - so don't take any of them, no matter what your doctor says - or don't go to a doctor at all, especially if you feel well.
4. Viral load and CD4 tests are useless - so don't use them.
5. AIDS deaths would have gone down anyway, even without new treatments - so you don't need medical care.
6. AIDS is over, or never existed, or only affected small risk groups - so there is no important need for medical research on AIDS or HIV, or for AIDS services.
7. The free speech of dissenters has been suppressed - so you can't believe anything you hear.
MYTH ONE: HIV does not cause AIDS.
AIDS is just a new name for old diseases
HIV infects cells of the immune system, mainly CD4 cells and macrophages - key elements of the cellular immune system, and destroys or impairs their function in the process. Progressive HIV infection results in the progressive depletion of the immune system, leading to immune deficiency. The immune system is said to be deficient when it can no longer play its role: fighting off infections, and keeping cancers from developing. People with cellular immune deficiency are much more vulnerable to infections such as Pneumocystis carinii pneumonia, toxoplasmosis, systemic and oesophageal candidiasis, generalised herpes zoster, cryptococcal meningitis, and to cancers such as Kaposi's sarcoma. These diseases are very rare amongst people without immune deficiency. Some of these diseases, namely those that are strongly associated with severe immunodeficiency, are called “opportunistic”' diseases, because they use the opportunity of a weakened immune system to develop.
Immune deficiency can also be present as a consequence of rare inherited diseases, and be acquired through cancer chemotherapy or immunosuppressive therapy in transplant recipients. However, HIV infection is the most common cause of acquired immune deficiency. The symptom complex associated with acquired deficiency of the cellular immune system was called “AIDS” when people realised they were looking at an epidemic of acquired immunodeficiency for which an explanation was lacking. It was soon apparent that the syndrome was frequent in groups with certain behavioural characteristics, such as homosexuals or injecting drug users, and certain geographical groups. The missing link that explained why some people in these groups developed AIDS, and others with the same behavioural or ethnic backgrounds did not, was found in 1983-84, when HIV was discovered. In cohort studies of such groups, the presence of HIV infection predicted overwhelmingly who would develop AIDS.
HIV infection typically follows the following course:
a) primary acute infection with a characteristic clinical picture;
b) prolonged period without obvious, visible symptoms - although laboratory studies can demonstrate continuous disease progression; and
c) a severe immunodeficiency resulting in the development of secondary opportunistic infections and tumours that, in turn, represent the major causes of death in AIDS patients.
The spectrum of opportunistic infections may differ in different geographical locations, depending on the prevalence of certain pathogens (parasites, fungi, bacteria and viruses) to which immunocompromised individuals may be exposed.
The evidence that HIV causes AIDS is overwhelming. Numerous laboratory, clinical research and epidemiological studies have shown, for example, that:
· There is significant correlation between the level of viral production and viral load and disease prognosis. The onset of AIDS is greatly delayed in individuals who have low levels of viral replication, while patients with high amounts of the virus in the blood and lymph nodes have a much worse prognosis.
· When HIV infection is treated successfully with highly active antiretroviral therapy, the immune system recovers partially and the disease manifestations of HIV infection often disappear, even if the patient has already progressed to AIDS. What symptoms remain depend on how much irreversible damage was done to the immune system before therapy began. The clinical response to therapy can be monitored and predicted by measurement of the amount of HIV in blood and lymph nodes.
· The main risk factors for HIV transmission (unprotected heterosexual or homosexual intercourse; blood transfusions; and needle-sharing during injection-drug use) are not new, but never resulted in a massive increase of morbidity and mortality prior to the appearance of HIV.
· AIDS and HIV infection are invariably linked in time, place and population groups.
Additional evidence that HIV causes AIDS comes from unfortunate accidental infections such as the one in which three laboratory workers who had no other risk factors developed AIDS after accidental exposure to a pure, molecularly cloned strain of HIV. In all three cases, HIV was isolated from the infected individual, sequenced and shown to be the infecting strain of the virus.
MYTH TWO: AIDS can occur without HIV
The existence of immunodeficiency was documented long before the onset of the AIDS epidemic but was extremely rare in the absence of cancer chemotherapy. These immuno-deficiencies have a very specific pathogenesis and specific clinical manifestations. Some very rare types of immunodeficiency occasionally present with the clinical symptoms of AIDS. However, surveys conducted in many countries have shown the number of these cases to be insignificant compared to the numbers of HIV-induced immune deficiency cases.
MYTH THREE: Seropositivity to HIV can be widespread without AIDS.
Speculation that HIV does not cause AIDS has in part been fuelled by arguments that point to the existence of groups of individuals who have been HIV-positive for many years without progressing to AIDS.
The course of HIV infection and the development of AIDS vary significantly between different individuals, indicating the presence of multiple factors that may influence the outcome of infection. In the most reliable cohort studies conducted in different regions of the world on HIV-infected individuals who do not receive antiretroviral therapy, AIDS symptoms develop on average approximately 8 to 10 years after initial HIV infection. About 5-10% of HIV-positive individuals develop AIDS symptoms very rapidly during the first years of infection and about the same proportion may be infected with HIV for 15 or more years without progressing to AIDS. It follows that the overwhelming majority of people with HIV infection will develop AIDS unless treated with antiretroviral therapy in a timely manner.
MYTH FOUR: The validity of AIDS epidemiological research is questionable because HIV testing is unreliable.
Testing for the presence of infections often uses the detection of antibodies that the human body produces in response to the presence of a pathogen. These antibodies are specific to a given pathogen, similar to a security lock and its key. Diagnosis of infection using antibody testing is one of the best-established concepts in medicine. Examples include the diagnosis of viral hepatitis, rubella, and many other infectious diseases. Antibody testing for these diseases has never been questioned. HIV antibody tests exceed the performance of most other infectious disease tests in both sensitivity and specificity. Recent HIV antibody tests have sensitivity and specificity in excess of 98% and are therefore extremely reliable.
Progress in testing methodology has also enabled detection of viral genetic material, antigens and the virus itself in body fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests.
Due to under-diagnosis, under-reporting, and reporting delays, surveillance based on cases with clinical manifestations of the acquired immune deficiency syndrome is unreliable in most countries - especially those with weak health care systems. Thus, epidemiological data on the spread of HIV are most commonly based on the measurement of HIV levels in various populations. Such studies use the antibody tests described above and are performed according to internationally accepted procedures, including measures to ensure quality control.
Over the past decade many countries have built up surveillance systems that include well-selected populations, such as women attending antenatal-care, which allow for extrapolation to larger populations in the countries. More recently, population based studies in a series of countries have proven the reliability of such systems. WHO and UNAIDS assist countries in their efforts to compile reliable estimates on prevalence and trends of HIV. Estimates resulting from these efforts are based on the best available data in all countries. Studies that are based on small or questionable samples are excluded.
Some commonly asked questions:
Q Does HIV cause AIDS? How should we think about it? How do we answer people who do not believe that HIV causes AIDS?
A The human immunodeficiency virus (HIV) has been decisively established as the cause of AIDS. A small but vocal group, ignoring the evidence, has continued to question the link between HIV and AIDS. Periodically, this results in media attention and generates some renewed public interest in their views. Most recently, there has been controversy in the South African and international media over the South African government's announcement that it would convene an international panel to re-examine the scientific evidence surrounding AIDS, including evidence regarding the cause and diagnosis of the disease. The debate has also recently resurfaced in other countries.

History of the controversy: The argument that HIV does not cause AIDS first attracted broad public attention in an article, published in Cancer Research in 1987, written by Professor Peter Duesberg of the University of California in Berkeley. Duesberg's contentions were rejected by scientists, but attracted attention in the mainstream press and also with specific groups outside the scientific community. For example, his attacks on the “AIDS establishment”, whom he accused of perpetuating the myth of AIDS for their own ends, were appealing to a public who already had a growing sense of disenchantment with the broad medical community. Similarly, his attribution of AIDS to specific lifestyle choices found favour with parts of society, especially those critical of the gay movement.

At the time that the controversy started, there were still some questions unanswered on the precise mechanisms of HIV disease. Ten years later there is a more complete understanding of how HIV causes AIDS.

Q What affect will AIDS have on fertility?
A According to Whiteside and Sunter the effect on fertility will be threefold. Firstly, the number of births may be reduced if women die before reaching the end of their child-bearing years. The second effect is that HIV infection and AIDS reduce fertility through physiological means. Finally, AIDS awareness, the use of condoms and increased empowerment of women will reduce fertility.

As the total fertility rate is already declining in South Africa on account of urbanisation and rising affluence, the epidemic and the programmes to fight it could cause the rate of decline to be steeper still.

Q What is the possibility of developing an AIDS vaccine?
A An AIDS vaccine is urgently needed in a world where over 5 million people are newly infected with HIV every year, but it will take time and a concerted international effort before we have one.

Given the complexity in implementing a vaccine development programme, it is essential that all countries affected actively participate in this process. Scientists around the world are working to understand the kind of immunity a vaccine would have to induce in order to protect someone against HIV infection. They are also looking into the genetic variability of the virus, which might affect the protection a vaccine could offer. The information that scientists generate is in turn being used by the pharmaceutical and biotechnology industry to develop "candidate vaccines" to be tested in HIV-negative human volunteers.

Most likely, the initial HIV vaccines will not be 100% effective (but then, few vaccines are) and they will have to be delivered as part of a comprehensive prevention package. What is important now is to ensure that countries where there is an urgent need for HIV vaccines participate in the global effort to ensure that a vaccine appropriate for their use is developed. Likewise, it is not too early to start planning now to ensure that a future vaccine is made available in the areas of the world where it is most needed.

In the long term, a safe, effective and affordable preventive vaccine against HIV is our best hope of bringing the global epidemic under control. However, it would be a mistake to think that the development of such a vaccine will be quick or easy or to expect that once a vaccine is available it will replace other preventive measures.

Q How are potential vaccines tested on humans?
A The first human trial of an HIV-preventive vaccine was conducted in 1987 in the United States. Since then, more than 30 small-scale trials have been conducted, including 12 in developing countries (Brazil, China, Cuba, Thailand and Uganda). These trials, carried out with the participation of more than 5000 healthy volunteers have shown that the candidate vaccines are safe and that they induce immune responses that could potentially protect people against HIV infection.

The first large-scale HIV vaccine trials, designed to show whether the candidate vaccines actually protect against HIV infection or disease, were launched in 1998 in the United States and in 1999 in Thailand. The trials involve 8000 healthy volunteers who are given one of two different versions of gp120, a protein located on the outside of the virus, depending on the virus strains prevalent in the two countries. The initial results from these trials may be available within the next two years. Parallel to this, other candidate HIV vaccines are being developed through different experimental approaches. Some are based on the HIV strains prevalent in developing countries. Most of these newer candidate vaccines will be tested in small-scale trials in human volunteers, and the best will proceed to large-scale evaluation for efficacy.

Vaccine development is complicated not only by the range of virus subtypes circulating but by the wide variety of human populations who need protection and who differ, for example, in their genetic make-up and their routes of exposure to HIV. Inevitably, different types of candidate vaccines will have to be tested against various viral subtypes in multiple vaccine trials, conducted in both high-income and developing countries. It is vital for developing countries to build up their technical and human capability to conduct such trials with the highest ethical and scientific standards and with the full participation of the community.

Q How effective is the condom at preventing STD’s and sperm penetration?
A Due to sperm’s relatively large size, blocking it is the least demanding of the two. Evidence shows that a natural rubber condom, free from defects, provides a complete barrier to sperm. There are many effective means of preventing or reducing the incidence of pregnancy arising from intercourse, but there are far fewer reliable options for avoiding transmission of STD’s. Studies have shown that condoms protect against a wide range of STD’s, including syphilis, gonorrhoea, chlamydia, herpes, and hepatitis B. (source: http://www.durex.com/; scientific articles)
Q There have been rumours of naturally occurring holes in latex that are big enough for HIV to pass through. Is this true?
A The reports of holes in latex appear to have originated from an article in Science Magazine about latex gloves, not condoms. Holes as large as 5 microns in diameter were evidently identified in latex used in gloves. However, gloves are only dipped in latex once when they are made, condoms are dipped twice in latex. Gloves are allowed to fail the water leak test at a rate of 40 per thousand, while condoms are only allowed 4 failures of the water leak test per thousand condoms before the entire batch is rejected. While holes large enough for HIV to pass through have been found in natural membrane condoms, latex condoms do not allow the HIV to pass through the condom unless the condom has been damaged or torn. Used properly, latex condoms are effective in reducing the risk of HIV infection. (Source: CDC)
Q I want to use a condom, but my partner does not. How do I negotiate for safer sex?
A Many women may have contemplated using condoms but may be uncomfortable suggesting condom use to their partners. Developing condom negotiation skills may help women in this situation.

Here are some sample responses women can practice and then use when a partner objects to condoms:

· Sensation objection: "I won't feel as much if I have a condom on."
Response: "You won't feel anything if you don't have a condom on."
· Sensation objection: "It doesn't feel good."
Responses: "I think it's really sexy when a guy uses a condom. It shows he cares. What if I put it on for you?" OR "I'd feel better."
· Availability objection: "I don't have one."
Response: "I do, and it's ribbed inside for your pleasure."
· Disease prevention objection: "If you trusted me, you wouldn't ask me to use one."
Response: "I trust that you're telling me the truth, the best you can. But with some STD’s, you can't tell if you have them just by looking. Let's be safe and use condoms."
· Disease prevention objection: "You won't catch anything from me."
Response: "If you love me, respect my health."
· Spontaneity objection: "It will interrupt sex."
Responses: "Let me put it on you. You'll love it." OR "I'll wait."
· Spontaneity objection: "It spoils the mood."
Responses: "It puts me in the mood." OR "Not if I help." OR "We could always just go to a movie."
· Traditional objection: "I don’t shower with a rain coat on” OR “I don’t eat sweets with the papers on."
Response: "You will not be eating any sweets without your raincoat on.”
(Adapted from www.thriveonline.com)
Q What is the female condom?
A The female condom is a strong, soft sheath that is inserted into the vagina before sexual intercourse. It has two plastic rings:
· one at the closed end, which helps insert the condom and keep it in place, and
· the other at the open end, which remains outside the vagina.
 
It is made of polyurethane plastic, which requires no special storage and can be inserted quite a while before having sex. It does not require immediate withdrawal after ejaculation and it can be used with both oil-based and water-based lubricants. Because it is usually visible during sex, a woman cannot easily use a female condom without her partner knowing about it, but women do have more control over use of this method than they do over use of a male condom. The female condom is not meant to replace the male condom. Rather, it is meant to increase the options available to fight HIV and other sexually transmitted infections.
 
Q How effective is the female condom?
A According to a Thai study among sex workers in brothels, when a female condom was provided as an extra option to the male condom, the women experienced a 34% decrease in the number of new sexually transmitted infections. The same study also found that sex workers who had access to both the female and the male condom were less likely to have unprotected sex than women who had access only to male condoms.

Use of the product is not expected to reach the high levels recorded in many countries for the male condom. Research in Zambia and Zimbabwe reveals that after a year of mass marketing, awareness of the female condom is high but use remains extremely low. Some studies show, however, that once women try the female condom, they like it. For example, among female drug users in Brazil, 75% who used the female condom reported being comfortable with it. Follow-up interviews three months later showed that 43% reported continued use, although women living in poor areas (favelas) were less likely to continue using the condom. The biggest problem is that female condoms are several times more expensive than male condoms and therefore not readily available to all. Efforts to expand access, increase global volume and further reduce the price continue. (UNAIDS global report – June 2000)

Q Is there a difference in the rate of HIV transmission between circumcised and uncircumcised men?
A For several years, researchers have been debating the relationship between male circumcision and HIV. Several studies have indicated that circumcised men are less likely to become infected with HIV than uncircumcised men. However, because circumcision is usually linked to culture or religion, it has been argued that the apparent protective effect of the procedure is likely to be related not to removal of the foreskin but to the behaviours prevalent in the ethnic or religious groups in which male circumcision is practised. In addition, some researchers have assumed that any association between circumcision and HIV may be complicated by the presence of other sexually transmitted infections, which have been found to be more common among uncircumcised men.

Clearly, the correlations are not straightforward. In the higher-income countries, the rates of HIV infection among men who have sex with men do not vary greatly even though the circumcision rates do: few men in Europe and Japan but four-fifths of men in the United States are circumcised. In Africa, however, circumcision seems to confer some protection. A study in Nyanza Province, Kenya, among men from the same ethnic group (the Luo), found that one-quarter of uncircumcised men were infected with HIV, compared with just under one-tenth of circumcised men. The protective effect remained even after other factors, such as sexual behaviour and sexually transmitted infections, had been taken into account. A study of over 6800 men in rural Uganda has suggested that the timing of circumcision is important: HIV infection was found in 16% of men who were circumcised after the age of 21 and in only 7% of those circumcised before puberty. A recent review of 27 published studies on the association between HIV and male circumcision in Africa found that, on average, circumcised men were half as likely to be infected with HIV as uncircumcised men.

When African men with similar socio-demographic, behavioural and other factors were compared, circumcised men were nearly 60% less likely than uncircumcised men to be infected with HIV.

Even though the weight of evidence increasingly suggests that circumcising men before they become sexually active does provide some protection against HIV, the practical implications for AIDS prevention are not obvious. Circumcision, where it is practised, usually has links to religious or ethnic identities and life-cycle ceremonies, and may customarily be done after puberty. If the same scalpel were used without sterilisation on a number of boys, this could actually contribute to the transmission of HIV. Finally, if circumcision were promoted as a way of preventing HIV infection, people might abandon other safe sexual practices, such as condom use. This risk is far from negligible – already, rumours abound in some communities that circumcision acts as a "natural condom". A sex worker interviewed in the city of Kisumu in Kenya summed up this misconception, saying: "I can sleep with circumcised men without a condom because they don’t carry a lot of dirt on their penis". While circumcision may reduce the likelihood of HIV infection, it does not eliminate it. In one study in South Africa, for example, two out of five circumcised men were infected with HIV, compared with three out of five uncircumcised men. Relying on circumcision for protection is, in these circumstances, a bit like playing Russian roulette with two bullets in the gun rather than three (UNAIDS report June 2000).

Q What is the risk of HIV transmission from oral sex?
A The likelihood of transmission of HIV from an infected person to an uninfected person varies significantly, depending on the type of exposure or contact involved. The risk of becoming infected with HIV through unprotected (without a condom) oral sex is lower than that of unprotected anal or vaginal sex. However, a lower-risk activity will increase in risk when it is repeated enough.

The Options Project found that 7.8% (8 out of 102) of recently infected men who had sex with men in San Francisco were probably infected through oral sex. Most of these men believed that the risk was minimal or non-existent. Nearly half (3 out of 8) of these cases reported oral problems, including occasional bleeding gums. Almost all (7 out of 8) of these men reported having had oral contact with pre-semen or semen.

The study results emphasise that any type of sexual activity with an infected person poses a risk of HIV transmission. (7th National Conference on Retroviruses and Opportunistic Infections, January 2000) Oral sex with someone who is infected with HIV is certainly not risk-free.

This is why scientists divide the risk of contracting HIV into four categories:

 
No risk
Social contact
Low risk
French Kissing (kissing with an open mouth), sharing toothbrushes and razors, etc.
Medium risk
Oral sex
High risk
Any form of unprotected sex, of which receptive anal sex has the highest risk incidence
Without question, the greater risk of contracting HIV rests with the performer of oral sex. Having ejaculating take place outside the mouth, not swallowing ejaculate, and/or reducing the frequency of these sex acts, lowers the risk. If one receives oral sex from a partner with a cold sore or herpes, the chances of contracting this sexually transmitted disease are higher, as compared to HIV infection.
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7 Ways to Correct the Top 'Alternative Facts' About HIV. 27/1/2017

Published by THEBODY

TheBody.com spoke with HIV advocates and experts across the United States to learn more about commonly encountered misinformation

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South African Child Gauge 2017.

Published by CI

The 2017 issue of the South African Child Gauge focuses on the theme of Survive – Thrive – Transform – and explores on how the Sustainable Development Goals can be used to create an enabling environment in which South Africa’s children not only survive, but thrive and reach their full potential.

When citing the Child Gauge, please remember to acknowledge the authors of individual chapters, for example:

Jamieson L & Richter L (2017) Striving for the Sustainable Development Goals: What do children need to thrive? In: Jamieson L, Berry L & Lake L (eds) South African Child Gauge 2017. Cape Town, Children’s Institute, University of Cape Town.

When linking to the book and its supplementary material, please link to this page, and not to individual pdfs downloaded from this page, as that separates the book from its accompanying material and other information on the series contained on our website. Thank you for complying with this request.

You can access the resource here

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UNAIDS DATA 2017. 20/8/2017

Published by UNAIDS

UNAIDS has collected and published information on the state of the world’s HIV epidemic for the past 20 years. This information has shaped and guided the development of the response to HIV in regions, countries and cities worldwide. This edition of UNAIDS data contains the highlights of the very latest data on the world’s response to HIV, consolidating a small part of the huge volume of data collected, analysed and refined by UNAIDS over the years.

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Accurate and Credible UNAIDS Data on The HIV Epidemic: The Cornerstone of The AIDS Response. 10/7/2017

Published by UNAIDS

Once a year, UNAIDS releases its estimates on the state of the worldwide HIV epidemic. Since the data can literally affect life and death decisions on access to services for treatment and prevention—and are used to decide how to spend billions of dollars a year—they need to be as accurate as possible and be regarded as credible by everyone who uses the information.

How we collect and interpret HIV data has huge consequences—a pregnant woman visiting an antenatal clinic can help calculate the size of the country’s HIV epidemic, can help shape national policies for the response to HIV and can influence the size of grants to respond to HIV from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President’s Emergency Plan for AIDS Relief and others.

So, how do we do it? 

Collecting data on the ground

We don’t count people. We can’t—many people who are living with HIV don’t know that they are, so can’t be counted. And everyone in a country can’t be tested every year to calculate the number of people living with HIV. Instead, we make estimates.

The data that are published in our reports, quoted in speeches and used by governments around the world to plan and implement their AIDS responses originate on the ground, in a clinic, in a hospital or anywhere else that people living with HIV access, or need, HIV services.

Take the example of a pregnant women visiting an antenatal clinic as part of her routine antenatal care. She will be offered an HIV test, which will show her to be either HIV-positive or HIV-negative. An HIV-positive result will, of course, open up for the individual mother the range of prevention of mother-to-child transmission of HIV services available to keep her well and her baby HIV-free, but the result, whether negative or positive, will also be used to determine the wider impact of services and the success of country programmes.

Some countries operate a so-called sentinel survey system, in which a network of reporting sites collect data. If the clinic is one of these, a sample of blood will be anonymized and collected with results from the other sentinel sites, resulting in a large set of data to estimate trends from the sentinel sites over time.

In other countries, data from all women who are being tested routinely at all antenatal care sites are used to estimate HIV prevalence. Her test result will be recorded and passed on to the country’s national-level HIV reporting agency.

Data from antenatal clinics, when combined with information from broader, but less frequently collected, population-based surveys, are the basis for HIV data collection in countries where HIV has spread to the general population.

For countries that have HIV epidemics mainly confined to key populations, data from HIV prevalence studies among those key populations are most often used. These prevalence studies are combined with the estimated number of people in those key populations—an estimate that is difficult to make, given that behaviours of key populations are outlawed in many countries.

In countries in which doctors are required to report cases of HIV, and if those data are reliable, those direct counts are used to estimate the epidemic. An increasing number of countries are setting up systems that use reported cases of HIV diagnoses.


Survey types

Population-based survey: a survey that is conducted in a random selection of households in a country. The survey is designed to be representative of all people in the country.

HIV prevalence study: a study of a specific population that collects blood samples from the population to determine how many people in that population are living with HIV. Typically, the results of that test are provided to the survey respondent.


Number crunching

Once a year, the country’s reporting agency will, helped by UNAIDS and partners, make estimates of the number of people living with HIV, the number of people on HIV treatment, the number of new HIV infections, etc., using software called Spectrum, which uses sophisticated calculations to model the estimates.

For estimates relating to children, a whole range of information, such as fertility rates, age distributions of fertility and the number of women in the country aged 15–49, is taken into account when computing the final numbers.

Estimates for different populations and age groups are calculated by Spectrum, taking into account different types of demographic and other data, building up a comprehensive picture of the country’s HIV epidemic.

The Spectrum estimates are sent to UNAIDS at the same time as the collection of the annual Global AIDS Monitoring reporting on the response to the HIV epidemic in the country. UNAIDS compiles and validates all the Spectrum files and uses the country-level data to make global estimates of the HIV epidemic and response.

UNAIDS publishes estimates for all countries with populations greater than a quarter of a million people. For the few countries of that size that do not develop Spectrum estimates, UNAIDS develops its own data, based on the best available information.

Ranges are important

In 2015, there were 36.7 million [34.0 million–39.8 million] people living with HIV in the world. The numbers in the brackets are ranges—that is, we are confident that the number of people living with HIV is somewhere within the range, but can’t say for sure what the definite number is.

All UNAIDS data have such ranges, but why can’t we be more accurate? UNAIDS data are estimates, which vary in their accuracy, depending on several factors. The size of sample taken for the estimate affects the range—a large sample means a small estimate range, and vice versa; if a population-based survey is conducted in a country, the estimate range will be smaller; and the number of assumptions made for an estimate has an impact on how narrow the range will be.

If it’s found to be wrong, it’s fixed

UNAIDS’ models are regularly updated in response to new information. For example, this year’s data will show a slight rise in the reported number of children becoming infected with HIV. This isn’t a real rise in young children acquiring HIV, but an adjustment in our knowledge of how infections occur in real life—in fact, once we apply this updated knowledge to previous years, we see that the number of new HIV infections among infants was higher then too.

Our new knowledge shows us that, after childbirth, higher numbers of women who are breastfeeding are becoming infected with HIV and hence passing the virus on to their children. Models had not fully captured the length of time for which women breastfed and were therefore at risk of passing on the virus through their milk if they became infected with HIV. With the model adapted to take into account women breastfeeding for longer than one year, the number of infants contracting HIV increased slightly for all years since the start of the epidemic.

Because of such finetuning, estimates from one year can’t be compared with estimates from a previous year. When UNAIDS publishes its yearly data, we revise all previous years’ estimates, taking into account the revised methodology. For example, the estimate published in 2006 for the worldwide number of people living with HIV in 2005 was 38.6 million—this was before we had incorporated national household surveys into estimates. By 2016, with the additional information from surveys, the number for 2005 had been revised to 31.8 million. Likewise, the estimate for AIDS-related deaths in 2005 was 2.8 million, which, by 2016, had been revised down to 2.0 million in 2005.

This finetuning has steadily improved the accuracy of our estimates, with the result that recent revisions are becoming smaller—the estimated number of people living with HIV in 2013 made in 2014 was 35.0 million, not far off the current estimates of 35.2 million.

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Editorial: Methodological Developments in the Joint United Nations Programme on HIV/AIDS Estimates. 4/2017

Published by IASJ

Introduction

The Joint United Nations Programme on HIV/AIDS (UNAIDS) publishes estimates of the HIV epidemic every year [1]. For 2016, estimates are available for 160 countries representing 98% of the global population. These estimates are produced by countries with guidance from UNAIDS. The methods used in this process continue to evolve over time under the stewardship of the UNAIDS Reference Group on Estimates, Modelling and Projections [2].

In 2014, the WHO convened the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) Working Group with the aim to define and promote good practice in reporting global health estimates [3]. The GATHER Statement is the outcome produced by this group. It defines a list of reporting requirements to allow for the accurate interpretation, and facilitate the appropriate use, of global health estimates [4]. UNAIDS fully endorses and supports the GATHER Statement.

The current special supplement, which details the methods used to produce the 2016 UNAIDS estimates, further supports the routine publication of data sources and methods used as part of an open and transparent process. It provides updates of the evolving understanding of the data on which the estimates are based, the methods used to derive the estimates, justification of changes in these methods, and the sources of new data available to inform these modifications. It follows a series of such collections [5–10] which have documented and described the evolving methods used to produce the UNAIDS Global AIDS estimates since 2004.

Key updates and modifications in Spectrum

The AIDS Impact Module and the Estimation and Projection Package (EPP) in Spectrum [11] are the core tools used by countries and endorsed by UNAIDS to produce HIV estimates. These tools are modified and updated as new data become available, in response to further method development, and to support the evolving needs of program planning, monitoring, and evaluation. Changes in the methods used can result in changes in both current and historical estimates.

A key change in the 2016 estimates is the reduction in the estimated number of children living with HIV (CLHIV) compared with previous estimates. Mahy et al.[12] describe the new evidence on the probabilities of mother-to-child HIV transmission and the age at which children initiate antiretroviral therapy, both of which are crucial assumptions. This leads to a 27% reduction in CLHIV compared with the 2015 estimates. The revised estimates are compared with the available empirical data which illustrate general consistency with nationally representative population-based surveys, although, given the paucity of empirical data on HIV incidence and prevalence, the potential for underestimation of HIV prevalence, especially among children at older ages, remains.

Among adults, new data available from the International Epidemiologic Databases to Evaluate AIDS Network are used to estimate revised model parameters in Spectrum for adult mortality on antiretroviral treatment (ART). Anderegg et al.[13] update a previous analysis from 2012 [14] and develop methods to adjust the observed all-cause mortality on ART to account for the unknown outcomes of patients that are ‘lost-to-follow-up’. Patient-level data from 43 countries across seven regions are used in this analysis. Mortality rates for each region are corrected on the basis of the ascertainment of vital status of those lost-to-follow-up from tracing studies in Kenya and linkage of data systems in South Africa. The revised estimates express higher on-ART mortality rates than those previously calculated. This is largely explained by this analysis benefiting from the data of many more sites than was possible previously. However, there remains a need for empirical data on the outcomes of patients’ lost-to-follow-up, in countries outside of South Africa and Kenya, to further improve the accuracy of these parameters.

For countries with concentrated or low-level HIV epidemics, Mahiane et al.[15] describe the ‘Fit to Program Data’ tool in Spectrum which allows estimation of HIV incidence from case-report data and vital registration of AIDS mortality. This tool was developed to provide an alternative option to fitting to surveillance and survey data in EPP, data which are often unavailable in low-level epidemic settings, require nationally representative trends over time, and robust size estimates for key populations. This new fitting tool allows countries with strong case-reporting systems and relatively complete registration of AIDS deaths to take advantage of the strength of these data to develop estimates. In 2016, 62 countries used this tool to produce estimates, compared with 16 countries in 2015. Fitting to program data in these countries provided good alternative fits compared with EPP when information about the timing of diagnosis, the proportion of the population undiagnosed, and the potential for misclassification of AIDS-related deaths over time is known.

Other modifications in EPP and Spectrum described by Stover et al.[16] include the implementation of updated demographic data at the national and subnational level, adaptations to the program data input to better reflect WHO 2015 guidelines on ART, improved estimates of uncertainty at the regional level, additional options for estimating incidence in Spectrum, and technical changes related to the sharing of estimates between different modules within the framework.

Better understanding of the data used in the estimates

HIV prevalence measured from periodic sentinel surveillance of pregnant women attending antenatal clinics (ANC) has historically been the basis in EPP for estimating trends in HIV prevalence over time in generalized epidemic settings [17]. However, these data present a number of challenges, which new methods seek to better accommodate.

First, these data from pregnant women are subject to a bias caused by the reduced fertility associated with HIV. Corrections for this are already made in the estimation process, but accumulating data availability allows a more detailed analysis. Marston et al.[18] use data from population cohorts in Uganda, Tanzania, and Zimbabwe to estimate the relationship between duration of HIV infection and fertility before the availability of ART. This is done to understand how increases in population level subfertility by duration of infection affect the relationship between prevalence among pregnant women and the population over the course of the epidemic.

Second, these trends can exhibit greater variation than expected from random sampling error alone, due to changeable sampling practices, testing procedures or local epidemic shifts. If this is not factored-in to the model fitting, too much weight could be attached to those data compared with high quality data sources, such as national population-based surveys. Eaton and Bao [19] propose three approaches to account for the uncertainty of nonsampling error in HIV prevalence measured in ANC sentinel surveillance and tested these with data from nine countries in southern and eastern Africa. The authors find that incorporating an additional variance parameter in EPP to allow for nonsampling error, and estimating this variance term via Bayesian inference, results in improved fitting to household survey prevalence and appropriately increased uncertainty intervals in the early epidemic period. This approach is recommended for implementation in EPP and will also have further applicability for the inclusion of other types of data in EPP fitting, notably routine testing data from prevention of mother-to-child transmission programs.

Third, as the ANC surveillance sites were historically chosen more for their convenience than a belief that they faithfully represent the wider communities of which they are a part, it remains a question about how to interpret those data in a spatial context. To examine this, Wilson et al.[20] investigate whether HIV prevalence measures among women attending ANC clinics are representative of prevalence in the local area, or whether estimates may be biased by women who travel away from their home areas to attend nonlocal clinics. Data from periodic surveillance rounds conducted in 19 ANC clinics in Zimbabwe between 2000 and 2012 are used to compare HIV prevalence and nonlocal patterns of attendance. The authors find that while HIV prevalence in towns was slightly underestimated due to women from lower prevalence rural areas traveling to towns to attend ANC in 2000, there was no distortion in HIV prevalence in more recent surveillance rounds. Thus, prevalence measures among women attending ANC in Zimbabwe provide reliable estimates of HIV prevalence in pregnant women in the local area. Further studies are needed to establish the wider generalizability of these findings.

Finally, countries with generalized HIV epidemics are currently transitioning away from periodic sentinel surveillance in ANC to the use of routinely collected data from all ANC sites. This transition has important implications for generating HIV estimates and the greater spatial density of these data will be central in developing more spatially specific estimates. There are also challenges, as countries will no longer have the continuity of data from the same ANC sentinel surveillance trend data over time, but will instead include data from all sites, with testing requiring patient consent and conducted using rapid tests, and so potentially subject to a range of different biases. Sheng et al.[21] propose new methods that allow for the inclusion of both sentinel and routine surveillance data in EPP and address these biases, and generate recommendations and further considerations to further test and refine these methods as routine program data become available.

Validation of surveillance data and model estimates

The estimates produced for each country represent the compilation of a large amount of data but inevitably also rely to some extent on assumptions and judgments. It is, therefore, important to take every opportunity to compare the outputs of the estimation process to other data and to assess how faithfully estimates align with reality. Two approaches have recently been used.

To assess the performance of the models in estimating incidence and prevalence trends, Silhol et al.[22] produced a subnational model projection in Spectrum using surveillance data from women attending ANC, census data, and population survey data from an HIV cohort study in Manicaland, Zimbabwe. The estimates obtained from the Spectrum projection were compared with the empirical estimates. Overall, model estimates of the incidence and prevalence were in good agreement with the data. However, the Spectrum estimates of HIV incidence among women declined faster than empirical estimates, and there were inconsistencies in the Spectrum estimated age-patterns of adult all-cause mortality. Among children, the latest Spectrum estimates of child HIV prevalence closely matched survey prevalence, but discrepancies were observed in the estimates of maternal and paternal orphanhood.

To assess the performance of the models in estimating mortality trends, Masquelier et al.[23] compare the 2016 Spectrum estimates of adult mortality and orphanhood in 43 countries in sub-Saharan Africa to household survey and census data. Among adults, the authors find discrepancies in the levels, sex ratios and age patterns of adult mortality. Although some of these differences may be explained by suspected systematic biases in the empirical measurements, some of the signals could point to factors affecting mortality that are not fully represented in the models. In particular, it appears that in high prevalence settings the bulge of AIDS deaths around ages 34–39 years for women in Spectrum is not found in empirical estimates, which show the spread of AIDS deaths is less concentrated and extends to younger women as well. For high-HIV prevalence countries, this analysis also indicates a higher prevalence of paternal orphans in the survey and census data than in the model estimates, which is consistent with findings by Silhol et al.[22], and suggests underestimation of HIV-associated male mortality in Spectrum. In low and intermediate HIV prevalence countries, both paternal and (especially) maternal orphanhood are lower in empirical estimates than in model-based ones. The ‘adoption effect’ – respondents reporting parental survival based on a current foster parent rather than the biological parent - may contribute to these discrepancies, particularly for maternal orphanhood.

Taken together, these highlight areas for further investigation and method development – particularly pointing toward the need to develop age-structured modeling of mortality data and prevalence and program data simultaneously – and indicates that, for now, caution should be taken in interpreting some estimates, notably age-specific estimates of child prevalence, age-specific estimates of mortality, and orphanhood estimates. Further work is currently underway to address these issues.

Development of new methods to inform future estimates

There is an increasing demand for estimates at the subnational level to inform program planning, decision–making, and resource allocation and to monitor and evaluate progress toward stated goals. A goal for future rounds is for estimates to be developed at much finer spatial scales and work to develop appropriate methods is progressing rapidly [24,25]. However, several developments that allow leveraging of available data to better represent subnational epidemics are already planned for use in the 2017 estimates round. In particular, Niu et al.[26] present a statistical model that incorporates a hierarchical structure in EPP to improve the precision of estimates at the subnational level. This method ‘borrows’ information from relatively data-rich areas to inform data-poor areas. The authors demonstrate the improvement of HIV estimates at the subnational level in both generalized and concentrated epidemic settings.

Conclusion

The 2016 UNAIDS estimates are informed by the best available data and evidence. The accuracy of these estimates is critical for HIV program planning, effective scale-up of services, and optimal use of resources. As such, the methods used to generate these estimates will continue to evolve in the future in support of continual refinement and enhanced precision. The generation of additional empirical data will be essential to further improve the ability to develop and validate model-based estimates.

 

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WHO Recommends 10 Measurements for HIV Epidemic. 13/05/2015

Published at WHO
11 May 2015


Launch of the WHO Consolidated strategic information guidelines for HIV in the health sector WHO Consolidated strategic information guidelines for HIV in the health sector

11 MAY 2015 | Bangkok, Thailand – The World Health Organization (WHO) released new guidelines recommending simplified indicators to measure the reach of HIV services, and the impact achieved at both the national and global levels.

The new Consolidated strategic information guidelines for HIV in the health sector are being launched at the 3rd HIV surveillance consultation starting today in Bangkok, Thailand. The guidelines were developed in partnership with the Global Fund, UNAIDS, UNICEF and the US President's Emergency Plan for AIDS Relief (PEPFAR).

WHO places high priority on strategic information since the beginning of the HIV epidemic. Today more than ever strategic information is key to an effective, focused and efficient HIV response.

Dr Gottfried Hirnschall, WHO's Director for the Department of HIV/AIDS and the Global Hepatitis Programme

The new consolidated guidelines recommend the use of 10 global indicators to collect information along the cascade of HIV care and treatment as a principal way to track epidemics and responses. These indicators are:

  • Number of people living with HIV
  • Domestic funding
  • Coverage of prevention services
  • Number of diagnosed people
  • HIV care coverage
  • Treatment coverage
  • Treatment retention
  • Viral suppression
  • Number of HIV deaths
  • Number of new infections

Based on essential information collected on these 10 key areas, HIV specialists will be able to assess the scale of the disease, and the impact achieved as a result of the investments made in a country, or globally.

"In today's context of moving towards even more ambitious HIV goals, countries need much more comprehensive, yet simplified tools to collect HIV strategic information, which is the main objective of the guidelines," said Dr Daniel Low-Beer, WHO’s Coordinator for HIV Strategic Information and Planning.

The host country for the launch, Thailand, strongly supports the guidelines. The representative from Thailand’s Ministry of Health, Dr Taweesap Siraprapasiri, said, "In Thailand, strategic information was the key ingredient for success achieved in the fight against HIV. These new guidelines will help us to harmonize the indicators to be collected and used, while enabling us to make policy decisions and programmatic adjustment more strategically tailored for the needs of the people affected by HIV in the country."

The new guidelines aim to help national decision-makers access all HIV strategic information essentials in one place. Alongside the top 10 global indicators, the guidelines offer 50 national indicators, to be selected by countries as the basis for their strategic information efforts. Previously, countries were required to collect information on more than 100 indicators to report on HIV programmes.

"UNAIDS fully supports the guidelines and hopes they will help countries to monitor and report on their achievements towards the 90-90-90 targets and other 'Fast-Track' targets," said Peter Ghys, UNAIDS Director for Strategic Information and Evaluation.

"The guidelines call for countries to better disaggregate their data - which inevitably reveal inequities and help us to respond and monitor the HIV epidemic in children and adolescents,” said Dr Priscilla Idele, UNICEF's Senior Adviser for Data and Analytics.

“It is critically important to support countries in measuring the impact of investments made in HIV programmes," said Dr Osamu Kunii, Head of the Strategy, Investment and Impact Division at the Global Fund. “This is a high priority for all partners in global health.”

WHO's new Consolidated strategic information guidelines for HIV in the health sector is intended for use by all specialists involved in national HIV programmes, as well as non-governmental organizations, donor agencies, and implementing partners engaged in HIV services both at the national and global levels.

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Consolidated strategic information guidelines for HIV in the health sector. 4/6/2015

Published at WHO
Written by Ward Rinehart, Sarah Johnson, Celine Daly et al.
May 2015
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This guidance consolidates, prioritizes and describes key indicators to monitor the national and global response of the health sector to HIV. Its goal is to help countries choose, collect and systematically analyse strategic information to guide the health sector response to HIV. The aim of consolidation is to ensure that all indicators are in one place, are prioritized and linked in a result chain, and can be used to support quality care along the health sector cascade of HIV services.
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Statistics in Perspective. 15/09/08

Statistics – An Introduction

When we speak of statistics, particularly around HIV and AIDS, people often complain that stats are confusing, that different sources contradict each other, or that statistics are figments of someone’s imagination. It might seem that way, especially when statistics are quoted without reference or where one hears that “they say that…”

(A comprehensive article on statistics is available from AVERT)

Evaluating Reliability

It is necessary to consider a few factors to help create a clearer picture of the value of statistics

  1. What is the origin of the statistics?
  2. What method was used to collect the statistics/data?
  3. When were the statistics published, and what time period was covered?

Each one of these aspects should be considered individually. Collectively it should then give one an idea of the dependability and reliability of the statistics.

1. What is the origin of the statistics ?

The reliability of statistics can be directly related to the origin or source thereof. If you trust the organisation, one can normally trust the statistics they produce.

 When looking at statistics around HIV testing the following specifics should be considered:

a.    With the most common tests, e.g. Elisa or OrasureR ens. , the virus is not identified, but the antibodies which the body developed in response to exposure to the virus are identified. If antibodies are present to the virus, one can assume that the virus is present. 

b.    The process of forming antibodies takes some time. In this time, known as the window period, an individual can be infected, and infectious, but test negative to presence of the virus. Newer more expensive tests are available that identify the virus and can provide a positive test must sooner.

c.     With HIV testing, a “positive” test means that the individual’s body developed antibodies to the HI- virus, and thus that the individual is infected by the HI-virus (an exception to this is young babies born to HIV positive mothers.) A negative test thus means that antibodies to the HI-virus have not been formed. This can be because the individual has not been exposed, or that the individual is still in the window period. If the possibility of infection exists and the test was negative, retesting should be suggested. In some cases “False Positive” results are found. It is thus important that any positive result be confirmed by retesting.

 2. Methods of Obtaining Statistics.

A wide variety of methods are used to obtain statistics. The following should be considered:

a.    Do the statistics refer to real incidence or estimations?  Research and statistics can provide information on actual HIV tests done, and thus give us information on incidence within a sample of a selected community (e.g. National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa), or of present or future estimations made on the base of existing knowledge. (E.g. Actuarial Society of South Africa AIDS Demographic Model 2002). 

b.   How was the individual’s status determined? Different methods have been used to determine the HIV status of individuals included in studies.       The most inaccurate would probably be asking the respondent. More reliable methods include the use of the Elisa test, as in the National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa  and the saliva test as with the HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds. Reproductive Health Research Unit. University of Witwatersrand.       In some studies, no test are done, as the purpose of the study is to determine the perception of risk, e.g. with the National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS Among South African School Pupils.

c.   How was the test sample or group selected? Correct sample selection methods are important to ensure representation in any sample group. If you merely select the first 10 scholars walking out the gate on a particular afternoon, and generalise this for the whole school, you might get faulty results. These 10 individuals might in fact be the 10 most sexually active grade twelve learners or, conversely, the 10 most inexperienced grade 8s. Methods should thus be used to ensure randomness.

d.   How were generalisations made?  Statistics can only be generalised for a group if the sample can be viewed as representative for the group as far as selection of the sample, size of the sample and the group and nature/type of participants. Thus generalising the results of the study “HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds” to the total South Africa population would probably be incorrect and irresponsible.It is also important to note whether the results refer to actual figures or percentages

3. When were the statistics published, and for which time period was it determined?

Especially in a rapidly developing pandemic such as HIV, it is critical that the most recent statistics are quoted. The National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa as well as the AIDS Epidemic Update of UNAIDS is repeated and published annually and using 2001 results would be senseless, unless it is done for comparison purposes.

It is therefore essential to look at the publication date of statistics and include the references where possible. It is often difficult to determine the relevance of an article or statistics if there is no indication of when the estimation or study was done. One often reads in the popular press of “South Africa’s 660 000 AIDS orphans” However, according to the AIDS Epidemic Update: December 2003 there were already 1.1 million children at that time that have lost one or both parents to AIDS.

Conclusion: 

It is clear that there is an very large amount of statistic information available. This information can play a valuable role in planning a response to the epidemic and making informed choices. It is however clear that this data must be used accurately and judiciously otherwise the possibility exists that statistics can lead to confusion and misperception.

References.

  1. Actuarial Society of South Africa. AIDS Demographic Model 2002 
  2. UNAIDS,. AIDS Epidemic Update: December 2003.
  3. Dorrington R E, Bradshaw D and Budlender D. HIV/AIDS Profile of the Provinces of South Africa: Indicators for 2002. Centre for Actuarial Research, Medical Research Council and the Actuarial Society of South Africa. 2002,  
  4. Department of Health. National HIV and Syphilis Antenatal Sero-Prevalence S urvey In South Africa 2003.
  5. Nelson Mandela Foundation, HSRC. Study of HIV/AIDS: South African National HIV Prevalence, Behavioural Risks and Mass Media - Household Survey (2002)
  6. Medical Research Council, Department of Health .The 1st South African National Youth Risk Behaviour Survey 2002.
  7. Reproductive Health Research Unit. University of Witwatersrand . HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds.
  8. SABCOHA The Economic Impact of HIV/AIDS on Business in South Africa. 2003.
  9. CIET. National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS Among South African School Pupils. 2004 
  10. 1Nelson Mandela Foundation. HIV Risk Exposure in 2--9 year-olds in the Free State. A Study of 2-9 year olds Served by Public Health Facilities in the Free State, South Africa. 2005  
  11. HSRC, Education Labour Relations Council. Study of Demand and Supply of Educators in South African Public Schools. 2005
Written by Lyn van Rooyen, CARIS.

 

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Common Sources of Statistics

Information about some of the best known and most quoted statistics sources can be found below.

News articles on a variety of different statistical reports for South Africa can be found here.

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HIV/AIDS Country Profiles. 2011

WHO country work 2011

WHO - World Health Organization

WHO/Europe produces country profiles on the HIV-related situation in each Member State of the WHO European Region. The information used for country profiles comes from different sources, including annual reporting mechanisms to which national stakeholders contribute.

HIV/AIDS country profile 2011: Albania

HIV/AIDS country profile 2011: Andorra

HIV/AIDS country profile 2011: Armenia

HIV/AIDS country profile 2011: Austria

HIV/AIDS country profile 2011: Azerbaijan

HIV/AIDS country profile 2011: Belarus

HIV/AIDS country profile 2011: Belgium

HIV/AIDS country profile 2011: Bosnia and Herzegovina

HIV/AIDS country profile 2011: Bulgaria

HIV/AIDS country profile 2011: Croatia

HIV/AIDS country profile 2011: Cyprus

HIV/AIDS country profile: Czech Republic
WHO/Europe, 2012

HIV/AIDS country profile 2011: Denmark

HIV/AIDS country profile 2011: Estonia

HIV/AIDS country profile 2011: Finland

HIV/AIDS country profile 2011: France

HIV/AIDS country profile 2011: Georgia

HIV/AIDS country profile 2011: Germany

HIV/AIDS country profile 2011: Greece

HIV/AIDS country profile 2011: Hungary

HIV/AIDS country profile 2011: Iceland

HIV/AIDS country profile 2011: Ireland

HIV/AIDS country profile 2011: Israel

HIV/AIDS country profile 2011: Italy

HIV/AIDS country profile 2011: Kazakhstan

HIV/AIDS country profile 2011: Kyrgyzstan

HIV/AIDS country profile 2011: Latvia

HIV/AIDS country profile 2011: Lithuania

HIV/AIDS country profile 2011: Luxembourg

HIV/AIDS country profile 2011: Malta

HIV/AIDS country profile 2011: Montenegro

HIV/AIDS country profile 2011: Netherlands

HIV/AIDS country profile 2011: Norway

HIV/AIDS country profile 2011: Poland

HIV/AIDS country profile 2011: Portugal

HIV/AIDS country profile 2011: Republic of Moldova

HIV/AIDS country profile 2011: Romania

HIV/AIDS country profile 2011: Russian Federation

HIV/AIDS country profile 2011: San Marino

HIV/AIDS country profile 2011: Serbia

HIV/AIDS country profile 2011: Slovakia

HIV/AIDS country profile 2011: Slovenia

HIV/AIDS country profile 2011: Spain

HIV/AIDS country profile 2011: Sweden

HIV/AIDS country profile 2011: Switzerland

HIV/AIDS country profile 2011: Tajikistan

HIV/AIDS country profile 2011: The former Yugoslav Republic of Macedonia

HIV/AIDS country profile 2011: Turkey

HIV/AIDS country profile 2011: Turkmenistan

HIV/AIDS country profile 2011: Ukraine

HIV/AIDS country profile 2011: United Kingdom of Great Britain and Northern Ireland

HIV/AIDS country profile 2011: Uzbekistan

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National HIV and Syphilis Antenatal Sero-Prevalence Survey In South Africa

 This study is done annually at government antenatal clinics in South Africa. Pregnant woman attending these clinics are offered the Elisa test in confidential circumstances and more than 16 000 women were tested in 2003. 

The primary objective of the study is described (in the 2003 report) as:

" to provide information on HIV and Syphilis prevalence among pregnant women attending antenatal care in the public sector. The specific objectives of the 2003 survey were to:

- Determine an estimate of HIV and syphilis prevalence among pregnant women attending public sector antenatal clinics and

- Describe HIV and syphilis trends in terms of time, place (province) and age among pregnant women.

- Determine estimate of HIV infection in the general population through modelling."



Generalisations to the general public are made based on the following assumptions:

"Assumption 1: The prevalence rate of HIV infection in all pregnant women is the same as the prevalence rate in women attending public antenatal clinics.

Assumption 2: The prevalence rate of HIV infection in all w omen the same as the prevalence rate in pregnant women

Assumption 3: Estimate of males infected= 85% of infected females

Assumption 4: The mother- to-child transmission rate= 30%

Download the National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa, 2009. (PDF. 2.10MB) Released November 2010

National HIV and Syphilis Prevalence Survey South Africa 2008. Released September 2009; Download sections of report as individual PDFs

National HIV and Syphilis Prevalence Survey South Africa 2007. Released 29th of August 2008.  According to the preface the Survey show that South Africa may be making some real progress in its response to the HIV epidemic. These are also the first results to show a comparison of the impact of HIV infection between districts over two consecutive years. Download complete report (PDF, 47p. 995.60KB)

 

 

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UNAIDS Report on the Global AIDS Epidemic 2013

2013 fact sheet

People living with HIV

  • In 2012, there were 35.3 million [32.2 million–38.8 million] people living with HIV.
    • Since the start of the epidemic around 75 million [63 million–89 million] have become infected with HIV.

New HIV infections

  • New HIV infections have fallen by 33% since 2001.
    • Worldwide, 2.3 million [1.9 million–2.7 million] people became newly infected with HIV in 2012, down from 3.4 million [3.1 million–3.7 million] in 2001.
    • New HIV infections among adults and adolescents decreased by 50% or more in 26 countries between 2001 and 2012.
  • New HIV infections among children have declined by 52% since 2001.
    • Worldwide, 260 000 [230 000–320 000] children became newly infected with HIV in 2012, down from 550 000 [500 000–620 000] in 2001.

AIDS-related deaths

  • AIDS-related deaths have fallen by 30% since the peak in 2005.
    • In 2012, 1.6 million [1.4 million–1.9 million] people died from AIDS-related causes worldwide compared to 2.3 million [2.1 million–2.6 million] in 2005.
    • Since the start of the epidemic an estimated 36 million [30 million – 42 million] people have died of AIDS-related illnesses.

Antiretroviral therapy

  • In 2012, around 9.7 million people living with HIV had access to antiretroviral therapy in low- and middle-income countries.
    • This represents 61% of people eligible for treatment under the 2010 WHO guidelines; and 34% of people eligible under the 2013 WHO guidelines.

HIV/TB

  • TB-related deaths in people living with HIV have fallen by 36% since 2004.
    • TB remains the leading cause of death among people living with HIV.

Investments

  • US$ 18.9 billion was available from all sources for the AIDS response in 2012.
    • The estimated annual need by 2015 is currently between US$ 22-24 billion.
  • In 2012, low- and middle-income countries increased domestic investments for HIV, accounting for 53% of all HIV related spending.

UNAIDS report on the global AIDS epidemic 2013

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UNAIDS Report on the Global AIDS Epidemic and AIDS Epidemic Update

UNAIDS provides an annual report on the state of the epidemic in the world. This report is seen as a key output for the organisation. In the introduction to the 2003 report it is stated that:

 "Two of the core functions of the Joint United Nations Programme on HIV/AIDS (UNAIDS) involve tracking the epidemic and developing strategic information to guide AIDS responses across the world. Accordingly, the UNAIDS Secretariat and the World Health Organization (WHO) produce an annual AIDS epidemic update that reflects the current knowledge and understanding of the epidemic."

Estimations of the numbers in this report are done based on a variety of tools and existing measures in each country. As the organisations realises that there might be some aspects that they have not included, an upper and lower estimation is normally provided.

2009 AIDS Epidemic Update

Download Report, 100p., 2.91 MB

You can read reports and access resources here.

2008 Report on the Global AIDS Epidemic

The 2008 Report on the Global AIDS Epidemic was released on the eve of the XVII International AIDS Conference.  UNAIDS publishes a new "Report on the global AIDS epidemic" every two years. The Report draws upon and publishes the best available data from countries and provides an overview and commentary on the epidemic and the international response. 

Information, resources and the complete report is available here 

2007 UNAIDS AIDS Epidemic Update

The 2007 AIDS epidemic update reports on the latest developments in the global AIDS epidemic. The 2007 edition  explores new findings and trends in the epidemic’s evolution.

You can download the full report (PDF, 1.60 MB) here and the shorter press release here (PDF, 112 KB)

2006 UNAIDS AIDS epidemic update December 2006. 

Information, resources and the complete report is available here. 

 

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Adult Mortality (Age 15-64) based on Death Notification Data in South Africa. Statistics South Africa

Adult Mortality (Age 15-64) Based On Death Notification Data In South Africa: 1997-2004. Report No. 03-09-05. Pretoria: Statistics South Africa. Anderson, Barbara A., and Phillips, Heston E. 2006.  Download the report (PDF, 198p, 1.5 MB)

Mortality And Causes Of Death In South Africa, 2006: Findings From Death Notification. Statistics South Africa, 2008 Download PDF (74p, 1.74 MB) This analytical report analyses data for people age 15-64. In this report, the data on deaths by age, sex, and year of death are adjusted to take into account incompleteness of death registration. The report found that death rates rose for every five year age group between 1997 and 2004. Mortality from unnatural causes of death change little over this period. The TAC Newsletter of 21 June 2006 comments on this report. Read more.

 

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The State of the World's Children

This reportprovides a wide-ranging assessment of the current state of child survival and primary health care for mothers, newborns and children. It examines lessons learned in child health during the past few decades and outlines the most important emerging precepts and strategies for reducing deaths among children under age five and for providing a continuum of care.

 The State of the World's Children 2008. Child Survival.  Download the report PDF (164p.; 4.33MB)
 
The State of the World's Children 2007: Women and Children. The Double Dividend of Gender Equality Executive Summary. Download Report (696.75KB)
 
The State of the World's Children 2005. Childhood Under Threat. Download the 2005 UNICEF report. -

 

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1st South African National Youth Risk Behaviour Survey

 In this study, a large variety of health related behaviours were investigated. The study is described as:

"This Youth Risk Behaviour Survey is one of the first studies undertaken in South Africa, and possibly in Africa, to establish the prevalence of key risk behaviours, namely: intentional and unintentional injuries, violence and traffic safety, suicide-related behaviours, behaviours related to substance abuse (tobacco, alcohol and other drugs), sexual behaviour, nutrition and dietary behaviours, physical activity and hygiene related behaviours."

23 Schools were identified and selected through random selection methods per province and 14 766 learners were invited to participate, of which 10 699 actually completed questionnaires.

"The terms of reference were to provide nationally and provincially representative data on the prevalence of the above behaviours that place school-going learners at risk.

Download in sections:

Download Part 1 Page 1 - 8, 472.66 KB

Download Part 2 Page 9 - 33, 296.89 KB

Download Part 3 Page 34 - 83, 433.56 KB

Download Part 4 Page 84 - 138, 378 KB
 
Download Part 5 Page 139 - 160, 288 KB

 

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Actuarial Society of South Africa AIDS Demographic Model 2002

According to Dorrington R E, Bradshaw D and Budlender D. in “HIV/AIDS Profile of the Provinces of South Africa Indicators for 2002. Centre for Actuarial Research, Medical Research Council and the Actuarial Society of South Africa. 2002”, the following is considered in this estimation and the determination of future trends in the epidemic:
- 1998-2000 antenatal clinic summary results;
- 1998 South Africa Demographic and Health Survey (SADHS) data, in particular, data on prevalence of STDs and condom usage;
- improved estimates of the population; and
- mortality data on the pattern and level of deaths that suggested, in particular, that non-HIV mortality for adults has not improved over time as expected.

This data has been adjusted to:
"- improve the fit to antenatal clinic survey data;
- allow for the possibility of making separate male and female assumptions;
- model the population groups separately;
- limit the trend in mortality and fertility rates over time;
- limit future in-migration;
- change the HIV survival curve to be a function of a Weibull distribution;
- allow for a bimodal distribution of paediatric HIV survival; and
- disaggregate the "contagion matrix" (used in ASSA600) into more measurable and controllable parameters of heterosexual behaviour. These include the probability that a partner comes from a particular risk group, the number of new partners per annum, the number of sexual contacts per partner, the age of the partner and the probability that a condom is used."

It can be seen that a complex actuarial model was used to take into consideration as many variables in the epidemic as possible and then estimate different future scenarios. It is also possible to manipulate some of the variables in order to sketch different scenarios. 
 
The ASSA2003 model was released in November 2005, and is the most recent version of the ASSA AIDS and Demographic model to be released.
The model is similar in structure to the earlier ASSA2002 version, with the following improvements:
  • The model is applied at a provincial level as well as a national level, and is therefore likely to be a useful planning tool for provincial health and other government departments.
  • The ASSA2003 model incorporates more recent data than the ASSA2002 version, such as the 2003 antenatal clinic survey data and the 2002/3 mortality data.

 

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GlobalHealthFacts.org

 GlobalHealthFacts.org has expanded its country-level data with 40 new indicators across a wide range of areas and topics. The data are displayed in tables, charts, and color-coded maps and can be downloaded for custom analyses. Globalhealthfacts.org, operated by the Kaiser Family Foundation, provides free, easy access to a range of global health information forall countries in the world, including key indicators for AIDS, tuberculosis, and malaria.

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HIV Risk Exposure Among Young Children. A Study of 2-9 Year Olds Served by Public Health Facilities in the Free State, South Africa

 The origin of this study is described as::

"In 2002, the Nelson Mandela Foundation (NMF), together with a consortium of donors, commissioned the Human Sciences Research Council (HSRC) to conduct the Nelson Mandela/HSRC study of HIV/AIDS. The study was the first of its kind to use household and community surveys to determine HIV prevalence and assess behavioral risk. The Foundation publicised and disseminated its findings with the intention of stimulating dialogue and informing policy development around HIV/AIDS locally and internationally.

One question that arose from the study was around the unusually high rates of infection in the 2-14 age group."

This study was commissioned to look particularly at this worrying area. Various factors were addressed.   Some of the issues under study were the practice of shared breastfeeding, or feeding through someone other than the biological mother, and poor hygiene and sterile practices in government healthcare facilities.

Download 112p, PDF 1.1 MB

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HIV and Sexual Behaviour Among Young South Africans. A National Survey of 15 - 24 Year Old

This study was commissioned by loveLife, and is sometimes called the loveLife study.

The aim of the study was "to:
- establish the prevalence of HIV and related behaviours among young people aged 15- 24 years
- assess young peoples sexual attitudes
- examine the extent of young peoples exposure to loveLife
- undertake this data collection with sufficient accuracy to permit monitoring of trends over time"

For this study, 17,450 jong people in the selected age group were tested using the Orasure® saliva test as well as interviews. Selection was done using census areas and figures for 2001. Generalization was made to the general population in this age group based on race and area. 

Download PDF, 86p. 1.36 MB

 

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Live the Future: HIV and AIDS Scenarios for South Africa, 2005-2025, Metropolitan, November 2006.

 These four scenarios are modelled around low or high economic growth and low or high social collaboration. The website provides an overview of the scenarios, key data and actions that can be taken at the individual, family, community, organisation and macro levels. Use the scenarios in your work. 

You can find more information about the process and download resources from the website

 

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National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS Among South African School Pupils

The results of this study was published in the British Medical Journal. For this study 269 705 scholars between 10 and 20 were asked to fill in questionnaires about there sexual behaviour and knowledge of HIV and AIDS.

Distressing results about teenagers perceptions of violence and sexuality are often quoted from this study.

Abstract

Objective To investigate the views of school pupils on sexualviolence and on the risk of HIV infection and AIDS and theirexperiences of sexual violence.

Design National cross sectional study.

Setting 5162 classes in 1418 South African schools.

Participants 269 705 school pupils aged 10-19 years in grades6-11.

Main outcome measure Answers to questions about sexual violenceand about the risk of HIV infection and AIDS.

Results Misconceptions about sexual violence were common amongboth sexes, but more females held views that would put themat high risk of HIV infection. One third of the respondentsthought they might be HIV positive. This was associated withmisconceptions about sexual violence and about the risk of HIVinfection and AIDS. Around 11% of males and 4% of females claimedto have forced someone else to have sex; 66% of these malesand 71% of these females had themselves been forced to havesex. A history of forced sex was a powerful determinant of viewson sexual violence and risk of HIV infection.

Conclusions The views of South African youth on sexual violenceand on the risk of HIV infection and AIDS were compatible withacceptance of sexual coercion and "adaptive" attitudes to survivalin a violent society. Views differed little between the sexes.

Download PDF 5p., 100.51 KB

 

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Nelson Mandela/HSRC Study (2002)

In this study 13 518 individuals were identified and selected randomly from national census figures. Of these, 9 963 agreed to being interviewed and 8 840 underwent antibody testing through saliva tests.

The importance and purpose of the study is explained as:

"Accurate information on national prevalence, improved understanding of the sociocultural context in which the epidemic occurs, and the relative impact of interventions, are key to mounting an effective response to the epidemic. Cognisant of this, the Nelson Mandela Children's Fund (NMCF) and Nelson Mandela Foundation (NMF) commissioned the Human Sciences Research Council to conduct a study to:
- Identify prevalent risk factors that predispose South Africans to HIV infections;
- Determine HIV prevalence in the population of South Africa using linked anonymous HIV saliva tests;
- Link the risk factors with biological measures to determine the association between the two;
- Model the prevalence data and forecast probable infection levels for the next ten years (this objective will be reported separately at a later date);
- Identify the social, economic, political, structural and cultural contexts within which behaviour occurs, obstacles to risk reduction, and whether current mass media educational efforts take these factors into account;
- Determine the extent to which current prevention, education and awareness programmes and campaigns reach all sectors of South African society, including the most vulnerable sectors of the population;
- Determine whether media messages are being understood and accepted in the population, and by whom." 
 
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Nelson Mandela/HSRC Study (2005)

 

The results of the second Nelson Mandela study was published in December 2005. Although the survey questionnaire was similar to the 2002 study, a number of indicators were modified based on the 2002 study and a number of new indicators and modules were added. Download.
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The Economic Impact of HIV/AIDS on Business in South Africa 2003

This study was published in January 2004 by the South African Business Coalition on HIV and AIDS (SABCOHA) and investigates, amongst other things, the way in the business sectors responded to the pandemic. The reasons why certain sectors were slow to respond were investigated and suggestions are made for changing this.

  For this study, a questionnaire was developed and tested and sent to 3003 companies. Of these 1006 responses were returned and included in the study.

The purpose of the study is described as:
"Effective management of HIV/AIDS requires an understanding of the nature and the extent of the impact of HIV/AIDS on business. Sustainable private sector responses to the epidemic will only be achieved if senior management is convinced of the business rationale for action. The hesitancy of many companies to invest in comprehensive HIV/AIDS workplace programmes may be due to a lack of reliable data to show the economic impact of the epidemic. By providing evidence of the impact of HIV/AIDS on business in South Africa, the SABCOHA survey strives to fill this gap." 

Download Report PDF 69p. 1.39 MB

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Study of Demand and Supply of Educators in South African Public Schools. 2005

In this study 21 358 teachers in more than 17 000 schools were approached to fill in a questionnaire about the factors influencing supply and demand of teachers. 

HIV and AIDS was part of the information about the health condition of teachers. Various information documents were made available based on this study, such as"Fact Sheet 6. HIV Prevalence Among South African Educators In Public Schools." In this document statistics are given about HIV infection in different age groups and other categories. 

Access press release and download a selection f reports from this study.

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Statistiek in Perspektief. 3/8/2007

Statistiek - 'n Inleiding

As ons oor statistiek praat, veral as dit oor MIV en VIGS gaan, kla mense maklik dat statistiek verwarrend is, dat bronne mekaar weerspreek, of dat dit uit die duim gesuig word. Dit kan maklik so voorkom, veral waar statistiek sonder verwysing aangehaal word, of waar daar gese word dat "Hulle so sê".  Om statistiek te evalueer, moet die volgende in ag geneem word:

A. Betroubaarheid van Statistiek

As mens statistiek se betroubaarheid evalueer is daar `n paar dinge wat in gedagte gehou kan word om die prentjie duideliker te maak:
1.Wat is die bron of oorsprong van die statistiek?
2.Watter metode is gebruik om die statistiek te bekom?
3.Wanneer is die statistiek gepubliseer, en vir watter tydperk is dit bereken?

Elkeen van hierdie items kan individueel oorweeg word, en gesamentlik behoort dit `n idee te gee van die betroubaarheid van die statistiek.

1.Wat is die bron of oorsprong van die statistiek?

Die betroubaarheid van statistiek kan direk in verband gebring word met die bron. Indien jy die organisasie wat die statistiek publiseer vertrou, kan mens gewoonlik ook die statistiek vertrou.

Met MIV- toetsing moet daar veral ook die volgende in ag geneem word:

a. By die algemeenste toetse, bv Elisa, OrasureR ens. word daar nie vir die virus getoets nie, maar wel vir teenliggaampies wat aandui dat die individu blootgestel is aan die virus, en dat die liggaam teenliggaampies teen die virus gevorm het. Indien die teenliggaampies teenwoordig is kan mens dus veronderstel dat die individu geïnfekteer is
b. Die proses om teenliggaampies te vorm neem 'n sekere tyd. Daar bestaan dus "vensterperiode" waarin 'n individu wel geïnfekteer kan wees, en ook ander kan infekteer, maar steeds negatief kan toets. Nuwe navorsing wat tans by die Universiteit van die Witwatersrand gedoen word mag hierdie leemte oorkom.
c. By MIV toetsing beteken 'n "positiewe" uitslag dat die individu se liggaam teenliggaampies teen die MI-Virus gevorm is, en dat hy wel geïnfekteer is met die MI-Virus. 'n Negatiewe toetsing beteken dat die individu nie teenliggaampies teen die MI-Virus gevorm het nie. Dit kan dus beteken dat die individu nie geïnfekteer is nie, of dat die persoon nog in die vensterperiode is. Indien die moontlikheid van infeksie bestaan en die toets negatief is, moet hertoetsing dus aanbeveel word. "Vals Positiewe" resultate kom soms voor. Dit is dus baie belangrik dat enige positiewe resultaat bevestig word.

2.Die metodes gebruik by verkryging van die statistiek.

'n Wye verskeidenheid van metodes word gebruik om statistiek te verkry. Hier moet in gedagte gehou word:

a. Of werklike insidensie of beramings ter sprake is.
Navorsing en statistiek kan vir ons resultate gee wat op werklike toetse en insidensie binne binne 'n bepaalde steekproef van 'n sekere groep bepaal is (bv. National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa) , of beramings wat vir die toekoms gemaak word op grond van bestaande kennis (bv. Actuarial Society of South Africa AIDS Demographic Model 2002)

b. Hoe persone se status bepaal is.
Daar bestaan verskillende metodes waarvolgens individue wat in 'n studie ingesluit is se MIV status bepaal word. Die mees onakkurate sal waarskynlik wees om die respondent te vra. Ander betroubare metodes sluit in die gebruik van die Elisa toets soos bv by die National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa en die gebruik van speekseltoets soos by HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds. Reproductive Health Research Unit. University of Witwatersrand. In sommige studies word daar ook gad nie toetsing gedoen nie, waar die doel van die studie bv is om persepsie van risiko te bepaal, bv. by die National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS Among South African School Pupils.

c. Hoe die toetsgroep geselekteer is. Dit is altyd belangrik dat korrekte seleksie metodes gebruik word om verteenwoordiging in enige steekproef te verseker. Om bloot bv die eerste 10 skoliere wat by die skoolhek uit loop se resultate te veralgemeen vir die skool, mag foutiewe resultate gee. Dit kan dalk juis die 10 seksueel aktiewe matrieks wees, of die 10 onkundigste graad sesse. Metodes moet dus gebruik word om ewekansigheid te verseker.

d.Hoe veralgemenings gemaak is . Veralgemening van statistiek kan slegs vir 'n groep gedoen word as die steekproef as verteenwoordigend beskou kan word wat seleksie van groep, aantal deelnemers en aard van deelnemers betref. Om dus bv die resultate van die HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds, as verteenwoordigend van die hele bevolking te beskou, sou waarskynlik onverantwoordelik wees. Daar moet ook gelet word daarop of persentasies of werklike getalle ter sprake is.

3. Wanneer is die statistiek gepubliseer, en vir watter tydperk is dit bereken?

Veral in 'n groeiende pandemie soos by MIV infeksie, is dit krities dat die onlangste beskikbare statistiek aangehaal word. Die National HIV And Syphilis Antenatal Sero-Prevalence Survey in South Africa sowel as die AIDS Epidemic Update van UNAIDS word bv. jaarliks herhaal, en om 2001 se statistiek te gebruik sou sinneloos wees, behalwe waar vergelykings gemaak word. Dit is egter altyd belangrik om op te let na die datum, en dit ook in verwysings in te sluit. Dit is dikwels moeilik om die relevansie van 'n artikel of statistiek te bepaal as daar geen aanduidings van wanneer die studie of beraming gedoen is nie. Daar word bv dikwels in populere pers verwys na "Suid Afrika se 660 000 Vigswesies". Volgens AIDS Epidemic Update: December 2003 is daar egter reeds 1.1 miljoen kinders in Suid Afrika wat een of albei ouers weens MIV verloor het.B. Enkele Studies wat dikwels in Suid-Afrika aangehaal word rondom MIV en VIGS

Bronne van Statistiek

Van die bekendste en mees gekwoteerde statistiek oor MIV en VIGS iword uit die volgende bronne verkry.

C. Slotsom

Dit is duidelik dat daar 'n magdom statistiese inligting oor MIV en VIGS beskikbaar is. Hierdie inligting kan 'n waardevolle bydrae lewer by die beplanning van 'n respons op die epidemie, en by die maak van ingeligte keuses. Dit is egter duidelik dat statistiek oordeelkundig en akkuraat gebruik moet word, anders bestaan die moontlikheid dat dit tot verwarring en wanpersepsies kan lei.

D. Bibliografie

  1. UNAIDS, WHO. AIDS Epidemic Update: December 2003.
  2. Actuarial Society of South Africa. AIDS Demographic Model 2002
  3. Dorrington R E, Bradshaw D and Budlender D. HIV/AIDS Profile of the Provinces of South Africa: Indicators for 2002. Centre for Actuarial Research, Medical Research Council and the Actuarial Society of South Africa. 2002,
  4. 4.Department of Health. National HIV And Syphilis Antenatal Sero-Prevalence Survey In South Africa 2003.
  5. Nelson Mandela Foundation, HSRC. Study of HIV/AIDS: South African National HIV Prevalence, Behavioural Risks and Mass Media - Household Survey (2002)
  6. Medical Research Council, Department of Health .The 1st South African National Youth Risk Behaviour Survey 2002.
  7. Reproductive Health Research Unit. University of Witwatersrand . HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 year olds.
  8. SABCOHA The Economic Impact of HIV/AIDS on Business in South Africa. 2003.
  9. CIET. National Cross Sectional Study of Views on Sexual Violence and Risk of HIV Infection and AIDS Among South African School Pupils. 2004
  10. Nelson Mandela Foundation. HIV Risk Exposure in 2--9 year-olds in the Free State. A Study of 2-9 year olds Served by Public Health Facilities in the Free State, South Africa. 2005
  11. HSRC, Education Labour Relations Council. Study of Demand and Supply of Educators in South African Public Schools. 2005

 Artikel deur

L.van Rooyen, CARIS.

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The Changing face of AIDS

 

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Advocacy

 

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CABSA and Advocacy - An Introduction

We often hear about advocacy, and sometimes we who operate in the faith context or from faith based organisation are unsure of our involvement in advocacy issues.

Over the last months, the CABSA staff thought and talked about this quite a bit.

We are increasingly realising the overall theme of everything we do is in fact ‘advocacy’.  An advocacy role can be seen from different perspectives.  Many different definitions exist for advocacy.  To start with, I looked at the following:

Social Welfare Forum: "Advocacy means any action geared towards changing the policies, positions or programmes of any type of institution. Advocacy is about identifying a problem in a community, coming up with a solution to that problem, establishing strong support for that solution and providing an effective implementation plan."

Merriam -Webster Online Dictionary: "Advocating: the act or process of advocating or supporting a cause or proposal

Advocate = support (1): to promote the interests or cause of (2): to uphold or defend as valid or right (3): to argue or vote for."

CABSA sees very specific added dimensions to advocacy in faith based contexts.  We verbalised this as firstly “Standing in the Gap” and secondly “Being a Prophetic Voice.”

Join CABSA as we continue to explore this theme in future.  In this section we will highlight different opinions and approaches to advocacy and specific themes around which advocacy is necessary. 

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Ecumenical Advocacy Alliance

Lyn's Comment: A very prominent advocacy voice in faith communities is the Ecumenical Advocacy Alliance, based in Geneva, Switzerland.  CABSA has been working with the Alliance in various ways and are official members of the Alliance.

I found the following useful in my understanding of the different forms of advocacy:
 
From "Final Report Evaluation of the Ecumenical Advocacy Alliance 2005 – 2008; Tübingen / Kampala, October 2008 by Bernward Causemann, Ashanut Okille",

".....the terminology of advocacy differs widely. For the purposes of this evaluation, we make the following distinction: Advocacy encompasses three different forms: Lobbying, Campaigning and Awareness raising/development education.
• Lobbying entails working with decision makers, trying to influence them not only through pressure but more by offering expertise and showing solutions for issues that are of concern to decision-makers. Lobbying is usually not directed at the public, it is usually longterm and often is highly flexible, taking in high complexity. People who lobby have to build a reputation for competence in a certain sector, and within that need to address varying issues and sometimes shift quickly to aspects within their competence that shows opportunities for influence in the desired direction. Others call similar concepts “constructive policy engagement” or “insider-track advocacy”.
• Campaigns happen in public and involve mobilising in various ways, and trying to convince or pressure decision makers to take certain decisions. Campaigns usually have very focused, easy to convey messages, clear targets and are time-bound. Experience shows that successful campaigns, after attaining their targets and the high attention is over, are often transformed into institutions or remain existent as networks and usually use the status and expertise acquired to concentrate on lobbying.
• Awareness raising/development education is directed more at the public than at decision- makers. It generally tries to make people aware of issues of injustice or issues that need attention. It is not targeted to achieve concrete change but builds a foundation on which targeted advocacy (both campaigning and lobbying) can build.
If the churches want to influence decision makers, they will need to apply all the forms of advocacy i.e. lobbying, campaigning and awareness raising. Depending on the issue, the concrete decision at stake and the timeframe (among other factors), sometimes lobbying will have more potential. In other cases, especially where there is much resistance to change, campaigns will be more effective. Effective lobbying will usually require the option of the people lobbying to draw upon the support of their constituencies which can be through campaigns, or through visible support from leaders of the constituencies."
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More Information on Advocacy from the Social Welfare Forum

"The aim of the Policy Engagement programme of the National Welfare Forum is to ensure public participation in the formulation of social service, welfare and development policies. The ultimate goal is to not represent civil society but to facilitate the process for members to coordinate and represent themselves."

Lyn's Comment: The material below is taken from various parts of the Participant Handout for the Policy Engagement programme, which can be downloaded from the Forum website The Participant Handout 2009 can also be downloaded

What Is Advocacy?

Advocacy means any action geared towards changing the policies, positions or programmes of any type of institution. Advocacy is about identifying a problem in a community, coming up with a solution to that problem, establishing strong support for that solution and providing an effective implementation plan.

Lobbying influential people for support is part of the advocacy process.

When the beneficiary is an individual the advocacy effort could be considered as Private Advocacy. When the advocacy aims to benefit the public at large, or a large group of individuals, it could be regarded as Public Advocacy. It is sometimes difficult to distinguish public advocacy from private advocacy.
Sometimes public advocacy efforts stem from private advocacy initiatives. Most advocacy conducted by Civil Society Organisations (CSOs) is public advocacy.
Examples of Private Advocacy:
When an individual campaigns for street lighting in their neighbourhood to prevent crime; When an individual campaigns for a bus stop in the neighbourhood.
Examples of Public Advocacy:
When organisations come together to launch a specific effort to combat crime in business, ego Business Against Crime; When several organisations come together to improve road safety or public transport. 

What is Social Justice Advocacy?
Social justice advocacy is public advocacy that draws attention to an injustice and promotes the public good. It focuses attention on improving the well-being of the poor and marginalised members of the community, for example, women, children, workers, the disabled, etc. 

What is Lobbying?
Lobbying comes from the verb "to lobby", which means an attempt by citizens to influence public officials at a high level. Lobbying is one of the most common methods used by citizens to influence public policy. It is used to put pressure on politicians and government officials to take up the interests of the people and to support their cause. In most democracies lobbying is recognised as a legitimate way for citizens to have their voices heard. However, critics of lobbying say that wealthy people and business are better able to spend time on and pay for various lobbying activities. 

Advocacy Goals
It is useful to remember that there are long term and short term goals in advocacy work. The long term goal relates to the change the campaign wants to make in people’s lives. It is known as the Impact goal. This goal reflects the problem the campaign wants to address.
Usually this change is only policy if a law changes or a new law/policy is developed. This change in the legislation or system is the short term goal on the journey toward solving the problem. It is known as the Effect goal and it usually describes the decision that the decision maker is called on to take.  These goals are met through an interactive process known as the cycle of advocacy. The stages in the advocacy cycle do not necessarily follow a specific order and often the campaign shifts from implementation mode back to redefining the problem as the campaign progresses and more information about the problem or stakeholders emerges.

The Advocacy Cycle 

‘Just as humans seek a dignity that says not by bread alone, so we as (social) advocates must work to effect change not by elections alone, not by mass mobilisation alone, not by lobbying alone, not by information alone, not by coalition alone, not by media alone and not by anything else alone.’   (Michael Pertschuk, Advocacy Institute, USA)

The advocacy process may involve any combination of the above approaches.
The effectiveness and success of any advocacy process depends, amongst other factors, on how well the following processes are implemented:

Analysis includes collective brainstorming of the problem which can be carried out in the form of a detailed problem tree analysis. The output of this exercise will form the basis for the advocacy approach to be developed later. During this stage research about the problem environment is critical to develop a comprehensive picture of the dimensions of the problem. This could merely entail the reference and synthesis of research already undertaken by other institutions, or the commissioning of tailor-made research.
Strategy Development entails making a realistic selection from the dream list of policy options already identified during policy analysis, and then prioritising based on what is realistic and expedient in terms of maximum outcome for minimum inputs. During this stage, the organization will also identify key stakeholders and possible strategic partners to engage.
Implementation refers to the operationalisation of the advocacy strategy to ensure that responsible individuals or teams are clearly mandated with specific tasks. Even though advocacy should be an organization-wide undertaking, the location of coordination and leadership around specific tasks is necessary to ensure that activities are carried out as planned and on time. Ideally, the advocacy plan should be integrated into the broader organizational and team work plans.
Evaluation and Review refers to the monitoring of advocacy and lobbying outcomes in relation to stated goals: How far have we come in relation to where we want to be and what further actions are needed to realize our goals? Was the strategy realistic, or does it require some strategic adjustment on our part? 

Advocacy Roles:
It is necessary to clarify the role that your organisation will play to achieve your policy goal. There are mainly four roles to consider:
1. Expert informant – Can you use your relationships with policy makers for providing technical advice on policy issues?
2. Capacity Builder – Can you support other organisations in their efforts to carry out advocacy?
3. Lobbyist – Do you want to take a visible approach and address your target audience personally?
4. Mediator – Can you broker competing interests of various groups and through mediation achieve policy change?"

 

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Advocacy Resources - General

 

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Are Grassroots Faith Organizations Better at Advocacy/Making Change Happen? 28/9/2017

Published by OXFAM

As part of thinking about how power operates in fragile/conflict states (for the LSE’s new Centre for Public Authorityin International Development, CPAID), I’m doing a bit more reading around the role of different kinds of ‘non state actors’. One of the most influential in many fragile/conflict settings are faith organizations, so I finally got round to reading ‘Bridging the Gap: The role of local churches in fostering local‑level social accountability and governance’ from Tearfund, which describes itself as a ‘Christian charity passionate about ending poverty’.

The report looks at Tearfund’s support for grassroots advocacy by its partner in Uganda, the Pentecostal Assemblies of God (PAG).This is part of a wider church and community mobilisation (CCM) process.

‘CCM approaches differ according to the context. However, they all involve the local church congregations participating in Bible studies and other interactive activities together, which catalyse them to work across denominations and with their local communities to identify and address the communities’ needs with their own resources.

As the first step, the church leaders at the denominational level are trained as CCM facilitators. The local church then goes through the ‘church awakening’ phase, which aims to change people’s attitudes to see themselves as all equal before God, to identify the resources they have and to build a vision for working together towards developing the community. The local church then liaises with community leaders and invites the wider community to come together to identify their needs, resources and skills. They then elect a Community Development Committee (CDC) which, with the help of the facilitator, maps community assets and key stakeholders, preparing a vision and action plan. The solutions vary across contexts – sometimes savings groups are formed – and in response to a variety of issues depending on the community’s most pressing needs, including food security, health, water and sanitation, or livelihoods.’

With a few tweaks of language, this could have been written by any secular NGO working on similar issues, but I was looking for the special sauce – what’s different about working through the Churches, compared to non-religious partners? Here’s what Tearfund says:

Local churches are trusted

CCM advocacy has proven that local churches are regarded with a high level of trust. They are trusted by their congregations, by the communities in which they are located and by local government.

The trust that the congregation and the majority of the community place in the church was a key driver in motivating participation in the CCM process, the advocacy training and also governance more generally. In Uganda, more than 80 per cent of people are Christian and it became apparent in the research that the church is a trusted authority figure, both by church members and by the wider community. This has led to an increase in citizen engagement in those communities who have completed the CCM and CCM advocacy training. This trust in the church enabled the CCM advocacy process to be established successfully in the community, with good engagement, and for the trainings to be taken on board quickly and effectively.

Participants’ responses revealed the main reason why the church is trusted. Firstly, as many in the community have embedded Christian values, trust derives from shared values. Many people consider the Bible an authority and therefore, where the CCM advocacy included references to the Bible, there was more engagement and take-up.

‘It would have not worked well with a secular NGO: the Bible has teachings, it encourages people to share, people fear God, they know it is God’s language and know they should listen!’ Woman from Arapai, where there was CCM and some advocacy

Secondly, as the church is established in the community and has a good reputation historically, people are willing to

Including changing local government, apparently. From the PAG website

Including changing local government, apparently. From the PAG website

be involved in its initiatives. Thirdly, linked to this is the way in which local church leaders and the church have existing relationships and links within the community. The process therefore did not require starting a new network or building new relationships. Finally, people felt safe to attend as it is a familiar environment for many. This meant that the church could become a ‘school for learning’ (to coin a phrase used in one community). Trust in the church allowed for this knowledge to be accepted and communities to use what they had learnt, as the knowledge had come from a trusted source.

Another key to the success of the engagement was the volunteerism encouraged by the church. Many groups explained that, whereas with NGO programmes the participants would expect handouts, the church is not expected to provide in the same way and people expect to volunteer their time at church. When discussing the motivation behind participating in CCM advocacy, more than 50 per cent of people referred to ‘my church’.

The training included biblical verses about advocacy: this encouraged community members to participate and understand that they have a right as citizens and a mandate to fight for justice, particularly on behalf of the marginalised such as widows and orphans. One hundred per cent of respondents who had had some of the advocacy training indicated that they had been encouraged by the church to attend government meetings, which they would never normally have been keen to do.

Government trusts the church

Ugandan local govtA key to ensuring increased good governance and accountability is the way in which the government sees the church and therefore the participating communities as trustworthy and honest. The government perceives the church as an important influencer in encouraging the community to obey the government and keep the peace. It is therefore willing to share information through the church, both about government programmes (eg immunisation schemes) and via sensitisation meetings (where government workers share learning on a particular topic, such as HIV prevention). The church is ‘faithful’ and embedded in the community, with a ready audience and an understanding of local issues.

‘We trust the church. We have so many organisations and individuals who come but, at the end, they disappear. But the church is there permanently. Even when there are changes in leadership, the church remains.’ Onya George, Regional District Councillor of Akonopeesa, Serere district’

Powerful and convincing stuff. The report acknowledges that things are not so easy when the community is less uni-faith, and that stirring it up with advocacy training might weaken its ‘trustworthiness’ in the eyes of government.

One thing I did wonder about was the use of ‘the Church’ in the singular. My experience of evangelical churches in Latin America is that they sometimes resemble ferrets in a sack, fighting for adherents, rather than cooperating – does that not complicate the effort to build an advocacy movement?

Oh, and in case you’re wondering, I’m a lifelong atheist.

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Inter Agency Statement – Ending Discrimination in Health Settings. 8/7/2017

Published by UNAIDS

Discrimination in health care settings is widespread across the world and takes many forms. It violates the most fundamental human rights protected in international treaties and in national laws and constitutions. People we work for and with experience it very often.

The World Health Organisation (WHO) had issues a Joint United Nations statement, signed by 12 UN agencies, on ending discrimination in health care settings. Recognizing that discrimination in health care settings is a major barrier to the achievement of the Sustainable Development Goals, United Nations entities commit to working together to support Member States in taking coordinated multisectoral action to eliminate discrimination in health care settings.

You can access this resource here

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'Advocating for Change for Adolescents' Toolkit. 16/6/2017

Published by WOMENDELIVER

Launched at the Global Adolescent Health Conference in Ottawa, Canada, this toolkit was developed by young people, for young people, through a collaboration between Women Deliver and The Partnership for Maternal, Newborn & Child Health. This toolkit provides guidance to youth networks on the design, implementation, and monitoring of an effective national advocacy campaign for adolescents. It encourages meaningful engagement of young people and provides as step-by-step roadmap to advocate for adolescent's health, rights, and wellbeing.

You can access this resource here

 

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UNAIDS and The Global Fund Launch Guidance on HIV Human Rights Programmes. 27/5/2017

Published by UNAIDS

To support countries to integrate human rights principles in their HIV prevention, testing and treatment programmes, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) jointly launched two mutually supportive technical documents on 29 May.

The UNAIDS guidance document Fast-Track and human rights offers practical advice on why and how efforts to Fast-Track HIV services should be grounded in human rights principles and approaches. It includes three checklists to support and guide the design, monitoring and evaluation of HIV services in order to realize human rights and equity in the AIDS response.

The Global Fund technical brief HIV, human rights and gender equality supports grant applicants to include programmes to remove human rights and gender-related barriers to HIV services. It also gives advice on implementing human rights-based and gender-responsive approaches to HIV.

Together, the documents will inform the development of Global Fund concept notes, national Fast-Track plans and other work to accelerate the response to HIV. They will provide practical guidance to national policy-makers, HIV programme implementers, communities, civil society organizations, the United Nations and donors as they design, oversee, fund, monitor and implement efforts to Fast-Track HIV programmes. 

Quotes

“We must go beyond talking about HIV-related discrimination and human rights violations. Now is the time to act and support governments, civil society and affected communities to respond to these challenges through programmes to advance human rights, dignity and equity.”

Michel Sidibé UNAIDS Executive Director

“Under its new strategy, the Global Fund is committed to reducing human rights-related barriers to HIV, tuberculosis and malaria services. We need to do this because it is the right thing to do, but also because it will increase the impact of our investments. We are taking a practical, pragmatic and programmatic approach, and this means ensuring countries vastly increase investment in the seven key programmes to reduce stigma and discrimination and increase access to justice that our new technical brief and the UNAIDS guidance document describe.”

Marijke Wijnroks Chief of Staff, The Global Fund to Fight AIDS, Tuberculosis and Malaria

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A Collection of Resources for Teaching Social Justice. 14/2/2016

Published by CULTOFPEDAGOGY

http://www.cultofpedagogy.com/wp-content/uploads/2016/02/Social-Justice-...

Ask teachers to describe the impact they hope to have on their students, and most will eventually say something along these lines: I want my students to grow into responsible citizens. I want my students to participate in society in an active, productive way.

And maybe: I want my students to change the world.

But how many of us know how to make that happen, really? Can we explicitly teach students how to change the world? If this question has been whispering in the back of your mind, the resources in this collection will help.

What is social justice, and how does it fit into the curriculum?

The National Association of Social Workers defines social justice as “the view that everyone deserves equal economic, political and social rights and opportunities.” To study social justice is to learn about the problems that dramatically impact quality of life for certain populations, and how people have worked to solve those problems.

If you teach social studies, you’ll have no trouble finding direct curricular links to social justice. The National Curriculum Standards for the Social Studies includes Civic Ideals and Practices as one of its 10 Themes of Social Studies, and this includes an emphasis on learning how to get involved in influencing public policy. In history and social studies class, social justice teaching is a natural fit.

In other content areas, teachers disagree over whether social justice has a place. We put ourselves in a vulnerable position by exploring issues that are seen as more controversial than others (a topic I will get into in the next section), and some teachers prefer to completely steer clear of those kinds of complications. For others, social justice was a driving force in why they became teachers, and they weave it into whatever content they are teaching. If you choose to address some or all of these issues in your classroom, the next section offers some tips for doing it effectively.

Some Advice for Teaching Social Justice

As an undergraduate, I served as a student counselor for three years and a resident assistant (RA) for one. I regularly delivered workshops on social justice topics, and I learned a few important lessons along the way. Here are some things to keep in mind when studying social justice issues with your students:

  • Make getting to know students a key component of any social justice teaching. If you and your students don’t spend time examining your own backgrounds, biases, and beliefs, you will be missing an essential component of any social justice curriculum. We all view every social justice issue through the lens of our own experience, and these different lenses can block our growth and learning if we aren’t aware of them. If we fine-tune our self-awareness, our individual lenses can richly inform classroom conversations and help us understand issues on a much deeper level, directly from each other.
  • Know that not all students feel the same way about these issues. Most, if not all, of these resources have been created from a pretty liberal, progressive viewpoint. For example, one of the lessons in the Teaching Tolerance series described below is on Confronting Unjust Laws. The lesson uses California’s Proposition 8 as an example of an unjust law. But not all of your students (or their families) will see a law like Prop 8 as unjust. In fact, some may strongly oppose same-sex marriage. That doesn’t mean you can’t successfully talk about controversial issues; in fact, teaching students how to respectfully discuss an issue with people who don’t share their opinions is a lesson that will serve them for the rest of their lives.
  • Familiarize yourself with the material before teaching. Sometimes we just skim materials before we teach. With social justice topics, this would be a mistake. Not knowing exactly what’s in all of your teaching materials, including the texts or videos you and your students will be looking at, can leave you vulnerable to problems when unexpected content pops up.
  • Keep your administrator in the loop. As with any potentially controversial lesson, it is essential that you talk to your administrator about it ahead of time. Show the curricular connections between your planned lessons and the standards you’re teaching. Talk about potential problems or objections that may come up and how you both plan to address them. That way, if your administrator gets a phone call from a concerned parent, she or he won’t be blindsided.

Featured Resources

When I set out to find good resources for social justice teaching, I was looking for classroom-ready materials, lesson plans with supplementary texts or videos that would prompt students to learn about, think about, and talk about social justice issues. I also hoped to find some that would actually teach students about activism, about how a citizen zeroes in on a problem, formulates a solution, then does the grassroots work necessary to see that solution come to life.

Some of these resources fit the bill perfectly, especially the first one on the list. Others do not include lesson plans at all, but serve such an important and innovative role in social justice education, I thought they were essential to include here.

Anti-Defamation League: Current Events Classroom

South-Carolina
The ADL’s Current Events Classroom is a collection of lesson plans that use current events as a springboard. For example, What is the School-to-Prison Pipeline?, a lesson for high school students, has students watch the video of the South Carolina police officer who flipped a student out of her chair. The rest of the lesson has students study and discuss the impact of zero-tolerance policies in schools, statistics on the connection between school suspensions and the juvenile justice system, and their own school discipline policy. The end of the lesson offers students a choice of next steps for taking action on this issue.

Most of the lessons in the collection are written for middle and high school students on a wide range of topics including anti-Muslim bigotry, the refugee crisis, homelessness, cyberbullying, and gender stereotypes. The longer I look at this collection, the more impressed I am with it. Definitely worth a look.

Update: Since publishing this post, a few readers have pointed out that some of ADL’s other website content (separate from this curriculum) takes a strong stance on issues relating to Israel and may offend some users. I still feel that this curriculum contains incredibly valuable lessons on very recent events that you won’t find anywhere else, but this reinforces my second and third points above: Know your audience, and read through the materials carefully. For more details on this issue, please read the comments below.

Teaching Tolerance: Classroom Resources

Anniston_bus
This award-winning organization comes up most often any time social justice teaching is discussed. There’s lots to explore on their site, including the Classroom Resources section, which is loaded with lesson plans and other resources teachers can use for free in their classrooms. One of these lessons is Confronting Unjust Practices, where students learn about the anti-segregation actions taken by the Freedom Riders and the attack on one of these buses in Anniston, Alabama (pictured above).

Other lessons from this library include What is Ageism?, Unequal Unemployment, and What Makes a Family? Lessons are available for elementary, middle, and high school students.

DoSomething.org

Do-Something
No lesson plans here: DoSomething.org is an outstanding organization whose goal is to support the work of young people who want to make a difference in their world. Students browse through a big list of campaigns, public education and activism projects students can launch right in their own communities, and choose one or more that they’d like to participate in. Once they have finished a campaign, students submit a photo or video to prove they completed the required steps. This entry makes them eligible to win prizes, including scholarships. Currently, only U.S. students are eligible for these scholarships, but DoSomething.org is expanding into other countries as well.

Although this site will not help you do any direct instruction about social justice, it provides incredible opportunities for students to actively participate in social justice projects. Most campaigns are just right for high school students, and some would be appropriate for middle schoolers as well. Some topics may be considered risque, so review the content before introducing it to students.

On a related note, DoSomething.org is the organization where Katia Gomez, the college student who started her own school in Honduras (featured in the first Cult of Pedagogy documentary last year), got her start. One more bit of trivia that totally doesn’t matter but might if you are a Melrose Place fan: DoSomething.org was co-founded by 90’s heartthrob Andrew Shue. Squeee!!

The Global Oneness Project

Amar
The Global Oneness Project offers a beautiful collection of multicultural films, photo essays, and articles that “explore cultural, social, and environmental issues with a humanistic lens.” Many of the featured stories are paired with a lesson plan for high school or college classrooms, aligned with Common Core and national standards.

One such pairing starts with the film Amar, which follows a young Indian boy living in a high-poverty neighborhood through a typical day that includes rising before dawn to do one of his two jobs and attending school. The accompanying lesson plan is called A Day in the Life, which has students examine the film and other resources related to the economic situation in India.

The films are truly stunning. This collection doesn’t include explicit teachings in any kind of civics or grassroots activism, but it will provide students with a deep understanding of lives completely unlike their own. And that kind of empathy is one of the most important building blocks for any kind of social justice action.

Pushing the Edge: Social Justice Resources Collection

PTE_Teacher_Remixed_Site
Educator Greg Curran’s podcast covers a range of educational topics, but quite a few episodes circle around issues of social justice. Recently, he curated these resources into a Social Justice Resources Collection. These episodes will be mainly useful for teachers to educate themselves about social justice education: what complications and questions come up, helpful do’s and don’ts, and why it’s worth it. He interviews practicing teachers and administrators who are walking the walk with social justice teaching. Listening to them will give you a template from which to build your own practice.

 

Here’s an example of one episode, where Curran interviews Nakisha Hobbs, principal of the Village Leadership Academy, a k-8 social justice school in Chicago.

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Invest in Advocacy (2016)

Published at

Advocacy by people living with and affected by HIV has been critical to the progress made the response to HIV since the beginning of the epidemic. Advocacy has sparked action in the face of denialism and indifference, mobilized unprecedented financial resources and enabled communities to participate in designing health services that meet their needs. When traditional policy- making processes stall due to bureaucracy, advocacy shines a light on the problem and leverages community power and political will to drive action and innovation. This is why AIDS advocates around the world remain a major force for an accelerated, more equitable scale-up of effective HIV and health programming.

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Social Justice Is a Christian Tradition — Not a Liberal Agenda. 8/11/2015

Published by SOJOUNERS

Many Christians are wary of participating in social justice because of a deep-rooted fear of being labeled “liberal,” “progressive,” or “secular.” They don’t want to be associated with “secular” movements, and are uncomfortable delving into issues that go beyond their cultural comfort zones.

But the Bible tells us that Jesus cared deeply about the social causes around him.

Instead of saying all lives matter, Jesus said, “Samaritan lives matter.”
Instead of saying all lives matter, Jesus said, “Children’s lives matter.”
Instead of saying all lives matter, Jesus said, “Gentile lives matter.”
Instead of saying all lives matter, Jesus said, “Jewish lives matter.”
Instead of saying all lives matter, Jesus said, “Women’s lives matter.”
Instead of saying all lives matter, Jesus said, “Lepers’ lives matter.”

So saying “Black Lives Matter” and participating in a movement seeking justice, positive reform, and empowerment is one of the most Christ-like things we can do.

Christians must recognize that our society is filled with numerous groups and communities facing systemic oppression, and we must act. We must be willing to admit and address the complex realities within our world that create such problems, and avoid the spiritual laziness that tempts us to rely on generic excuses and solutions.

Christians do a disservice to the gospel message by removing the cultural context from Jesus’s ministry and watering down his message to one of religious platitudes. We like to generalize the words of Jesus and transform his life into a one-size-fits-all model that can apply to all of humanity.

Throughout the New Testament Jesus was more complex than we give him credit for.

He intentionally, purposefully, and passionately addressed very specific causes. He radically addressed the diverse and complicated conflicts of the time and shattered the status quo.

Jesus wasn’t just preaching a universal salvation message for the world, but he was also addressing specific political, social, and racial issues. He was helping those who were being abused, violated, and oppressed.

Involving ourselves within these issues — serving those who need justice — is an example of following Jesus that today’s Christians must adhere to, because throughout the world there are millions of people who are suffering. But many Christians remain simply apathetic, ignorant, or refuse to admit any problems exist.

They’re uncomfortable facing the complex and controversial issues surrounding race, ethnicity, history, and culture.

To avoid such discomfort, many Christians assume that equality and justice looks like a total dismissal — and rejection of — any cultural, ethnic, or distinguishing form of identity. They believe our very humanity should supersede all other labels or descriptions, and that a love of Christ wipes away any “superficial” characteristic such as skin color, heritage, or other cultural identifier.

Ironically, verses like this show that these things — race, ethnicity, culture — DO matter to God, because God is recognizing the very public fact that there are various laws, expectations, practices, and opinions regarding each distinction mentioned.

Paul is validating all of the cultural issues associated with Jews, Gentiles, slaves, the free, men, and women rather than disregarding them. He’s stating that Jesus is relevant to these differences, and is working throughout their lives by understanding and recognizing the unique pros and cons they’re dealing with — the privileges, disadvantages, stereotypes, assumptions, treatment, rights, social value, and expectations they face on a daily basis.

Participating in social justice is a Christian tradition inspired by Jesus, not liberal causes, populist agendas, media platforms, lawmakers, or mainstream fads. It’s a deeply spiritual practice.

Instead of being motivated by political affiliations, financial gain, power, pride, control, or our own secular motivations, we should be active participants for the sake of following Jesus — for the purpose of glorifying God by through acts of justice, empowerment, and love.

Because everyone is created in the image of God and loved by God, we are responsible for identifying with the victimized — not rejecting their existence.

That’s why the New Testament goes into great depth detailing the newfound worth given to the Gentiles, slaves, and women. These countercultural instructions to believers were radically progressive, to the point where the gospel writers had to put them in writing to make sure they were implemented within the newly formed church.

While God does love everyone and all believers are united in Christ, this doesn’t negate the fact that we have a unique cultural identity and upbringing and are called to recognize the marginalized, help the oppressed, and avoid rejecting their significance by denying their identity or ignoring their plight.

By acknowledging and actively participating in the #blacklivesmatter movement, addressing racism, immigration, gender equality, and a litany of other issues, you are following in the steps of Jesus.

It’s not a matter of pitting social causes against the gospel message of Christ; it’s a matter of realizing that these causes ARE actually an important part of that gospel message.

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CTs for Feminist Movement Building Activist Toolkit.

 

By: 
Just Associates, Association for Progressive Communications, Women'sNet

Activists around the world use information and communications technologies (ICTs) to speak out and stand up against injustice, to take action against violence and inequality, and build movements for transformative change. But the big questions for many activists remain: How do we tell our own stories and make ourselves heard? How do we tell stories that empower and inspire, and challenge mainstream stories that tend to silence, erase women’s lives, experiences and voices? How do we communicate with each other and with people beyond our movements? What is the best way to develop messages that reach out to people and make our movements bigger? What tools make the most sense for our context and capacity?  How can we communicate safely and securely in a world that has become increasingly risky for activists and women’s rights activists online and offline?

We hope ICTs for Feminist Movement Building: Activist Toolkit will help YOU:

  • Experiment and be creative about communicating
  • Think about how communications can help to build movements for social justice
  • Fight gender stereotypes and Amplify women’s voices so they can tell their own stories
  • Design strategies that make sense for their organisations and movements
  • Be safe, be smart and be secure!

DOWNLOAD the toolkit IN FULL or INDIVIDUAL CHAPTERS at the bottom of the page.

About the Toolkit

In this toolkit, we draw on the experience and contexts of women activists in southern Africa and beyond. And while we focus on women’s rights activists, anyone who is part of a movement for social change will find it useful.

The toolkit aims to assist activists to think through their communication strategies in a way that supports movement building. It offers an exciting and practical guide to writing a communication strategy and reviews a number of tools (ICTs) and technology-related campaigns which can be used in organising work. At the core, this toolkit is also about feminist practice and how to use tools to communicate in ways that are democratic, amplify women's voices whilst challenging stereotypes and discriminatory social norms. We hope it will assist activists in making creative, safe and sustainable choices in using ICTs in our communication strategies.

Just Associates (JASS), in partnership with Women’sNet and the Association for Progressive Communications (APC), is proud to present the ICTs for Feminist Movement Building: Activist Toolkit.  ICTs for Feminist Movement Building is designed to support more effective, resilient, visible and safe movements by helping activists to understand ICTs, influence how they are developed, empower ourselves to use them and harness them to make a difference.

This toolkit highlights the extraordinary potential of ICTs to help us bring about social justice, equality between women and men, as well as for all oppressed groups. While much of our activism and organising happens in-person and “offline”, linking tools of the online world creates powerful ways to make our campaigns visible in new and wider spaces.

Special thanks to Warda of WE Designs and Donovan Ward for their creative design and artwork on the ICT Toolkit.

Click below to download.

 

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Publication Date:

Aug 2015

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Community Advocates Training Manual.

Subtitle: The HIV/AIDS Prevention Project for Vulnerable Youth in  Northern Nigeria

Published by the Population Council 2007

Abstract: The Community Advocates Training Manual is a joint effort between Population Council/Abujaand its partners  Adolescent Health Information Projects (AHIP), Federationo Muslim Women Associations in Nigeria (FOMWAN) and Islamic Education Trust( IET). The curriculum aims to improve knowledge and strengthen the skills of community representatives from the northern region of Nigeria to openly discussen sitive issues relating to HIV/AIDS, reproductive health and marriage.

Contents:
-Acknowledgements
-Table of Contents
-Acronyms
-Introduction
-Module one:  The Training Environment
-Module two:  Introduction to Advocacy
-Module three: HIV/AIDS & SRH Issues
-Module four:  Advocacy Skills
-Module five: Planning and M & E

Download this training manual here (PDF, 827.45 KB, 75 pg)

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Investing in Community Advocacy for HIV Prevention: Showing Results 12/06/2013

Publication Date: December 1, 2010

From the International Council of AIDS Service Organizations (ICASO), this report summarises the existing and emerging results, lessons, and recommendations of the 5-year Prevention Treatment Advocacy Project (PTAP) in 10 countries. It seeks to demonstrate the value added and impact of investing in community sector advocacy on HIV.

Implemented from 2005-2009 in 10 countries, PTAP aimed to contribute to a policy and programming shift by building the knowledge and capacity of communities (in effective advocacy, networking, and communication) and, in turn, mobilising a broad-based community movement for HIV prevention. It paid particular attention to areas of strategic importance to achieve scale up, including access to HIV counselling and testing, programmes that help people living with HIV, new prevention technologies, and the needs of key populations. PTAP was led by ICASO's International and Regional Secretariats and implemented by national focal point organisations, and was funded by the Bill and Melinda Gates Foundation, the Canadian International Development Agency of the Government of Canada (CIDA), the Danish International Development Agency (DANIDA), the Ford Foundation, the International AIDS Vaccine Initiative (IAVI), and Positive Action.

The report includes the following 10 case studies:

  1. Promoting community sector involvement in National Strategic Plan (NSPs)/National Strategy Application (NSAs), Rwanda
  2. Involving key populations in NSPs and communities in national budgets, Kenya
  3. Reviewing/introducing legislation to address stigma and discrimination, Ukraine
  4. Empowering people living with HIV to advocate on stigma and discrimination, Jamaica
  5. Using culturally sensitive strategies to mitigate stigma and discrimination, Botswana
  6. Establishing positive prevention as a key strategy, China
  7. Scaling up access to voluntary counseling and testing and female condoms, Belize
  8. Advocating on harm reduction and substitution therapy, Russia
  9. Advocacy by and for people living with HIV to scale up Drop-In Centres, India
  10. Establishing a civil society think tank to create a movement on prevention, Nigeria

The results of these experiences are detailed; in brief:

  • "The largest cumulative result of PTAP was the increased contribution by the community sector to shaping national policies and programs to support the scaling up of HIV prevention alongside expanded access to treatment. This involved advocacy within key national processes: from target setting for universal access to the development of National Strategic Plans (NSPs), with particular attention to mobilizing action on HIV prevention, promoting the role of the community sector and using evidence to prioritize people living with HIV and key populations. It also involved engaging in and influencing countries’ budgeting processes and allocation of resources, including the development of proposals to the Global Fund."
  • "Advocacy to change the legal environment for HIV prevention - particularly relating to stigma and discrimination, criminalization (of behaviours and HIV transmission) and the rights of people living with HIV and key populations - was a strong focus of PTAP. In many cases, national-level efforts to change unjust and oppressive laws and policies were complemented by programs to empower affected communities to learn about their rights, document violations and take the lead on advocacy."
  • "PTAP partners advocated for the introduction, improvement and/or expansion of good practice interventions that are critical to the scale and quality of HIV prevention. These included positive prevention, HIV counseling and testing, new prevention technologies, prevention of vertical transmission and joint HIV/TB [tuberculosis] interventions, alongside population-specific approaches (such as harm reduction for people who inject drugs). To complement this, PTAP also advocated for the expansion of access to HIV treatment..."
  • "The empowerment and involvement of people living with HIV and key populations was central to PTAP. In all 10 countries, important results were achieved in mobilizing and building the capacity of such groups and ensuring their meaningful involvement in advocacy on HIV prevention. In turn, this was part of the Project's broader strategy to build a diverse, skilled and powerful community movement to support the scale up of HIV prevention alongside expanded access to treatment."

PTAP partners highlighted a number of challenges to community advocacy on HIV prevention. Examples included those related to the national context (such as governments not meeting international commitments); national response to HIV (such as priorities not being matched with resources); legal and social environment (such as oppressive legal environments); community sector (such as limited capacity for national policy work); and funding environment.

Lessons learned from PTAP include:

  • Community advocacy can bring significant impacts on national policies (such as the prioritisation of key populations in NSPs) that, in turn, bring concrete programmatic benefits and resources.
  • Resource mobilisation is challenging for community advocacy.
  • Community advocacy needs to be evidence- and capacity-based (responding to gaps in the national response and the "added value" of communities), while building on international commitments.
  • Community advocacy needs to combine capacity building with structural opportunities for constituencies to develop a shared agenda.
  • Advocacy targets need to be specific to contexts and involve a range of stakeholders and target institutions, rather than individuals.
  • People living with HIV and key populations must be at the heart of compelling advocacy messages.
  • HIV prevention programmes alone are not enough; they need supportive environments that enable people to fulfill their rights and provide protection from infection.

Recommendations are offered for action on the part of the community sector and national governments and other key stakeholders. It is suggested that the community sector, including people living with HIV and key populations, should: continue to be advocates for the scaling up of HIV prevention alongside treatment; work to develop the package of knowledge and, particularly, skills needed to engage effectively in national advocacy and policy-making on HIV; and work to build the infrastructure necessary to gather information, channel input, and give feedback on advocacy work in order to engage and represent a wide range of constituents. It is suggested that other key stakeholders: be open to evidence-based advocacy by the community sector; welcome the role of community advocacy in highlighting regional and international agreements and best practices on HIV prevention; treat the community sector as genuinely equal partners within the national response to HIV; provide free and transparent access to their information, for example on budget allocations; and secure supportive environments for effective responses to HIV and increasing the impact of the services that they fund.

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Live Justly is an in-depth scriptural and practical study to help people live justly

Live Justly is a website with is an in-depth scriptural and practical studies to help people live justly in 6 key areas of life:
advocacy, prayer, consumption, generosity, creation care and relationships.

Live Justly is part of the Michah Challenge, below they explain why we should live justly:

"Justice is often invoked by passionate teachers, pastors, and leaders inviting us into NEW action. For example, a justice-themed sermon from a leader or pastor to encourage the church to volunteer, go on a missions trip, or give to a cause. Justice is often focused upon doing something new, but what about the actions you and I take every day?

Here’s the thing: justice isn’t always about doing something new; it’s about infusing what we already do with Kingdom values. We wake up every day and make about fifty decisions–we decide what clothes to wear, what food to eat, how to commute to work or school, how to treat our friends, family, and strangers, what to pray for, where to invest our money, and so on. Justice isn’t simply an action once a year; it is a lifestyle. Our prayer is that our everyday actions will be infused with justice–not our definition of justice but God’s revelation of justice in Scripture.

The scriptures and the movement of the Holy Spirit have deeply touched our own lives here at Micah Challenge, and the call to seek justice has permeated our everyday life choices–pushing us not just to seek justice but to live justly. Perhaps you too feel that call to seek justice.You are not alone in this experience–countless churches, campus groups, small groups, families, and individuals have heard the call and asked us “what’s next?”"

You can enter the Live Justly website here

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Participatory Advocacy: A Toolkit for VSO Staff, Volunteers and Partners. 11/09

Voluntary Service Overseas (VSO) have recently launched: ‘Participatory Advocacy: A Toolkit For VSO Staff, Volunteers And Partners’ . It provides a rich variety of approaches to advocacy. Although the toolkit has been written primarily for the use of VSO staff, volunteers and partner organizations, you can adapt and use all the materials for your own organization and cultural, social or political situation. Use this toolkit to plan and implement effective strategies that lead to enduring social change.

To download this resource, click here (PDF, 3.55 MB, 51pg)

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Practical Action in Advocacy Part C

Part C of Understanding Advocacy.

Published by Tearfund 2002
ISBN 1 904364 00 4

Part C of Understanding Advocacy.  The advocacy cycle is suitable for all types of advocacy work and following it will improve your chances of success. The five sections in Part C explain the five steps in the advocacy cycle, from identifying the issue at the start, to evaluation at the end. These five stages lead into one another, but you may need to keep going back to previous stages if you want to gather more information or change your methods.

The actual time for planning and doing advocacy work will vary, depending on the urgency and complexity of a particular issue, the amount of information needed and the advocacy methods chosen. The basic process outlined in the introduction provides a framework and the main questions to address for an immediate response to an issue. You will need to work through each section in more detail for issues requiring a more longterm response.

Headings Include:
- Introduction: The advocacy cycle
- Issue Identification
- Research and analysis
- Planning: Putting it all together
- Action
- Evaluation
- Resources and contacts

Download this document here (PDF, 849.80 KB, 84 pg)

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Understanding Transformational Advocacy - 3 May 2013

CABSA received the following worthwhile information (see attached file) from Tearfund via the Micah challenge.

The subject is Introduction to Transformational Advocacy written by Tom Baker (tom.baker@tearfund.org)

He defines transformational advocacy as "the process of challenging ourselves and our leaders to change behaviour, policies, and attitudes that perpetuate inequality and deny God’s will for human flourishing.”

In addition to the document made vailable, there are also plans to run workshops.

Aims of session;

  • Participants leave with an understanding on the concept of transformational advocacy.
  • Participants leave with practical tools about how they can implement the idea of transformational advocacy into their contexts.
  • Participants leave inspired about the potential for getting engaged with transformational advocacy and ideas about how they can go about doing that. 

 

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Advocacy & Communication - Handbook for CBOs. IDASA (2006).

In a democratic society there are many different groups which might have competing interests. You need to make your voice heard and get your viewpoint across to achieve your vision. The formal terminology for this process is advocacy, lobbying and communication.   Many CBOs already use these tools very successfully. However, obstacles sometimes occur when CBOs operate on their instincts, rather than using more objective and structured tools to ensure their impact is as wide as possible. People expect CBOS to operate in a highly professional manner.
This notebook will help you and your CBO to ensure that you use these tools in the most effective way possible. We will look at advocacy, lobbying and communication as separate processes, but will also highlight the links between them. Often they are difficult to tell apart, but they need to work in harmony to ensure your campaigns are successful.
Contents:
1. Introduction
2. Advocacy
3. Lobbying
4. Communication
5. Running a Campaign
6. The TAC example
7. The RAPCAN example
8. Conclusion
9. References
Download (PDF - 447KB) from IDASA website at www.idasa.org.za, under Programmes, Institutional Capacity Building.
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Advocacy 2.0 Guide: Tools for Digital Advocacy

Quick and Easy Guide to Online advocacy. This guide presents advocates with a collection of popular online services that can be used for advocacy quickly with little to no technical support. There are services for publishing photographs and video, for setting up a campaign blog or for using mobiles to communicate in a group. An amazing amount of functionality and tools are available simply by connecting to the Internet and opening up a web-browser. You don't need to have a lot of technical expertise to try some of these. You also don't need much money, these services are offered at low- to no-cost. http://onlineadvocacy.tacticaltech.org/

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Endorse the NGO Code of Good Practice

On December 1 2007, the Code of Good Practice for NGOs Responding to HIV/AIDS will re-open for new endorsements.

The NGO Code of Good Practice sets out the key principles, practice and evidence base required for successful responses to HIV, drawing on the knowledge and experience gained since the response to HIV began. Key issues addressed in the Code include:

- The meaningful involvement of people living with HIV and affected communities.
- Evidence-based programmes based on the needs of the most vulnerable.
-Transparent governance and accountability to beneficiary communities.

160 NGOs have already signed on to the Code. We invite you to make YOUR commitment to continuous improvement and accountability today by reading the Code and sending a signed endorsement letter to the Code Secretariat

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Footsteps 45: Advocacy

 Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Proverbs 31:8

An advocate is someone who speaks out on behalf of someone else to bring about justice. In Jesus we have the perfect example of an advocate. While we were still God’s enemies, he died on the cross so that our sins could be forgiven. Now he pleads with God on our behalf, as our advocate in heaven. There are many other examples of advocacy in action in the Bible, including Abraham, Moses and Nehemiah.

Advocacy means to speak or take action either with, or on behalf of, the poor, to change the situations that cause their poverty and bring about justice.

To download a pdf version of Footsteps issue 45 click here (PDF 904 KB)

- See more at: http://tilz.tearfund.org/en/resources/publications/footsteps/footsteps_4...

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HIV and AIDS Advocacy & Media Relations. Training Manual for Religious Leaders.

Religions for Peace has a commitment to strengthen advocacy among religious communities regarding the AIDS pandemic. Due to stigma and discrimination, children are often deprived of basic social services and the support of their extended families. Such an enviroment can open the door for abuse, sexual exploitation, and other issues.   Advocacy means championing a cause; creating awareness and understanding about AIDS; and working to ensure that relevant policies and programs are put in place. HIV/AIDS advocacy helps drive a more effective response globally, regionally and nationally.

This training manual, used together with the participants’ handbook, is meant to strengthen the advocacy and media relations skills of religious leaders at both national and community levels in order to expand their advocacy efforts on behalf of children orphaned and made vulnerable by HIV/AIDS, with the goal of bringing greater priority to their needs and expanding the response. Download here

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How a Red Ribbon Conquered the World. 2/6/2011

History of the red ribbon as symbol for HIV and AIDS

By Tom Geoghegan BBC News, Washington DC

Thirty years after the HIV virus was first documented, the red ribbon is the ubiquitous symbol of support for those living with the illness. Who thought of it and how did it get so big?

In the sparse surroundings of a former classroom on a spring day in 1991 - a decade after the rise of Aids - a group of 12 artists gathered to discuss a new project.

They were photographers, painters, film makers and costume designers, and they sat around in the shared gallery space known as PS122 in New York's East Village.

Within an hour or so of brainstorming, they had come up with a simple idea that later became one of the most recognised symbols of the decade - the red ribbon, worn to signify support for people with HIV/Aids.

"We wanted to make something that was self-replicating," says Patrick O'Connell, who chaired the meeting. "It's extremely simple, like Bauhaus but half a century later. You cut the ribbon 6-7 inches, loop it around your finger and pin it on. You can do it yourself."

The ribbon was the latest project by Visual Aids, a New York arts organisation founded by O'Connell that raises awareness of HIV/Aids.

When they sat down in the shared gallery space of PS122 in May 1991, they wanted to get people talking about the illness that was decimating their professional and social network, in the face of public indifference and private shame.

People were dying without even telling their friends why they were sick, and the artists wanted a visual expression of compassion for people living with Aids and their carers.

"Even in New York, we were very aware of how many people couldn't talk about it, or were oblivious, or were going through it themselves but ashamed to talk about it," says photographer Allen Frame, who was also one of the 12. "We wanted to make people feeling isolated more supported and understood."

Their inspiration came from the yellow ribbons tied on trees to denote support for the US military fighting in the Gulf War, he says. Pink and the rainbow colours were rejected because they were too closely associated with the gay community, and this was an illness that went well beyond.

"Red was something bold and visible. It symbolised passion, a heart and love."

The shape had no significance but was easy to make.

It took two more meetings to refine the design and then they set to work on making the ribbons themselves, distributing them around the New York art scene and dropping them off at theatres.

Initially there was a text that went with it, to explain why they were being worn, although this was later dropped because it became superfluous.

A few weeks after that first meeting, the group sent a box of 3,000 ribbons to the Minskoff Theatre on Broadway, ahead of the Tony Awards for the theatre industry. Some of them were making ribbons and watching the televised event as actor Jeremy Irons, one of the presenters, came on to the stage wearing one.

"Within three days, the media finally figured it out and it snowballed. I started being contacted by people in Hollywood," says O'Connell.

Demand increased to such a degree that supply needed to be outsourced, and Visual Aids used a charity working with homeless women to make the ribbons. They sent out 10,000 ribbons for one Oscars ceremony, and over the coming years they made about 1.5m.

Stars like Bette Midler and Richard Gere were not only wearing them, but openly discussing why it was important. A ribbon-sporting culture developed within the acting profession.

"It became trendy and sometimes I think celebrities felt blackmailed and thought they had to show up wearing a ribbon, which wasn't the case," says O'Connell. "We weren't keeping count that way."

The ribbons first crossed the Atlantic in large numbers on Easter Monday in 1992, when more than 100,000 ribbons were distributed at an Aids benefit concert in London's Wembley Stadium for Freddie Mercury.

They also began to proliferate in mainstream American life. Schools and churches across the US touched by the illness started to contact Visual Aids for advice on how they could explain it to children and parishioners - the answer was to hold a ribbon-making event.

"This was a way to educate people in a non-combative way," says O'Connell, who has a ribbon on every item of clothing. Direct action was still important, he says - campaigners occupied the Stock Exchange and tried to re-enact a funeral on the White House lawn - but the ribbon was a way to broaden the conversation.

One unforeseen consequence has been the number of awareness ribbons that have been adopted since - pink for breast cancer being the most well known.

The artists purposefully never trademarked it - the point of the project was to invite more people in, says O'Connell - which meant it could appear anywhere without Visual Aids' permission or any payments. It even turned up on a US Post Office stamp.

But he and some of the other artists behind the concept believe the proliferation and merchandising of the ribbon - ornamental ribbons selling for $19.95 in department stores and red ribbon mugs - has commercialised and trivialised their idea.

In a spirit more in tune with the one envisaged by Visual Aids, the ribbon is replicated in many different forms for memorials on World Aids Day, and its symbolism no longer needs any explanation.

In the poorest parts of the world, ribbon production has been central to efforts to raise funds and change attitudes, says Sir Nick Partridge, chief executive of the Terrence Higgins Trust in the UK.

Women's collectives make ribbons and adorn them before selling them in their community.

"A number of people living with HIV really appreciate seeing other people wearing the red ribbon. They realise they're not alone and recognise that the majority of people wearing them probably don't have HIV themselves, and that sense of support and solidarity is very, very important.

"There has been some criticism, that it is only a symbol. But symbols are important, and the way in which the red ribbon was embraced by community activists, doctors and researchers is a unifying emblem in what is a very disparate epidemic.

"The brilliance of the artists was not copyrighting it. Making it freely available was a gift to the Aids community worldwide."

Those 12 artists never worked together again as a group, but with the battle against the illness ongoing, their activism continues.

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Media Advocacy Manual.

American Public Health Association.  Advocacy is used to promote an issue in order to influence policy-makers and encourage social change. Advocacy in public health plays a role in educating the public, swaying public opinion or influencing policy-makers.
Media coverage is one of the best ways to gain the attention of decision-makers, from
local elected officials to members of Congress. Download PDF ( 74.82KB; 15p.)
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Survival is the First Freedom: Applying Democracy & Governance Approaches to HIV/AIDS Work. PACT 1999

This tool kit aims to provide a collection of tools for use in applying democracy and governance approaches to HIV/AIDS work. It is a compilation of the diverse expertise and experiences from the United States Agency for International Development (USAID), Pact, and other development organisations. It was produced to assist efforts to scale up responses to the pandemic and increase access to prevention and care services through collaboration at individual, community, and national levels. This tool kit is designed for use by donor organisations, civil society, government, and the private sector. According to the publisher, ultimately the aim is to develop a dynamic website so that users can add new tools to create an ever-expanding and up-to-date learning tool.  
The tool kit is organised around key democracy and governance concepts that have direct application to specific needs in HIV/AIDS programming.
Specific tools for relating these focus areas with HIV/AIDS work are included at the end of each section.
Download pdf (3.22 MB)
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The Internet Advocacy Book

The online version of The Internet Advocacy Book is a free resource for non-profits and socially-progressive political organizations who use the internet to advocate for their cause.While "techies" may benefit from The Internet Advocacy Book, the intended audience is non-profit executives, cause marketing consultants, and political campaign professionals.Rather than a "how to" format, The Internet Advocacy Book is written as a "how better to" guide, with laser focus on the best uses of your internet-advocacy time. Here, you'll find candid advice and insightful recommendations, without the bias or self-interest of rah-rah sales reps. This approach is evident throughout the book. For each topic, you'll notice that the coverage of advantages and disadvantages includes at least as many cons as pros. Self-assessment scorecards will help you identify areas of current strength as well as weakness. And our recommendations are concise and specific; so you may find that you can accomplish many of your internet marketing goals with in-house staff and volunteers.

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Why Advocate on HIV? (Tearfund) 2008.

“Advocacy is about influencing people, policies, structures and systems in order to bring about change. It is about influencing those in power to act more fairly.”

“This booklet is for organisations that are engaged in work with people who are living with or affected by HIV but have not yet considered carrying out advocacy on HIV. In this short guide, we look at what advocacy is, what global and local commitments have been made to address HIV, and why advocacy on HIV is necessary.

We look briefly at how to begin advocacy work on issues around HIV, and recommend further resources and contacts.

The aim of this booklet is to inspire organisations to integrate advocacy into their work in responding to HIV, in order to bring long-term positive change.

Download PDF (256.17 KB)

 

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Advocacy Resources - Access to Treatment

 

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High-Priced Medicines and Lack of Needs-Driven Innovation: A Global Crisis That Fuels Inequality. 9/2017

Published by OXFAAMERICA

In 2015, the UN Secretary-General established a High-Level Panel on Access to Medicines to ‘review and assess proposals and recommend solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies’. The High-Level Panel (HLP) report, released in September 2016, was welcomed by former Secretary-General Ban Ki-moon, who ‘encouraged all stakeholders to review the report and its recommendations’ and ‘to chart a way forward in appropriate fora to ensure access to medicines and health technologies for all who need them, wherever they are.’

One year later, the UN and relevant UN agencies have not taken action to move the report’s recommendations forward. Direct opposition by some governments –especially the United States –and pharmaceutical companies has caused unnecessary delays. Yet many governments, experts and civil society organizations have welcomed the report, reaffirming the need for new ways to address the global crisis of high medicine prices and lack of needs-driven innovation. The current system for biomedical research and development (R&D) is driven by market dynamics, as pharmaceutical companies invest in medicines that can produce the highest profit. This model results inunaffordable prices.

The pricesof new and even some old medicines continue to be too high to be affordable across the world. In South Africa, a 12-month course of Herceptin, a breast cancer medicine produced by Roche, costs approximately US$38,000 or about five times the country’s average household income. The price of the first real cure for hepatitis C was launched at a cost of US$1,000/pill/day, which would require around US$300bn in order to treat the three million infected people in the United States. The same story is repeated in other countries.

You can access the resource here

 

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TAG Releases An Activist's Protocol Review Toolkit. 23/5/2017

Published by TAC

Treatment Action Group (TAG) released a toolkit designed to facilitate community participation in the development and review of clinical trials protocols.

The three tools contained in the toolkit are intended to help Community Advisory Boards (CABs) think through different aspects of trial design and implementation, organize feedback for the research team, and evaluate impact on study design and implementation.

The Protocol Review Toolkit for Activists was developed in consultation with members of the Global Tuberculosis Community Advisory Board (TB CAB) and the Community Research Advisors Group (CRAG).

You can access the resource here

 

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Advancing the Right to Health: The Vital Role of Law. 1/1/2017

Published by HEALTHSYSTEMTRUST

  This report aims to raise awareness about the role that the reform of public health laws can play in advancing the right to health and in creating the conditions for people to live healthy lives. By encouraging a better understanding of how public health law can be used to improve the health of the population, the report aims to encourage and assist governments to reform their public health laws in order to advance the right to health.

The report highlights important issues that may arise during the process of public health law reform. It provides guidance about issues and requirements to be addressed during the process of developing public health laws. It also includes case studies and examples of legislation from a variety of countries to illustrate effective law reform practices and some features of effective public health legislation.

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Analysis 58: Medicines Patents, Access and Innovation. 6/2016

Published by BROTFEURDIEWELT

Millions of people around the world do not have access to the medicines they need to treat disease or alleviate suffering.  Strict  patent  regimes  interfere with widespread access to medicines by creating monopolies that can lead to  medicine  prices well beyond the reach of the people who need them.

The magnitude of the AIDS crisis in the late nineties brought this issue to public attention, when millions of people in developing  countries  died from an illness for which medicines existed in Western countries, but which were usually not available or affordable elsewhere. Faced with a huge health crisis – 8,000 people worldwide dying daily – the public health community launched an unprecedented global effort that eventually resulted in the largescale  availability  of  quality assured  generic HIV medicines  and  a  steady  scale-up of treatment  programmes that provided access for many to those medicines. Today, 17 million people are on HIV treatment (UNAIDS 2016) leading longer, healthier lives as a result.

However, trends in international intellectual property law could impact many of the policy tools used to scale up HIV treatment. Developments in global health, and specifically policies designed to ensure access to medicines, are now  at  an  important  juncture.  Impressive  progress  has been made in access to medicines for HIV and many lessons can be learned from that experience. But it is important  to  examine  whether  those  lessons can be applied  to other  new  medicines,  including  medicines to treat  HIV, that are high priced because, for example, they are not included in the  Medicines  Patent  Pool  (MPP). 

The  Medicines Patent Pool was set up as a one stop shop for voluntary  licences.  The MPP negotiates  licenses  with  patent holders,  mostly  pharmaceutical  companies,  which  allow generic manufacturers to produce these medicines, including in combination with other products. This has facilitated generic competition in the market and access to lower priced treatments for HIV including fixed-dose combinations which are easier for people to take than single pills.

Today’s pharmaceutical patent regimes affect almost all  medicines  developed  since  1995  in  most  countries.  The high prices of new medicines, such as for cancer, tuberculosis, hepatitis C, and HIV cause huge access challenges globally, in both developed and developing countries.  While important  progress  has  been  made  to  increase  access  to  HIV  medication,  dealing  with  high priced patented  anti-retrovirals  (ARVs)  that  are  only available from the patent holder remains a problem.

You can access the resource here

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Public Health Groups Call for Congress to Reject TPP 12/4/2016

Published at

By Vicki Needham - 04/12/16 08:51 PM EDT

More than 50 public health groups on Tuesday called on Congress to reject a trade agreement between the United States and 11 other Pacific Rim nations because it will block access to affordable medicines.

Led by Doctors Without Borders and Oxfam America, the groups wrote a letter to Congress arguing that the Trans-Pacific Partnership (TPP) agreement contains provisions that would undermine public health and in many cases make it more difficult to deliver lifesaving medicines to patients.

The health groups — Health GAP, Alliance for Retired Americans and National Nurses United — say that the TPP would extend the monopolies of pharmaceutical companies, keep drug prices high and prevent medical providers from getting the medicines they need while blocking the availability of generic drugs in many TPP countries.

"In the United States, TPP would tie Congress’s hands, potentially for decades to come, preventing policymakers from having flexibility as they formulate sensible policies to promote access and keep medicines affordable,” the groups wrote.

They said the TPP would take apart public health safeguards and force developing countries to change their laws "to incorporate abusive protections for pharmaceutical companies," making it harder to obtain affordable medicines.

“Competition has consistently proven the most effective means of reducing prices and ensuring prices continue to fall over time,” the letter said.

“As written, the TPP is inconsistent with U.S. domestic health priorities and global health policy," the groups wrote.

"We urge Congress to reject the TPP as long as these damaging provisions are part of it. The stakes for public health are too high.”

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The Global Fund has Been Backing Away From Efforts to Promote Generic Competition 5/4/2016

Published at
Fund’s strategy has come under growing scrutiny

With progressively stricter patent protections, the costs for new treatments continue to rise. It is a global problem that affects countries across income levels, but it is particularly challenging for poor and transitioning economies.

Until recently, The Global Fund has advocated for the affordability, availability, and financing of medicines and other health commodities, taking the time-tested position of promoting generic competition as the most effective means for bringing down the price of medicines.

According to The Global Fund’s 2012 Guide to Policies on Procurement and Supply Management of Health Products, the Fund has long supported efforts to “address barriers and practices that prevent access to affordable medicines by promoting generic competition in order to help reduce costs,” including “the use of TRIPS flexibilities [see below] to ensure the lowest possible prices for quality medical products, and allows for grant monies to be used for securing the necessary expertise.”

But lately the Fund has increasingly taken a very conservative approach or even remained silent when its political weight could have been used to promote the pro-generic policies that many countries rely on to ensure access to quality medicines.

As a result, The Global Fund’s strategy regarding intellectual property (IP) has come under growing scrutiny from rights advocates and health and development partners, including Médecins Sans Frontières (MSF), UNITAID, and Health GAP. They have called on the Global Fund to use its influence to promote the use of generic competition, and to supplement those efforts by leveraging its purchasing power to lower the price of medicines.

Free trade pacts

This campaign to protect affordable access to medicines is intensifying as the Trans-Pacific Partnership (TPP) – a landmark agreement that will create the world’s largest free trade zone and affect 40% of the world’s economy – undergoes the final legislative processes for ratification.

Besides increasing costs as a direct result of stricter patent protections, trade pacts have generally favored IP rights holders to the disadvantage of competition and consumers. But the TPP goes further than previous pacts in that it threatens future access to affordable medicines. The TPP creates additional forms of monopoly protections – i.e. over and above minimum protections that already been agreed globally.

For example, the TPP expands provisions for monopoly drug patents and grants additional enforcement powers to foreign pharmaceutical corporations to directly challenge domestic public health policies. Activists argue that these longer, broader, and stronger patent protections will result in higher drug costs and longer times to bring generic drugs to market, thus pricing vital drugs out of the reach of millions of people. If ratified, they say, unprecedented monopolies on medicines will undermine the flexibilities negotiated under TRIPS that safeguard a country’s access to affordable drugs.

TRIPS (Trade-Related Aspects of Intellectual Property Rights) is one of the annexes to the agreement establishing the World Trade Organization (WTO), the international body overseeing the global trading system, in 1994. For member countries of the WTO, TRIPS introduced protections for IP rights.

In response to concerns raised about the damaging impact of IP regimes on public health and development, particularly for developing nations, the DOHA declaration was issued by the WTO in 2001. DOHA stated that IP provisions in trade agreements should not infringe on the human rights obligations of governments. It affirmed the right of WTO members to make full use of TRIPS flexibilities (e.g. compulsory licensing, parallel importing, voluntary licensing, exceptions, and exemptions) to protect public health and ensure access to medicines for the poorest.

Fund is uniquely positioned

Procurements of health commodities constitute 40-50% of The Global Fund’s annual grant disbursements, making the Fund uniquely positioned to influence the price of key medicines – particularly given the Fund’s expressed desire to maximize value for money. But instead, the Fund appears to be backing away from public health–friendly, pro-competition policies that it has actively promoted in the past.

An immediate case in point is its silence during global IP debates, and specifically during recent negotiations in which least developed countries (LDCs) requested an extension from the WTO in implementing stricter IP rules. In the end, the WTO granted their request, although it limited the extension to 2033 with the possibility of additional extensions. 

Another example is the Market Shaping Strategy which The Global Fund Board recently adopted. The policy attempts to expand the Fund’s role in shaping market dynamics to increase access to health products (see GFO article). Critics charged that an initial draft of the strategy circulated by the Secretariat for comment was too weak on IP barriers and generic competition issues. Members of the NGO and communities delegations of the Board provided hundreds of pages of input to the Secretariat to try to strengthen the language. But the revised text presented to the Board still fell short even though some last-minute lobbying at the Board meeting where the strategy was adopted resulted in some improvements to the language.

Although The Global Fund professes to support efforts to address IP barriers to affordable medicines, it has failed to develop strategies for overcoming IP barriers in implementing countries. Moreover, according to activists, the Fund has taken the position that such matters are outside the scope of its Market Shaping Strategy.  

Many actors are involved in the fight for more affordable medicines, including development initiatives such as UNITAID and the Medicines Patent Pool, which provide substantial investments to ensure affordable access to medicines. MSF contends that the existing tools and levers to overcome IP barriers can be significantly leveraged with the Global Fund’s market and political power – if only that power were forthcoming.

Another issue raised by MSF is the Global Fund’s approach to centralizing key activities, such as bulk procurement and the e-marketplace. Strategies that centralize these activities seek to drive innovation and reduce costs, among other benefits, but they also build near-monopsony power for The Global Fund, potentially at the expense of building country capacity to address IP barriers in order to to protect their public health interests. (In economics, a monopsony is a market structure in which only one buyer interacts with many would-be sellers of a particular product.) MSF says that negotiations to lower the price of medicines lack transparency and oversight mechanisms, reducing country ownership in the process.

Brook Baker of Health GAP adds that “even if the Global Fund is promoting pooled procurement, it could provide countries with better information on patent status and help them amend their laws and use TRIPS flexibilities to access affordable more affordable generics.” He said that the Fund could also be doing more to strengthen procurement and supply system capacity in low-middle-income countries.

“Grant funds can be used to support IP/TRIPS-related work, so countries can put activities related to this in their proposals,” Baker said. “But the availability of Global Fund support for this IP work is not explicit. There should be clarity on this for recipient countries, both in advocacy and in TA. This is a particular concern for countries transitioning from Global Fund support, where the Fund should leave behind a set of policies and practices for effective procurement that will have an impact not just for commodities related to HIV, TB, and malaria.”

Explore all avenues

“All avenues for securing affordable access to medicines should be explored,” asserts Rohit Malpani, Director of Policy & Analysis with MSF. “The Global Fund, through its sheer weight, can employ a variety of means to enable recipient and graduating countries to protect their public health priorities. That means explicit support for the use, or threat of use, of TRIPS flexibilities in addition to leveraging its procurement options.”

“Further,” he adds, “The Global Fund should encourage wide review of these procurement options to inform its support to specific countries. It should conduct and publish clear analyses on the impact of free trade agreements or other trade policies on generic competition for health commodities.”

Another recommendations put forth by MSF and Health GAP is that The Global Fund should hire an in-house IP specialist as part of its market analysis work. In addition, they said, the Fund should align with, and build on, the work of UNITAID and the Medicines Patent Pool on overcoming IP barriers by, for example, negotiating voluntary licenses for key commodities and expanding access to generics to low- and middle-income countries.

There is another problem, according to Brook Baker. “Commercial interests wield substantial influence on Global Fund procurement and pricing strategies,” he said. “It’s the elephant in the room.” The U.S. is the Global Fund’s largest donor, and it has an enormous pharmaceutical lobby that backed the TPP and its pro-industry IP provisions. The Global Fund’s second largest donor is the U.K., also with its own powerful pharmaceutical industry pushing for longer monopolies on brand-name drugs, making it harder for generic companies to enter the market. 

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Early Diagnosis and Treatment for Children and Adolescentsi Living with HIV: Urgent Call by Religious and Faith-Inspired Organizations for Greater Commitment and Action. 4/2016

Download pdf from CARITAS

As professionals engaged in the response to the continuing and grave challenges posed by the HIV epidemic, at global, national, and local levels, we gathered from Africa, Asia, Europe, Latin America, and North America, to share our knowledge, experience, and good practice models but also our grave concerns, with special attention to the wellbeing and future of children, vulnerable to, or already living with HIV. We were joined in these strategic reflections and discussions by other key stakeholders, including officials of multi-lateral organizations and national governments, non-governmental organizations (NGOs) facilitating provision of services (implementing agencies), and various innovative funding, research, development, and advocacy organizations committed to advance the shared vision to end new infections of HIV among children and keep their mothers healthy, and to end AIDS as a public health threat by 2030. “We need to bring our minds and our hearts together to face the future to take us to the end of AIDS.”ii

Rejoicing in the Signs of Hope and the Grace of God

We grounded our time together in prayer and discernment of Sacred Scripture and the centuries-old traditions of people of faith to reach out to, and accompany, as part of our mission as people of hope, those sisters and brothers who find themselves most in need, marginalized, rejected, and stigmatized.

Working in the “vineyard” of religious and faith-based action, we deeply appreciated the acknowledgement offered by our international colleagues and partners during this consultation: “You’ve worked tirelessly, often without the resources, long before the Global Fund, long before PEPFAR;” “You were there when all we could do was stand beside bedsides and help people die with dignity”iii; “You are a bridge to bring the science to the people. The data makes that very clear.”iv “ Faith- based organizations are an essential and irreplaceable piece of this puzzle.”v

On a related note, we celebrated with many others, but most especially with our sisters and brothers living with or affected by HIV, in the scientific, technical, and practical progress made to date:vi

  • The number of children who died of AIDS-related causes in 2014 (150 000) is 41% lower than in 2001, when global paediatric HIV mortality peaked;

  • Since 2000, new HIV infections among children have declined by 58%. Yet the epidemic continues to have profound effects on the youngest people. In 2014, 2.6 million children under 15 years of age were living with HIV;

  • Since 2000, antiretroviral medicines have averted an estimated 1.4 million HIV infections among newborns and infants;

  • Approximately 73% of pregnant women living with HIV worldwide have received treatment to stop transmission of HIV to their babies. This is a giant leap from 36% receiving effective regimens in 2009 and from 2000, when only 1% of pregnant women living with HIV had any form of access to prevention of mother-to-child HIV transmission services;

  • In 2013 worldwide, only 42% of newborns exposed to HIV received early infant diagnostic services in their first two months of life.

    We shared the stories of entire families, and especially of their HIV-positive children, being accompanied by our faith-based programmes and benefitting from education from primary to tertiary levels; entering into value-based and respectful inter-personal friendships with peers; excelling in sports; and developing self-sufficiency skills as they transition from adolescence to young adulthood.

Confronting Persistent and Grave Obstacles

Despite our best efforts, specialized skills, and holistic, person- centered, community-based, and family-centered vision and approach to care, the children and families under our care continue to face serious challenges as they seek universal access to effective, accessible, and acceptable prevention education, treatment, care and support:

  • When analyzing overall mortality among children, we note that more than six million children still die, mainly of preventable and treatable diseases, before their fifth birthday each year.

  • Four out of every five deaths of children under age five occur in sub-Saharan Africa and Southern Asia.

  • Tuberculosis (TB) is common in countries that have a high burden of children living with HIV and high under-five mortality. Yet, TB/HIV co-morbidity among children has been largely overlooked globally and grossly under-reported.

  • The proportion of children living with HIV who receive antiretroviral therapy more than doubled between 2010 and 2014 (from 14% to 32%), but coverage remains notably lower than it does for adults (41%). Only 820 000 of 2.6 million children living with HIV have access to treatment.

  • Even when services are readily available, stigma can prevent parents from bringing their children forward for test results and for initiation of treatment.

  • Long delays in return of EID test results continue to interfere with and timely initiation of treatment.

  • Children are still being initiated on anti-retroviral treatment too late; one-half of children living with HIV and who are not receiving anti-retroviral treatment die before the age of two years (UNAIDS), yet, on average, children are not initiated on treatment until 3.8 years of age (UNAIDS/Ideea).

  • Impairment of neuro-cognitive development and stunting have been noted among children living with HIV; early initiation of anti- retroviral therapy and adequate nutrition have shown positive impact in this regard.

  • Stock-outs of testing supplies and medicines create frustration, defaults, and desperation, among parents and primary caregivers who make great sacrifices of time and meager financial resources to bring their children to clinics and hospitals in search of testing and treatment.

  • Funding often is tied to bio-medical services alone, when there is strong evidence base demonstrating the need and effectiveness of a holistic approach that combines medical, emotional, and spiritual support to child and parents/caregivers: "The HIV epidemic among children and adolescents is defined not only by the virus and medical interventions to control it but also by social, economic and political conditions that they find themselves in. We know that children thrive when they are placed in a supportive and nurturing environment from their earliest days. UNAIDS is committed to increasing attention to social protection, especially for children and adolescents."vii

  • Medication distribution and delivery systems remain complicated, and medicines continue to require cold chain storage, even in countries without a reliable electrical supply.

  • In many countries and districts HIV, TB, ante-natal, maternal and child health, and other medical services continue to be delivered in “silo” fashion and thus result in missed opportunities for early diagnosis and initiation of treatment.

  • Despite strong advocacy and some innovative approaches to issues related to intellectual property, this “progress” has not yet yielded large-scale production of “child friendly” diagnostics and medicines that can be used in low-technology and low-income countries and among poor and marginalized populations in middle- and low-income areas of “rich” countries.

  • We also recognize that some faith-based organizations have held attitudes that contributed to the marginalization of people living with and affected by HIV and that, at times, our silence could be linked to the worsening situation of HIV infection.

    What do we need from NOW until 2020viii, with specific interim targets and reviews on an annual basis, to address these life-threatening issues?

  • Variability and disruption in funding can have catastrophic results for formerly successful projects; we cannot assume programmes will be maintained without adequate and sustainable funding from both international solidarity and domestic sources.

  • Invest in programmes to prevent HIV infection in parents;

  • Expanding numbers of adolescent youth can result in higher vulnerability to HIV infection among this population, in particular, among girls; we need to better understand their needs and to develop more effective means to assure that they enter and are maintained in school, which, in itself has been demonstrated as an effective prevention strategy.

  • Since there is high mobility among many families and children, especially among the poorer populations, more “portable”, “Smart Card” medical and social records and other information communication technology are needed in order to track their progress and to enable them to stay in care over time and place.

  • A multi-pronged approach to HIV must be developed in order to extend past the bio-medical service system in order to include nutritional support, services to children with disabilities, mental health services, spiritual, social, and emotional support, education, and economic empowerment and assistance, and social services, attention to the impact of conflict and other humanitarian crises, and sensitivity to cultural and religious contexts.

  • Invest in social services for children and families, including social protection, in order to address the underlying causes that hinder the response to HIV, including poverty, abuse, stigma, and harmful social norms and develop social indicators to demonstrate effectiveness of these interventions.

  • Attention must be given to greater involvement of men and boys if we want to reduce HIV vulnerability among women and girls, including elimination of inter-personal and domestic violence.

  • Access to, and availability of, timely lab testing, including virologic tests, for early infant diagnosis must be increased through innovative systems and new technologies to allow infected infants to be started on antiretroviral treatment rapidly.

  • Testing of children in high yield venues such as index-case based testing and OVC programs, malnutrition and TB clinics, and sick child wards must be intensified to identify children living with HIV. Training on disclosure to children of their HIV status must be provided for health care workers and parents/caregivers.

  • Providing effective and well-tolerated drugs for children remains critical to ensuring scale up of paediatric treatment and improved clinical outcomes.

o Formulations must be palatable, suitable for infants and young children, adaptable for varied weights, and co- formulated as much as possible.

o Immediate new formulations are needed for children and are more potent, better tolerated and minimally toxic regimen allowing full harmonization with adult treatment strategies.

o Second and third-line treatment regimens must be available in paediatric formulations to allow treatment of children failing initial regimens.

  • Innovative strategies for prevention, retention and adherence are needed especially for adolescents, who are at high risk of loss to follow up and onward transmission.

  • Serious study and analysis needs be given to integration of HIV Testing and Counseling into immunization programmes

  • Strengthen the capacity of, and retaining, paid and volunteer community health workers and facilitate task shifting in order to expand outreach, efficiency, and effectiveness.

  • Consistent and broadly accepted targets and sub-targets should be defined for diagnosis, treatment and retention in care of children living with HIV; no target should be accepted if it is based on the assumption that large numbers of children will die before elimination can be reached.

  • Inter-sectoral and inter-ministerial cooperation should be formalized within governmental offices engaged in response to HIV .

    The unique voice of faith communities and related organizations to save the lives of children living with HIV and their parents, and to accompany the empowerment of affected families

    Thus we commit ourselves to:

    Addresspsycho-socialandspiritualneedsofchildrenandfamilies; Delivertestingandtreatmentservicesatlocalcommunitylevel;
    Utilize the sermons and other educational services, including

    pastoral and clergy training and formation programmes, to deliver direct, comprehensive, effective, and understandable messages for individuals, families, and communities, in relation to physical, emotional, behavioral and spiritual health and wholeness;

    Shape positive attitudes that counteract fear and tendencies toward stigma and discrimination;

    Integrate value-based sexual and responsible relationship education into their curricula and into preparation for life-changing transitions (adolescence, marriage, death and mourning, etc.);

    Initiate and sustain effective advocacy approaches to address social justice-related barriers and obstacles to universal access to early and sustained testing and treatment for HIV, TB, and other co- infections

Increase partnership and collaboration with government and other civil society actors;

Assume a critical role in implementing, and monitoring progress in achieving, the Sustainable Development Goals (SDGs) and other international commitments and to safeguard respect for human rights;

Assure access to treatment and provide social, emotional and spiritual support for arriving migrants and refugees;

Maintain focus and concern on marginalized, low-prevalence, and/or hard-to-reach populations within our respective countries,

Contribute to ethical and theological reflection, and ecumenical and inter-religious dialogue, on overcoming obstacles and barriers to effective Early Infant Diagnosis and Treatment of Children living with HIV;

i According the United Nations Convention on the Rights of the Child, Article 1, “a child means every human being below the age of eighteen years unless under the law applicable to the child, majority is attained earlier”, in this document, it will be presumed that adolescents are included in such references to children.

ii Dr. Luiz Loures, Assistant Secretary-General of the United Nations and Deputy Director of Programmes, UNAIDS, 11 April 2016.

iii H.E. Deborah Birx, Coordinator, U.S. President’s Emergency Plan for AIDS Response and for Global Health Policy, 11 April 2016. iv Dr. Luiz Loures, 11 April 2016.

v H.E. Deborah Birx, 11 April 2016.
vi Unless otherwise specified, references are from UNAIDS: How AIDS Changed Everything: MDG 6: 15 years, 15 lessons of hope from the AIDS response. Geneva: UNAIDS, 2015 vii Dr. Luiz Loures, Global Partners Forum: a holistic approach needed to keep children and young people safe from HIV, 20 July 2014, http://www.unaids.org/en/resources/presscentre/featurestories/2014/july/...

viii Quickening the pace to achieve the Fast-Track Targets would reverse the AIDS epidemic by 2020. With achievement of these new targets, by 2030 the epidemic would be dwindling. In contrast, with business as usual (keeping service coverage at 2013 levels), the epidemic will have rebounded by 2030, representing an even more serious threat to the world’s future health and well-being and requiring substantial resources for what would then be an uncontrolled epidemic.” http://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014repo..., page 12

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The Vancouver Consensus: A New Declaration Against HIV. 04/08/2015

Published at The Body Pro
Written by Warren Tong
20 July 2015


"Medical evidence is clear: All people living with HIV must have access to antiretroviral treatment upon diagnosis. Barriers to access in law, policy, and bias must be confronted and dismantled," declares the Vancouver Consensus, a consensus statement unveiled on the opening night of IAS 2015, in Vancouver, Canada.

The consensus commemorates the last time the global HIV community gathered in Vancouver, in 1996, when data were presented supporting the use of triple-drug combination antiretroviral therapy. Since then, the START study has shown that starting treatment immediately, regardless of a patient's CD4 count, greatly reduces the risk of death and other complications.

In addition, data have shown that effective treatment reduces the transmissibility of HIV, with the final results of the HPTN 052 study (being presented on July 20 at IAS 2015) expected to show a reduction in chances of HIV infection by over 95% in serodiscordant couples.

Although an estimated 15 million people living with HIV worldwide are receiving antiretroviral therapy, "It is time to reach the 60 percent of people living with HIV who are not accessing treatment, including 19 million who do not yet know their status," the Vancouver Consensus states.

Additionally, as part of a combination prevention effort, the consensus calls for PrEP to be made available to those at risk of acquiring HIV.

To help reach these goals and others, the consensus makes a few calls for action, stating:

We call on leaders the world over to implement HIV science and commit to providing access to immediate HIV treatment to all people living with HIV. We call on donors and governments to use existing resources for maximum impact and to mobilize sufficient resources globally to support [antiretroviral] access for all, U.N. 90/90/90 goals for testing, treatment and adherence, and a comprehensive HIV response. We call on clinicians to build models of care that move beyond the clinic to reach all who want and need [antiretrovirals]. We call on civil society to mobilize in support of immediate rights-based access to treatment for all.

Read and sign the Vancouver Consensus.

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Statement by H.E. Archbishop Silvano M. Tomasi Trade Related Intellectual Property Rights (TRIPs) Council. 19/6/2015

10 June 2015
File size: 50KB
See attachement below.


Full title: Statement by H.E. Archbishop Silvano M. Tomasi, Permanent Representative of the Holy See to the United Nations and Other International Organizations in Geneva World Trade Organization (WTO) Trade Related Intellectual Property Rights (TRIPs) Council .

Mr. President,
I join previous speakers to congratulate you on your election. The World Health Organization (WHO) estimates that about one-third of the population lacks regular access to essential medicines and vaccines. It believes that 10 million lives could be saved annually if such resources were more readily available.
The Least Developed Countries (LDCs), as the poorest and weakest segment of the international community, are most vulnerable. The classification of LDCs is contingent on a number of key human development indicators, including levels of poverty, literacy and infant mortality. At the beginning of the Millennium, the Least Developed Countries enjoyed the strongest and longest growth rates since the 1970s, benefiting from sustained global growth, surging commodity prices and buoyant capital flows. Between 2000 and 2008, the average annual growth of this Group’s real gross domestic product (GDP) exceeded 7 per cent, raising hopes that some LDCs may be able to graduate from this category within the present decade. However, with the global financial crisis in 2008 and the drastic change in external conditions, LDCs have experienced a slowdown of economic activity. As a result, their economic growth has been much weaker during the past five years.  It has been well below the target rate of 7 per cent annual growth established in the Istanbul Programme of Action (IPoA) which is considered necessary for attaining the Millennium Development Goals (MDGs).(...)
 
READ FULL LETTER IN THE ATTACHMENT.

 

 

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Faith Advocacy Toolkit. Advocacy for Universal Access: A Toolkit for Faith-Based Organisations.

A World AIDS Campaign resource designed to equip and inspire people of faith to use the strength of their communities to advocate for Universal Access to HIV prevention, treatment, care and support.

English Faith Advocacy Toolkit
French Faith Advocacy Toolkit
Spanish Faith Advocacy Toolkit

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Death by Patent. 11/5/2015

Published at POZ
Written by Benjamin Gerritz
29 April 2015


The proposed Trans Pacific Partnership raises concerns over access to HIV/AIDS treatment. When thinking about trade policy, tariffs and quotas may be what typically comes to mind. The truth is multilateral trade agreements have affected people in numerous ways, including impeding on access to HIV medications.

As the U.S. Congress prepares to vote on a very important trade bill in the coming weeks, I hope our elected officials deeply consider the policy failures of the past so as not to repeat the trading of HIV-positive lives away.

The World Health Organization (WHO) currently estimates there are 35 million people living with HIV, myself included. Since 1981, the WHO has recorded 39 million AIDS-related deaths. These numbers would unquestionably be much higher were it not for health programs such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the U.S. Ryan White program.

PEPFAR has been heralded as among the most successful global health programs, but this program also exposed a trade policy failure often referred to as a death by patent. The announcement of PEPFAR's creation was delivered during President Bush's State of the Union in 2003. During this speech, the president called on Congress to commit $15 billion to address the growing global AIDS pandemic, citing the cost effectiveness of allocating funds for HIV medications.

At the time, the president stated the cost of treatment for one person had dropped from $10,000 per year to $300. He was accurate about the cost, but he hadn't factored in the Pharmaceutical Research and Manufacturers of America (PhRMA) factor. The $300 was for generic HIV medications manufactured in India, but $10,000 was the patent protected price in the United States.

Following the State of the Union speech, PhRMA moved quickly to ensure PEPFAR would not purchase India's generics. Pharmaceutical companies and policy makers used patent and intellectual property terms in the U.S.–backed World Trade Organization (WTO) to restrict access to generic treatments. This resulted in the first years of PEPFAR characterized by the program paying $10,000 per year for medication for one person, which was not what the president initially intended.

It would take years of advocacy from groups such as TAG, ACT UP and Doctors Without Borders before the WTO eased restrictions allowing generic HIV medications to flow to people in need. During this struggle, at least 10 million needlessly died. This easing of the WTO's trade barriers for HIV medications has translated into 12 million people who are currently receiving medicines through global health programs. Over 80 percent of PEPFAR's medications are currently being purchased from India at a price of less than $100 per year. The $100 cost likely sounds very refreshing to Americans living with HIV who, like me, would have to pay $3,400 per month or more for our lifesaving medication without insurance.

It is with both PEPFAR's success and the WTO's failures in mind that I am deeply concerned there may be a repeat of death by patent coming. Right now, the United States is negotiating a massive free trade agreement between 11 countries throughout the Pacific Rim and Southeast Asia. This deal, known as the Trans Pacific Partnership (TPP), has sparked widespread outrage over potential implications.

In referring to the TPP, the director of the WHO recently stated, "If these agreements open trade yet close access to affordable medicines, we have to ask: Is this really progress at all, especially with the costs of care soaring everywhere?" The terms of this trade agreement, like previous ones including the WTO, have been negotiated in secret with the public and even members of the U.S. Congress barred from knowing the full extent of what is being negotiated on our behalf.

What is known is the terms are being written by 600 negotiators, the vast majority of whom represent U.S. multinational corporations with PhRMA as the TPP's chief lobbyist. Through leaked copies of the TPP text by Wikileaks, people have been provided information on the trade agreement's terms. One of the terms authorizes corporations to sue sovereign governments over laws passed to protect public health. This provision is tragically similar to the one used to restrict access to medicines under the WTO previously.

In the coming weeks, the U.S. Congress will be voting on a Fast Track bill designed to quickly pass the terms of the TPP through Congress. If Congress passes Fast Track, it will mean the TPP will come before Congress for a simple yay or nay vote devoid of substantive debate or amendments. This would provide a narrow opportunity to ensure the TPP doesn't repeat the faults of the WTO.

I assume most members of Congress would characterize the previous death by patent situation as having been a tragedy we could have prevented. I hope, when our elected officials cast their votes on Fast Track, all of the implications of their decisions are deeply considered.

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Join the Global Fund's Born HIV Free Campaign. 19/5/10

The 'Born HIV Free' campaign is being launched today at an event starring Carla Bruni-Sarkosy in Paris.

19 May 2010

The 'Born HIV Free' campaign is being launched today at an event starring Carla Bruni-Sarkosy in Paris.

This social media campaign is part of the replenishment process for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will culminate in October 2010 with the announcement of international donors' financial contributions for 2011-2013. The Born HIV Free campaign adds to the calls for a fully funded Global Fund by emphasizing the Fund's crucial role in helping to prevent vertical or 'mother-to-child' transmission of HIV.

  1. Most children could be protected from being infected with HIV when in the womb, during pregnancy or through breastfeeding if their mothers had access to the proper prevention, care and treatment services. In 2008, some 430,000 children under 15 became infected with HIV - the vast majority through vertical transmission
  2. A fully funded Global Fund is a vital part of the international architecture that can help achieve Universal Access to HIV prevention, treatment, care and support, including for parents and their children

As people of faith, we are compelled to ensure that each child born is free from disease or disadvantage because we believe that each individual is precious and endowed with an inherent dignity that demands our care and attention. This is all the more so when protection from HIV infection in the womb, during delivery or through breast-feeding is achievable if we are alert, diligent and committed.

The EAA highlighted vertical transmission as part of its 2009 'Prescription for Life' campaign. The campaign saw hundreds of children asking pharmaceutical companies to do more to improve testing and treatment for infants and children living with HIV, including by improving access for all HIV-positive expectant mothers to antiretroviral medicines. During 2010, it continues to advocate for the prevention of vertical transmission, of which support for the Born HIV Free campaign is a part.

What can you do?

1. Join the Born HIV Free facebook page (click here) or become a follower on Twitter (click here). (The EAA has also recently launched a 'Live the Promise' facebook group, you can join this too by clicking here)

2. Raise awareness of the issues surrounding children and HIV by hosting the EAA's 'Prescription for Life' exhibition in your office, church or school. More information can be found here
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Live the Promise Action Alert. Urge G8 to make 2010 count for Universal Access. 4/5/10

In 2005, the G8 committed to providing Universal Access to HIV prevention, treatment, care and support by 2010. This target will not be met.

Despite some progress in expanding access to treatment, UNAIDS calculates that for every two people who first accessed treatment in 2007, five became newly infected with HIV in the same period. What's more, under the new World Health Organization treatment guidelines, an estimated 11 million people with advanced HIV infection today have no access to antiretroviral therapy.

In 2010, the G8 must recommit to achieving Universal Access and must ensure that, this time, its words are translated into action. This will require political and financial commitment to a time-bound action plan that must be agreed upon at the G8's upcoming Summit in Canada this June.

Join with a wide range of civil society actors in urging the G8 to act now to achieve Universal Access. The world, including the 33 million people currently living with HIV, cannot afford to wait any longer.

What can you do?

1. Read and sign on to the EAA letter urging the G8's Canadian hosts to make 2010 count for Universal Access. The deadline for signatures is 4 June 2010. Organizational signatures (organization name and the country in which you are based) are preferred. To indicate your support, send an e-mail to rfoley [at] e-alliance.ch or fax: + 41 22 710 2387.

EAA will then send the final letter with all the signatures to Prime Minister Harper in Canada. You will receive a copy of the letter to send to your own country's Canadian embassy.

G8 countries are: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom and the United States of America.

2. Add your voice to wider civil society calls for G8 action on Universal Access by:

signing up to the World AIDS Campaign's online petition here writing a letter as part of the International AIDS Society's campaign here highlighting Universal Access as a key message within the Interfaith Partnership and the 'At the Table' campaign

Letter

Dear Prime Minister Harper,

We are writing to urge you, as host of June's G8 Summit in Canada, to ensure that 2010 is a pivotal year in the drive to provide Universal Access to HIV prevention, treatment, care and support.

As faith-based organizations from around the world, we deeply regret that the G8's 2005 pledge to provide Universal Access to all who need it by 2010 will be missed. Despite some progress in expanding access to antiretroviral treatment since 2005, the stark reality is that 1.7 million adults and 280,000 children died as a result of AIDS in 2008 and today an estimated 11 million people still wait for life-saving treatment, including hundreds of thousands of children.

The Universal Access goal is not about figures; it is about life and death. The G8 must seize the opportunity provided by its upcoming Summit to renew its political and financial commiment to achieving Universal Access and to reassure the 33 million people currrently living with HIV of its commitment to them.

Recent history has shown that a reconfirmation of the Universal Access pledge on its own, however, is simply not enough. Although the G8 has laudably recommitted to Universal Access every year since 2005, the goal remains unmet. In 2010, therefore, a G8 promise must be followed by G8 action. Crucially, a fully costed and time-bound plan of action for realizing Universal Access must be developed and agreed upon.

In particular, the promise of Universal Access will remain a distant dream without adequate funding. The G8's failure to deliver the funds it committed in 2005 comes at a time when a global scale-up of treatment and prevention access is increasingly urgent to meet the health and development Millennium Development Goals (MDGs) by 2015. For example, the Global Fund, which is essential to achieving Universal Access and the health MDGs, has just launched a replenishment process, yet even the highest scenario presented to donors in March, will not achieve these goals.

What's more, the effects of the global financial crisis coupled with severe shortages of HIV treatment, stalled progress on the expansion of HIV prevention and services, and the unacceptable violations of the human rights of people living with and affected by HIV, remind us that any hard won progress is fragile and reversible. In 2010, it is imperative that the G8 moves forward rather than back on the Universal Access goal.

Please be assured of our prayers and support as you discuss these issues with other world leaders and seriously consider how to turn your words into action. As people of faith, many of us are already active in HIV prevention, treatment, care and support programs, actively supported not only by international donors but funds from within religious communities. It is only when we all pull together to scale up both action and financial commitment that all people living with HIV will receive the treatment and support they need to live life to the full. It is only then that fewer people will become infected with the virus. And it is only then that Universal Access will be achieved.

Yours in faith,

[organizational signatures to be added here] 

 

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TAC and Partners Announce Universal Access Campaign. 28/5/10

Treatment Action Campaign

28 May 2010

Contents:

-TAC and partners to march for universal access
-Africa wins every time you INVEST in HIV and TB
-Letter to President Barack Obama from TAC and partners
-Letter to President Jacob Zuma from TAC and partners
-Letter to United States Vice President Joe Biden

1)      TAC and partners to march for universal access

On 17 June 2010, TAC and partners will be holding a peaceful demonstration in Johannesburg. We will be calling on governments and funders to scale up funding to meet the targets for universal access to HIV treatment, prevention and care. The demonstration will be held during the World Cup, targeting world leaders in attendance to meet their funding commitments for HIV and health.

The campaign will be held in partnership with:
SECTION27, incorporating the AIDS Law Project
AIDS Rights Alliance of Southern Africa (ARASA)
Congress of South African Trade Unions (COSATU)
Community Media Trust (CMT)
World AIDS Campaign
AIDS Consortium
SAfAIDS
Soul City
Children’s Rights Center
Equal Education

Included in this newsletter is information on why we are marching ‘Africa wins every time you INVEST in HIV and TB’. Also included are copies of letters sent by TAC and partners to South Africa President Jacob Zuma, United States President Barack Obama and United States Vice President Joe Biden. In these letters we call on the Presidents and Vice President to take leadership to ensure that universal access targets are met across the region and funding is expanded to meet these targets.

2. Africa wins every time that you INVEST in HIV and TB!

Expanded and sustained funding is needed to meet universal access targets for HIV treatment, prevention and care. Commitments to meet universal access by 2010 were made in July 2005 by G8 nations. This created the momentum that led to a global commitment to universal access by 2010, as endorsed by country leaders at the 60th session of the United Nations General Assembly. The global commitment to universal access is also reflected in the Millennium Development Goals – particularly, MDG 6 – which in addition to universal access, also commits countries to the target of halting and reversing the spread of HIV by 2015.

Yet today we are far from meeting universal access targets and governments and funders have already begun to backtrack on their funding commitments - threatening to undermine the gains made and future access to treatment, care and prevention. Worldwide about 4 million people are receiving antiretroviral treatment (ART) – however, this represents only 42% of the people who need it. Further, less than a quarter of HIV positive pregnant women have access to prevention of mother to child transmission (PMTCT).[1]

Reaching universal access is necessary to reducing AIDS mortality, opportunistic diseases and new infections as well as upholding our fundamental right to health. 

RESOURCES FOR HEALTH

Developed and developing nations are not meeting their funding commitments for HIV and health. International financing mechanisms for health and HIV such as the Global Fund are struggling to secure the finances necessary to continue to expand programmes. A reduction in HIV funding will lead to millions of avoidable deaths across the region.

The Abuja Declaration

In 2001 African nations committed (in the Abuja declaration) to placing the fight against HIV/AIDS ‘at the forefront and as the highest priority issue in our respective national development plans… for the first quarter of the 21st century’. Related to this was the pledge to expand funding for health to 15% of their annual budgets. Yet today African nations continue to spend far too little on health and only 6 of 52 African nations have met or surpassed the 15% target. African nations remain particularly reliant on external funding to support their ART programmes. It is estimated that Global Fund support is responsible for at least 40% of people on treatment in Southern and West/Central Africa, and 80% of people on treatment in East Africa.

The President’s Emergency Plan for AIDS Relief (PEPFAR)            

In the past, the United States (US) has been a global leader in its response to HIV/AIDS and expanding access to ART through PEPFAR. Yet today, under the Obama administration, the US is turning away from PEPFAR in favour of the new Global Health Initiative (GHI). The GHI broadens the mandate of health interventions without expanding funding, resulting in less funding for HIV. The financial year 2010 and 2011 budget requests have included a flat-lining of AIDS funding, and decreased funding for treatment.

Expanding funding for other health interventions and priorities should be done but not at the expense of patients on and in need of ART.

It is also extremely distressing that the US has stated that PEPFAR will move away from providing ‘direct care’ in favour of ‘technical assistance.’ PEPFAR funded programmes could be forced to close their doors as the US moves away from funding direct care. Across the region PEPFAR programmes have already begun to slow or in some cases even cap enrolment onto ART.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GLOBAL FUND)

The move away from funding ART by the US is part of a larger global trend away from funding HIV in favour of other millennium development goals (MDGs) and health interventions (below we will address a number of these arguments). This trend is threatening the future of the Global Fund, the single largest multilateral funding mechanism for the health sector and HIV. The Global Fund has saved nearly 5 million lives since 2005, or 3,600 people a day. The Global Fund finances ART treatment for almost two thirds of people in the developing world. The Global Fund must raise $20 billion for its upcoming round to increase the scale-up of ART and build on efforts to meet universal access.

ART – IMPROVING HEALTH OUTCOMES AND MEETING MDGs

Expanded access to HIV treatment, prevention and care is necessary to meeting universal access but it is also necessary to meeting a number of other MDGs and improving health outcomes.

ART and prevention

Governments and funders have argued that funding for prevention should be prioritized over ART. However, it is becoming increasingly clear that ART is necessary as part of a package of prevention services to reduce HIV incidence. Studies have shown that ART reduces the risk of sexual transmission of HIV in sero-discordant partnerships when the HIV positive partner is adhering to treatment. (ART is effective as part of a package of prevention services and sero-discordant partners should continue to use condoms). ART is already used as a prophylaxis treatment to prevent HIV transmission to infants and rape survivors, yet access to these services remains limited.

ART and maternal health

HIV continues to be the leading cause of maternal and infant mortality in the African region. In at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV. Expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5.

Initiating mothers onto ART treatment earlier will reduce maternal mortality. 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 2%. Further, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

ART and opportunistic infections and mortality

Evidence has shown that initiating ART at a CD4 count of 350 cells/mm3, rather than below 200 cells/mm3, reduces opportunistic diseases and death. (The START trial, which is currently enrolling patients, will provide more evidence on the optimum time to initiate treatment.) Further ART is necessary to the successful treatment of a number of diseases. In line with this, South Africa has updated its HIV treatment guidelines to provide earlier ART to all patients co-infected with HIV/TB.

ART and health system strengthening

Health system strengthening is necessary to effectively responding to an HIV epidemic and to improving health outcomes. Further, any reduction in funding for ART will increase opportunistic infections and AIDS related diseases - thereby increasing the burden on health systems. Experiences in a number of countries have shown that AIDS programmes have begun to strengthen health systems. In 2009, Médecins Sans Frontières reported that HIV/AIDS programmes have had a positive impact in terms of human resources for health, improved laboratory monitoring and pharmacy capacity and management, and more effective health management information and procurement systems.

NOW IS THE TIME FOR UNIVERSAL ACCESS – BUILDING ON SUCCESSES

South Africa, the epicenter of the epidemic, is turning the tide in its AIDS response. For the first time there is real political will to reduce new infections and to ensure that all people in need are able to access treatment. This is evident through expanding funding for HIV as well as the implementation of updated evidence based policies and treatment guidelines. It would be a tragedy if these gains were undermined by the international backlash away from funding HIV. 

With expanded funding, HIV programmes across the region are positioned to expand treatment and care, reduce new infections, build country health systems, support universal access targets and lay the path to meeting a number of other MDGs. Now is the time for governments and funders to leverage the successes of HIV programmes and partnerships built to strengthen their global health responses and expand access to ART to all people in need. 

African nations - meet your Abuja funding commitments for health.
President Obama - protect access to ART by expanding PEPFAR funding.
Make universal access happen – replenish the Global Fund.
Governments and funders - close the gap for universal access

3. Letter to President Barack Obama from TAC and partners

 
President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500  
Fax: +001 202 456 2461
 
cc: Ambassador Donald H. Gips
Consulate General Cape Town
2 Reddam Ave, Westlake
Cape Town, 7945
Tel: +27 021 7027300
Fax: +27 021 702 7493
               
cc: Embassy of the USA
PEPFAR
P.O.Box 9536
Pretoria, 0001
Tel: +27 012 431 4209
Fax: +27 012 342 6167

18 May 2010

Dear President Barack Obama,

RE: Expanded and sustainable funding is needed to meet universal access targets for HIV treatment, prevention and care.

Over the past decade the United States has expanded access to treatment for over 2.4 million people living with HIV/AIDS. The Presidents Emergency Plan for AIDS Relief (PEPFAR), established in 2003 under former President George W. Bush, built treatment and care programmes and strengthened health systems across the developing world. When country governments refused to acknowledge HIV/AIDS, PEPFAR secured the right to life for millions.

In 2005, the United States, as a G8 nation, committed to supporting universal access to HIV treatment, prevention and care. This commitment was later endorsed by country leaders at the 60th session of the United Nations General Assembly. The global commitment to universal access is also reflected in the Millennium Development Goal 6 – which in addition to universal access, also commits countries to halting and reversing the spread of HIV by 2015.

In its seventh year, PEPFAR is strategically positioned to expand treatment and care, reduce new infections, build country health systems, support universal access targets and lay the path to meeting a number of other millennium development goals (MDGs).

Today over 4 million people are receiving antiretroviral treatment, but this only represents 42% of people that need it. Expanded and sustainable funding is needed to meet universal access targets. Despite PEPFAR’s unique positioning to strengthen the impact of global AIDS programmes and global health outcomes, the US is backing away from its commitments on HIV/AIDS.

In 2008 PEPFAR was set to expand with the passing of the Lantos-Hyde legislation. This landmark legislation approved $48 billion for PEPFAR over the next five years, with $39 billion earmarked for HIV. However, over the past year, it has emerged that HIV/AIDS programmes may never see this level of funding as across the region PEPFAR programmes are capping patient enrolment.

The approved $48 billion did not make it into the 2010 Congressional budget, and Congress increased PEPFAR funding by just 2.2% for 2011, the smallest in the programme’s history. Further, President Obama, during your electoral campaign you committed to expanding funding by $1 billion per year, yet you only asked for a $366 million increase for 2010. These unmet PEPFAR funding commitments will undermine efforts to meet universal access.

In the past year the number of HIV positive people that PEPFAR started onto treatment was the smallest it has been for four years. Programmes across the region are feeling the effects of contracting PEPFAR funding. In some countries where programmes are heavily PEPFAR funded, most-visibly Uganda, the flat-lined budget has resulted in patients who are eligible for treatment being turned away from facilities without receiving care.Further, the future of PEPFAR funded treatment programmes are threatened as the US aims to move away from providing ‘direct care’ to ‘technical assistance’. The move away from providing direct care has been promoted to develop country ownership and funding of ART programmes as developing countries often spend far too little on health and HIV.

The lack of funding by developing countries is a valid concern, echoed by civil society across the region. The Treatment Action Campaign (TAC), the AIDS Rights Alliance of Southern Africa (ARASA) and partners launched a regional campaign in 2009, to pressure developing country governments to expand funding for HIV and health and to promote effective use of funds through civil society budget monitoring. We have already begun to see real gains in South Africa, the epicentre of the epidemic, in expanding funding to reach universal access targets.

In addition, while there is a great need for technical assistance to build health care systems in the developing world, this investment should not be made at the expense of the care that millions are receiving through PEPFAR funded programmes. The reality is that a premature move by PEPFAR away from providing direct care will have devastating health consequences in the region. Transferring patients from PEPFAR funded programmes, to government facilities without the drugs, capacity or resources to absorb the patients will result in treatment resistance, increased mortality and preventable new infections.

Why the move away from funding HIV/AIDS is based on flawed arguments with potentially profound and devastating consequences.

President Obama, in 2006 you visited Africa as an advocate of people living with HIV. In Kenya you took an HIV test to encourage others to get tested and lessen the stigma and discrimination faced by people living with HIV. In South Africa you visited the Treatment Action Campaign’s Khayelitsha offices and spoke to HIV educators working in township schools. After visiting Africa you campaigned around the need to strengthen and expand PEPFAR stating: ‘We are all sick because of AIDS - and we are all tested by this crisis.

Today, under your administration, the United States’ policy priorities are shifting away from HIV/AIDS programmes. This shift in priorities has been promoted by arguments that funding for HIV has crowded out funding for other diseases and has expanded at the expense of other MDGs and health systems strengthening. These arguments are flawed as a move away from funding HIV/AIDS will worsen health outcomes, set us back in meeting a number of other MDGs and destabilize health systems.

Opponents of HIV funding argue that money should instead go to other MDGs and particularly infant and maternal health. Yet, HIV continues to be the leading cause of maternal and infant mortality in the African region – in at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV. It is estimated that every minute a child is born with HIV.

It is clear that expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5. Initiating mothers onto ART treatment earlier will reduce maternal mortality - 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 1%. Also, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

Another argument against HIV funding is that the HIV programme is isolationist, neglects other diseases and is carried out at the expense of health system strengthening. Experiences on the ground have shown this claim to be unfounded. In many cases HIV programmes have supported strengthening services for a wide range of diseases. HIV care has often included: early screening for cervical cancer, enhancing utilisation of sexual and reproductive health services, testing for and treating TB and malaria (which along with AIDS are responsible for most of the world's infectious disease deaths) and promoting access to safe water supplies and better nutrition.

In 2009 Medicins Sans Frontieres reported that HIV/AIDS programmes have had a positive impact in terms of human resources for health, improved laboratory monitoring and pharmacy capacity and management, and more effective health management information and procurement systems.

Antiretroviral therapy is also essential to the successful treatment and prevention of many other diseases rife in sub-Saharan Africa. These medicines are a major contributor to reducing opportunistic infections and AIDS related diseases. Far too few patients are accessing treatment too late. The consequences of late treatment are more new infections, more opportunistic diseases, more AIDS-related disease and high rates of mortality.

In addition, we are seeing increasing evidence that ART is an effective method of prevention and that expanded access to ART, is necessary as part of a comprehensive package of prevention services. ART is already used in the region to prevent mother to child transmission (PMTCT) and for post exposure prophylaxis (PEP) for rape survivors. However it is now recognized that ART is an important prevention method to reduce to risk of sexual transmission of HIV in sero-discordant partnerships – to the extent that experts based at the World Health Organization have suggested immediate treatment of all people living with HIV as a potential strategy for eliminating the epidemic.

Another fatal miscalculation in the arguments to reduce HIV funding is that they do not contextualize the devastating human, social, political and economic impacts of reducing access to treatment. HIV has disproportionately affected young adults in the developing world – the backbone of any economy. A reduction in treatment for HIV would be reflected through the economy, thereby impairing development. Further, vulnerable segments of the society, especially women, have the highest rates of HIV prevalence. Reducing access to health services would further marginalize these groups.

Now is the time to build on gains made in recent years and reach universal access across the region!

We call on the US to build on the strong partnerships it has nurtured across the developing world and leverage the lessons and successes of PEPFAR to strengthen its global health response in a rational, responsible and humane manner.

Today we are seeing the implementation and strengthening of evidence based policies for prevention and treatment in the region. We are positioned to eradicate mother to child transmission of HIV by 2015 – with sufficient funding and political will. Further there is increasing evidence that antiretroviral treatment and prevention cannot be separated and that treatment must be scaled up, as part of a comprehensive package of prevention services, to reduce new infections.

South Africa, the epicentre of the epidemic, has 17% of the global burden of HIV and 28% of the global population with dual HIV/TB. After years of dragging its feet and undermining HIV/AIDS efforts, the new South African government, under the leadership of President Jacob Zuma and Health Minister Aaron Motsoaledi, have put in place evidence based treatment policies as well as expanded funding for HIV. The government is also taking steps to strengthen the health system, overcome barriers and integrate the delivery of health services. In this new era of real political will to address the HIV epidemic, now would be the worst possible time for the US to back away from its HIV commitments.

Be a champion for the region! Be a champion for universal access!

During the 2010 World Cup in South Africa, TAC, ARASA and partners will march for the right to access treatment for all people and the need to ensure that sufficient and sustainable resources are made available. We will march for you, President Obama, not to turn your back on the President’s Emergency Plan for AIDS Relief and the lives supported by it. Further we will call on you to take advantage of the opportunities to end mother to child transmission, reach universal access and improve health outcomes across the region.

On 17 June 2010 we will be engaging in a peaceful demonstration in Johannesburg to demand expanded and sustainable resources for health. We ask that you come out and meet us, once again, to accept our march memorandum. We ask that you recommit to expanding funding for HIV/AIDS. Further, we call on the United States of America to take leadership by example to ensure that all developed nations uphold their commitments to universal access for HIV treatment, prevention and care.

 
Yours respectfully,
Vuyiseka Dubula
General Secretary of the Treatment Action Campaign
 
Endorsed by:
 
SECTION27
SAfAIDS
Community Media Trust
World AIDS Campaign
AIDS Rights Alliance of Southern Africa
Congress of Southern African Trade Unions
 
4. Letter to President Jacob Zuma from TAC and partners
 
President Jacob Zuma
Office of the President
Private Bag X1000
Pretoria 0001
Tel: +27 (0)12 323 8246
Fax: +27 (0) 12 323 8246
 
cc: Mr Mandisi Mpahlwa
Economic Adviser to the President

27 May 2010

Dear President Jacob Gedleyihlekisa  Zuma,

RE: South Africa must take leadership to push for universal access for HIV treatment, prevention and care at the 2010 G20 Summits

President Jacob Zuma, over the past few months, under your leadership, we have finally begun to see the political will needed to address the HIV epidemic in South Africa. We commend you for your leadership and for putting in place evidence based policies to effectively respond to the epidemic. We urge you now to show leadership to meet universal access targets for HIV prevention, treatment and care across the region.

Over the past few months, the policies that have been put in place by you and the Minister of Health, Aaron Motsoaledi, have put South Africa on the path to achieve universal access targets. South Africa must spearhead universal access through proper funding and implementation of the updated policies.

This year South Africa will participate in the 2010 G20 Summits to be held in Canada during June and South Korea during November. South Africa is the only African country on the G20 and therefore represents the needs of the entire region and other developing countries. We urge you, President Zuma, to use this global platform to advocate for universal access targets to be met across the region. Meeting universal access targets will require expanded and sustainable funding from developed and developing nations.

In July 2005, the G8 made a commitment to support universal access to by 2010. This created the momentum that led to a global commitment to universal access by 2010, as endorsed by country leaders at the 60th session of the United Nations General Assembly. A key target was that 80% of people who need HIV prevention, treatment and care must have access to these services. The global commitment to universal access is also reflected in the Millennium Development Goals (MDGs) – particularly, MDGs 4,5 and 6 – which in addition to universal access, also commits countries to the targets of halting and reversing the spread of HIV, reducing child mortality and improving maternal health.

Today universal access remains a distant target. About 4 million people globally are receiving antiretroviral treatment – however, this represents only 42% of the people who need it.

It is particularly concerning that, despite how far we are from meeting our targets for universal access, funders have already begun to backtrack on their commitments. Without expanded funding, programmes across Africa will be unable to continue to initiate new patients onto treatment. Further, the emphasis of funders away from supporting ‘direct care’ to providing ‘technical assistance’ will jeopardise future access to treatment for many patients receiving treatment from programmes supported by international funding.

We call on you to take leadership at the G20 Summits to protect millions of lives across the region. To ensure the sustainability of current treatment programmes and to ensure future access to treatment for new patients the following steps need to be taken:

1.       Developed nations must recommit to supporting universal access targets. Further, developed nations must ensure that sufficient and sustainable resources are made available to meet these targets. Cuts in international funding for HIV must be reversed.

2.       African governments need to continue to scale-up funding to improve health outcomes, strengthen healthcare systems and meet universal access targets.

1.       Cuts in international funding for HIV must be reversed. Developed nations must recommit to supporting universal access targets. Further, developed nations must ensure that sufficient and sustainable resources are made available to meet these targets.

a) Global Fund to Fight AIDS, TB and Malaria (Global Fund)

The Global Fund to fight AIDS, TB and Malaria acts as the single largest multilateral funding mechanism for the health sector. The Global Fund has saved nearly 5 million lives since 2005, or 3,600 people a day. It accounts for two-thirds of international funding for TB treatment, 70% of international funding for malaria treatment and prevention, and pays for two-thirds of those receiving ART.

Despite commitments from developed nations to support universal access, the Global Fund has been chronically underfunded. While the Global Fund originally aimed to generate $10 billion from the G8 annually by 2008 only $3 billion was yearly given by these countries. Over the past year there have been a number of worrying signals and statements indicating that the Global Fund will be unable to secure sufficient funding for upcoming rounds.

President Zuma, we call on you to champion the replenishment of the Global Fund at the G20 Summits. Sustainable and expanding funding for the Global Fund is necessary to meeting universal access targets.

b) President’s Emergency Plan for AIDS Relief (PEPFAR)

It is estimated that, from 2003-2009, PEPFAR treatment support saved over 3 million adult lives. PEPFAR programmes were set to expand in 2008 when the United States Congress reauthorized the programme for five more years at a cost of $48 billion. However it has now become clear that developing countries may never see this level of funding.

$48 billion did not make it into the 2010 Congressional budget, and Congress increased PEPFAR funding by just 2.2% for 2011, the smallest in the programme’s history. Further, while President Barack Obama’s electoral campaign platform pledged to give $1 billion a year, he asked for only a $366 million increase for 2010.In the last year, the number of HIV-positive people that PEPFAR started on treatment was the smallest it has been for four years, even while demand increases as patients live longer and the disease continues to spread unabated.

In countries where ART programmes are heavily PEPFAR funded, most visibly Uganda, the flat-lined budget has resulted in patients being turned away from facilities without receiving care. Civil society and doctors in Uganda have reported that they have already been instructed to stop enrolling new patients onto PEPFAR funded ART programmes.

In the past, the United States has championed expanding access to treatment and today millions of patients across the region rely on PEPFAR funded programmes for ART. A move away from funding lifelong treatment programmes by PEPFAR would be unconscionable. Further, the need for treatment has not been met, and PEPFAR’s unmet funding commitments are undermining efforts to meet universal access.

South Africa must reinforce the continued need for the United States to be a leader in expanding access to prevention, treatment and care. Especially as the US’s move away from funding HIV is based on flawed arguments (see below: Why the arguments of the opponents of HIV funding are flawed).

c) Financial Transactions Tax

The Financial Transaction Tax (FTT) is a proposed financing mechanism to raise money for health and other social needs. South Africa should champion the mechanism at G20 Summits to close the gap between service provision and need.

The FTT would be a modest levy placed on all financial transactions to raise revenue to help finance the fight against AIDS, maternal mortality, extreme poverty, climate change and other development challenges. South Africa and the region continue to face a wide range of developmental needs as well as mounting anger and dissatisfaction about poor service delivery and therefore we must support this initiative for health financing. The FTT would be an important source of funding to address a number of these needs.

2.       African governments need to continue to scale-up funding to improve health outcomes, strengthen health care systems and meet universal access targets.

Developed countries have argued that they are backing away from HIV funding to promote country ownership of ART programmes. Concern about under spending on health by developing countries is valid. Developing countries are not meeting their financing commitments for health. Most notably, African heads of state committed, in the Abuja declaration of 2001, to:

“placing the fight against HIV/AIDS at the forefront and as the highest priority issue in our respective national development plans for the first quarter of the 21st century.”

\Related to this commitment was a pledge to “set a target of allocating at least 15% of our annual budget to the improvement of the health sector”. However, no clear roadmap towards achieving this target was set at either the regional or national levels.

Almost ten years later, progress towards the Abuja target remains extremely slow. East Africa has recorded the greatest increase in regional average spending on health, going from 7.9% in 2001 to 9.4% in 2010. Southern Africa has increased only marginally from 10 – 10.3%, while West/Central Africa has recorded almost no increase in regional average spending on health. Throughout sub-Saharan Africa, only six countries have achieved or surpassed the Abuja target.

African government can no longer rely solely on international funders to support their treatment programmes. Governments must take steps to expand funding for health and HIV as well as set out clear plans to meet the Abuja targets.

President Zuma, we call on you to champion meeting the Abuja targets across the region by expanding funding for health. We call on you take a firm stand against recent rhetoric by African Finance Ministers dismissing their development declarations.

Why the arguments of opponents of HIV funding are flawed

Developed countries, and particularly the United States, have been increasingly shifting away from funding HIV in favour of other health interventions and millennium development goals. A number of the arguments against funding HIV are flawed and below we will respond to some of the key arguments raised by developed countries as justification for reducing HIV funding

Opponents of HIV funding have argued that HIV funding is isolationist and has crowded out funding for other health interventions and millennium development goals (MDGs). A global health priority that is being championed as a critical area for focus, over HIV (MDG 6), is that of maternal and child mortality (MDGs 4 and 5). However, a wealth of scientific evidence has shown this thinking to be deeply flawed. HIV continues to be a leading cause of maternal and child mortality in the African region – in at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV.

It is clear that expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5. Initiating mothers onto ART treatment earlier will reduce maternal mortality. 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 1%. Further, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

Opponents of HIV funding argue further that HIV programmes are isolationist, neglect other diseases and are carried out at the expense of health system strengthening. Experiences on the ground have shown this claim to be unfounded. In many cases HIV programmes have supported strengthening services for a wide range of diseases. HIV care has often included: early screening for cervical cancer, enhancing utilisation of sexual and reproductive health services, testing for and treating TB and malaria (which along with AIDS are responsible for most of the world's infectious disease deaths) and promoting access to safe water supplies and better nutrition.

In addition, ART is essential to the successful treatment and prevention of many other diseases rife in sub-Saharan Africa. These medicines are a major contributor to reducing opportunistic infections and AIDS related diseases.

President Zuma, our South African government has recognized that improving a number of health outcomes can only be done through integrated health services and health systems strengthening. South Africa is now taking steps to integrate ART delivery with other needs including sexual health, antenatal care and treatment for tuberculosis as well as strengthening health systems.

In high prevalence countries, responding effectively to HIV and other health needs cannot be done without health systems strengthening and integration of health services. In many countries HIV programmes have laid the groundwork to do just this. Undermining HIV programmes will worsen health outcomes and weaken health systems. Instead, strengthening health systems and responding to a range of health needs should be done in partnership with, not at the expense of, HIV programmes. HIV is not over funded – health is underfunded.

Opponents of HIV treatment have further argued that HIV treatment receives too much attention, which undercuts investment in prevention. There is increasing evidence that ART is necessary as part of a comprehensive package of prevention services including: expanded access to male and female condoms; reproductive health and family planning services; medical male circumcision; PEP; PMTCT and safe infant feeding methods.

ART is already widely used for prevention of mother to child transmission (PMTCT) and post-exposure prophylaxis (PEP) for rape victims. Evidence is now showing that HIV positive patients adhering to ART have a reduced risk of transmitting HIV to their sexual partners – to the extent that experts based at the World Health Organisation have suggested immediate treatment of all people living with HIV as a potential strategy for eliminating the epidemic.

A more recent study, the Partners in Prevention HSV/HIV Transmission Study, which followed 3,408 couples in 7 African countries, confirmed that ART reduces the probability of transmission of HIV. The study found that: ‘ART use is associated with substantially lower risk for HIV transmission among heterosexual, African, HIV serodiscordant couples, where the HIV-infected partner did not meet national criteria for ART initiation at enrollment.

Lack of access to treatment is indirectly responsible for many new infections and for hindering other goals of the HIV response. As such, investing in ART now could lead to tremendous cost savings down the line – not only for HIV transmissions, but also for other morbidities such as tuberculosis that are associated with untreated HIV. While prevention undoubtedly needs more attention and resources, this must go hand in hand with treatment – not instead of treatment.

Moving forward – recommitting to universal access

We have demonstrated that the trend away from funding HIV is based on flawed arguments. The fatal miscalculation in the arguments to reduce HIV funding is that they do not contextualize the devastating human, social, political and economic impacts of reducing access to treatment. HIV has disproportionately affected young adults in the developing world – the backbone of any economy. A reduction in treatment for HIV would be reflected through the economy impairing development. Further, vulnerable segments of the society, especially women, have the highest rates of HIV prevalence. Reducing access to health services would further marginalize these groups.

President Zuma, during the G20 Summits this year you will represent the health and social needs of the region. It is clear that HIV remains an emergency in our societies across the region. However a strong framework has been built to scale-up and expand access to prevention, treatment and care and, with expanded and sustainable funding, universal access can become a reality.

There is a need for strong leadership to rally support for expanded and sustainable funding to achieve universal access targets. We call on you, President Zuma, to take leadership to rally this support. At the 2010 G20 Summits, G20 governments must recommit to ensuring that these targets are met.

 

Yours respectfully,
Vuyiseka Dubula
 
General Secretary of the Treatment Action Campaign
Endorsed by:
SECTION27
SAfAIDS
Community Media Trust
World AIDS Campaign
AIDS Rights Alliance of Southern Africa
Congress of Southern African Trade Unions
 
5. Letter to United States Vice President Joe Biden
 
Vice President Joe Biden
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20501
United States of America
FAX: 202 456 2461
 
cc: Ambassador Donald H. Gips
Consulate General Cape Town
2 Reddam Ave, Westlake
Cape Town, 7945
Tel: +27 021 7027300
Fax: +27 021 702 7493               
 
cc: Embassy of the USA
PEPFAR
P.O.Box 9536
Pretoria, 0001
Tel: +27 012 431 4209
Fax: +27 012 342 6167

28 May 2010

Dear Vice President Biden,

RE: Request for meeting to discuss the future of the President’s Emergency Plan for AIDS Relief and achieving universal access targets for HIV treatment, prevention and care.

The Treatment Action Campaign (TAC) and partners would like to request to meet with you to discuss the future of HIV/AIDS funding and the President’s Emergency Plan for AIDS Relief (PEPFAR) during your visit to South Africa in June 2010.

PEPFAR, established in 2003 under former President George W. Bush, has expanded access to antiretroviral treatment across the developing world. Over the past decade the United States has expanded access to treatment for over 2.4 million people living with HIV/AIDS. During a time when many governments refused to acknowledge the crisis of HIV/AIDS, PEPFAR secured the right to life for millions by funding access to treatment.

In its seventh year, PEPFAR is strategically positioned to expand treatment and care, reduce new HIV infections, build country health systems, support universal access targets and lay the path to meeting a number of other Millennium Development Goals (MDGs). In Africa, expanding access to antiretroviral treatment is necessary to achieving MDGs 4,5 and 6 – to reduce child mortality, to improve maternal health and to halt and reverse the spread of HIV.

Yet, despite PEPFAR’s unique positioning to strengthen the impact of global AIDS programmes and global health outcomes, the US is backing away from its commitments on HIV/AIDS. The US is turning away from PEPFAR in favour of the new Global Health Initiative (GHI). The GHI broadens the mandate of health interventions without expanding funding, which will result in less funding for HIV. The financial year 2010 and 2011 budget requests have included a flat-lining of HIV/AIDS funding, and decreased funding for anti-retroviral treatment.

We are deeply concerned that: the US has flat-lined funding for HIV and that funding for antiretroviral treatment is decreasing, and,

PEPFAR is moving away from providing ‘direct care’ in favour of ‘technical assistance’.

The flat-lined budgets have already resulted in the capping of patient enrolment onto ART and, in some cases, patients are already being turned away from facilities without receiving care. Targets to meet universal access to HIV treatment, prevention and care, endorsed by the USA, cannot be met without expanded funding for HIV.

Also, while there is a great need for technical assistance to build health care systems in the developing world, this investment should not be made at the expense of the care that millions are receiving through PEFAR funded programmes.

In his previous visit to South Africa, President Barack Obama, visited TAC’s Khayletisha office and spoke to HIV educators working in the township’s schools. At this point he expressed support for expanding access to HIV treatment, prevention and care. The need to expand access to these services remains an emergency in Africa - less than half of people in need are able to access treatment.

On May 19th we wrote to President Obama outlining these concerns. We hope to address these issues with you directly during your visit to South Africa. We will also be organising a mass march to your Consulate in Johannesburg on June 17th in order to demonstrate to you and the world the growing concerns and fears around this issue.

We look forward to your response and to introducing you to TAC and our partners.

Yours sincerely,
Vuyiseka Dubula
General Secretary of the Treatment Action Campaign 
Endorsed by:
SECTION27, incorporating the AIDS Law Project
AIDS Rights Alliance of Southern Africa (ARASA)
Congress of South African Trade Unions (COSATU)
Community Media Trust (CMT)
World AIDS Campaign
AIDS Consortium
SAfAIDS
Soul City
Children’s Rights Center
Equal Education

 

 

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A Perscription for Life

An action guide from the Ecumenical Advocacy Alliance encourages young people to take the lead in calling for improvements in testing and treatment for infants and children living with HIV. "Prescription for Life" provides information and resources for schools, families, faith groups and communities to empower young people to write letters to pharmaceutical companies and governments, and promote the issue through the media.

The action guide is available in English, French and Spanish. Use it in church and community settings, and promote it widely through your networks. Together, we can make a difference and give a future to millions of children.

Background
It is estimated that 2.1 million children, aged under 15, are living with the Human Immunodeficiency Virus (HIV). Yet children remain largely forgotten in global and national efforts to address HIV and AIDS. This is especially the case for children's access to diagnostic testing for HIV and medicines to treat HIV, known as antiretrovirals (ARVs).

Currently, only 15 percent of children in need of HIV treatment have access to it. The lack of testing and treatment is particularly severe in Sub-Saharan Africa.

When children living with HIV do not get appropriate treatment, they suffer and die faster than adults living with the virus. Despite evidence that HIV treatment is very successful in children, more than 900 children die of AIDS-related illnesses every day.

Letters generated from this year-long action will be used to keep governments accountable to commitments made in the Convention on the Rights of the Child and also used in focused advocacy with pharmaceutical companies by EAA participants. An exhibit of the letters will be prepared for the 20th anniversary of the Convention on the Rights of the Child on 20 November 2009.

Download or order free print copies of the guide. The resource is available in English, French and Spanish.
You can order copies of the resource in South Africa from Lyn
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Equal Treatment

Equal Treatment or just ET, is TAC's high-quality magazine dedicated to covering health and HIV matters. It is produced five times a year and currently translated into isiXhosa, isiZulu and Setsonga. To receive a hard copy of ET, Click Here and we can send you a copy at no charge. We do request though that if you are from a medical institution, professional organization or from overseas, that you please make a donation to the TAC in exchange for recieving the magazine. Donations can be made here. If you are interested in ordering large quantities of the magazine for your workplace or union etc, Click Here.

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Intellectual Property and Access to Health Technologies. 2016

Published by UNAIDS

 

This document provides a review of key issues related to intellectual property policies and their potential impact on access to HIV and other medicines. It is intended as an introduction to the issues for civil society engaged in the response to HIV and other health concerns.

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Advocacy Resources - Gender Based Violence

 Browse the selection of resources:

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Women living with HIV speak out against violence. 26/11/2014

Published at UNAIDS
26 November 2014
PDFsize 326KB - download here

To mark the International Day for the Elimination of Violence against Women on 25 November and the 16 Days of Activism against Gender-based Violence, UNAIDS published Women living with HIV speak out against violence, a collection of powerful essays written by women living with and affected by HIV.

Intimate partner violence affects one in three women globally and has been shown to increase the risk of acquiring HIV, while research shows that preventing such violence can reduce HIV incidence by 12%. In some settings, young women who have experienced intimate partner violence are 50% more likely to acquire HIV than women who have not. As reported in the publication, women living with HIV also face institutional violence, including forced sterilization and forced abortion as well as denial of health services.

Sabine Böhlke-Möller, Ambassador of Namibia to the United Nations Office in Geneva, and Luiz Loures, UNAIDS Deputy Executive Director, jointly launched the publication. Depicting women’s experiences of violence and proposing action to end the AIDS epidemic and violence against women, the publication also highlights the imperative of a united and multisectoral response to eliminating violence against women and ending the AIDS epidemic by 2030. 

Quotes

“When you commit violence against a woman, you commit violence against everyone.”
Luiz Loures, Deputy Executive Director, UNAIDS

Download here

 

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The Easy Way Men Can Help End Violence Against Women. 23/9/2013

Huffington Post

http://i.huffpost.com/gen/1368777/thumbs/n-SOCIAL-MEDIA-large570.jpg?7

Tweeting could play a key role in putting an end to violence against women, according to the executive head of UN women.

While addressing the crowd on Sunday at the Mashable Social Good Summit, Phumzile Mlambo-Ngcuka, the head of UN Women, urged advocates to use the power of social media to expand the conversation around protecting and empowering women.

“I would like all those men and boys…to stand up against violence against women [by] “tweeting about it, hosting conversations, fighting against those sites that abuse women,” Phumzile Mlambo-Ngcuka, the former deputy president of South Africa, said.

According to Mlambo-Ngcuka, technology provides "open-access education," which will give women more of an opportunity to become informed about how to protect themselves and find necessary resources.

According to a 2003 UNIFEM report, one in three women will be raped, beaten, coerced into sex or otherwise abused.

Established three years ago, UN Women has made stopping violence against women and girls a top priority. Mlambo-Ngcuka has impressed the importance of technology and men taking on a more active role in finally putting an end to such devastating figures.

"You need men –- you just cannot crack these issues without winning over men," Mlambo-Ngcuka said in a recent interview with the Associated Press. "We need to win the priests, the rabbis, the traditional chiefs."

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16 Days of Activism Against Gender Violence

The 16 Days of Activism Against Gender Violence is an international campaign originating from the first Women's Global Leadership Institute sponsored by the Center for Women's Global Leadership in 1991.  Participants chose the dates, November 25, International Day Against Violence Against Women and December 10, International Human Rights Day, in order to symbolically link violence against women and human rights and to emphasize that such violence is a violation of human rights.

This 16-day period also highlights other significant dates including November 29, International Women Human Rights Defenders Day, December 1, World AIDS Day, and December 6, which marks the Anniversary of the Montreal Massacre.

The 16 Days Campaign has been used as an organizing strategy by individuals and groups around the world to call for the elimination of all forms of violence against women by:

• raising awareness at the local, national, regional and international levels
• strengthening local work
• linking local and global work
• providing a forum for dialogue and strategy-sharing
• pressuring governments to implement commitments made in national and international legal instruments
• demonstrating the solidarity of activists around the world

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16 Days of Activism: Objectification of Women, Alcohol Use and Domestic Violence in South Africa. 2/12/11

This CAI paper presents an analysis of the results of a study conducted by the South African Department of Social Development in 2008.

Consultancy Africa Intelligence

By Dr. M Weideman
2 December 2011

In support of the South African ‘16 Days of activism for no violence against women and children’ campaign, which started running on 25 November 2011 and ends on 10 December 2011, this CAI paper presents an analysis of the results of a study conducted by the South African Department of Social Development in 2008. The study examined the nature and prevalence of domestic violence in South Africa. It is argued that objectification of women and alcohol use are key contributing factors to the prevalence of domestic violence, and that interventions focussing on these factors will have the largest measurable impact on reducing violence. Some recommendations are made.

Background

In 2008, the Department of Social Development appointed Development Research Africa and the CSIR Defence, Peace, Safety and Security Unit to conduct a study on the nature and prevalence of domestic violence in South Africa. The rationale for conducting the research stemmed from the desire to find solutions to two concerns facing the Department of Social Development. First, as various studies and statistics have shown, domestic violence is both prevalent and extreme in South Africa; and second, the apparent failure of interventions to decrease the prevalence and extremity of domestic violence. This paper is the author’s interpretation and analysis of the data generated.(2)

Domestic violence in South Africa (3)

According to the United Nations Children’s Fund, women and children are often in greatest danger in the place where they should be safest: within their families. For many, ‘home’ is where they face a regime of terror and violence at the hands of somebody close to them – somebody they should be able to trust.(4) Accurate statistics and/or datasets on the prevalence of domestic violence in South Africa are not available as a result of the methodological challenges involved in data gathering among those who still find themselves in dangerous situations. Knowledge about the frequency and extent of domestic violence in South Africa is thus largely based on police statistics, victim surveys and a series of estimates by NGOs working with survivors.

It is estimated that one in every four women is assaulted by an intimate partner every week,(5) that one adult woman out of every six is assaulted by her partner, and that in at least 46% of these cases, the men involved also abuse the woman’s children. Further, on average, a woman is raped in South Africa every minute, totalling approximately 386,000 women each year.(6)

In a LoveLive study, 39% of young women in South Africa between the ages 12-17 state they have been forced to have sex.(7) In the same study, 33% said that they were afraid of saying “no” to sex, while 55% agreed with the statement “there are times I do not want to have sex but I do because my boyfriend insists on having sex.”(8) The study does not record how many of these forced sex experiences were reported to the police.

The available data also indicates that incidents of domestic violence, in which especially women are victims, are increasing. A recent survey conducted in Gauteng found that half the women in Gauteng (51.3%) have experienced abuse/violence, and 75.5% of men admitted to perpetrating abuse/violence against women.(9) The same study found that one in four women had experienced sexual violence, and 37.4% of men disclosed perpetrating sexual violence.(10)

The domination of, and violence directed at women, are arguably a result of the prevalence of patriarchal family relationships in South Africa.(11) Patriarchal stereotypes and gender roles often result in the abuse of women being normalised or legitimised within domestic relationships.(12) This has been rooted in traditions that encourage ideas of men’s rights to ownership of, and entitlement to power over women. Violence against women is used as a way of securing and maintaining the relations of male dominance and female subordination that are central to the patriarchal social order.(13)

This paper argues that domestic violence in South Africa is exacerbated by the objectification of women (a variant of the belief in male ownership of women’s bodies) through the mainstreaming of advertising for pornography and the widespread use/abuse of alcohol and drugs.

Methodology

Although quantitative and qualitative methodologies were used during the research process, this article is based exclusively on the findings generated by the quantitative survey conducted by Development Research Africa. The survey component of the research was designed utilising the definitions of the types of domestic violence in the Domestic Violence Act.

The survey questionnaire was administered to approximately 1000 victims/survivors of domestic violence (a minimum of 150 respondents per province, in six provinces). The six provinces were randomly selected and included the Western Cape, Eastern Cape, Northern Cape, Free State, Limpopo and the North West Province.

In order to ensure the safety of respondents, Development Research Africa cooperated with various organisations assisting and working with victims/survivors of domestic violence. These organisations facilitated safe access to victims/survivors of domestic violence who were willing to talk about their experiences, as well as trained counsellors, social workers and psychologists when required.

Key findings (14)

The key findings summarised below establish a clear link between alcohol abuse, objectification of women and domestic violence against women and children.

Survivors’ understanding of domestic violence

The majority (75%) of respondents felt that being a victim/survivor of domestic violence should not be a source of shame. Most (92%) understood that domestic violence is a crime, but these findings are skewed by the fact that in most cases the survivors interviewed had already accessed places of safety. Perhaps a better indicator of the societal understanding of domestic violence and the rights of women (or rather, lack thereof) is the finding that only a few respondents described forced sex within a romantic relationship, or forced sex with someone known to the survivor, as rape.

“When I refused to have sex with him [my partner] he stabbed me.”
“He kicked me in front of my children and forced me to have sex with him.”
“I was beaten in front of his family and my children. When he was finished, he forced me to have sex with him.”

Prevalence of domestic violence according to survivors
When asked how prevalent domestic violence was in their respective communities, 62% of respondents said that is very common or common. More disturbingly, only 24% of respondents did not have friends in abusive relationships at the time of the interviews.

Profile of domestic violence in South Africa
Survivor accounts of their experiences indicate the complexity and magnitude of abuse. Of the respondents surveyed, 76% reported being victims of physical abuse, 90% of emotional abuse, 48% of economic abuse and 28% of sexual abuse. The overlapping categories above suggest that the respondents tended to experience more than one (and often all) type(s) of abuse. Given an assumed reluctance to speak about sexual abuse, the lack of understanding of what constitutes sexual abuse and the descriptions of incidents by respondents during the interview process, one can infer that the extent of sexual abuse is much higher than reported.

Respondents were also asked to describe their worst abusive experience. The majority of incidents cited were examples of physical or sexual abuse. Those who mentioned incidents of emotional/verbal abuse emphasised humiliation and incidents in which their children were involved. Most of the incidents reported seem to have been prompted by a combination of alcohol/drug use, jealousy and perpetrator notions of sexual ownership of female bodies.

“My phone rang when he was there. He would not believe me that it was a friend who called. He threw boiling water in my face.”
“He asked me to follow him to the shebeen. When we arrived there he asked if anyone wanted a woman for sex. When I refused he beat me.”
“He just accused me of sleeping with another man and then he beat me and then he forced me to have sex.”
“He pimps me out. He made me a sex worker. He beats me if I don’t bring home enough money.”
“He came to my office. He walked in and locked the door behind him. He started punching me and accusing me of having an affair.”
“I was cleaning the house when he said I must go to the bedroom for sex. I asked him to wait. He threw boiling cooking oil at me.”
“When I refused to have sex with him he stabbed me.”

Examples of physical abuse include accounts of being choked, strangled, suffocated, beaten – with bare fists, rods, bricks, guns, furniture, rocks – spat at, bitten, kicked, defecated or urinated on, burnt, locked up and starved, tied up, stabbed and prevented from getting medical attention.

“Afterwards, I had to pick my teeth up from the floor.”
“He choked me. Then he poured paraffin over me and threatened to burn me alive. He forced me to eat dog food while he watched.”
“He would bang my head against the floor, kick me, slap me and choke me.”
“He beat me and tried to strangle me. I was gasping for breath. I thought I was going to die.”
“He kicked me when I was pregnant. Then I lost my baby.”
“I was frying fish on Good Friday. He came in and choked me. Then he threw me on the bed and stabbed me with a fork.”

The typical victim/survivor of domestic violence in South Africa is abused every day and remains in the abusive relationship for several years. Approximately 77% remained in abusive relationships for more than a year, 23% for two to five years, 14% for five to ten years, and 12% for more than ten years.

The research echoes findings of previous studies and found that 83% of the abusive incidents take place at the home of the victim/survivor (63% in the house and 19% in the yard/garden). The next most likely place for abuse to occur is at the homes of friends or family, or at work.

In approximately half of the abusive incidents, perpetrators used a weapon. Of these, 10% were guns, and 51% were knifes. Other often used weapons included canes, boiling water, pangas and axes.

“Yesterday he held a panga. He told me he would not hesitate to kill me.”
“When I was pregnant he would threaten me with a knife.”
“The worst day was when the used a blade to cut me, he used a hammer to hit my knees, and then he threw me and the children out in the night.”
“The worst day was when he used an axe. I was hit in the head. I had to go to hospital.”
“The worst day was when he stabbed me in my neck and locked me up. I almost bled to death.”
“He hit me with the barrel of his firearm. When I ran away he fired a shot at me, but fortunately he missed me.”
“He poured petrol over me and burnt me.”
“He threw boiling water in my face. I was in hospital for three weeks.”

Violence and abusive behaviour is often directed at the children of the survivor/victim as a means to exert control over her. Abusers sometimes harmed children in an effort to terrorise their mothers. Experiences reported by respondents included incidents of children being raped in front of their mothers.

“He beat me using stones, while his friends raped my 6-year old.”
“He came home drunk and told me to go and wake up my baby. He beat us.”
“He came home drunk and the started beating me and the children.”
“The worst was the night he started abusing me and my children, and then he grabbed the panga and almost killed me.”
“The worst was when he said that he would kill my children. Then he pointed a gun at us.”

Generally, the abuse is witnessed by others, and in almost half the reported cases, other persons were present while the abusive incidents were taking place. The majority of the witnesses to domestic violence were in the position to assist the victims (i.e. were adults), but did not do so. More specifically, the witnesses of the abuse were children (38%), adult family members (28%), adult friends (19%), work colleagues (2%), neighbours (2%) and adult strangers (10%). Only 17% of respondents said that their abuse has not been witnessed by other persons.

“The worst incident for me was when he beat me in front of his friends. He kicked me, pulled by my hair, used bricks to beat me, strangled me and then shoved me out to lie in the rain.”
“He hit me in front of his friends and their partners, calling me names and saying that I am never satisfied with one man. He just kept hitting me.”
“The worst for me was at my friend’s party. He dragged me out of the party and started to hit and kick me until I started bleeding from my vagina.”
“The worst is when he fights with me in front of other people and tears my clothes off.”
“The worst is when he beats me in front of his friends.”
“He came home drunk and started biting me in front of his mother and the children.”
The worst was when he threatened to kill me with a spade in front of my children and my neighbours. He was very drunk. I felt hopeless and helpless.”
“We were arguing and then he took my two children hostage. He threatened to kill me. He pulled the trigger. The bullet hit me in the left thigh.”

The above also raises concerns about the impact of domestic abuse on the children who are witnessing these events on a regular basis. It was found, for example, that 88% of the victims/survivors of domestic violence interviewed had children living with them.  

“He strangled me and forced me to say I am having an affair, in front of the children. I felt so humiliated because I wet myself.”

Further, in approximately 14% of the cases the respondent was abused by more than one person at a time. In 72% of these cases, the other abuser was a friend or family member of the primary abuser. In 64% of these cases, the primary abuser orchestrated the additional abuse.

Profile of the victims and survivors of domestic violence
The overwhelming majority of adult victims are women (other categories of adults include the elderly and a small proportion of men). The victims and survivors are not more likely to belong to any particular racial, cultural or language groups. Nevertheless, the majority of the respondents were economically vulnerable (unemployed and without income). Slightly less than half of the respondents were actually economically dependent on the perpetrators – 44% said that they were financially dependent on the perpetrator, while 41% said that they were dependent on the perpetrator for accommodation.

In the vast majority of cases the victims/survivors were either married (53%) or had intimate relationships with (22%) the perpetrator/abuser. A further 21% of perpetrators were family members of the victims/survivors.

Consequences of domestic violence for the victims and survivors
The average respondent participating in the research has required medical attention at least twice as a result of physical violence. Further, 35% reported that they had permanent injuries as a result of physical abuse. Approximately 10% (and one can assume that this matter is under-reported) said that they had contracted HIV or other sexually transmitted diseases, and a further 12% reported a negative impact on their reproductive health – infertility, unwanted pregnancies, abortions, miscarriages – as a result of physical and sexual violence.

The respondents participating in this research were severely traumatised (even though the majority of these women had already received some assistance/counselling). Some of the commonly reported symptoms of trauma included eating disorders, sleeping disorders, chronic headaches (or other aches and pains), overwhelming feelings of anger, severe anxiety and fear, and depression.

Profile of the perpetrators of domestic violence
The majority of perpetrators were male (84%) and were living with the victims at the time of the abuse (67%). There is an important association between the propensity to domestic violence and drug and alcohol use – 76% of perpetrators regularly “use” alcohol and other drugs, while approximately half were considered to have serious substance abuse problems. The research revealed that perpetrators tend to also behave violently towards other people. In 30% of the reported cases, victims were aware of someone else who had been abused by the perpetrators in the same way, which suggests that they are repeat offenders.

Perpetrators who have access to pornography, are likely to use it, or to pay for sex. The majority of perpetrators (84%) regularly use offensive and abusive language. Perpetrators also tend to be very jealous and controlling (71%). Perpetrators tend to have patriarchal and sexist attitudes and to dehumanise and objectify women. They are also unlikely to show remorse for their actions.

Key identified causes/triggers for domestic violence

The following causes/triggers for domestic violence are presented in order of frequency. Triggers are defined as events that precede violent incidents and differ from underlying causes (i.e. underlying long-term contributing factors such as abuse in childhood, sexist attitudes in society).

Alcohol and drug use
Victims and perpetrators reported that abuse was most likely to take place when perpetrators were using alcohol or drugs. Further, the majority of respondents said that they fear the abusers most when the abusers use alcohol. Victims were also afraid at, or after, “social events” where perpetrators would use drugs or alcohol, and then tended to become controlling and jealous.

Analysis of the “worst case scenarios” also indicated that the perpetrators were more likely to be violent when they had access to money (e.g. “month end”) or  when the victim had access to money (e.g. “when he wants to take  my money”). This money would be used by perpetrators to purchase alcohol, drugs or sex – activities that are mostly followed by violence or other forms of abuse.

The author of this paper calculated (based on the interviews conducted) that drugs/alcohol use was a trigger for domestic violence in at least 64% of the worst incidences reported, and in at least 73% of overall incidences reported. When asked whether the abuser tended to use alcohol, or to be drunk before or during incidents of abuse, approximately 73% said yes. A further 30% said that they knew that the perpetrator was using drugs at the time of the worst incident (drug-use is likely to be under-reported).

Other, more recent, research supports the arguments above. The Gender Links study on gender-based violence in Gauteng province, cited earlier, found that men's alcohol consumption was closely associated with perpetration of all forms of violence, including rape. It also found that 4.2% of women had been raped while drunk or drugged and that 14.2% of men surveyed had forced a woman to have sex when she was too drunk or drugged to refuse.(15)

Objectification and control
Accounts of the worst incidences of domestic violence experienced by respondents indicated that most incidents were preceded by the perpetrators 1) either assuming infidelity on the part of the victim/survivor, or expressing extreme jealousy, 2) perpetrators expressing frustration at their inability to control the movement or behaviour of their victims, 3) when victims decline or refuse to have sex with the perpetrators. Perpetrators appear to operate from the assumption that they ‘own’ women and accordingly treat women like objects. Perpetrators assume that women do not have a right to decline sex (i.e. do not have control over their own bodies). Such attitudes and behaviours are exacerbated when alcohol and drugs are involved.

Financial stress
Financial stress, unemployment and poverty were contributing factors to domestic violence in 21% of the incidences reported.

The way forward

South Africa’s commitment to eradicating domestic violence has been illustrated by the introduction of legislation such as the Domestic Violence Act (DVA) which aims to provide speedy, effective and accessible legal relief to a very wide range of complainants.(16) This commitment and its legislative framework, even if implemented effectively, however, is not sufficient to reduce the prevalence of violence and other abuse, because it does not address key issues such as the objectification of women and prevalent drug and alcohol use. 

Objectification of the female is so prevalent in South African society that the victims/survivors of violence interviewed in the research had internalised the dehumanising consequences of objectification to the extent that they did not even recognise when they were raped. They had been conditioned – through experienced and witnessed abuse, and a society that continues to use the female form as a source of entertainment, a means to selling products, and an item for sale in itself - to give ownership of their lives and bodies over to male partners/friends and family members.

What is required is the promulgation of further appropriate legislation and interventions based on a complex and factual understanding of the prevalence and nature of the phenomenon, as well as the widespread attitudes and beliefs that arguably facilitate violent behaviour towards women. 

Recommendations:
Addressing alcohol abuse and the effect thereof on families: The biggest causal factor relating to violent incidents identified in the survey research was alcohol and drug use. Resources and interventions aimed at treating the disease of alcoholism and the effect it has on families will have the biggest measurable effect on reducing violence and abusive behaviour. The many non-governmental organisations and civil society recovery groups working in these areas could be included in state-driven initiatives without incurring significant costs.

Introducing initiatives and legislation to reduce the objectification of women: Current mainstreaming of ideas and activities that portray and use women as sexual objects need to be addressed and at the very least, the advertising regulated. Current social and cultural condoning of objectification will only contribute to increased violence against women. The current prevalence of these sexist attitudes feed into ideas of sexual ownership and the general oppression of women. It is expressed in the high levels of domestic violence, the extremely high number of rapes, and the prevalence of HIV and AIDS amongst young married women.

Education and information dissemination: Widespread, multi-level and multi-stakeholder education and information dissemination activities are necessary. The content of such initiatives should focus on; what constitutes domestic violence, which behaviours are illegal, what help and resources are available, developing respect for women among perpetrators and victims, and developing self-esteem among women. Strategies and initiatives embarked upon will differ depending on the target audience. These include:

- Workshops and training sessions hosted by the Department of Social Development for subject experts and domestic violence practitioners.

The research showed that both the victims and perpetrators of domestic violence watch television, but are much less likely to listen to the radio or read newspapers. Television is an expensive but very wide reaching medium. Innovative thinking could reduce the cost of utilising this medium. Possibilities include utilising SABC education, or approaching writers and producers of popular South African television dramas and soap operas to write domestic violence interpretations into performed scripts.

- Part of the information and education targeted at the broader society level should focus on what the many witnesses to domestic violence can do to assist the victims, as well as, promote a culture of responsibility and willingness to assist. In some societies, families have relied upon community-based support mechanisms to resolve issues of conflict. The local community therefore needs to be mobilised to oppose domestic violence in its midst. Actions taken by local people may include greater surveillance of domestic violence situations, offering support for victims-survivors and challenging men to stop the violence.

- Community information and education programmes regarding the nature and unacceptability of domestic violence should be developed. Such programmes should address cultural forms of behaviour that uphold male aggression, beating, punishment and abuse of women as acceptable. Developing integrated responses to domestic violence through involvement of local community groups, community health workers and women serves to create sustainability and accountability.

- Tolerance and gender-awareness education must be included in school and tertiary institutions’ curricula. Further, the business and public sectors should be encouraged to provide similar education to their employees. One focus area of such training should be on the right and autonomy women should have over their own bodies. Sexism and objectification have been internalised by many women to the extent that it did not occur to them that being forced to have sex was rape.

- Most of the victims of domestic violence interviewed for this survey are economically vulnerable. Reducing economic vulnerability will increase the ability of women to leave abusive relationships, as well as to reduce their direct involvement in the mainstreaming of sexual exploitation and objectification of women as ‘entertainment.’ It is necessary to ensure (through policy and programmes) that women have the opportunities to economically empower themselves.

- Direct interventions and services provided to victims of domestic violence should as a core component include treatment for depression and anxiety, as well as focus on the development of self-worth and self-esteem.

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16 Ways to Say NO to Violence against Women. 18/11/11

16 Days of Activism against Gender Violence
18 November 2011

The 16 Days of Activism against Gender Violence Campaign runs from 25 November 10 December, and calls upon everyone to take action to end violence against women and girls. We have a host of events and actions lined up for you!

Say NO – UNiTE is launching  16 Ways to Say NO to Violence against Women. Visit here and pick as many actions as you want, or take the featured action of the day.

You can take actions online or offline, by participating in the highlighted events or by organizing your own. If you are organizing a 16 Days action, we want to know about it! Please post it on www.saynotoviolence.org. Stay tuned for news and more here and spread the word on Facebook and Twitter.

If you are not in New York or haven’t RSVP-d to attend the UN official observance of the International Day for the Elimination of Violence against Women, join us virtually on 23 November here. Youth activists are meeting the UN Secretary-General, UN Women Executive Director Michelle Bachelet and other high-level participants to discuss ways to end violence against women and girls. We will be live tweeting from the event – follow #UNiTEyouth and @SayNO_UNiTE on Twitter.

Together we can end violence against women.

Say NO – UNiTE Team, UN Women

 

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CLF Sestien Dae van Aktivisme

CLF-materiaal kan jou hande versterk in die Sestien dae van aktivisme-veldtog

Die 16 dae van aktivisme teen geweld is ’n inisiatief wat regoor die wêreld in die tydperk tussen 25 November en 10 Desember gevier word. Suid-Afrika het 1999 by die veldtog aangesluit, maar die oorspronklike veldtog is in 1991 deur die Centre for Women’s Global Leadership in New Jersey begin. Die veldtog benadruk die felheid van die geweld wat veral teen vroue en kinders gepleeg word.

Die 16 dae-veldtog word gebruik om mense bewus te maak van hoe ons samelewing ly as gevolg van geweld. Dit skop af met die internasionale dag teen vrouegeweld en eindig met Internasionale Menseregtedag op 10 Desember. Ander dae wat in hierdie tyd beklemtoon word is Wêreld Vigsdag op 1 Desember, Internasionale Gestremdheidsdag op 3 Desember en International Women Human Rights Defenders Day op 29 November.

Die lys van aktiwiteite gedurende hierdie dae is lank: filmvertonings oor menseregtevergrype in verskillende lande, besprekings tussen aktiviste en ander rolspelers oor hoe om die probleem te oorkom, asook dialoog tussen die verskillende kerke wat betrokke is. Daar is ook vele fondsinsamelingspogings vir nie-regeringsorganisasies en ander organisasies wat gemeenskapsopheffingswerk doen.

CLF het verskeie pamflette wat handel oor temas wat aangespreek word in hierdie veldtog. As jou kerk of uitreikgroep ’n aksie beplan vir hierdie tyd, bestel betyds materiaal wat julle gedurende hierdie tyd kan gebruik. Of as jy as individu weet van iemand wat vasgevang is in die kloue geweld of sosiale probleme, reik uit na hierdie persoon met CLF se materiaal. Dit is gratis, in beperkte hoeveelhede beskikbaar.

Van die temas wat inskakel by hierdie veldtog is bv:

          -MIV positief wat nou?
          -‘n Lewe vry van VIGS
          -Die mishandelde vrou
          -Gesinsgeweld – is jy ‘n slagoffer?
          -Verkragting
          -Kan misdadigers verander?
          -Van slagoffer tot oorwinnaar
          -Kan die wonde van molestering genees?
          -Alkohol – iemand na aan my drink te veel
          -Alkohol – wat is die feite?
          -Hoe weet mens alkohol is ‘n probleem?
          -Ek kan nee sê
          -Tiener of mamma (tienerswangerskap)

 

 

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Take Action Kit

Centre for Women's Global Leadership 2011

Abstract: The Center for Women's Global Leadership would like to specially thank the following individuals and organizations who have volunteered their time to provide translations of 16 Days Campaign materials: Aleksandra Petrić (United Women Banja Luka, BiH), Chrysant Kusumowardoyo, Dr. Goran Racetovic, Giorgo Filippou (Association for the Handling and prevention of Domestic Violence), Magdalena Wnukowicz (Fundacja Autonomia), Rana Feghali, Dudziro Nhengu (Research and Advocacy Unit), Patricia Mourão (Instituto Magna Mater), Masumi Honda & Hisako Motoyama (Asia-Japan Women's Resource Center / AJWRC), Rada Elenkova (Bulgarian Gender Research Foundation – Plovdiv Branch), Festa Andrew Mwanyingili (Women's Dignity),  Nicole B. Mwaka (Directrice Carrefour des Femmes et Familles), Xiuhua Wan (Jana's Campaign), and Luo Zhai(Women’s Leadership Project of the Center for Civic Leadership).

Contents:
-Cover Letter: English,
-Theme Announcement: English,
-Campaign Profile: English
-Key Dates: English
-A Guide to Planning Your Campaign: English
-Information Sheet #1 (Bridging Movements): English
-Information Sheet #2 (Small Arms): English
-Information Sheet #3 (Conflict Related Sexual Violence): English
-Information Sheet #4 (Political Violence Against Women): English
-Information Sheet #5 (Sexual Violence by State -Agents): English
-UN Resources Sheet:
-EnglishGEAR Information Sheet: English
-Say NO Information Sheet:English
-UNiTE Information Sheet: EnglishWILPF Information -Sheet: English

-Cover Letter: English,
-Theme Announcement: English

Download these documents here

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The Role of Traditional Leadership

Subtitle: Preventing Violence against Women towards Effective HIV Prevention in Southern Africa.

Published by SAfAIDS

Abstract: Introduction Traditional leaders and traditional structures remain infl uential among a large majority of the population in Southern Africa, in both urban and rural areas. Traditional leaders wield influence and command much respect in their communities. Despite undeniable evidence that shows the linkages between violence against women and HIV, traditional leaders’ potential to actively participate in HIV prevention activities and projects to eliminate violence against women however, remains untapped. With adequate support, traditional leaders can facilitate positive change in local communities working to address HIV and violence against women.

Download this document here (PDF, 801.67 KB, 4 pg)

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2009 16 Days Take Action Kit

The Center for Women's Global Leadership developed a toolkit using the themes "COMMIT ▪ ACT ▪ DEMAND: We CAN End Violence Against Women!". 

You can donwnload a selection of tools and guidelines in various languages from the website

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GBV Communication Skills Manual

The training is designed so that all the materials used can be shared with participants at the end of the workshop

Family Heatlh International

The curriculum in this gender-based violence (GBV) manual on communication skills represents collaboration between Family Health International (FHI), the Reproductive Health Response in Conflict (RHRC) Consortium, and the International Rescue Committee (IRC). The manual includes a training outline, a list of materials needed, an in-depth training curriculum, and all transparencies, handouts, and activity sheets necessary to conduct a training. The training is designed so that all the materials used can be shared with participants at the end of the workshop, which will allow for subsequent trainings on topics relevant to their context. The training is designed to be completed in 5 days, beginning with an overview of GBV and then covering areas focusing on engagement strategies for work with GBV survivors, methods to support the service provider, and service provider responsibilities and community referrals facilitation skills overview, training review, and evaluation.

 Contents:
-Introduction
-Curriculum
-Day 1: Overview of Gender-based Violence
-Day 2: Engagement Strategies in Working with Survivors
-Day 3: Engagement Strategies (con’t)
-Day 4: Supporting the Service Provider
-Day 5: Service Provider Responsibilities and Community Referrals
-Facilitation Skills Overview, Training Review and Evaluation
-Binder Documents

Download this manual here (PDF, 2.35MB, 194pg)

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Get Moving! The GBV Prevention Network's Movement Building Initiative.

Get Moving! utilizes reflection sessions, exercises and readings, designed to stimulate personal and / or organizational reflection about GBV prevention work.

Published by The Gender Based Violence Prevention Network
January 2009

There are six phases in the Get Moving process. To correspond with each phase, the GBV Prevention Network published the Get Moving! series of booklets which are designed to stimulate personal and/or organisational reflection about movement building. The publications include ideas for reflection sessions, exercises, and readings that ideally would be conducted within member organisations, as well as readings and suggestions for journal writing that participants can do independently. According to the publication, the Get Moving! process is for any group or organisation interested in thinking more about the ideas and values that underpin GBV prevention work and what it would take to truly prevent GBV in the region.

Download the resources by phase:

Get Moving! Phase 1: Looking Within (PDF, MB, 32pg)
Get Moving! Phase 2: Supporting Each Other (PDF, 5.52MB, 36pg)
Get Moving! Phase 3: Living our Beliefs (PDF, 3.12MB, 32pg)
Get Moving! Phase 4: Fostering Activism (PDF, 3.16MB, 32pg)
Get Moving! Phase 5: Reaching Out (PDF, 2.29 MB, 32pg)
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I Endorse The Safe World for Women Campaign.

This is a campaign that seeks people to endorse this campaign which seeks to demand of the government to take action against gender-based violence. This campaign demands the government to:

-Pass and enforce laws addressing all forms of violence against women and girls.
-Ensure an effective range of support is available for victims and survivors.
-Undertake research to find out the scale of violence against women and girls.
-In conflict situations, put in place special policies to address sexual violence
-Explain to the public the reason for the 16 year delay in acting on the 1993 resolution.

Sign up for this campaign here

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Promoting Gender Equality to Prevent Violence against Women

Focuses on violence against women by intimate partners

Published by WHO June 2009
ISBN 978 92 4 159788 3

This briefing document focuses on violence against women by intimate partners. It examines the relationship of gender inequalities to gender-based violence and finds evidence that school, community, and media interventions can promote gender equality and prevent violence against women by challenging stereotypes that give men power over women. The document describes some of the promising methods of promoting gender equality and their effectiveness, including school-based interventions to work with schoolchildren before gender attitudes and behaviours are deeply ingrained and community interventions.

Download this document here(PDF, 591.08KB, 18pg)

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Reporting Gender Based Violence: A Handbook for Journalists

To encourage and support sustained media coverage of gender-based violence (GBV)

Published by Inter Press Services November 2009
ISBN: 978-0-620-45143-7
This handbook for reporters is designed to encourage and support sustained media coverage of gender-based violence (GBV) beyond the annual 16 Days of No Violence Against Women and Children. The handbook is divided into twelve sections which each include an overview of a key issue, some facts and statistics, and a sample feature article to provide an example of best practice and/or what to consider when writing about GBV. The publication also includes discussion questions for facilitators who plan to use this handbook in training.
Content:
-Custom, tradition and religion
-Domestic violence
-Sexual gender-based violence
-Femicide
-Sex work and trafficking
-Sexual harassment
-Sexual gender based violence in armed conflict
-HIV and AIDS
-Child abuse
-The role of men in combating violence against women
-The criminal justice system
-The cost of gender-based violence

Download this document here(PDF, 2.75 MB, 76pg)

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Speak Out. Youth Report Sexual Abuse. A Handbook for Learners on How to Prevent Sexual Abuse in Public Schools

Published by the Department of Basic Education in South Africa July 2010

Authors: Dr Patricia Watson, Rolaball Eduscript and Julia Grey

This handbook is designed to contribute towards creating a safe, caring, and enabling environment for learning and teaching in public schools in South Africa. The purpose of the handbook is to equip learners with knowledge and understanding of sexual harassment and sexual violence, its implications, ways to protect themselves from perpetrators, and where to report incidences of sexual violence or harassment

Contents:
-Foreword
-Stop Abuse
-Agony Auntie
-What is sexual abuse?
-School rules to protect you
-Signs of sexual abuse
-Teachers have a duty to stop sexual abuse
-Speak out! Report abuse to the police
-Speak out! Report abuse at school
-Speak out against rape!
-Be smart: Protect yourself
-Speak out! Power in group action
-Contacts
-Words to know

Download this resource here (PDF, 6.4 MB, 32pg)

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The Role of Religious Communities in Addressing Gender-Based Violence and HIV

The training began with opening speeches from a range of senior religious leaders and experts on GBV and HIV

USAID Publication August 2009
Author: Britt Herstad

This report summarises the United States Agency for International Development (USAID) Health Policy Initiative, Task Order 1, project titled The Role of Religious Communities in Addressing Gender-based Violence and HIV, which was designed and implemented in Africa by Futures Group International and Religions for Peace. Recognising the importance of collaborating to prevent and reduce gender-based violence (GBV) and HIV among women and girls, the initiative partners worked to improve the capacity of religious leaders and faith-based organisations (FBOs) to respond to GBV and its links to HIV.

To that end, the first component of this project brought together African religious leaders - with a particular focus on women of faith - for a regional training workshop on GBV as related to HIV. From July 30-August 2 2007, 23 delegates from 8 countries - Democratic Republic of Congo (DRC), Ghana, Kenya, Liberia, South Africa, Tanzania, Uganda, and Zambia - came together to participate in a 4-day regional training in Nairobi, Kenya. An emphasis on the participation of women infused this project, as reflected from the very beginning; participants in this regional training were drawn, in part, from the African Women of Faith Network (AWFN) and the National Inter-Religious Councils, established by Religions for Peace.

As detailed in the report, the training began with opening speeches from a range of senior religious leaders and experts on GBV and HIV. As a beginning exercise, participants were asked to agree or disagree with a few statements; this was designed to spark initial conversation about the topics at hand. For instance, most participants disagreed with this statement: "It is not appropriate for religious leaders to discuss matters relating to women and sexuality."

Download the resource here (PDF, 42pg, 625.43KB)

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You & Rape

This booklet is our contribution to sharing the information we’ve gathered

Published by Rape Crisis Cape Town Trust

In 1992, the Natal Midlands Black Sash, Rape Crisis, and a number of other women’s organisations in Pietermaritzburg began a public rape education programme. This programme was the result of the rising number of rapes, and the need for society to support men and women who have been raped in a way that restores their dignity. It was designed to support rape survivors in bringing their attackers to trial - if that is what the survivor chooses to do. Although rape is a difficult subject for many people to discuss, men and women need to share their experiences as rape survivors in order to help and strengthen each other. This booklet is our contribution to sharing the information we’ve gathered from our experience over the years. The book has been updated several times. With this latest update, Rape Crisis has included the new sexual offences act and recent information regarding medical and social aspects of rape.

Contents:

- Introduction
- What is rape?
- What to do if someone has raped you
- Reactions to rape
- Healing
- Myths and Facts about Rape
- Male Rape
- Ideas about preventing rape
- Sexual abuse of children and mentally challenged adults
- Some points for discussion

Download this 33-page PDF here in:

English (788 KB)
Afrikaans (812.49 KB)
Xhosa (798.49 KB)
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International Day For The Elimination Of Violence Against Women. 25/11/09

Afroaidsinfo.org

Introduction
By resolution 54/134, taken on 17 December 1999, the General Assembly of the United Nations designated 25 November as the International Day for the Elimination of Violence against Women. Governments, international organizations and NGOs were invited to organize activities designed to raise public awareness of the problem on that day1. This article attempts to contribute to the cause by presenting disturbing facts on violence against women.
 
 Statistics on violence against women: the global picture
Sexual and gender based violence against women paints a disturbing picture2:
  • Up to one-third of adolescent girls report forced sexual initiation.
    • For example, a recent study suggests that in the United Kingdom:
      • one in three teenage girls has suffered sexual abuse from a boyfriend,
      • one in four has experienced violence in a relationship,
      • one in six has been pressured into sexual intercourse,
      • one in sixteen said they had been raped.
  • Mass rape of women and girls continues to be seen as somehow a legitimate military weapon.
    • Reports suggest that, in Bosnia and Herzegovina, in a war that lasted a mere three years, somewhere between 10,000 and 60,000 women and girls were raped.
  • Sexual violence against men and boys continues undaunted, unreported, understudied, and too often a source of ridicule and derision.
    • According to a number of studies, somewhere between 5 and 10% of adult males report having been sexually abused in their childhood.
  • Women suffer violence in health care settings, “including sexual harassment, genital mutilation, forced gynecological procedures, threatened or forced abortions, and inspections of virginity.”
  • Sexual violence in schools abounds almost in every country in the world
  • In Canada, 23% of girls experience sexual harassment.
  • There was a 25% rise in rape and sexual assaults between 2005 and 2007: Among all violent crimes, domestic violence, rape, and sexual assault showed the largest increase.
Around the world, the numbers speak for themselves, but to whom do they speak, and who is listening, who is taking the count and who is assessing accountability? It seems the whole globe, in its entirety and in each of its parts, is haunted by sexual and gender-based violence. Around and about the world daily, reports and studies on sexual and gender based violence are published3.
 
Where does it start?
According to Daniel Moshenberg, gender and sexual violence begins and ends at the intersection of sexual inequality and gender inequality4.
 
Some abusers learned abusive behaviour from their parents. Their early history consisted of receiving abuse themselves and/or seeing others abused (one parent abusing the other or their sibling, etc.). As a consequence, abuse is the normal condition of life for these people. Such people have internalised a particular relationship dynamic, namely the complementary roles of "abuser" and "victim". They are familiar with and fully understand the terror of being the helpless victim from their own childhood experience. The opposite of being a victim is not simply opting out of abuse; it is instead, to be abusive.
 
Given the choice between being the out-of-control victim, or the in-control abuser, some of these people grow up to prefer the role of the abuser. As they become adults, they simply turn this relationship dynamically around and start acting out the "abuser" side of the relationship to which they have been conditioned. By choosing to be the aggressor and abuser, they may get their first sense of taking control over their own destiny and not being at the mercy of others. That they hurt others in the process may go unregistered or only occur as a dim part of their awareness.
 
http://www.centersite.org/admin/tools/phpAdsNew/www/delivery/lg.php?bannerid=446&campaignid=135&zoneid=43&cb=dec1742a43Abusive behaviour can also result from mental health issues or disorders. For example, someone with anger management issues, a diagnosis of intermittent explosive disorder, or a drinking or drug problem may easily get out of control during arguments (e.g., because there is something wrong with their ability to inhibit themselves at the brain level) and verbally or physically strike out at their partners and dependents.
 
Still other people who abuse end up abusing because they have an empathy deficit, either because of some sort of brain damage, or because they were so abused themselves as children that their innate empathic abilities never developed properly
 
What can be done about it?
It is obvious that people exposed to gender and sexual based violence will need physical, psychological, emotional and social support. In many countries the support is being supplied by the government and locally, by a variety of non-governmental organizations. Good examples are rape crises centres, help-lines, health services and shelters. The problem with people who become victims of gender and sexual violence is that they are often afraid or even ashamed and stigmatized to find such help and support.
 
A more sustainable solution must be found. Preventing sexual violence will require a cultural shift in terms of gender role expectations, acceptable mechanisms for conflict resolution and the unacceptability of violence5.
This will necessitate work with children to challenge gender stereotyping (e.g. masculine aggression and female passivity) and to promote non-violent conflict resolution skills. This could be reinforced by similar work with parents in relation to developing non-violent parenting and conflict resolution skills. This may need to be reinforced by sensitisation and advocacy work with existing community structures, leaders, and local agencies to promote the unacceptability of sexual violence and the adoption of appropriate social sanctions against its perpetrators6.
 
Certain institutions may be strongly associated with "cultures of violence" and their members may be among the likely perpetrators of sexual violence. Specific targeting may therefore be necessary in order to reach military, police and security personnel or inmates and staff in custodial settings, such as prisons.
 
The relationship between the structural determinants of sexual violence and development need must be better understood. It is highly likely that the same activities which address gender inequality (such as education for girls and women’s access to resources including credit), poverty and sustainable livelihoods, and which promote civil society participation and good governance will also be helpful to the prevention of sexual violence7.
 
Conclusion
Gender and sexual violence is not just an illusion. Treating sexual and gender based violence as exceptional likewise leaves the conditions and situation unchanged. The work of transformation, in Africa, as around the world, is slow, long, and necessary.
 
For further reading visit our current awareness section to view regular sexual violence news items.
 
Sources
  1. UN: The Dag Hammerskjold Library, International Day for the Elimination of Violence Against Women. Available at http://www.un.org/Depts/dhl/violence/ and accessed on 28 October 2009.
  2. Moshenberg, Daniel: Sexual and gender based violence: every day, everywhere and yet … 16 September 2009. Available at http://concernedafricascholars.org/sexual
    -
    and-gender-based-violence/ and accessed on 28 October 2009.
  3. Subscribe to the newsletter of the South African Sexual Violence Research Initiative at http://www.svri.org/ for more information.
  4. Moshenberg, Daniel: Sexual and gender based violence: every day, everywhere and yet … 16 September 2009. Available at http://concernedafricascholars.org/sexual
    -and-gender-based-violence/ and accessed on 28 October 2009.
  5. Crehan, K &  Gordon, P: Shades of sadness: gender, sexual violence and the HIV epidemic. Available at http://www.alliancesforafrica.org/content_files/files/
    GenderSexualViolenceandHIV.doc and accessed on 31 October 2009.
  6. Ibid
  7. Ibid
Author: Pieter Visser
Reviewed by: Hendra van Zyl and Marike Kotze
Contact: afroaidsinfo@mrc.ac.za
Date: November 2009
Last updated: 11 November 2009
 
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Thursdays in Black.

CABSA enthusiastically support the Thursdays in Black Campaign.Join us, sign the pledge, order buttons at http://www.thursdaysinblack.co.za/

The campaign was spearheaded in South Africa by the Diakonia Council of Churches

They write as follows about this campaign:

"Thursdays in Black Campaign has its roots in groups such as Mothers of the Disappeared in Argentina, Black Sash in South Africa and the Women in Black movements in Bosnia and Israel. Thursdays in Black, as a human rights campaign, was started by the World Council of Churches during the 1980's as a peaceful protest against rape and violence - the by-products of war and conflict. The campaign focuses on ways that individuals can challenge attitudes that cause rape and violence."

"This campaign, which was launched in South Africa by the Diakonia Council of Churches during the 16 Days of Activism Campaign at the end of 2008, is an ongoing drive to raise awareness and encourage people to work towards a world without rape and violence against women and children."

"We encourage local churches to join hands with people around the world by wearing black on Thursdays to indicate that we are tired of putting up with rape and violence in our communities and that we have a desire for a community where we can all walk safely without fear of being beaten up, verbally abused, raped, of being discriminated against due to one’s gender or sexual orientation."

"Wearing black on Thursdays highlights the unacceptably high levels of abuse against women in our society."

"The response has been positive and many people, both women and men, have committed themselves to wearing black on Thursdays. This is an outward sign of mourning and of standing in solidarity with women who have died at the hands of their partners and signifies a desire to make a difference in our world."

"The buttons have been distributed at various workshops, where gender-based violence is addressed and where the links between HIV infection and gender injustice are stressed. The members of the Self Help Groups are being empowered to understand the implications of gender-based violence and many of them appreciate the opportunity of wearing black on Thursdays to highlight this debilitating scourge in our rural communities."

"Various churches have distributed the buttons and information leaflets at their Synods and other gatherings of church leaders. In the past three years approximately 6,000 buttons and flyers have been distributed – some as far afield as Cape Town. Diakonia Council of Churches’ website promoted the campaign during the 16 Days of Activism Campaign and this additional source of information solicited much interest."

"In recent months Women’s Manyano Organisations have promoted the Thursdays in Black Campaign to raise awareness on ‘Violence Against Women’ (and Children)."

If you would like more information about the Thursdays in Black Campaign or would like someone to address your church or organisation on this topic, please contact CABSA or the Diakonia Council of Churches office on [031] 310-3500.

You can order buttons or get more information from CABSA. Contact Lyn at o11 796 6830 or by e-mail.

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World Council Of Churches Campaign Against Violence Against Women. 25/11/09

Join the WCC in their campaign to stop violence against women:

Global Women of Faith Network. Your participation in the Restoring Dignity initiative so far has been inspiring. We appreciate your leadership and want to thank you for taking action at  www.wcrp.org/initiatives/women/restoring-dignity
 
Today marks the official launch of Phase II of the UN Secretary-General’s and UNIFEM’s Say NO—UNiTE initiative. The Say NO-UNiTE initiative will count actions by individuals, governments, civil society partners and faith-based partners. Please visit the Religions for Peace dedicated partner page on the Say NO website:
 
On this webpage, we invite you to create your own resources and actions, update photos from your interfaith event, and even link videos to youtube! And the best part, it’s very easy to use! But if you have any snags, email us at GlobalWomenofFaith@religionsforpeace.org for technical support.    
 
TAKE YOUR FIRST ACTION TODAY! Sign the Call to Action to the UN Secretary-General by 23 November 2009.  
 
With much appreciation for your leadership and support on this momentous occasion,
 
Ms. Jacqueline Ogega
Religions for Peace
Director, Women's Mobilization Program
 
P.S. - Please help spread the word! Forward this email to everyone you know—friends, relatives, co-workers, your sisters and brothers in faith—and help RESTORE DIGNITY-End Violence Against Women.
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2009 International Women's Day - 08/03/09

IWD is a global day celebrating the economic, political and social achievements of women past, present and future.

From the official International Women’s Day Website

About
International Women's Day has been observed since in the early 1900's, a time of great expansion and turbulence in the industrialized world that saw booming population growth and the rise of radical ideologies.International Women's Day has grown to become a global day of recognition and celebration across developed and developing countries alike. For decades, IWD has grown from strength to strength annually. For many years the United Nations has held an annual IWD conference to coordinate international efforts for women's rights and participation in social, political and economic processes. 1975 was designated as 'International Women's Year' by the United Nations. Women's organisations and governments around the world have also observed IWD annually on 8 March by holding large-scale events that honour women's advancement and while diligently reminding of the continued vigilance and action required to ensure that women's equality is gained and maintained in all aspects of life.

2000 and beyond
IWD is now an official holiday in China, Armenia, Russia, Azerbaijan, Belarus, Bulgaria, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Mongolia, Tajikistan, Ukraine, Uzbekistan and Vietnam. The tradition sees men honouring their mothers, wives, girlfriends, colleagues, etc with flowers and small gifts. In some countries IWD has the equivalent status of Mother's Day where children give small presents to their mothers and grandmothers.

The new millennium has witnessed a significant change and attitudinal shift in both women's and society's thoughts about women's equality and emancipation. Many from a younger generation feel that 'all the battles have been won for women' while many feminists from the 1970's know only too well the longevity and ingrained complexity of patriarchy. With more women in the boardroom, greater equality in legislative rights, and an increased critical mass of women's visibility as impressive role models in every aspect of life, one could think that women have gained true equality. The unfortunate fact is that women are still not paid equally to that of their male counterparts, women still are not present in equal numbers in business or politics, and globally women's education, health and the violence against them is worse than that of men.

However, great improvements have been made. We do have female astronauts and prime ministers, school girls are welcomed into university, women can work and have a family, women have real choices. And so the tone and nature of IWD has, for the past few years, moved from being a reminder about the negatives to a celebration of the positives.

Annually on 8 March, thousands of events are held throughout the world to inspire women and celebrate achievements. A global web of rich and diverse local activity connects women from all around the world ranging from political rallies, business conferences, government activities and networking events through to local women's craft markets, theatric performances, fashion parades and more.

Many global corporations have also started to more actively support IWD by running their own internal events and through supporting external ones. For example, on 8 March search engine and media giant Google some years even changes its logo on its global search pages. Year on year IWD is certainly increasing in status. The United States even designates the whole month of March as 'Women's History Month'.

So make a difference, think globally and act locally !! Make everyday International Women's Day. Do your bit to ensure that the future for girls is bright, equal, safe and rewarding.

 

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Decrease Violence To Decrease Risk of HIV Among Woman and Girls.

(Global Health Council) Addressing violence against woman and HIV/AIDS simultaneously can reduce the incident of both and have a positive impact on the lives of woman and their families. This policy brief examines the way in which violence fuels increased HIV vulnerability for woman and girls. It highlights successfully and innovative efforts needed to prevent it and recommends policy action. Download PDF (257.91KB 4p)

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Ring The Bell. 25 Nov to 10 Dec 2008

Ring The Bell - 16 Days of Activism Campaign on Violence Against Women and Children

The Diakonia Council of Churches, The Centre for HIV/AIDS Networking (HIVAN/HIV-911) and the World Conference on Religion and Peace (WCRP) have partnered together for the 16 Days of Activism Campaign 2008.

The Campaign commences on 25 November and ends on 10 December and is designed to generate awareness of the plight of women, children and men who experience violence at the hands of others.

This year we have chosen the theme “Ring the Bell – Say NO to Violence”.  We trust that the campaign will encourage everyone to take a stand by “Ringing the Bell” on offenders – having courage to intervene.

A specific theme and colour has been chosen to mark each of the days of the campaign.  There are many ways to get involved, show your support, and simply take time to reflect during the 16 Days of Activism Campaign.

 

Date
Day
Colour
Campaign Theme
25
Tues
green
Women who are current being abused by their partners
26
Wed
blue
Women who are or have escaped an abusive environment
27
Thurs
black
Women killed at the hands of their of their abusive partners
28
Friday
orange
Women who have survived rape, sexual abuse / harassment
29
Sat
yellow
Children who are victims or witness domestic violence in the home & sexual abuse
30
Sun
white
People / service providers who work within the field of GBV
1
Mon
red
Women / Children infected and affected by HIV
2
Tues
grey
Men who work within the field of GBV or are taking a stand against GBV
3
Wed
orange
Women who have survived rape, sexual abuse / harassment
4
Thurs
black
Women killed at the hands of their of their abusive partners
5
Friday
white
People / service providers who work within the field of GBV
6
Sat
green
Women who are current being abused by their partners
7
Sun
red
Women / Children infected and affected by HIV
8
Mon
grey
Men who work within the field of GBV or are taking a stand against GBV
9
Tues
yellow
Children who are victims or witness domestic violence in the home & sexual abuse
10
Wed
blue
Women who are or have escaped an abusive environment
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Department of Basic Education (DBE) and LEAD

header-stoprape

 

The Department of Basic Education (DBE) and LEAD SA have announced details of a major initiative to raise rape awareness and educate the 10,2-million learners in South African schools.

Basic Education Minister, Angie Motshekga, said “The collective rage in the country had to be turned into tangible action.”

The Minister said she has today issued a directive to all provincial education departments to instruct schools across the country to call special assemblies at 8am on Friday, 1 March.

“Following the singing of the National Anthem, we want principals, educators, learners or activists to address the assemblies for 15 minutes about rape and sexual crimes. The focus will be on education/awareness and more importantly what to do.

“We also want to appeal to our learners to report any form of abuse from anyone to the authorities,” said Minister Motshekga.

In his reply to the State of the Nation address in the National Assembly yesterday, President Jacob Zuma commended the Department of Basic Education for “looking at inculcating values of nationhood at an early age, promoting rights and responsibilities among children.

“We acknowledge and applaud the good work of many civil society organisations that are raising awareness about violence against women and many other issues affecting society,” President Zuma added.

“The DBE will provide guidelines for the talks to the education departments as part of the directive,” she added.

In addition to these guidelines, NGOs are encouraged to assist with the mornings’ talks.

stoprape-info

Rape Response booklet and Pledge

A pledge based on the Bill of Responsibilities, which includes a statement on violence and rape, will also be circulated and educators and learners are urged to adopt it at the assemblies.

Click here to view pledge

A downloadable rape response booklet and a poster which will help to guide educators on how to cope with this sensitive topic is also available.

Click here to view the 12-page rape response booklet
and here to view a poster on response protocol.

The pledge will be available in all 11 official languages.

The DBE has called on all schools to prepare worksheets for learners about violent and sexual crimes.

“We want boy and girl learners to complete these worksheets at home, with their families if possible, and return them to their teachers. It’s part of the education/awareness programme.”

The DBE said the school assemblies will be concluded by 8.30am.

Minister Motshekga said the initiative was “critical not only to highlight the rape bane but also to educate our children.”

“We have partnered with Lead SA like we did with the Bill of Responsibilities (BOR) and the Happy Birthday Madiba song.

“1 March is the start of Human Rights Month. We need to also teach our youth about their rights and responsibilities as per the BOR,” said Minister Motshekga.

Lead SA said the partnership with the DBE will go a long way in heightening awareness and education.

“We also hope the 10,2-million learners will take the messages home so that society at large can act. The ‘StopRape’ message needs to reach every corner of South Africa.”

Lead SA said it encouraged active citizenry. “Let’s all unite and fight rape with one voice.”

After the pledge has been taken by the millions of learners on 1st March, we encourage each and every citizen to also adopt it. “Take it to your offices, factories and homes… Say NO to rape.”

Minister Motshekga called on civil society to support the “StopRape” initiative.

Proudly South African and Shout SA have already come out in support of the awareness programme.

Proudly South African says it will also include the messaging in its national “Ubuntu schools” campaign which was launched shortly after the gang rape of a Soweto teenager in April last year.

RapePledge

 

 
 
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Say NO – UNiTE to End Violence against Women

Say NoSay NO – UNiTE to End Violence against Women is a global call for action, launched in November 2009, on ending violence against women and girls. It is presented by UNIFEM as a contribution to advance the objectives of UN Secretary-General Ban Ki-moon’s campaign UNiTE to End Violence against Women through social mobilization. UNIFEM Goodwill Ambassador Nicole Kidman is the Spokesperson of Say NO.

Based on country data available, up to 70 per cent of women experience physical or sexual violence from men in their lifetime. It happens everywhere – at home and at work, on the streets and in schools, during peacetime and in conflict. Violence against women and girls has far- reaching consequences, harming families and communities, stunting human development, and undermining economic growth. Everyone has a role to play in combating this global pandemic; the time to act together is NOW.

Say NO aims to trigger and highlight actions by individuals, governments and civil society partners. Actions can range from reaching out to students at schools, to volunteering at local shelters, advocating for legislation or donating funds towards programmes that protect women and girls from violence. Every action will be counted to showcase the global groundswell of engagement that exists on the issue. The initial target is to reach 100,000 actions by March 2010 and 1 million actions in one year.

Say NO builds upon the momentum generated during its first phase when 5,066,549 people signed on to a global call to make ending violence against women a top priority worldwide. Heads of States and Ministers from 69 Governments and more than 600 Parliamentarians have added their names to Say NO since then.

Working through traditional as well as online networks and social media, Say NO will engage participants from all walks of life. A range of web-based and other tools available on saynotoviolence.org will support partners in their advocacy efforts, highlight their work to a global audience and inspire others.

In line with the Secretary-General’s campaign framework that calls for an increase in funding for the multi-lateral UN Trust Fund in Support of Actions to Eliminate Violence against Women, Say NO encourages donations for the UN Trust Fund, which supports local and national programmes catalyzing change on the ground.

Say NO - UNiTE to End Violence against Women is an expanding global coalition of individuals, organizations, governments and the private sector to realize a vision that is ambitious, but must never be impossible – a future that is free from violence against women and girls. Let us count you in – take action to end violence against women now.

More information and toolkit available on website.

 

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World YWCA International Women's Day Statement 25/03/09

Unite to end Violence Against Women
Every day, in many homes, women are beaten and abused. Violence against women is not only widespread-it is often fatal. The most common form of violence against women is domestic violence, but women and girls face abuse and violence at every stage of their lives. An extreme manifestation of gender inequality, violence against women is a global problem deeply ingrained in societies and has serious impacts on women's health and well-being. 

The elimination of all forms of violence against women and girls is a top priority for the World YWCA. In nearly 70 countries, YWCAs provide services for women facing violence and abuse. For many women, the YWCA represents a safe space. From shelters and safe houses run by YWCAs in the USA, Canada, Zambia and Sri Lanka to campaigns to prevent trafficking championed by YWCAs in Finland, Belarus, Albania and Samoa. National and local YWCAs around the world are committed to seeing an end to violence against women. Through advocacy and services, YWCAs are working to ensure women and girls in their
communities can live lives free of violence. 

On International Women's Day, the World YWCA calls on governments, international organisations and civil society to: 

1. Prevent violence, ensure safety and security for women and girls

In addition to carrying out research on the cause of violence, governments must take steps to prevent violence before it starts. A strategic way to prevent violence is to introduce and enforce laws that protect women-there must be no impunity for acts of violence against women. Governments must consider initiatives, such as the YWCA Canada 'Rose Button' campaign, that call for actions to prevent violence before it starts. 

One of the first obligations of CEDAW requires United Nations member states to entrench women's human rights in their constitutional and legal systems. Raising public awareness on laws that protect women is crucial in preventing violence against women. 

UN Security Council Resolution 1325 on women, peace and security calls on UN member states to take special measures to protect women and girls from violence, particularly in situations of armed conflict. Women's bodies must not be used to wage war. 

2. Invest in women and girls

Adequate and accessible funding must be provided for services that provide holistic care for survivors of violence. Women's right to information must be upheld. Lack of information prevents many women from accessing services that would support them to regain dignity in
their lives. 

Organisations running programmes such as shelters for women in violent relationship, help-lines and counseling facilities must be adequately financed to ensure their services remain reliable and accessible. As Governments consider their strategies to deal with the global
financial crisis, funding and support for social services must not be cut or reduced.

3. Redefine gender stereotypes

Governments must work with civil society to change negative stereotypes as a strategy to prevent violence against women.

Information and programmes that help young women and men develop healthy relationships are crucial in order eliminate negative stereotypes. A society that understands the impact and effects of violence against women is better versed to address the issues at government and policy level. Education on violence against women must be integrated in programmes that reach different sectors of society including men and boys. Programmes such as the YWCA Week Without Violence-commemorated annually in November around the world-help
educate communities on the types of violence women in their country face.

4. Understand intersectionality of HIV and VAW

Socio-economic factors and legal challenges that put many HIV-positive women at risk of violence must be addressed. The World YWCA is particular concerned about recent laws some countries are adopting that criminalize HIV. These laws have a particular impact on women and leave them vulnerable to violence. Governments, international organisations and civil society must ensure that laws and policies that uphold women's human rights are implemented in order to protect women from violence. 

The World YWCA joins with the global community to call for an end to violence against women and ensure women and girls can live lives free of violence.

The World YWCA is a global network of women and young women leading social and economic change in 125 countries. It advocates for peace, justice, human rights and care of the environment, and has been at the forefront of raising the status of women for over a century.

Contact Information

email: kaburo.ko...@worldywca.org

phone: +41229296030

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Advocacy Resources - Human Rights

Lyn's Comment: HIV and human rights are 'intertwined' in an number of ways.

The introduction to the publication “HIV/AIDS & Human Rights In A Nutshell” developed by the Program on International Health and Human Rights, François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health and the International Council of AIDS Service Organizations, starts as follows:
"Human rights are fundamental to any response to HIV/AIDS. This has been recognized since the first global AIDS strategy was developed in 1987. Human rights and public health share the common goal of promoting and protecting the well-being of all individuals. "

"The promotion and protection of human rights are necessary to empower individuals and communities to respond to HIV/AIDS, toreduce vulnerability to HIV infection and to lessen the adverse impact of HIV/AIDS on those affected."

It is sometimes difficult for faith communities to deal with a rights-based approach.  To help us understadn our role and the interaction of HIV and rights, I again quote from the document:

"We understand human rights and HIV/AIDS to work together in three separate, but related ways. These are:

Accountability: Human rights provide a system for holding governments accountable for their actions.
Advocacy: Governments are responsible for what they do, do not do, and should do for their populations. This enables activists to engage in a wide range of advocacy actions targeted towards securing human rights enjoyment and protection for people living with and affected by HIV/AIDS and all other groups vulnerable to HIV infection.
Approaches to Programming: Human rights-based approaches to programming aim to integrate human rights principles such as nondiscrimination, equality and participation, including the greater participation of PLWHA,into the response at local, national and international levels."
 
You can download the document. (PDF; 2.12MB,
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HIV Justice Toolkit to Support Advocacy Against HIV Criminalisation Now Online. 5/10/2017

Published by HIVJUSTICE

HIV JUSTICE WORLDWIDE today announced the launch of the HIV Justice Toolkit, which aims to support advocates to oppose HIV criminalisation at all levels – from educating communities and lawmakers to defending individual cases.

Curated by Sally Cameron, Senior Policy Analyst at the HIV Justice Network (HJN) with input and assistance from HJN’s Global Co-ordinator, Edwin J Bernard and HJN’s Research/Outreach Co-ordinator, Sylvie Beaumont, the Toolkit’s creation was faciliated by the HIV JUSTICE WORLDWIDE Steering Committee, designed by Thomas Patterson/NAM, and supported by a grant from the Robert Carr civil society Networks Fund.

“We are delighted at the launch of this timely HIV Justice Toolkit. Advocates will find that the use of this Toolkit will increase collaborative and targeted responses for the most vulnerable – in our case women living with HIV, who often suffer the most because of HIV criminalisation. The Toolkit is timely in galvanising action and encouraging activists and communities to proactively mount evidence-based advocacy campaigns to end HIV criminalisation.”

Lynette Mabotte, Southern and East Africa Regional Programmes Lead,
AIDS and Rights Alliance for Southern Africa (ARASA)

The Toolkit is a comprehensive compendium of almost 300 documents and videos, organised under twelve main headings, each of which is broken down into futher subsections.

  1. How HIV criminalisation undermines the HIV response
  2. What the experts says
  3. Organising advocacy
  4. Understanding the law
  5. Initiating policy and law reform
  6. Supporting fair and robust trials
  7. Using science to prove your argument
  8. Working with police
  9. Educating prosecutors
  10. Educating judges
  11. Getting the message right
  12. Other toolkits

The entire Toolkit is also searchable by keyword.

“This easy-to-read summary of critical resources is a tremendous contribution to the fight to end HIV criminalisation. We will reference and utilise this important new addition to the HIV JUSTICE WORLDWIDE site frequently.”

Sean Strub, Executive Director, Sero Project

Although the Toolkit is currently only available in English, where documents already exist in other languages, these are included.

HIV JUSTICE WORLDWIDE are now working on a French version of the Toolkit, with other languages (i.e. Spanish and Russian) due in 2018, depending on demand, capacity and funding.

Explore the resources contained within the HIV Justice Toolkit at: http://toolkit.hivjusticeworldwide.org/

New video advocacy tool: How to organise to change the law – the story of the Colorado Mod Squad

https://youtu.be/MVAKetslLTI

The Toolkit also features a new video advocacy tool, ‘The Colorado Story’ which explains in 15 minutes how a group of dedicated advocates in Colorado ‘modernised’ their HIV-related laws to improve the legal environment for people living with HIV.

Featuring Barb Cardell and Kari Hartel of the Colorado Mod Squad and Colorado State Senator, Pat Steadman, the video was written and introduced by HJN’s Edwin J Bernard, with interviews by Mark S King, and directed / produced by Nicholas Feustel for the HIV Justice Network/HIV JUSTICE WORLDWIDE.

About HIV JUSTICE WORLDWIDE

HIV JUSTICE WORLDWIDE is a growing, global movement to shape the discourse on HIV criminalisation as well as share information and resources, network, build capacity, mobilise advocacy, and cultivate a community of transparency and collaboration.

The mission of HIV JUSTICE WORLDWIDE is to seek to abolish criminal and similar laws, policies and practices that regulate, control and punish people living with HIV based on their HIV-positive status.

We believe that this HIV criminalisation is discriminatory, a violation of human rights, undermines public health, and is detrimental to individual health and well-being.

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Review of Global Commission on HIV and the Law Identifies Progress and Challenges. 14/7/2017

Published by UNAIDS

Five years ago, a landmark report published by the Global Commission on HIV and the Law urged governments to promote laws and policies grounded in evidence and human rights in order to turn the tide against AIDS. On 12 and 13 July, members of the commission and other experts came together to assess the progress made in advancing the report’s recommendations, look at the barriers that remain and discuss opportunities for further progress.

The participants recognized the role of the commission as a catalyst for social justice and human rights in the HIV response. Since the release of the commission’s report in 2012, efforts to advance the report’s recommendations have been documented in 88 countries. Several countries have conducted comprehensive assessments of laws, policies and practices affecting people living with HIV and have changed legislation as a result. National conversations on the rights of people living with and vulnerable to HIV have led countries to reform discriminatory practices against people living with HIV. Judges, civil society organizations and partners have been instrumental in helping to overturn discriminatory legislation and counter HIV stigma.

Despite this progress, persistent and new forms of human rights challenges face the HIV epidemic and response. Shrinking space for civil society, reduced funding for human rights, discrimination in health-care settings and an increasingly challenging political and social space are among the challenges that call for continued action. In the light of this, the participants called for an update report of the Global Commission on HIV and the Law to reinvigorate progress in advancing human rights and ensuring that no one is left behind. 

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Removing Human Rights Barriers to End the HIV Epidemic. 15/3/2016

Author: Mark Dybul, Global Fund to Fight AIDS, Tuberculosis and Malaria

Enlarge imageA HIV-positive woman receives medicine through an intravenous drip at Medecins Sans Frontieres-Holland (AZG)'s clinic in Yangon, Myanmar, February 21, 2012.  REUTERS/Soe Zeya Tun
A HIV-positive woman receives medicine through an intravenous drip at Medecins Sans Frontieres-Holland (AZG)'s clinic in Yangon, Myanmar, February 21, 2012. REUTERS/Soe Zeya Tun

Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

The HIV response over the past 15 years has been tremendous. In 2000, there was no global public health response to the epidemic.  In 2016, almost every country around the world is implementing prevention and treatment programmes.

Just as important, there is a growing recognition that HIV discriminates, and does not affect people equally. The only way to maximise the impact of our investments, and end the epidemic, is to do a lot more to remove human rights-related barriers to services. We have to move toward treating everyone like a human being, being more inclusive, and finding the best side of our humanity. The sustainable development goals call on us all to do precisely that.

The Global Fund has had a human rights objective in its strategy since 2011. We realised then that human rights-related barriers to services were preventing us from achieving maximum impact.

Indeed, in many settings the impact of our grants is greatly reduced because of these barriers – whether it is in generalised epidemics in Africa where women and girls often do not access testing and treatment or are not retained in treatment because of stigma and discrimination and gender-based violence; or in concentrated epidemics where men who have sex with men, people who use drugs, sex workers, transgender people, migrants, and prisoners often cannot access prevention and treatment because of the discrimination they experience in health-care settings, or the violence perpetrated by police.

It is worth noting that in many settings, many of the same vulnerable groups are susceptible to TB, and TB remains the leading cause of death among people with HIV.

The good news is that seven key programmes that reduce human rights-related barriers to services have been clearly defined by UNAIDS, our close partner, to whom we defer on technical matters. They have been costed, and include:

1.      Stigma and discrimination reduction;
2.     HIV-related legal services;
3.     Monitoring and reforming laws, regulations and policies relating to HIV;
4.     Legal literacy (so-called ”know your rights” programmes);
5.     Sensitization of law-makers and law enforcement officials;
6.     Training of health care providers on human rights and medical ethics related to HIV; and
7.     Reducing discrimination and violence against women, as well as harmful gender norms.

 

Collectively, over the last five years we have made some progress in increasing investments in these programmes. Most countries that apply to the Global Fund for funding now acknowledge that human rights-related barriers hinder many people’s access to the services we fund.

LACK OF FUNDING

However, investment in these programmes remains minimal. Indeed, many grants do not contain any programmes to remove human rights barriers, or include only one or a couple of them. Even where country grants include programmes, they are rarely scaled up and reach only a small proportion of people in need.

We need to do better on removing human rights barriers - not only to achieve the Global Fund’s objective to respect and promote human rights and gender equality, but because it is the right thing to do and because it is essential to our efforts to invest more strategically to end HIV. In the new Strategic Framework of the Global Fund for 2017-2022, which our Board adopted in November, one of our main objectives is therefore to “introduce and scale up programmes that remove human rights barriers to accessing services”.

We will concentrate our efforts on 15 to 20 countries with particular needs and opportunities for introduction and scale-up of these programmes.

The target will be implementation of comprehensive programmes to address the human rights-related barriers to services, resulting in increased uptake of and retention in services through decreased stigma and discrimination, particularly in health-care settings.

Other positive aspects include increased access to justice; reduction of violence against and reduced discrimination against women and girls; greater support among law enforcement officials for prevention and treatment services; a more conducive policy environment and strengthened participation of affected persons in programmes linked to these interventions.

This effort to scale up programmes will be accompanied by a rigorous effort to further increase the evidence of the health impact of the programmes.

We look forward to working with all our partners to make our collective vision a reality – greater access to HIV services, resulting in more infections averted and lives saved, thanks to a concerted effort to reduce human rights-related barriers and, ultimately, to create the inclusive human family we were intended to be. To end HIV, we must overcome discrimination in laws and policies, in practice and in our hearts. We must grasp the historic opportunity to become better people and societies built on the firm foundation of an inclusive human family.

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A Hand BookFor Civil Society. 12/11/2015

Published at United Nations

2008


   The United Nations human rights programme works to promote and protect the human rightsof everyone, everywhere. It is carried out through different United Nations human rights institutions and agencies, and includes the various human rights bodies and mechanisms addressed in this Handbook, all of which have the common aim of promoting and protecting  internationally agreed human rights—civil, cultural, economic, political and social—rights that were proclaimed in the Universal Declaration of Human Rights over 60 years ago.

   As the global authority on human rights, the Office of the United Nations High  Commissioner for Human Rights (OHCHR) is responsible for leading the United Nations  human rights programme and for promoting and protecting all human rights established under the Charter of the United Nations and international human rights law.

   Its vision is of a world in which the human rights of all are fully respected and enjoyed.OHCHR strives to achieve the protection of all human rights for all people, to empower people to realize their rights and to assist those responsible for upholding such rights in ensuring that they are implemented.

 

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Africa: 18th International AIDS Conference Stresses Right to Health

Universal access is a global commitment to scale up access to HIV treatment, prevention, care and support.

AllAfrica

By Cheryl Pellerin
19 July 2010

With the HIV/AIDS epidemic still raging and the global economic crisis threatening desperately needed funding, an estimated 20,000 participants from 185 countries are assembling in Vienna July 18-23 for the 18th International AIDS Conference (AIDS 2010).

Since the first cases were reported in 1981, HIV -- the virus that causes acquired immunodeficiency syndrome (AIDS) -- has become one of the world's most serious health and development challenges. More than 25 million people have died of AIDS, and another 33.4 million now live with HIV/AIDS.

Over the past 15 years, scientific advances and global efforts to address the epidemic have made it possible to prevent and treat HIV even in the poorest nations. According to the World Health Organization, the number of people with HIV receiving treatment in poor countries has increased 10-fold since 2002.

AIDS 2010 speakers will describe the state of the epidemic and outline critical choices facing world leaders in the years ahead.

"This year's conference theme, 'Rights Here, Right Now,' reminds us that health care should be a right for everyone, but isn't," former U.S. President Bill Clinton said at the opening conference session July 18. "Notwithstanding the current economic difficulties, the evidence of the progress that has been made in the last few years is not an excuse to walk away from that right. It's an excuse to run toward it for all of us."

According to conference organizers, Vienna was chosen as the host city for AIDS 2010 in part because of its location near Eastern Europe, a region with a growing epidemic driven mainly by injected drug use. Southern Africa, home to 67 percent of all people with HIV, is the world's most heavily affected region.

MULTIDISCIPLINARY FORUM

Since the first international AIDS conference was held in Atlanta in 1985, the meetings have offered a multidisciplinary forum for networking and sharing information about new research and evidence-based programs and policies. A range of stakeholders has been able to evaluate the latest scientific developments and lessons learned and chart a course forward.

In a July 7 preview of AIDS 2010 in Washington, Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, part of the U.S. National Institutes of Health, said pressing topics at the meeting would include universal access to treatment, the importance of prevention, and new modes of prevention that include vaccine progress and treatment with antiretroviral drugs as a way to prevent HIV transmission.

Results of a study of a new microbicide gel that contains an antiretroviral drug will also be shared at the conference. A microbicide is a gel or cream that women could use before or after sex to protect themselves from infection.

"If the microbicide does work," he said, "it will be the first time that a microbicide has been shown to have a positive effect."

Universal access to AIDS treatment is one of the eight targets of the United Nations Millennium Development Goals. Target 6 calls for halting and beginning to reverse the spread of HIV/AIDS by 2015, and achieving universal access to HIV/AIDS treatment by 2010. With only five months left in the year, prospects are slim for meeting the 2010 goal.

According to the Joint U.N. Programme on HIV/AIDS (UNAIDS), universal access is a global commitment to scale up access to HIV treatment, prevention, care and support. Ninety-nine countries have set targets for treatment, and 98 have set targets for one or more prevention interventions. An interactive map of global progress is available on the UNAIDS website.

Treatment with anti-retroviral drugs also can be a form of prevention, Fauci said in a recent interview with America.gov.

"If you get the virus level down in people who are infected," he said, "they are much less likely to infect other people."

"There's going to be a lot of talk about how do we pay for this," Jon Cohen, a reporter for Science magazine who is providing coverage of the meeting for the Kaiser Family Foundation, said in an interview July 17.

"The dreams, what people want to see happen, are great," he said. "The rich countries of the world are all feeling like they have empty pockets and the aspirations are higher than ever. There will be a lot of conflict and a lot of discussion about how do we pay for what we want to do and what we've promised people we're going to do."

U.S. NATIONAL POLICY

A week before AIDS 2010, on July 13, the United States -- where 1 million people live with HIV/AIDS and one person becomes infected with HIV every 9.5 minutes -- released its own national HIV/AIDS strategy (PDF, 1.37 MB).

In the report, the vision is that "the United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination."

"Reducing new HIV infections, improving care for people living with HIV/AIDS, narrowing health disparities â-- these are the central goals of our national strategy," President Obama said July 13.

"They must be pursued hand in hand with our global public health strategy to roll back the pandemic beyond our borders," he said. "And they must be pursued by a government that is acting as one. So we need to make sure all our efforts are coordinated within the federal government and across federal, state and local governments, because that's how we'll achieve results that let Americans live longer and healthier lives."

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REAct Guide. 9/3/2015

Published at HIV Alliance
18 February 2015
PDF Size - 11.7 MB


The guide provides an introduction to Rights – Evidence – ACTion (REAct), a community-based system for monitoring and responding to human rights-related barriers in accessing HIV and health services.

The five REAct units in the guide provide information on the principles behind the system; the steps you need to take to set it up; who needs to be involved; what the human rights issues are; how to collect data; using the information management tool, Martus; adapting the system to your context; and how to implement REAct.

Download English Guide here

Download French Guide here

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UNAIDS Calls for Zero Discrimination and Ensuring Rights to Health, Dignity and Security on Human Rights Day. 10/12/2012

UNAIDS

GENEVA, 10 December 2012—On the occasion of Human Rights Day, there is evidence that global solidarity and shared responsibility are expanding people’s right to health across the world. More than half the people in need of antiretroviral treatment are now receiving it, far fewer people are dying from AIDS-related illnesses, 25 countries have reduced new HIV infections by more than 50% and new HIV treatment and prevention science promise yet more results.

But AIDS is far from over and there are still major challenges to reaching people with life-saving HIV services. People living with HIV have fought for and gained impressive recognition of their right to non-discrimination. However zero discrimination in the response to HIV is far from being achieved. HIV-related discrimination continues to impact the lives of many people living with HIV, and still prevents millions of people from coming forward to test for HIV and access prevention and treatment services.

Effective programmes and protective laws can overcome discrimination and marginalization in the context of HIV. But many of the people most affected by the epidemic remain marginalized and criminalized––sex workers, people who use drugs, men who have sex with men and transgender people. They are unable to benefit from their rights to health, non-discrimination and freedom from violence.  As the world strives to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths, efforts must be doubled to realize the rights of all people affected by HIV. 

This International Human Rights Day is dedicated to the principle of inclusion and the right to participate in public life. We need to work to ensure that all members of society have the opportunity to fully realize their rights to health, dignity and security in a world with HIV.


Key elements to ensuring a rights-based approach to HIV include:

  • Strong and supportive links to care and treatment must be included in HIV testing programmes;
  • Efforts to expand treatment must ensure access to the right medicines at the right time, including second line medicines that in many places remain prohibitively expensive;
  • Health systems need to be strengthened to become places of care and support, not denial and discrimination;
  • Communities and civil society also need to be strengthened and resourced to work in synergy with health services;
  • A wide range of HIV prevention services must be made available, especially to young people who are often denied their rights to information and services about HIV and sexuality;
  • Women living with HIV must be able to fully exercise their reproductive and sexual health rights;
  • And punitive laws must be replaced by protective ones
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Thousands March in Vienna for Rights of AIDS Patients. 21/7/10

Several thousand activists and anti-AIDS campaigners marched through Vienna's city centre

21 July 2010

VIENNA — Several thousand activists and anti-AIDS campaigners marched through Vienna's city centre on Tuesday evening, demanding more respect for human rights in the fight against HIV.

Men and women of all ages, nationalities and sexual orientation paraded down the famous Ring boulevard in the early evening, carrying banners and accompanied by vuvuzelas and loud whistles.

Julio Montaner, director of the International AIDS Society (IAS), which organised the world AIDS conference in Vienna, led the march, alongside the head of UNAIDS Michel Sidibe, and Michel Kazatchkine, head of the Global Fund to Fight Aids, Tuberculosis and Malaria.

"Even if we had the resources and the technology, we could not achieve universal access to treatment for patients without respect for human rights," Kazatchkine told AFP amidst the noisy crowd.

Auma Obama, the half-sister of US President Barack Obama, who helps US charity CARE's anti-AIDS efforts in her native Kenya, also attended and did a little dance with her fellow demonstrators.

The march ended at Vienna's historic Heldenplatz (Heroes' Square), where Sidibe and Kazatchkine joined voices with other activists to call for more funds for the fight against AIDS as well as "Rights Here, Right Now" -- the slogan of the Vienna conference.

Singer and AIDS activist Annie Lennox performed a few songs but also swung scorching criticism at governments in eastern Europe, where the AIDS epidemic is spreading the fastest, shouting: "Where are you? A catastrophe is taking place in your backyard and you're ignoring it."

As for conference host Austria, "your one-million-euro donation to the Global Fund in 2002 is embarrassing," she stormed.

"This event alone will have generated over 45 million euros for the city of Vienna: set the example, put your money where your mouth is and donate generously to the Global Fund," she urged.

Lennox later asked for a minute of silence to remember the victims of AIDS.

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Physicians for Human Rights Advocacy Toolkit. 2007.

This toolkit describes advocacy techniques and activities geared toward the health professions and health professional students. It aims to support health professionals to advocate for human rights by accessing "their specialized skills, ethical obligations, and credible voices". For students, the website strives to advance understanding and lifelong investment in health and human rights activism, and to cultivate their contributions as advocates promoting health and human rights through local chapters of Physicians for Human Rights (PHR), as well as blog posting, action alerts, and campaign organising. The advocacy toolkit includes such aids as templates, phone scripts, sample letters, and other downloadable tools. Toolkit online
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Advocacy Resources - Poverty

 

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Micah Network Prayer Week 23/02/09 - 01/03/09

Prayer Week

Micah Network member agency Tearfund UK is holding a Global Poverty Prayer Week from 23 February to 1 March 2009. They ask that we join with them, and the tens of thousands who were involved in the first prayer week in 2007, to be part of a growing network of local churches that are making poverty personal. Tearfund have put together resources that make it easy to pray about big issues like HIV and clean water.

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Advocacy Resources - TB

 

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Guide: An Activist’s Guide to Regulatory Issues. 07/01/2016

Published at health e.org

04 January 2016


Created by the US HIV activist organisation the Treatment Action Group, the document begins by broadly outing regulators roles before covering issues like pre-approval access to TB drugs as well as accompanying concerns regarding equitable access. These concerns are illustrated with country examples.

The guide then moves on to explain how TB drugs move from research into clinical trials and also cases of accelerated access to drugs like bedaquiline and delamanid.

Finally, the guide outlines strategies activists can use to increase access to new TB drugs such as import waivers, off-label use and operational research.

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Guide: Close the gap – TB and Human Rights. 9/12/2015

Published at health e news

9 September 2015


According to ARASA, this document serves as a framework for activists in southern and East Africa working on HIV, TB and human rights issues. The guide is divided into the five key topics identified as needing urgent attention in the region, namely:

  • Promoting a rights-based approach to TB,
  • The criminalisation of TB,
  • Unequal access to TB care and treatment,
  • TB and gender, and
  • Most at-risk populations.

For each topic, the guide provides background to the issue and case studies from partner countries in the region, to provide best practice examples of how civil society has been able to undertake advocacy efforts to promote rights-based responses regarding the topic. A framework for a way forward for TB activists in the region regarding each topic is outlined, including policy advocacy where there are no rights-based approaches in country’s national TB strategies and documentation of case studies to gather evidence of violations of human rights.

The document concludes with several calls to action, including the use of compulsory licensing to increase the production of 
generic TB vaccines, diagnostics and treatment.

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Call to Action for Childhood TB

We, participants gathered at the ‘International Childhood Tuberculosis Meeting’ held March 17-18, 2011 in Stockholm, Sweden recognize that:

o        Worldwide, at least 1 million TB cases occur each year in children under 15 years of age.
o        The true burden of TB in children is unknown because of the lack of child-friendly diagnostic tools and inadequate surveillance and reporting of childhood TB cases.
o        Children with TB infection today represent the reservoir of TB disease tomorrow.
o        Children are more likely to develop more serious forms of TB such as miliary TB and TB meningitis resulting in high morbidity and mortality.
o        Despite policy guidelines, the implementation of contact tracing and delivery of isoniazid preventive therapy (IPT) to young and HIV-infected children is often neglected by public health programmes.
o        Most public health programs have limited capacity to meet the demand for care and high-quality services for childhood TB.
o        TB care for children is not consistently integrated into HIV and care and maternal and child health programs.
o        BCG, the only licenced TB vaccine, has limited efficacy against the most common forms of childhood TB and its effect is of limited duration.
o        Due to inadequate case detection it is estimated that a large number of children suffering from TB are not appropriately treated. This is further compounded by drug stock outs and the lack of child-friendly formulations of drugs for TB treatment and prevention.
o        Children are rarely included in clinical trials to evaluate new TB drugs, diagnostics or preventive strategies.
 
To address this current situation, we, the undersigned, call for:
o        National TB programmes to include and prioritize childhood TB in their national strategic plans in order to address millennium development goals for children and pregnant women.
o        All health care providers to integrate childhood TB into their services.
o        The scientific community to include children—of all ages—in clinical and operational studies.
o        TB drug and diagnostic product developers to specifically include children in development plans and implementation of research at an early stage.
o        Donors to encourage collaboration with researchers, local communities, TB control programmes and other stakeholders to address the growing problem of childhood TB concentrating on:
Innovative research to develop child-friendly TB diagnostics, drugs, biomarkers and vaccines
The strengthening of public health facilities and services so that mothers and children with and without HIV can receive appropriate TB care
o        Providers of technical assistance to invest in building local technical and programmatic capacity to prevent, diagnose and treat TB in children in all age groups.
o        The WHO to accelerate in-country adoption and use of childhood TB guidelines.
o        Policy makers to adopt the existing and new WHO recommendations for childhood TB, evaluate implementation, scale-up and assess the impact of implementation strategies.
o        Civil society to demand equitable prevention, diagnostics, treatment and care services for childhood TB and to monitor the scale- up of these services.

To ensure that all children exposed to TB or suffering from TB are correctly managed and receive the appropriate treatment, the individuals and institutions signing on to this call to action, pledge to advocate for universal access to prevention, diagnosis and treatment of TB for people of all ages.

We furthermore call on the international community to endorse this call for action to ensure that there is capacity to address the needs of children with TB.

To sign on to this call-to-action please reply with your name, country, and organization/affiliation (if appropriate) to childhoodTB@treatmentactiongroup.org

 

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Children are Unknown Victims in Global TB Response

It is estimated that at least one million tuberculosis (TB) cases occur each year among children, and most of them in developing countries. These are conservative estimates because many children with TB are not notified, and many others live without access to proper diagnosis or treatment. This makes it difficult to calculate the true number of children affected by the disease. 

Childhood TB has not received the attention it deserves in the global TB response. The real tragedy is that children have been largely neglected in research, epidemiology and surveillance. “Children who are exposed to TB include those from poorer families, those in close contact with TB patients--especially infected relatives, malnourished children, and children living in overcrowded conditions. We lack the proper mechanisms to really help these infants and children.” says Zari Gill, World Vision’s director of infectious disease.

World Vision has specifically been working to draw attention to the impact of TB on children and to raise awareness in communities of the signs and potential effects of TB in children. Staff also work to strengthen local health systems to increase access to diagnosis and treatment, and to help communities monitor their TB patients to assure they complete their full course of TB treatment.

In its community-based response, World Vision trains local volunteers to conduct directly observed treatment short-course (DOTS) for TB treatment to help increase community knowledge about TB transmission, prevention and treatment. Training community volunteers contributes to the capacity of the local health system, freeing health staff time to focus on diagnosis and contact tracing, which is instrumental in the fight against TB. Contact tracing enables the community to identify where a person infected with TB contracted the disease, seeking to treat the disease at the source to prevent re-infection as well as further spread of the disease.

Globally, World Vision joins other organisations in its fight against TB. World Vision partners with the Stop TB Partnership and TB REACH. The TB REACH initiative of the Stop TB Partnership has a fast-track competitive selection of innovative projects, rapid disbursement of funds and a robust monitoring and evaluation system. TB REACH offers a lifeline by finding and treating people in the poorest, most vulnerable communities in the world. In areas with limited or nonexistent TB care, TB REACH supports innovative and effective techniques to find people with TB quickly, avert deaths, stop TB from spreading, and halt the development of drug-resistant strains. 

One of the newest projects funded by TB REACH is in Rwanda, where the World Vision team has launched the TB project on a national scale. In the first four months of the project in Rwanda, World Vision has helped to identify 154 new TB cases in adults and children, educated more than 1500 youth, obtained extensive media coverage, trained and equipped community health workers in three districts, and provided eight microscopes to local health facilities—necessary equipment for TB case detection.

Esperance Akayezu is a 24-year-old mother of two who was helped through this TB response project. Just six months ago Esperance believed dying was better than living. Since then, with the help of WV Rwanda’s tuberculosis (TB) response project, she has received diagnosis and treatment for her TB, as well as other assistance. She no longer despairs of life.

Esperance lives in a mud house with her pregnant sister and her two children, Uwase Divine and Ishimwe Prince, who are being treated for malnutrition. The entire family lives on sparse wages earned by local farm work. She has struggled to raise her two children in these circumstances, and her TB disease has put her children at risk of infection.

Esperance retells her first encounter with World Vision’s TB programme: “A few months ago, a community health worker who works with World Vision invited me to a TB screening. The next day, I went with her for screening. My results showed I was positive for TB, but, fortunately, HIV-negative. I was shocked and really needed some extra support.”

Since receiving help, Esperance is healthier and her children are protected from becoming infected with TB by their mother. Through community health workers trained by World Vision, Esperance receives regular home visits and medication. World Vision also assists with porridge, vegetable seeds and rabbits for her kitchen garden. She has gained 13 kilograms thanks to better nutrition.

“I thank World Vision and local health centre staff because they have advised me on several issues and provide counselling whenever I need it,” she said.

Thanks to generous sponsors, all TB patients have been supported through community-based DOTS, as well as small income generating activities such as small livestock (pigs, goats, rabbits). They also receive vegetable seeds and training about HIV and nutrition -- conducted especially for prevention and management of TB.

Read World Vision’s Call to Action to Prevent Childhood TB.

 

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Global Health and Nutrition

A Call to Prioritise Children in the Global TB Response:

In the global response to tuberculosis (TB), children are the “silent sufferers.” Since they pose a low threat for transmission, children with TB have been relatively neglected. This is a stark violation of their right to health as per Article 24 of the Convention on the Rights of the Child. Attention is focused primarily on adults with TB because they are symptomatic, readily diagnosed and considered potential transmitters of infection.

Children are particularly vulnerable to severe disease and death due to TB. It is estimated that at least one million children develop TB each year..1 This unacceptably high toll of disease and death among children is made worse by the HIV epidemic. TB manifestations are more severe and progression to death is faster among HIV-positivchildren, yet they are at risk of diagnostic error and inappropriate treatment. Increased international travel and immigration have led to an increase in childhood TB rates in traditionally low burden, industrialised countries, and threaten to promote the emergence and spread of multidrug-resistant strains. Children with latent TB infection become a reservoir for future transmission when the disease reactivates in adulthood, fuelling future epidemics.2 We need to simultaneously address many risk factors for TB, especially HIV and AIDS and undernutrition3 as well as addressing the social determinants of tuberculosis4

A child usually gets TB infection from being exposed to a sputum-positive adult--usually a parent. Because of their immature immune systems, young children under age ten are especially at risk of not only becoming infected but of developing active tuberculosis.

Children also suffer when their mothers have TB, often requiring them to leave school to care for their family or leaving them as orphans when their mother dies. Tuberculosis is the third highest cause of death among women of reproductive age 5and therefore has a massive impact on the lives and health of children. Annually 700,000 women die of TB.6 Without rapid scale-up of TB programmes, as many as four million women will die between 2011 and 2015, leaving millions of children orphaned.

World Vision’s Experience:

World Vision works with children, families, communities and donors all over the world to improve the well-being of children. World Vision’s global Child Health Now campaign calls on governments to meet their commitments and increase their efforts to improve child health in order to meet MDG 4 by 2015. Throughout its experience with TB over the past decade, World Vision has identified critical needs and gaps in the response to TB among children, including:

- Children with TB are not detected: Diagnostic tests appropriate for children are not accessible.
- Children with TB are not notified: Glaring gaps in epidemiological data.
- Children with TB are not treated: Paediatric formulations and doses of drugs are not available, nor compatible for treatment with HIV.

World Vision’s Call on behalf of the “Silent Sufferers” of TB:

- Increase political commitment: Include a focus on childhood TB in global TB efforts, including the Global Plan to STOP TB, and ensure that 10% of global TB funding is designated to address TB in children.
- Heed the call to Children’s Rights: Address TB in children as a basic human right. - Improve point-of-care diagnostics for TB in children by 2015. - Ensure paediatric formulations and doses of TB Preventive Therapy and anti-TB drugs compatible with antiretroviral drugs for HIV treatment are available by 2015.
 
1 Guidance for National Tuberculosis Programmes on the management of tuberculosis in children, Stop TB Partnership,
2 Pediatric Tuberculosis: The Lancet Infectious Diseases
3 Malnutrition and Tuberculosis: Macallan DC
4 The Social Determinants of TB; From Evidence to Action: April 2011, Vol 101, No. 4 | American Journal of Public Health 654-662
6 WHO: Tuberculosis and Gender  

 

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Understanding and Challenging TB stigma: Toolkit for Action

‘Understanding and challenging TB stigma’ has been developed in response to the need to address TB stigma especially where TB and HIV co-infection rates are high. The publication contains a range of participatory games, exercises and picture tools to help address TB stigma, suitable for a range of contexts and settings.


It was written by and for trainers and will help trainers plan and organise participatory educational sessions with community leaders or organised groups to raise awareness and promote practical action to challenge HIV and TB stigma and discrimination.

This toolkit was developed as part of the Alliance Africa regional stigma training programme through a partnership with ZAMBART (Zambia AIDS-Related Tuberculosis project) Project in Zambia involving participatory workshops with health-workers, people living with HIV and ex-TB patients. Swedish International Development Agency (Sida) and the European Union were the main funders that supported the development of this toolkit.

This toolkit includes 19 participatory exercises with clear and easy to follow instructions aimed at exploring different issues related to TB and stigma:

Naming TB stigma through pictures

How has TB affected my life? (reflection)

Naming TB stigma in different contexts

Forms, effects and causes of TB stigma

Assessing baseline knowledge

Fears about getting TB (risk continuum)

Fears about getting TB at home

Countering myths and misconceptions

TB diagnosis and stigma

Do’s, Don’ts and DOTS

Challenging TB stigma in health facilities

TB-HIV link

The burden of secrecy

Sharing the burden of care

TB and human rights

How men and women experience TB stigma

Children and the wall of silence

To tell or not to tell (children and information)

Empowerment and action planning

Who is this toolkit for?

This toolkit is primarily intended for use by NGO support programmes in Africa who are working on, or intend to work on TB and HIV related issues. The toolkit will also be useful to NGOs and CBOs themselves as well as training organisations and individual trainers working on TB and HIV-related issues.

How can you get a copy of this toolkit?

Electronic copies:

· Click this link to download a PDF of Understanding and challenging TB and Stigma from the Alliance website (3mb).

Printed copies:

· You can order a free copy by replying to this email with TB and Stigma in the subject line. Please also confirm your postal address in your reply in case it has changed since we last contacted you.

Please note that only organisations working in Africa can request a printed copy and the quantity is limited to one per organisation.

How can you help more people get access to this toollkit?

We are keen to promote these resources to people working in Africa. Please pass this information to others who may not have access to the same information as you by mentioning this new toolkit in your e-mail group or similar forum; or on your website by using the link above.

Garry Robson

Communications Assistant

International HIV/AIDS Alliance

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World TB Day - March 24th

24 March marks the day in 1882 when Dr Robert Koch detected the cause of tuberculosis, the TB bacillus. This was a first step towards diagnosing and curing tuberculosis.  World TB Day raises awareness about the global epidemic of tuberculosis (TB) and efforts to eliminate the disease. One-third of the world's population is currently infected with TB.  The Stop TB Partnership, a network of organizations and countries fighting TB, organizes the Day to highlight the scope of the disease and how to prevent and cure it.

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Topline Media Messages for World TB Day 2011

Everyone in the world who needs TB care should be able to get it. That is not happening now.

Proof points/secondary messages:

• A third of people with TB are not reached with accurate diagnosis and appropriate care--that's about three million people each year. Most of them are in vulnerable and marginalized groups such as prisoners, slum dwellers, migrant workers, and drug users, or are living in poverty pockets.

• Civil society, health workers and businesses need to team up to drive universal access to TB care.

• In the 21st century, no one should die from TB, a curable disease. But at least 8 million people will die unnecessarily between now and 2015 if we don't take action.

2. Investing in TB saves lives - and TB is a cost-effective investment.

Proof points/secondary messages:

• It costs as little as $100 to provide life-saving care for drugsensitive TB in many developing countries.

• In 2006 the Disease Control Priorities Project counted TB treatment among the ten "best buys" in public health (DCPP, Disease Control Priorities in Developing Countries. 2006, Oxford University Press: New York. p. 289-309.)

• In 2009 researchers reported that countries could earn up to 10 times what they invest in TB care. (Economic Benefit of Tuberculosis Control, Ramanan Laxminarayan, Eili Klein, Christopher Dye, Katherine Floyd, Sarah Darley, Olusoji Adey here)

• In 2008 the Copenhagen Consensus ranked TB case finding and treatment fourth most cost-effective among interventions to control disease (CCC. Copenhagen Consensus 2008. 2008 [cited 2010 April 15]; Available here).

 

3. New genetic tests for TB will soon make it possible to rapidly identify everyone who needs TB treatment.

Proof points/secondary messages:

• Progress on rapid TB tests offers lots of promise, but we must also ensure that all will have access to the new test and that those who are diagnosed have access to high-quality TB care

• For every 100 people living with HIV who have MDR-TB: traditional microscopy will detect zero. Xpert will detect 95.

• For every 100 people living with HIV who have active, drugsusceptible TB: traditional microscopy will detect 40. Xpert 70-80

• 1 Xpert machine (the 4-module model) can test 4,000 people per year. Total cost is $100,000

• Greater investment in research will take us to the next critical step: a cheap, simple rapid TB test that can be used in any basic health care setting and requires little technical knowledge.

• The current treatment for TB is very long - six months or more. A new four-month treatment is on the horizon, but will only come to market if there is sufficient investment.

• We will not eliminate TB without a vaccine that is safe and effective in preventing the disease in people of all ages.

4. No one living with HIV should die from TB.

Proof points/secondary messages:

• There has been a huge investment in life-saving antiretroviral treatment, but TB takes the lives of far too many people infected with HIV and is threatening progress.

• Two million people living with HIV will die of TB between now and 2015 if we don't intensify efforts.

• All TB patients should be tested for HIV and all people in HIV care should be screened for TB. In places where TB represents a risk all people living with HIV should be receiving preventive treatment or anti-TB drugs as appropriate.

• In June, global leaders will meet at the UN in New York to seek a way forward on ending deaths from TB among people with HIV.

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Civil Society Campaigns

 

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Call to Action: Make your voice heard by Obama: March to the US consulate on June 17th to save lives!

Dear Colleagues

This is a call for the NGO Sector to support this campaign led by the TAC and endorsed by numerous organisations.  
We are asking you to do 2 things:
1.       ENDORSE THE LETTER:
Read the attached letter outlining the campaign and what we are calling for, and then endorse it. Send to as many orgnisations and networks to endorse and support. Sign the letter and send it to Catherine Tomlinson at the Treatment Action Campaign (contact details below).
2.       JOIN THE MARCH:
On 17 June we will be marching to the US Consulate in Johannesburg to make United States President Barack Obama aware of the deaths that will result from his anti-treatment policies. We will hand over a Memorandum to senior US government officials including Deputy President Joe Biden who is visiting for the World Cup. We call on the NGO Sector to mobilise and support the march, send this call far and wide within your networks.

If you would like to know more about the march, please contact  Catherine Tomlinson at the Treatment Action Campaign email  or call (0) 21 422 1700 .

WHAT ARE WE ASKING FOR:
 We are calling on President Barack Obama:

  to reverse the funding cuts for HIV and to ensure that PEPFAR continues to expand funding to meet universal access targets.

We are calling on the United States and Europe:

  to replenish the Global Fund on AIDS TB and Malaria (GFATM) to meet universal access. The Global Fund has indicated that it must raise between $17 and $20 billion for its upcoming round to continue to expand its programmes. nbsp; The United States and Europe must publicly guarantee that this funding is made available to meet the expectations that they themselves have created by their commitments to universal access.

We are calling on President Zuma and Health Minister Motsoaledi:

;  to represent the needs of Africa during this year’s global forums on the MDGs. < To lead developing countries in echoing our calls for expanded and sustainable funding for HIV.

Mobilization:

TAC has mobilised branches and members to attend the march on 17 June. The expected figures include 1500 people from Gauteng, 800 people from Mpumalanga , 600 people from Limpopo and 65 people from the Free State.

By the end of today Phillip will email all partners pick up points in each province.

Media:

TAC has sent out the letters to Obama, Biden and Zuma to all media. TAC has also sent out a press statement announcing the march and with background of the march.

MSF has also published information on the M&G thought leader blog and is preparing an editorial to be published next week. Have other partners sent out statements?

TAC Ekurhuleni has secured a spot on KhaziFM to mobilize communities in Ekurhuleni to join the march. Are other districts raising awareness about the march?

The street posters advertising the march will go up on Monday.

On Monday morning, TAC and partners will send out a press statement on the march as well as march and press conference details. All partners should send this off on their media lists.

On Tuesday the press conference will be held at the COSATU offices in Johannesburg. There will be a TAC, MSF and COSATU speaker.

What else can we do? Will work on a facebook page over the weekend. Any ideas from partners?

Material:

The posters, pamphlets, t-shirts and banner will be delivered to the TAC office on Monday. MSF will be bringing 20 000 kites and XX paper shoes.

March permission and memorandum:

We have received permission to hold the march and will be gathering in George Lea Park at 10:00 am.

The US ambassador has responded to our letters. (will forward response to partners). TAC is trying to organize to meet with representatives of the US Embassy over the weekend to organize who will accept the memorandum.

Please see attached posters for the resources for health march on the 17th June, please all offices print and put them up in the office. Also attached are details of pick up points in Gauteng.

Rally:

More details to be sent.

We call on you to join the march. AIDS is not over. Be seen. Be heard by the world while they are watching the World Cup played in our country.

Thank you

Denise

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Civil Society Consensus Statement. 10/10

A ten point agenda for saving and bettering lives

Section27
October 2010
 
Meeting the challenges of HIV treatment and prevention through independent mobilisation and work through the SA national aids council (SANAC)

CABSA decided to endorse the Consensus Statement sent to government and SANAC.  The finalised document as it was sent is attached. The statement was also endorsed at the COSATU-civil society conference. By mid November 2010 65 organisations indicated their support.

The Deputy President, Minister of Health and CEO of SANAC are all aware of this statement.  Minister Motsoaledi has read the statement, and SANAC Deputy President Mark Heywood handed it directly to Deputy President Motlanthe.

See the document attached below

The document articulates the concerns of civil society about the challenges around HIV and TB prevention, and the malfunctioning of the SANAC Secretariat. The document makes recommendations as well as outlines demands for SANAC to play its role in co-ordinating and supporting   sectors.



The demands are:

1.    We Demand Sustained Political Leadership and Engagement from the Highest Level of Government on an effective and efficient HIV response!

2.     We Demand a Unified Communications Strategy on HIV and TB Prevention!

3.    We Support the HIV Counselling and Testing (HCT) campaign – but implementation must be drastically improved!

4.    We Demand the integration of Community Health Care Workers (CCWs) into the health system!

5.    We Demand a Human Resources for Health plan by March 2011!

6.    We demand expanded access to improved ART regimens, better HIV and TB drug regimens & TB Integration!

7.    We Demand a Plan for Sustainable National and International Financing of the HIV and TB Response!

8.    We demand Social Assistance for people who are chronically ill!

9.    We demand that SANAC be revived as an effective and accountable institution driven by civil society priorities!

10.    Build independent, effective, accountable Civil Society organisations!



Please circulate and discuss the document in your organizations and networks, and forward your input and endorsements to Kate Paterson [paterson@section27.org.za]



 

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OSLO Declaration on HIV Criminalisation. 2/12

Prepared by international civil society in Oslo, Norway on 13th February 2012

1. A growing body of evidence suggests that the criminalisation of HIV non-disclosure, potential exposure and non-intentional transmission is doing more harm than good in terms of its impact on public health and human rights.[1]

2. A better alternative to the use of the criminal law are measures that create an environment that enables people to seek testing, support and timely treatment, and to safely disclose their HIV status.[2]

Download this declaration here(PDF, 117.32 KB, 5pg)
Sign the Declaration

3. Although there may be a limited role for criminal law in rare cases in which people transmit HIV with malicious intent, we prefer to see people living with HIV supported and empowered from the moment of diagnosis, so that even these rare cases may be prevented. This requires a non-punitive, non-criminal HIV prevention approach centred within communities, where expertise about, and understanding of, HIV issues is best found.[3]

4. Existing HIV-specific criminal laws should be repealed, in accordance with UNAIDS recommendations.[4] If, following a thorough evidence-informed national review, HIV-related prosecutions are still deemed to be necessary they should be based on principles of proportionality, foreseeability, intent, causality and non-discrimination; informed by the most-up-to-date HIV-related science and medical information; harm-based, rather than risk-of-harm based; and be consistent with both public health goals and international human rights obligations.[5]

5. Where the general law can be, or is being, used for HIV-related prosecutions, the exact nature of the rights and responsibilities of people living with HIV under the law should be clarified, ideally through prosecutorial and police guidelines, produced in consultation with all key stakeholders, to ensure that police investigations are appropriate and to ensure that people with HIV have adequate access to justice.

We respectfully ask Ministries of Health and Justice and other relevant policymakers and criminal justice system actors to also take into account the following in any consideration about whether or not to use criminal law in HIV-related cases:

6. HIV epidemics are driven by undiagnosed HIV infections, not by people who know their HIV-positive status.[6] Unprotected sex includes risking many possible eventualities – positive and negative – including the risk of acquiring sexually transmitted infections such as HIV. Due to the high number of undiagnosed infections, relying on disclosure to protect oneself – and prosecuting people for non-disclosure – can and does lead to a false sense of security.

7. HIV is just one of many sexually transmitted or communicable diseases that can cause long-term harm.[7] Singling out HIV with specific laws or prosecutions further stigmatises people living with and affected by HIV. HIV-related stigma is the greatest barrier to testing, treatment uptake, disclosure and a country’s success in “getting to zero new infections, AIDS-related deaths and zero discrimination”.[8]

8. Criminal laws do not change behaviour rooted in complex social issues, especially behaviour that is based on desire and impacted by HIV-related stigma.[9] Such behaviour is changed by counselling and support for people living with HIV that aims to achieve health, dignity and empowerment.[10]

9. Neither the criminal justice system nor the media are currently well-equipped to deal with HIV-related criminal cases.[11] Relevant authorities should ensure adequate HIV-related training for police, prosecutors, defence lawyers, judges, juries and the media.

10. Once a person’s HIV status has been involuntarily disclosed in the media, it will always be available through an internet search. People accused of HIV-related ‘crimes’ for which they are not (or should not be found) guilty have a right to privacy. There is no public health benefit in identifying such individuals in the media; if previous partners need to be informed for public health purposes, ethical and confidential partner notification protocols should be followed.[12]

This document is also available in French, German, Italian, and Spanish here

References

[1] UNAIDS. Report of the Expert Meeting on the Scientific, Medical, Legal and Human Rights Aspects of Criminalisation of HIV Non-disclosure, Exposure and Transmission, 31 August-  2 September 2011. Geneva, February 2012.

[2] UNAIDS/UNDP. Policy Brief: Criminalization of HIV Transmission. Geneva, July 2008; Open Society Institute. Ten Reasons to Oppose the Criminalization of HIV Exposure or Transmission. 2008; IPPF,GNP+ and ICW. Verdict on a Virus. 2008. See also: IPPF. Verdict on a Virus (documentary) 2011.

[3] GNP+/UNAIDS. Positive Health Dignity and Prevention: A Policy Framework. Amsterdam/Geneva, January 2011.

[4] UNAIDS/UNDP. Policy Brief: Criminalization of HIV Transmission. Geneva, July 2008.

[5] UNAIDS. (2012) Op. cit.

[6] Marks G et al. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 20(10):1447-50, 2006; Hall HI et al. HIV transmissions from persons with HIV who are aware and unaware of their infection, United States. AIDS 26, online edition. DOI: 10.1097/QAD013e328351f73f, 2012.

[7] Bernard EJ, Hanssens C et al. Criminalisation of HIV Non-disclosure, Exposure and Transmission: Scientific, Medical, Legal and Human Rights Issues. UNAIDS, Geneva, February 2012; Carter M. Hepatitis C surpasses HIV as a cause of death in the US. Aidsmap.com, 21 February 2012.

[8] UNAIDS. Getting to Zero: 2011-2015 Strategy. Geneva, December 2010.

[9] Bernard EJ and Bennett-Carlson R. Criminalisation of HIV Non-disclosure, Exposure and Transmission: Background and Current Landscape. UNAIDS, Geneva, February 2012.

[10] GNP+/UNAIDS (2011) Op. cit.

[11] Bernard EJ and Bennett-Carlson R (2012) Op. cit.

[12] UNAIDS. Opening up the HIV/AIDS epidemic: Guidance on encouraging beneficial disclosure, ethical partner counselling & appropriate use of HIV case-reporting. Geneva, 2000.

 

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Global Fund Call to Action. 04/12/2011

PLEASE SIGN ON TO THE CALL TO ACTION BELOW, you can send your reply to jw@icssupport.org, and please also put up the Call to Action on your websites.

The cancellation by the Global Fund to Fight AIDS, TB and Malaria of all new programming until 2014 is unacceptable. This decision will cost lives and cripple international efforts to deliver on health-related goals, breaking promises made to some of the world’s most vulnerable people, and punishing the Global Fund's success of the last ten years. 

People living with HIV and their supporters, as well as communities affected by TB or malaria, are extremely concerned about the damage under-funding of the Global Fund is causing. We therefore demand that:

 

· The Global Fund Board and Secretariat mobilise the resources necessary to scale-up the response to the three diseases through a new funding opportunity for 2012, estimated at US$2 billion.[1]

 

·       Donors to the Global Fund – particularly governments – urgently deliver on the commitments they made to meet health goals[2] and to fund the Global Fund at its Replenishment Meeting in 2010.[3]

 

·       The Global Fund hold an emergency donor conference and issue a new call for proposals before the International AIDS Conference in July 2012 to fully fund the scale-up of programmes that will fundamentally changing the course of these three epidemics, and put the world on the path towards ending AIDS.

This is 200 days from 1 January. 200 days to save the Global Fund.

We cannot wait until 2014 for the Global Fund to support further scale-up of programmes and life-saving treatment. We urgently call on the Global Fund to meet the timeline above and for donors and affected countries to ensure that interventions with the highest impact on the three epidemics are supported.

The clock is ticking. Millions of lives are at stake.



[1] See “Resource Scenarios 2011-2013”, p 15. Scenario 2 estimates the cost of a new Round in 2011 to be US$2.7 billion. An estimated US$0.6 billion is available in uncommitted assets for continuation of essential programs, which would be assumed to be included in funding requests through new proposals. US$1.1 billion of the funding required could be raised if all 2010 donor pledges to the Global Fund were met.

[2] Including the UN health MDGs (http://www.un.org/millenniumgoals/) and the UN High Level Meeting on HIV/AIDS (http://www.un.org/en/ga/aidsmeeting2011/)

[3] The US contribution partially falls outside the replenishment and is under threat by Congress; Belgium, Denmark, EC and the Netherlands have not contributed their 2010 pledges and Denmark has since announced a pledge reduction; Spain, Italy, and Ireland did not pledge and have outstanding payments from previous years. For 2010 pledges, see http://www.theglobalfund.org/en/mediacenter/pressreleases/Donors_commit_US$11_7_billion_to_the_Global_Fund_for_next_three_years/ for pledges and http://www.theglobalfund.org/documents/core/financial/Core_PledgesContri...

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Petition to the World Council of Churches - Please support!

Health and Healing – Healing is part of the churches’ mission and has to remain at the core of the work of Christian communities as well as the World Council of Churches.

What’s it all about?

For more than 2000 years, acts of healing have characterized the life and essence of Christian communities. They are central to the mission of local parishes as well as to the charitable work of churches around the world.

We are worried that issues of 'Health and Healing' will not be represented as an independent programme within the World Council of Churches following the General Assembly in Busan in November this year.

What needs to happen?

Together with our partners we have drafted an appeal pleading to preserve the WCC’s health work. The Appeal can be read below.

We are asking you to take note of this document and to add weight to the concern through your signature. We are collecting the names of all supporters and will forward them to the WCC’s Central Committee.

 

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Research and Science of HIV

Lyn's Comment:

I sometimes hear concerns that information on scientific research, especially about potential prevention and treatment options, is conveyed in a way that might lead to false hope and misinformation.  The news in this section of the website is about new developments – about methodologies and treatments that have not yet been proven, or has not been developed in practical application.  Although these are not of immediate benefit, it is still exciting to learn which future developments hold hope.

You might also read of some new development in other relevant sections, such as vaccines or microbicides.

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Research News 2018

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SA to Conduct First HIV Study On Transgender Women. 4/1/2018

Published by IOL

The Human Sciences Research Council (HSRC) on Thursday said that it would be conducting the first South African integrated biological and behavioural survey on HIV in transgender women looking at HIV prevalence in South African transgender women.

This study will be conducted in the Cape Town, Johannesburg, and the Buffalo City Metro in the Eastern Cape beginning later this month.

The HSRC said that these sites were selected because of the existence of civil society organisations working with transgender women to provide technical assistance, including the Feminist Collective in East London, and the Sex Workers' Advocacy and Education Taskforce (SWEAT) among others.

The study was initiated and supported by the United States Centers for Disease Control and Prevention (CDC) with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). It will be supported by various South African and international academic and civil society partners.

The study aims to survey 300 transgender women in each of the three study sites with a total sample of 900 respondents. 

In addition, respondents will also have access to HIV antibody testing to test for HIV prevalence, antiretroviral testing, HIV viral load testing to test the level of HIV in the body, screening for TB and testing for sexually transmitted infections.

HSRC's chief executive, Professor Crain Soudien, said in a statement that South Africa will be able to document the HIV prevalence in transgender women for the first time.

"The data can also be used to monitor the sequential stages of HIV medical care, that is the care and treatment cascade that transgender women experience from diagnosis to achieving the goal of viral suppression, a very low level of HIV in the body," Soudien said.

"Our fight against HIV will gain traction if we continue to investigate, and understand, the significant behaviours, attitudes and perceptions which can contribute towards infection, effective treatment and support.  It is work such as this that gives expression to the slogan, social science which matters."

The study aims to identify the social, structural, economic and cultural factors that are related to HIV infection in transgender women, understand risk behaviours and practices related to HIV infection and onward transmission in transgender women, and also determine the percentage of transgender women who are HIV positive in the three study sites.

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Research News 2017

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New Molecule Shows Promise in HIV Vaccine Design. 29/10/2017

Published by SCIENCENEWSLINE

Researchers at the University of Maryland and Duke University have designed a novel protein-sugar vaccine candidate that, in an animal model, stimulated an immune response against sugars that form a protective shield around HIV. The molecule could one day become part of a successful HIV vaccine.

"An obstacle to creating an effective HIV vaccine is the difficulty of getting the immune system to generate antibodies against the sugar shield of multiple HIV strains," said Lai-Xi Wang, a professor of chemistry and biochemistry at UMD. "Our method addresses this problem by designing a vaccine component that mimics a protein-sugar part of this shield."

Wang and collaborators designed a vaccine candidate using an HIV protein fragment linked to a sugar group. When injected into rabbits, the vaccine candidate stimulated antibody responses against the sugar shield in four different HIV strains. The results were published in the journal Cell Chemical Biology on October 26, 2017.

The protein fragment of the vaccine candidate comes from gp120, a protein that covers HIV like a protective envelope. A sugar shield covers the gp120 envelope, bolstering HIV's defenses. The rare HIV-infected individuals who can keep the virus at bay without medication typically have antibodies that attack gp120.

Researchers have tried to create an HIV vaccine targeting gp120, but had little success for two reasons. First, the sugar shield on HIV resembles sugars found in the human body and therefore does not stimulate a strong immune response. Second, more than 60 strains of HIV exist and the virus mutates frequently. As a result, antibodies against gp120 from one HIV strain will not protect against other strains or a mutant strain.

To overcome these challenges, Wang and his collaborators focused on a small fragment of gp120 protein that is common among HIV strains. The researchers used a synthetic chemistry method they previously developed to combine the gp120 fragment with a sugar molecule, also shared among HIV strains, to mimic the sugar shield on the HIV envelope.

Next, the researchers injected the protein-sugar vaccine candidate into rabbits and found that the rabbits' immune systems produced antibodies that physically bound to gp120 found in four dominant strains of HIV in circulation today. Injecting rabbits with a vaccine candidate that contained the protein fragment without the sugar group resulted in antibodies that primarily bound to gp120 from only one HIV strain.

"This result was significant because producing antibodies that directly target the defensive sugar shield is an important step in developing immunity against the target and therefore the first step in developing a truly effective vaccine," Wang said.

Although the rabbits' antibodies bound to gp120, they did not prevent live HIV from infecting cells. This result did not surprise Wang, who noted that it usually takes humans up to two years to build immunity against HIV and the animal study only lasted two months.

"We have not hit a home run yet," Wang noted. "But the ability of the vaccine candidate to raise substantial antibodies against the sugar shield in only two months is encouraging; other studies took up to four years to achieve similar results. This means that our molecule is a relatively strong inducer of the immune response."

The researchers' next steps will be to conduct longer-term studies in combination with other vaccine candidates, hone in on what areas of gp120 the antibodies are binding to and determine how they can increase the antibodies' effectiveness at neutralizing HIV.

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Population Council Advances Non-Antiretroviral Multipurpose Prevention Technology For HIV and STI Prevention to Clinical Trial. 12/10/2017

Published by POPCOUNCIL

First in-human clinical trial of griffithsin, a naturally occurring anti-HIV protein, which limits risk of cross-resistance to antiretroviral (ARV) products

NEW YORK, NY—The Population Council today announced the enrollment of the first participant in the Phase I clinical trial evaluating PC-6500 (griffithsin in a carrageenan gel), an investigational multipurpose technology to prevent HIV and sexually transmitted infections (STIs), two major threats to sexual health around the world. This is the first in-human study of griffithsin (GRFT), a naturally occurring algae protein that inhibits HIV and other pathogens, including Herpes Simplex Virus (HSV-2).                                                                                                              

“Multipurpose products that prevent sexually transmitted infections, including HIV, must be a research and development priority,” said James Sailer, vice president and executive director of the Center for Biomedical Research at the Population Council. “We are excited to be enrolling participants in the first trial of a griffithsin-containing multipurpose prevention technology, which could be an important addition to the HIV and STI prevention toolbox.”

PC-6500 is an investigational MPT comprised of griffithsin (GRFT) in a carrageenan gel. The goal of the trial is to assess the safety, pharmacokinetics (PK) (how the body processes the compound) and pharmacodynamics (PD) (how the body is affected by the compound) of PC-6500 to support the further development of GRFT as an MPT to prevent HIV and STIs for on-demand or sustained use.

The trial is being conducted at Albert Einstein College of Medicine in the U.S., and 27 women aged 18–49 will be enrolled. Results are expected in 2018. Seven women will participate in an open-label period receiving a single dose of PC-6500; data from this trial will inform the randomized, placebo-controlled safety, PK and PD assessment of PC-6500. Twenty women will be randomized to receive either PC-6500 or a placebo and will use the gel once daily for 14 days.

Griffithsin, initially discovered in the Center for Cancer Research at the National Cancer Institute, is the most potent anti-HIV agent described in the literature to date and can be produced relatively easily and inexpensively. Griffithsin has been found safe and effective when tested against HIV and HSV-2 in animal studies.

“Griffithsin’s mode of action and the fact that it is not used in HIV treatment means there is no risk that users of a griffithsin-prevention product could develop cross-resistance to ARVs that are used for treatment,” said George Creasy, medical director at the Population Council’s Center for Biomedical Research. “This may increase the possibility that a griffithsin multipurpose prevention technology could become an over-the-counter product and increase access for people in high-demand, low-resource settings.”

Population Council scientists are pursuing multiple delivery systems for GRFT, including fast-dissolving inserts and intravaginal rings to provide on-demand and sustained protection. Additional delivery systems may be developed in the future. Support for the Non-ARV-based Microbicide that Blocks HIV and Other STIs project is provided by the U.S. Agency for International Development, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) (USAID Cooperative Agreement number AID-OAA-A-14-00009).

The Population Council is working to help women and men worldwide avoid HIV, other STIs, and unintended pregnancy. HIV infection is the leading cause of death among women aged 15–44. HSV-2 infects more than 500 million people around the world.

 

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Scientists Set the Stage for Combination HIV-Antibody Treatment and Prevention. 25/9/2017

Published by POZ

Researchers have reached an important milestone in the long-range effort to harness the power of so-called broadly neutralizing antibodies against HIV for use as treatment and prevention of the virus. Experiments in monkeys found that synthesizing three such antibodies into one protected the primates against exposure to SHIV, a simian version of HIV developed for research purposes.

Compared with individual antibodies, the “trispecific” antibody, which contains three prongs, each of which affects a different site on the surface, or envelope, of HIV, proved superior in thwarting the virus in the test animals. This finding suggests that, just as with standard antiretroviral (ARV) treatment, a combination-therapy approach will prove the most potent and put up the highest barrier against resistant virus.

Publishing their findings in the journal Science, National Institutes of Health (NIH) researchers, working in partnership with the Paris-based pharmaceutical company Sanofi, conducted extensive laboratory tests to identify the most promising double or triple combinations of antibodies. They used Sanofi’s technology to combine these antibodies into single, multipronged antibodies. Ultimately, they found that the combination that best attacked HIV included the antibodies VRC01, PGDM1400 and 10E8v4.

Scientists are currently investigating VRC01 in a pair of large, multiyear Phase III clinical trials to determine its efficacy as pre-exposure prophylaxis (PrEP) against HIV when infused every eight weeks.

The researchers in the trispecific antibody study infused eight macaque monkeys with VRC01, eight monkeys with PGDM1400 and eight monkeys with the triple-pronged antibody. Five days later, they exposed all the monkeys to two strains of SHIV. One strain of the virus was vulnerable to attack by VRC01 and the trispecific antibody but resistant to PGDM1400, while the other strain was vulnerable to attack by PGDM1400 and the trispecific antibody but resistant to VRC01.

Five of the eight monkeys (62.5 percent) that received PGDM1400 and six of the eight (75 percent) that received VRC01 became infected with SHIV. None of the animals that received the trispecific antibody were infected.

Sanofi and the National Institute for Allergies and Infectious Diseases (NIAID), a division of the NIH, are gearing up for a Phase I human trial of the trispecific antibody to begin in 2018. The trial will test the antibody’s safety and how it is metabolized in HIV-negative individuals. NIAID is also looking into launching another Phase I trial of the trispecific antibody among HIV-positive individuals.

Scientists hope that successful clinical trials—there are three main phases before a new treatment may receive approval from the Food and Drug Administration—may yield a new way to treat and prevent the virus, with intermittent infusions of antibodies.

The study authors believe that this method of combining antibodies could also lead to new treatments for infectious diseases other than HIV, as well as autoimmune diseases and cancers.

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Progress Reported on Monthly HIV Shot. 17/8/2017

Published by HEALTHLINE

A new clinical trial reveals promising results on a monthly HIV shot that could someday replace the current daily regimen of pills.

HIV AIDS treatment

A daily regimen of pills for those living with HIV may soon be a thing of the past.

A clinical trial published in the Lancet showed a new injectable antiretroviral therapy (ART) given every four or eight weeks may be just as effective as the daily oral medications that are currently used to keep the virus under control.

The current treatment for people living with HIV involves a lifelong, daily schedule of oral medication.

Maintaining the strict regimen is a struggle for some people, and low compliance can cause treatment failure and a rise in drug-resistant mutations.

The authors of the study hope the long-lasting ART could revolutionise HIV treatment.

“Adherence to medication remains an important challenge in HIV treatment. Long-acting injectable ART could provide some patients with a more convenient approach to manage HIV infection that avoids daily oral dosing, and the need to keep, store, and transport medications as they go about their daily lives,” Dr. David Margolis, an author of the study, said in a press release.

How the trial was conducted

The trial took place at 50 sites in the United States, Canada, Germany, Spain, and France.

During the study, 309 participants were first put on daily oral medication for 20 weeks.

Once they had achieved viral suppression, some of the study participants were then given the injectable ART as a form of maintenance therapy either every four weeks or every eight weeks for a 96-week period.

At the end of the trial, viral suppression was maintained in 94 percent of participants who were given the injectable ART every eight weeks, compared with 87 percent in the four-week group.

Of the patients who were given oral medication throughout the 96-week period, 84 percent maintained viral suppression.

Researchers say the results are promising and further trials will take place.

“The introduction of single-tablet medication represented a leap forward in ART dosing, and long-acting antiretroviral injections may represent the next revolution in HIV therapy by providing an option that circumvents the burden of daily dosing. The results through to 96 weeks with this two-drug regimen are encouraging, and we now need further research, including the ongoing phase 3 trial, to confirm these findings,” Margolis said.

HIV treatment has evolved

Slightly more than 1 million people in the United States are infected with HIV. Of those, 1 in 7 don’t know they’re infected.

This latest study represents another potential advancement in a long evolution of medication options.

“The evolution of treatment for HIV since the discovery of the virus has seen the development of single agents, then multiple agents that sometimes needed to be taken every four hours, to the development of single pills that could be taken once daily. The development of injectables that might need to be administered only every four or eight weeks, or perhaps even longer with further developments, represents an evolution in treatment that aims to make taking antiretroviral therapy more convenient and therefore more likely,” Rowena Johnston, PhD, vice president and director of research at the Foundation for AIDS Research (amfAR), told Healthline.

“We know that adherence to pill taking, whether for HIV treatment or prevention, or for blood pressure and diabetes medications, or for contraception, is difficult for some people,” Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition (AVAC), told Healthline.

“We know that simplified regimens like once-daily pills, and potentially this periodic injection, can help many people stick to their treatment or prevention better. That means better health for them, and when the HIV in their system becomes undetectable it means they can’t pass on HIV to their sexual partners,” he added.

The importance of adherence

Low adherence to HIV medication can have severe consequences.

Failing to adhere to the regimen of medication can make someone with HIV more susceptible to other infections. It can also allow the virus in their system to mutate and become resistant to the drugs they’re prescribed.

This means a person may need to move on to second- and third-line therapies that are more difficult to adhere to and are often also more expensive.

A long-lasting injectable ART may assist in improving compliance for some people. But Warren points out that currently, healthy people living with HIV may get two to six months of their medication from a pharmacy at one time.

As such, a monthly or two monthly injection may actually require more visits to a healthcare provider than an oral medicine would.

However, he says, having more options is a positive step forward.

“Any treatment regimen, whether a daily pill or an injection every two months, has an adherence component. A periodic injection will work well for some people and not for others. The bottom line is we need more options that meet the needs of more people,” he said.

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The Future of Research: HIV Cure and Cancer. 14/9/2017

Published by IASOCIETY

As the second leading cause of death globally, cancer is a serious global health problem, accounting for 8.8 million deaths in 2015 alone.

Across the world, scientists are collaborating to develop effective treatments and tools to combat this disease and save lives, making remarkable advances. In the long search for innovative ways to achieve a cure or remission for HIV, a rigorous analysis of these approaches and inter-disciplinary collaboration between the two fields could be a game changer for researchers and scientists working towards a cure for HIV. In fact, efforts are already underway to evaluate various cancer drugs to assess their capacity to reduce viral persistence.

To explore the crosslink between these two fields, the International AIDS Society (IAS) hosted an unprecedented forum, the IAS HIV Cure & Cancer Forum, at the Institut Curie, immediately prior to the 9th IAS Conference on HIV Science in July 2017. The aim of this forum was to promote interactions between the HIV cure and cancer fields, and to share knowledge and accelerate research on virology, immunology and epigenetics in HIV and cancer. 

Today, on World Cancer Research Day, it is worth reviewing the key outcomes from the recent Forum, with an eye towards galvanizing synergistic, results-oriented collaboration with these disciplines. 

Although HIV, a viral infection, is distinct from cancer, a constellation of diseases linked with abnormal cell growth, there are a number of synergies between the HIV and cancer research fields. Immunotherapy, a growing focus for HIV cure research, builds in part on learning generated from the cancer field. In both HIV cure and cancer research efforts, a number of parallel obstacles are encountered, including the persistence of virus and certain types of cancer, immune system functioning, treatment resistance, and “residual disease”, when the disease itself is undetectable but a few cells are able to reactivate and cause a relapse.

There is also epidemiological overlap between HIV and cancer. People living with HIV are several thousand times more likely than uninfected people to be diagnosed with Kaposi sarcoma, at least 70 times more likely to be diagnosed with non-Hodgkin lymphoma, and, among women, at least five times more likely to be diagnosed with cervical cancer.

The convergence of the cancer and HIV cure agendas underscores the potential value of interdisciplinary collaboration.

The Forum underscored the urgent need for HIV and cancer researchers to combine their expertise to advance research in therapeutic strategies. To develop therapeutic and curative regimens, both for the immune system and for infected or malignant cells, is to understand the destiny and plasticity of cells. Recent progress in characterizing the epigenetic parameters that define cell identity, and the ability to reprogramme these choices, offer new research opportunities to explore.

Additionally, the two disciplines must continue working together to develop and apply novel technologies in a post-genome era. Where possible, the two disciplines should share knowledge to accelerate research, overcome obstacles and identify new opportunities for collaboration. As one example, proven methods for counteracting side effects of antiretroviral therapy might aid in minimizing side effects of immunotherapies in cancer.

As the HIV cure field could greatly benefit from the scientific advances in cancer research, greater collaboration could also help the cancer field emulate an amazing strength and pillar of the AIDS response – patient engagement and advocacy. HIV activism played a pivotal role in combatting indifference and accelerating access to new treatments. The HIV cure field provides an advocacy model to other disciplines, such as cancer, to mobilize authorities on a global scale to advocate for focused research, screening, and reduced treatment costs.

Both the HIV and cancer fields have benefited from a granular, disease-specific focus. But the Forum demonstrated how collaboration and mutual learning between these fields could also prove equally beneficial.  As a researcher, I am now even more convinced that the collaborative interaction between HIV and cancer research could be the future and I look forward to working with my fellow scientists to continue this exploration together.

 

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Why Curing HIV May Be Like Curing Cancer – And May Be As Difficult. 3/8/2017

Published by AIDSMAP

Part 1 of a report from the 2017 IAS HIV Cure and Cancer Forum.

For the last few years, a specialist symposium on HIV cure research has preceded the International AIDS Society (IAS) Conferences and this one was no exception, with a 1.5-day Forum at Paris’s Curie Institute on the weekend the 9th IAS Conference on HIV Science (IAS 2017) opened.

This time round, there was a difference; this one was called the IAS HIV Cure and Cancer Forum. This is due to the dawning recognition that curing HIV and curing cancer have aspects in common, and that established or experimental cancer drugs may also have a part to play in curing HIV.

HIV and cancer: similarities and differences

There are many differences, of course, as Monsef Benkirane of France’s Institute of Human Genetics said in an opening lecture. HIV is caused by an infection and cancer by spontaneous misbehaviour by cells (though in some cancers, this may be set off by infections). Down in the heart of the cell, however, this issue is the same: cancer cells and HIV-infected cells harbour rogue genetic material that leads cells either to grow uncontrollably (cancer) or to derange the immune system (HIV). This means that they are both hard to cure: potentially, just one HIV-infected cell or one cancer cell can lead to a relapse.

It also means that the same tools that are now leading to a dramatic improvement in cancer cure and remission rates, including sophisticated drugs that target markers specific to cancer cells, could be used with HIV.

HIV-infected and cancer cells share one deadly trick. Cells with their rogue DNA can ‘de-differentiate’ when they are under attack, whether by drugs or the immune system. This means they retreat to an earlier stage of cellular evolution where they are invisible to the immune system. Benkirane said: “When you treat, you actually create new cancer stem cells”.

In HIV, something similar happens: energised immune cells that actively produce virus swiftly burn out, but a proportion return to a quiescent state, ready to spring into action again as soon as the pressure from antiretroviral therapy (ART) is eased. This is the “HIV reservoir”, and its identification and destruction (for a complete cure) or reduction/containment (for long-term remission) is the central barrier to be overcome if we are to find a cure.

The line of attack taken furthest by HIV cure researchers has used HDACs (histone deacetylase), drugs that ‘kick’ the sleeping genes in reservoir cells back into a state of wakefulness. The full strategy has been called ‘kick and kill’ as it has been hoped that the reservoir cells, once reactivated and visible to the immune system, could be killed naturally by immune responses or purged by antibody-based drugs that target them.

But repeated experiments with different HDACs have shown that, while they certainly wake up reservoir cells and turn them into short-lived virus-productive ones, they are unable to prevent new cells being ‘seeded’ with HIV and then returning to a quiescent state. The size of the reservoir cells therefore does not change significantly.

Immune checkpoint inhibitors

The drug targets we really need to work on are the cellular molecules that prompt the cell to stop whatever immune job it is doing and revert to its quiescent state. Both cancer cells and HIV-infected cells are particularly rich in these so-called immune checkpoint receptors. It is thought that their function is, when the body is facing a hostile environment ranging from viral proliferation to chemical attack, to sequester a proportion of the immune system so that not all of it is permanently damaged.

There are a number of different immune checkpoint molecules. Ones already targeted by some cancer drugs include CTL-4 (cytotoxic T-lymphocyte-associated protein 4), PD-1, where the PD stands for “Programmed Death” (one of the things PD-1 can do is make cells self-destruct), TIGIT (T-cell immunoreceptor with Ig and ITIM domains), and JAK (Janus kinase). These are all inhibitory molecules, butting cells into the reservoir state, though some like the TLR (toll-like receptor) family are excitatory and TLR agonists (stimulators) continue to be under investigation as cell activators.

As with the HDACs, a number of CTL4, PD-1 and JAK inhibitors already exist as cancer drugs. These include the CTL-4 antagonist ipilimumab (prescribed under the brand name Yervoy for advanced melanoma), the PD-1 antagonists nivolumab (Opdivo) and pembrolizumab (Keytruda) which are used for advanced melanoma, small-cell lung cancer and kidney and bladder cancer, and the JAK inhibitors baricitinib (Olumiant) and ruxolitinib (Jakafi), which are used against a rare bone marrow cancer called myelofibrosis and also against auto-immune disorders such as rheumatoid arthritis and psoriasis. Some of these drugs have shown life-prolonging effects in cancers that used to be rapidly terminal.

The Cure and Cancer Forum heard about several experiments using these agents in cancer patients with HIV. Timothy Henrich of the University of California, San Francisco, a researcher who has previously produced spells of HIV undetectability off ART in two patients given bone marrow transplants, gave data from three patients with lung cancer and HIV who were given multiple doses of pembrolizumab.

In all three patients, measures of T-cell activation decreased and in one patient, who was on ART, the amount of intracellular DNA (a measure of how many cells in the ‘reservoir’ are infected) went down transiently. In a third patient, who was not on ART, both his general T-cell function decreased and his blood plasma viral load.

Brigitte Autran of Hôpital Pitié Salpêtrière in Paris gave data from 12 patients with non-small-cell lung cancer who had been given nivolumab. They were a diverse group. One was a cisgender and another a transgender woman, the others were gay men. They were aged between 40 and 77 and had been diagnosed between 1980 and 2005. CD4 counts ranged between 60 and 700 cells/mm3. Most had viral loads below 20 copies/ml, though in two cases they were marginally detectable, at 34 and 53 copies/ml.

In one patient, the one with the lowest CD4 count, there was a significant T-cell rise and a rise in the proportion of cells with an HIV-specific immune response. In another, a rise in the HIV-specific immune response was accompanied by a significant decrease in intracellular HIV DNA. However, he was the only one who showed indications of a shrunken HIV reservoir and other immunological effects in him and other patients appeared transient.

Christina Gavegnano of Emory University in Atlanta, Georgia presented data from animal studies of baracitinib in recently-infected monkeys and found that, compared with treatment with lamivudine, there was a 700-fold reduction in the number of non-dividing latent CD4 T-cells established in the body. The drug could possibly be used as an addition to ART that would slowly shrink the HIV reservoir to the point where a treatment interruption could be considered. A human trial of ruxolitinib in 60 adults (A5336) is underway.

Results with PD-1 and CTL-4 antagonists, and JAK inhibitors, have not so far been impressive, with only a minority of patients demonstrating strong or durable responses, if any. Sharon Lewin of the University of Melbourne said that interpreting PD-1 blocker studies in people with cancer is already difficult because cancers are heterogeneous and people with HIV who have cancer may not be representative of other HIV-positive people.

“We need to do studies in HIV-positive patients without cancer,” she said. “And we need to study combination therapies. But combinations of immune checkpoint inhibitors, while proving to have more powerful results in some cancers, are too toxic to use with people who only have HIV.” 

In some studies of patients with melanoma, as many as 50% of patients had experienced severe or life-threatening side-effects or even deaths from the drugs.

Reservoir-cell signal found

One thing that would help efforts to cure HIV and to use new types of drugs to eradicate HIV-infected cells would be if reservoir cells could be identified more easily. The proportion of central memory resting T-cells that are infected with HIV – the reservoir cells – ranges from one per thousand to one per million. So far, however, we have had no clear way to identify them – and that means no way to target these cells alone and no other cells with drugs, which is the way to reduce toxicity.

In what might be the biggest news in cure research at the conference, it looks like that marker might have been found. Two different studies presented at the Cure Forum and at the main conference found that reservoir cells express much higher levels of a cellular receptor molecule called CD32a than other cells. While reservoir cells also express somewhat higher levels of other proteins, including immune checkpoint receptors and the CD2 molecule, this is the first time such a strong association has been found.

Genevieve Martin of the University of Oxford told the Forum, and in a conference presentation, that levels of CD32a were no higher generally in people with HIV than in HIV-negative people, with about 1.5% of immune cells in general expressing it. But in people with HIV, reservoir cells had from 100 to 1000 times as much of the molecule expressed on their surface; and these cells were also likely to be enriched with PD-1 and other immune checkpoint receptors.

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Can We Achieve a Complete HIV Cure in More Patients? 3/8/2017

Published by AIDSMAP

Part 3 of a report from the 2017 IAS HIV Cure and Cancer Forum.

What all the different approaches discussed in the previous report have in common is to put HIV infection into persistent remission, but they do not completely remove HIV from the body. But in what is still the one case of a person cured of HIV, that is what was achieved; researchers have not managed to find any trace of HIV in the body of Timothy Ray Brown (who attended a symposium presenting the main data from the Cure and Cancer Forum) nearly a decade after he was cured.

A cancer patient, Brown’s cure involved a hazardous bone marrow transplant that made him very ill and left him with some permanent nervous system damage. Nonetheless, experiments continue to induce the complete removal of HIV using similar transplant technology in patients with cancer and HIV.

In the HIV Cure and Cancer Forum (held before the IAS 2017 conference), Maria Saldago of the IrsiCaixa AIDS Research Institute near Barcelona in Spain presented results from ICISTEM, a cohort of patients with HIV and advanced cancers (mainly leukaemia and lymphoma) who have had bone marrow transplants. As such patients are rare, ICISTEM has only collected data on 23 patients, 11 of whom have died.

Salgado presented data on the six patients in the remaining 12 who have had more than two years’ follow-up.

In five of these six patients, the HIV-free bone marrow stem cells rapidly replaced their cancerous and HIV-infected lymphocytes. Ultrasensitive tests can find no HIV RNA in their blood – their viral load, in short, approaches zero – and can also find no HIV DNA in their reservoir cells. In some patients, HIV undetectability in reservoir cells happened within a month; in others, HIV levels slowly declined over a period of up to a year.

The key to full replacement by new cells appeared to be graft-versus-host disease (GvHD), a condition in which the grafted bone marrow cells ‘reject’ the body’s own cells as foreign – essentially the reverse of what happens in typical transplant rejection. This is normally a condition transplant doctors try to avoid, as it creates severe and in some cases lethal inflammation.

In the case of these patients, and in Timothy Ray Brown, GvHD appears to have been an essential part of the process whereby their HIV-infected immune system may have been replaced by a non-infected one. In fact, it may be the essential step: although Brown was transplanted with cells from a donor who was naturally immune to HIV, only six out of the 23 ICISTEM patients have received cells from HIV-immune donors.

Are the ICISTEM patients cured? We don’t know. Although the researchers have failed to find a single copy of HIV DNA in one million resting reservoir cells in some of the patients, the test will be to take these patients off antiretroviral therapy (ART). We have had disappointments before, as when HIV reappeared, after a delay, in the so-called ‘Boston patients’ even though their DNA became completely undetectable.

Salgado told the Cure and Cancer Forum that treatment interruptions were planned for early next year. Then we will find out if Timothy Ray Brown finally has company.

Will enough people come forward for cure research?

Finally, the limiting factor on cure research may not be the complexity of the science involved or the current lack of one strategy that looks more promising than others, but the reluctance of people with HIV to come forward for HIV cure research. While previous surveys have shown a general altruistic interest by people with HIV in volunteering for cure research, when possible consequences are spelled out, interest declines.

Michael Louella of the University of Washington AIDS Clinical Trials Unit has done research into community attitudes towards cure research. A lot of people with HIV, he said, are currently happily on one-pill-a-day therapy and stable and do not want this disrupted.

In addition, the current state of the science means that these chronically-infected people are not the ones cure researchers seek out: the people they need are the cancer patients or those with cancer in remission, the ones failing therapy or who have never needed it, the few treated within days of infection, the few who have voluntarily stopped ART, and the ones who are virally suppressed but who fail to mount an immune recovery.

Louella said that surveys of opinion about HIV cure research had pretty consistently found that people had ‘red lines’ that would deter them from entering a study. These included clinical events such as the reactivation of genes that could cause cancer, CD4 count falls, and the possibility of drug resistance; uncomfortable procedures such as lumbar punctures (spinal taps) and bone marrow biopsies; and side-effects ranging from vomiting to hair loss.

However, the single most often-cited reason that people might hesitate to join a trial was the possibility that they might become infectious again.

“People are loath to lose their hard-won viral undetectability,” Louella commented.

In addition, the cure field itself is unclear about its goals and procedures. What should the ethical policy be on ART interruptions? How do we translate suggestive results from small groups of exceptional patients into larger studies? Is there a way of determining the most promising research avenues and eliminating those that are less fruitful? And how do we deal with the media, who threaten to create popular disillusion by portraying every small research advance as a “cure breakthrough”?

While that breakthrough will one day happen, the road towards it might be slower and less direct than many had thought when cure research was first focused on as a possibility.

 

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South African Girl (9) is Third Child with HIV Remission: Study. 24/7/2017

Published by JACARANDAFM

A South African girl has become only the third child to beat the AIDS virus into long-term remission - almost nine years and counting - after receiving a drug cocktail in infancy, researchers announced Monday.

The child was given a ten-month course of anti-AIDS medicine until she was one year old, then taken off the drugs as part of a medical trial.

Eight years and nine months later, the virus is still dormant and the girl healthy without needing treatment, a research team reported at the International AIDS Society conference on HIV science in Paris.

"This new case strengthens our hope that by treating HIV-infected children for a brief period beginning in infancy, we may be able to spare them the burden of life-long therapy," said AIDS expert Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) which funded the study.

Some scientists refer to sustained, drug-free remission as a "functional cure".

Unlike a traditional cure, where the virus is eradicated, the patient still has HIV in their system but it is so weakened that it cannot replicate or spread to sexual partners.

Researchers hope that by treating people as soon as possible after infection, they can one day induce drug-free remission for sustained periods of time, perhaps for good.

This has become a major focus of research amid fading hopes of finding a permanent cure.

The virus has proven more sneaky than imagined -- it has the ability to hide out in human cells and play dead for years, only to re-emerge and attack as soon as treatment is stopped.

Anti-retroviral (ARV) treatment inhibits the virus, but doesn't kill it, and infected people have to take pills daily for life which are costly and have side-effects.

- Relapse possible -

A rare group of infected people -- fewer than one percent -- are able naturally to stop the virus replicating. They are known as "elite controllers", but the mechanism by which they keep the virus at bay remains a mystery.

The girl does not have "elite controller" DNA, said the study authors.

Among people taking virus-suppressing anti-retroviral drugs, only a few have attained drug-free remission.

They include 14 adults in a French trial who were able to quit their medication after three years and stayed healthy.

A French woman aged 20, treated as a baby, has been healthy for 14 years since stopping her medication -- the longest-known remission.

In the United States, the so-called Mississippi Baby was in remission for 27 months after being given ART for the first 18 months of life, but the virus rebounded in a major let-down for researchers.

Now there is the South African girl -- the first case of remission in a child enrolled in a trial to test the effectiveness of early treatment, for a limited time.

"Relapse is a possibility in any case of remission," underlined study co-leader Avy Violari of the University of the Witwatersrand in Johannesburg.

However, "the fact that remission has been for a long period suggests this is likely to be durable," she told AFP.

Researchers do not understand how the girl achieved remission when 410 other children in the trial did not.

"We can't tell if her immune system would have controlled the virus on its own or if the treatment made a difference," said Sharon Lewin, a professor of medicine at the University of Melbourne.

- 'Impressive' -

The girl was diagnosed HIV-positive on her 32nd day of life. After ten months of treatment, levels of HIV in her blood went from "very high" to undetectible.

Tests conducted when she was nine-and-a-half years old showed the vaguest trace of virus, unable to replicate, said the team. The girl had healthy levels of key immune cells.

Some fear the girl is in a minority of people for whom early treatment is sufficient to induce remission.

"Early treatment is good for lots of reasons. Early treatment stops HIV transmission, early treatment means the immune system stays in better shape and early treatment keeps the (virus) reservoirs small," Lewin told AFP. 

"Early treatment may also increase the chance of remission, but more studies are needed to really prove this."

Michael Brady, medical director of the Terrence Higgins Trust, an AIDS charity, said remission was "impressive".

"We just need to understand more about why this is and then find ways to apply it to others," he commented on the study.

The children in the trial were monitored for rebounding virus levels, and the experts stressed it is not a good idea for people to take themselves off ARV treatment.

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In South Africa, HIV Rates Are Rising In Young Women And Girls. Our New Series Looks At The Reasons Why. 2/8/2017

Published by PRI

Across Women's Lives meets those on the front lines of the fight to stop the rising rate of HIV in young women.

Advocates say they’re beginning to curb HIV transmissions.

At the International AIDS Conference in Paris last week, officials released numbers showing improvement: New infections of children fell by half from 2010 to 2016. AIDS-related deaths have also fallen about 50 percent from their 2005 peak, when the disease killed 1.9 million people.

“This will probably be, in history, the first pandemic that we will be able get control of without a vaccine or a cure,” says Deborah Birx, the US Global AIDS Coordinator who oversees the President’s Emergency Plan for AIDS Relief (PEPFAR).

Controlling the disease requires a multi-pronged effort involving $19 billion in aid and relies on antiretroviral therapy, circumcisions and other interventions to reduce transmission and keep people healthy.

Swaziland has the highest HIV prevalence in the world at 28.8 percent. In July, officials celebrated halving Swaziland’s HIV infection rate. But in a neighboring country, for a select group of people, HIV rates are rising. Across Women’s Lives travels to South Africa to find out what’s happening for women and girls there.

Globally, HIV rates have stabilized over the past 15 years. But global and regional averages can be misleading. Almost half of people living with HIV live in East and Southern Africa.

There, public health officials are working to control the transmission of the disease in a new population of young people.

In 2016, PEPFAR surveys found 3 countries in Africa with measurable progress. But those rates don’t show the whole picture. Nearly 1 in 5 of those living with HIV globally call South Africa home.More than 7.1 million South Africans are HIV positive and public health officials expect to spend $2.5 billion in 2017 to check the disease. But in South Africa, young women contract HIV at rates twice as high as young men.

This series looks at the effort to stop rising HIV rates in young women and girls.

According to a report from the NGO Avert, “poverty, the low status of women and gender-based violence (GBV) have been cited as reasons for the disparity in HIV prevalence between genders, with GBV attributable to an estimated 20–25 percent of new HIV infections in young women.”

South Africa is home to one of the highest rates of rape in the world. The law changed in 2007 to include a better definition of rape, which previously had only covered vaginal penetration of a woman.

"We’ve got to address the sexual violence in our country because that is really driving HIV in this country," says Marlene Wasserman, the host of a popular talk radio show where Wasserman answers questions as Dr. Eve. "One of the things we know is that a contributor towards men raping, is if they themselves were survivors of trauma, or victims of trauma, or if they themselves have witnessed trauma."

South Africa has one of the highest rates of rape in the world

While not a perfect comparison, the United States had a rate of 38.6 rapes per 100,000 people in 2015, also a significantly higher rate than most other countries in the world. Rates in South Africa are falling, but are still so much higher than the rest of the world.

Rate of rape per 100,0002008200920102011201220132014201520406080

Note: For South Africa numbers, the years shown in chart refer to the period from April 1 of the year before to March 31 of the year shown. The graph above shows rapes, not sexual offenses, reported to the South African police. It is difficult to compare rape rates in different countries because of different definitions of rape and sexual assault, but US figures are included to show the vastly higher rate in South Africa. It is also impossible to measure how many rapes are not reported to police.
Source: Africa Check rape statistics in South Africa, UN population data, UN Office on Drugs and Crime

Alex Newman / PRI

"You’ve got people who are economically, absolutely, absolutely poverty stricken, and powerless," Wasserman says. "And so when you have that, as a foundation of men who are powerless, and not able to provide for themselves or a family, there’s a huge amount of anger that happens. And when there’s a huge amount of anger, there’s a huge amount of violence. Male-on-male violence is huge in this country. And it’s expanded into male-on-female violence."

But there’s another factor that also is playing a major role in South Africa’s HIV problem.

‘It’s insanely wealthy’

Researchers say young women are at a greater risk because of early sexual activity and relationships with older men who are already HIV positive.

“Instead of having relationships with their age cohort, they were having relationships with men about seven to eight years older, who are already HIV positive,” Birx says. “It was the age differential that really resulted in the [higher] risk factor to young women.”

Almost half of young women report sexual activity by age 18

AgePercent reportingEngaged in sexVoluntaryCoerced12131415161718010203040

Source: South African Medical Journal, 2015

Alex Newman / PRI

In some cases, this relationship is characterized by the use of the social hashtag #blessed. In South Africa, a “blesser” is an older, wealthier man who can “bless” a younger woman with gifts.

“The Blesser culture is nothing new,” explains Nolwazi Mkhwanazi, a medical anthropologist at the University of the Witwatersrand in Johannesburg, who has studied teenage pregnancy in many communities in South Africa. “It used to be called transactional sex; it used to be called intergenerational sex.”

That intergenerational sex is a driver of HIV infections in young women. The older men often have HIV and then pass the disease on the young woman.

“These blessers are high risk men,” Wasserman explains. “These are men who are probably married, and they’ve got multiple partners. And they’re not using condoms.”

But the rise of smartphones and camera phones has changed the practice.

“It’s happening literally in my phone and all around me,” says Lebohang Masango, 26, who is writing a dissertation about the blesser culture. “It’s very possible that blessers were always around, but it’s just now — because of the highly narcissistic quality of Instagram — we get this insight into how these people are living.”

Masango says the use of #blessed on Instagram exploded in South Africa in December 2015. Being #blessed is similar to having a “sugar daddy,” but with differences.

“When the whole blessers thing exploded, it was about the sheer obscenity of the wealth,” Masango explains. “It was insanely wealthy. Many people are not accustomed to the levels of luxury consumption that were being displayed, especially from relatively unknown young women on social media.”

Some women who seek out blesser relationships are from South Africa's middle class and already have some money to buy clothes and makeup to attract a blesser, Masango says.

"Sandton (a wealthy neighborhood in Johannesburg) is the richest square mile in Africa," Masango says. "It has beautiful restaurants, beautiful nightclubs, a lot of the time when these relationships are solidified, it happens because they met in these areas. You have to have access to that money to begin with. You have to spend money for a blesser to look at you and say, 'I want her on my arm, I want to take her to Dubai.' "

Jokes are even made about how to tell how serious a "blesser" is. A cartoon in South Africa shows levels of blessers. A level one blesser can buy a girl phone credit; a level five blesser takes her on vacation to Dubai.

“[The blessee] wants the three C’s: she wants the cash, the credit card, and the car,” Wasserman says.

For her research, Masango has been seeking out women who defy the stereotypical blesser relationships.

“One young woman, she uses Tinder in order to meet older men,” Masango says. “She’s incredibly firm in her beliefs and very unapologetic about how she feels about being compensated for her time in romantic relationships. 'You pay for my time, you’re paying for my attentions'. She’s studying engineering so she could be studying and spending her energies on herself at a particular time so he must pay for her time and her emotional labor if she will be spending that time with him, instead. She just does this because it’s fun and she refuses to engage with men in ways that are not materially beneficial to herself. That already is a break from the dominant narrative.”

Masango says the women she has met in her research are older — in their early and mid-20s and speak responsibly about HIV prevention.

“The young women I’m studying with really [have] amazing sexual health practices,” she says. “They test before they sleep with anyone. They insist on condoms. They are the people — all of those advertisements — it reached them and it resonates and it works in their lives. They protect themselves even as they’re doing something as risky as having multiple concurrent partner sex.”

Masango’s research matches what PEPFAR has been finding.

Birx, with PEPFAR, says surveys have shown that young women know about HIV, but not all the education efforts seem to work.

“The young women had incredible knowledge about HIV, but none of them believed they were at risk for getting HIV,” she said.

Jabulile, a high school student in South Africa, poses in front a green field.

Jabulile, 17, is a high school student in Khalytsha, a partially informal township in Western Cape, South Africa. Jabulile is a radio reporter at her school and the show often talks about sex and pregnancy. "I have been close with someone who is HIV positive, but like, the way they live their life, it made me believe HIV isn't that much of a big deal," Jabulile says. "It's in your blood, it doesn't affect your personality at all. It doesn't mean you should change who you are and how you define life."

Credit:

Jasmine Garsd / PRI

Still, anthropologist Nolwani Mkhwanazi says talking about sex is a really hard thing to do in South Africa.

“Even though sex ed is part of life, life orientation, teachers, especially in rural areas, find it very difficult because of cultural ideas of who has the right to speak about sex and when,” Mkhwanazi says. “It's very different to teach sex education, including ideas around contraception. They can't get this information from nurses and hospitals either because of the same ideas.”

The 90-90-90 goal

HIV officials use something called 90-90-90 or the HIV cascade to describe their plan for defeating the disease.

It’s an approach to curbing the epidemic that tries to bring down the rate of infection and, over time, eradicate the disease. The goal: 90 percent of people living with HIV know their status; 90 percent of those who know their status are on antiretroviral therapy (ART) and 90 percent of those on ART achieve viral suppression by 2020.

In some countries, PEPFAR and other public health groups have made massive progress toward 90-90-90 targets.

In July, PEPFAR announced that Swaziland, Zimbabwe, Malawi and Zambia are nearly there.

Progress toward 90-90-90 goals

Surveys conducted last year showed significant progress in four countries.

Percent of populationAware of HIV statusOn ARTVirally suppressedSwaziland (15+)Zimbabwe (15-64)Malawi (15-64)Zambia (15-59)0102030405060708090100

Source: PEPFAR

Alex Newman / PRI

The data for Swaziland, Zimbabwe, Malawi and Zambia is from a 2016 PEPFAR survey. In South Africa, 86 percent know their status; 65 percent are on ART and 56 percent on ART are virally suppressed, according to UNAIDS.

PEPFAR has funded voluntary male contraception and antiretroviral drugs. Once a person’s viral load is suppressed with ARTs, the person is likely to live a longer, healthier life, and the likelihood of transmitting HIV plummets — it can be as effective as consistent condom use.

PEPFAR was established in 2003 by President George W. Bush and was reauthorized in 2008 and again in 2009 under Barack Obama. It’s not entirely clear if funding for PEPFAR will change during the Trump administration. In April, Bush defended the program in an op-ed in the Washington Post: “Saving nearly 12 million lives is proof that PEPFAR works, and I urge our government to fully fund it,” he wrote.

South Africa has largest population living with HIV

Population living with HIV (estimate)199019921994199619982000200220042006200820102012201401234567

Source: UNAIDS

Alex Newman / PRI

Since it’s inception, PEPFAR reports it has prevented nearly 2 million babies from being born with HIV, supported more than 11.5 million people on ARTs and provided HIV testing and counseling to 74.3 million people.

It is unclear exactly how the Trump administration will fund PEPFAR. Unlike other agencies, PEPFAR is not specifically targeted for drastic cuts, but the budget submitted to Congress calls for big cuts — $13.5 billion to foreign aid programs like USAID, many of which contribute to PEPFAR’s bottom line — that many think will have devastating effects in Africa.

Intervention before transmission, not after

In 2012, officials added a new drug to their toolkit. PrEP, which stands for pre-exposure prophylaxis, is a pill that can be taken daily (studies are underway exploring other methods of taking the drug) and can prevent the HIV virus from replicating in a person’s blood. The WHO identified the drug as a preventative tool in 2012; in 2014 the CDC began recommending its preventative use in high-risk populations.

In the United States, PrEP, usually available under the drug named Truvada, is available mostly to gay men. In 2016, drug manufacturer Gilead reported that about 79,000 people had prescriptions. Of those, 60,872 were men and 18,812 were women. Researchers said use picked up in major cities with large gay populations where advocacy groups encouraged men to use the drug. Uptake by women is still low, though.

To be sure, in the US PrEP can be quite expensive. For those without insurance, it can be $1,300 a month or more. Even for those with insurance, co-pays and deductibles can still make the drug several hundred dollars a month.

In South Africa, only sex workers are given free access to PrEP, but the government plans to expand it to young women. For now, there are a number of trials investigating different methods to administer PrEP. The current method, a once-a-day pill, is sometimes a regimen that cannot be followed, so drug companies are testing an injectable PrEP that lasts 8 weeks.

Investigators are also doing trials on a slow-release vaginal ring.

Ziynda holds on the of the vaginal rings used in a trial at the Desmond Tutu HIV Foundation. Vaginal rings can be used for birth control, but the trial is adding PrEP to the ring to reduce the risk of contracting HIV. "God created us in a very special way as women," Ziynda, 32, says. "Because who knew that you can have something inside of you that stays with you but you don't feel it?" AWL is not publishing the last names of young women featured in these stories.

Credit: Jasmine Garsd / PRI

"It's a silicone ring and it's impregnated with an anti-retroviral," says Dr. Katherine Gill, a medical officer leading the trials at the Desmond Tutu HIV Foundation in Cape Town.

Gill says that the ring, if proven safe, could "avert at least a million HIV infections [globally] over the next 20 years."

Reporting by Andrea Crossan, Jasmine Garsd and Alex Newman. Produced by Sophie Chou, Alex Newman and Kuang Keng Kuek Ser. Edited by Christina Asquith and Jonathan Kealing.

 

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A ‘Lively’ Year For HIV Research So Far. 19/7/2017

Published by MEDICALBRIEF

This has been a lively year for HIV research says an i-base report. Even though only one new drug was approved (a once-daily version of raltegravir) several key generic approvals (dolutegravir and tenofovir/FTC) are perhaps just as important.

The report says: “Three new fixed-dose combinations (FDCs) have been submitted to the US Food and Drug Administration (FDA)/European Medicines Agency (EMA) with expected decisions soon, including one with a new integrase inhibitor (bictegravir).

“Early data presented for several new compounds, including from new drug classes that are in early stages of research, are an optimistic sign that HIV is still a potential market for new drugs.

“While current ART is safe and effective there are ways it could become better still: formulations with smaller pills, less frequent dosing, long-acting compounds (weekly, monthly, yearly), with lower doses, fewer side effects and drug interactions, stronger resistance profiles – and it could be cheaper and more accessible. Some of these factors feature in compounds already filed for regulatory approval.”

The report says this year the pipeline includes compounds in current classes (NRTIs, NNRTIs, PIs and integrase inhibitors) and compounds with new targets and mechanisms of action (including a capsid inhibitor and several monoclonal antibodies), see Figure 1. It also includes a two-drug combination submitted with an indication as maintenance therapy (dolutegravir/rilpivirine).

Importantly, compounds from new classes – monoclonal antibodies (mAbs), entry inhibitors, maturation inhibitors and capsid inhibitors – are all expected to work for people with multiple drug resistant (MDR) HIV who are dependent on new drugs. And, the report says, some of these drugs have potential to be used in very different ways – as treatment, as part of a cure strategy and for prevention as PrEP.

The report says only new HIV drug approval since the pipeline report in July 2016 was for a once-daily formulation of raltegravir. The new version still requires a two-pill dose (2 x 600 mg) but has improved pharmacokinetic (PK) properties that allow once-daily dosing without regard to food. Approval was based on 48-week results from the phase 3 treatment-naive ONCEMRK study. The improved PK profile also results in lower peak drug concentrations and higher trough levels, and less interpatient variability.

The report says the regulatory approval of several generic formulations over the last year is also important – in September 2016, tentative approval by the FDA of a generic formulation of dolutegravir has the potential to significantly improve treatment in countries who have access to in-patent generics. This will be especially true once the FDC (with TAF/FTC) also becomes available.

EMA approval of three generic formulations of TDF/FTC that use a different base salt for tenofovir, but that has been referred to European courts to decide on patent issues. The FDA also approved a generic version of TDF/FTC. The patent implications and timeline for US generic access and pricing is unclear and might take years: generic drugs are sometimes priced very highly in the US.

The report says several compounds have already been submitted for regulatory evaluation based on primary endpoint results from phase 3 studies. In September 2016, the first single pill protease-inhibitor based fixed dose combination (FDC) of darunavir/cobicistat/FTC/TAF (D/C/F/TAF) was submitted in both the US and Europe, with a decision expected later in 2017.

The applications are based on studies with darunavir/cobicistat plus tenofovirDF/FTC as control and at least one study at IAS will report on this FDC. The reduced milligram dose for TAF compared to TDF makes this formulation possible as a single tablet.

On 12 June 2017, a new drug application was issued to the US FDA for a single tablet FDC of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). A similar submission to the EMA in Europe is expected during 3Q 2017.

Bictegravir (formerly GS-9883) is a once-daily integrase inhibitor, that (unlike elvitegravir) does not need to be boosted or to be taken with food. This is also a potent compound, used at low milligram dose (50 mg) leading to a small pill when combined with TAF, few drug-drug interactions and a similar resistance profile to dolutegravir.
Four phase 3 studies include a treatment naive study comparing it to dolutegravir and several switch studies in people with viral suppression on current treatment.

The most recent publicly presented data were results from a small phase 2 non-inferiority study in 98 treatment-naive study that showed very similar results compared to dolutegravir.

The report says results from two phase 3 studies in treatment naive adults will be presented as late breaker abstracts at the IAS 2017 in Paris.

Although both dolutegravir and rilpivirine are long-approved as oral drugs (in 2013 and 2011 respectively, in the US), in June 2017 a new oral coformulation with both drugs in a single pill was submitted for regulatory approval as an FDC for maintenance therapy.
The application is for use as a switch option in people with suppressed viral load on earlier treatment and is notable for being the first FDC that doesn’t include NRTIs. The application is based on results from the SWORD 1 and 2 studies presented at CROI 2017 that showed dual arm was non-inferior to continuing ART.

Dolutegravir-based dual therapy with 3TC is also discussed below.

The report says the unpredictability of drug development is always important to remember and this year included gains and losses of some compounds and the re-emergence of others.

Doravirine is a once-daily NNRTI that can be taken with or without food that has few drug-drug interactions and that retains activity against common first generation NNRTI mutations (K103N, Y181C, G190A and E138K). It is being developed in an FDC with generic TDF/3TC and has the compound name MK-1439A. Results from a two-part, dose-finding, phase 2 study in treatment-naive participants presented at CROI 2016 last year, reported doravirine to be non-inferior compared to efavirenz with 78% in each group having undetectable viral load at week 48.

This year another randomised phase 3 study reported doravirine to be non-inferior compared to boosted darunavir with similar safety and efficacy results. New nano-formulations of this compound are also in development and IAS 2017 will include phase 3 results comparing the MK-1439A FDC to efavirenz/TDF/FTC in people on first ART.

Cabotegravir (CAB) is a second-generation integrase inhibitor being developed by ViiV Healthcare as both an oral tablet and long-acting (CAB-LA) injectable formulation. It has potential use as both treatment and, the injectable formulation, as PrEP.

CAB-LA has an extremely long half-life: a single injection results in drug levels that are still detectable in some people more than a year later. This requires that a lead-in phase using the oral formulation is essential before using the injection to screen for likely risk of hypersensitivity reaction. The long half-life means that anyone stopping CAB-LA when used as treatment needs to switch to alternative ART. When used as PrEP, current studies recommend switching to daily oral PrEP for a year.

The oral formulation has a similar drug resistance profile to dolutegravir, and is also being studied as part of dual oral therapy with rilpivirine (see dolutegravir/rilpivirine above). Results from a phase 2b included 144-week results from 243 treatment-naive participants who started triple therapy ART (dose-ranging cabotegravir or efavirenz, plus background TDF/FTC NRTIs), and who switched to oral cabotegravir plus rilpivirine maintenance therapy at week 24 if viral load was undetectable.

The report says the phase 2 LATTE-2 study, using dual injection maintenance therapy (CAB-LA co-formulated with rilpivirine LA) reported good efficacy and tolerability at week-48 with >90% of participants having undetectable viral load and high patient satisfaction with injections (even though these caused usually minor side effects). See study details.

Several international phase 3 studies of cabotegravir LA for PrEP are already underway, with oral TDF/FTC as the comparison. New nano-formulations of cabotegravir LA are also in development.

The phase 3 programme includes two large international studies in treatment-naive and -experienced participants: FLAIR (First Long-Acting Injectable Regimen) and ATLAS (Antiretroviral Therapy as Long-Acting Suppression). IAS 2017 will include updated 96-week results from LATTE-2.

Dolutegravir showed a higher barrier against drug resistance in treatment-naive studies than any other antiretroviral to date and this led to several independent research groups looking at whether dolutegravir could be used in combinations with less than three active drugs.

In addition to using dolutegravir with rilpivirine (see above), several studies are using dolutegravir with lamivudine (3TC) including with the two drugs co-formulated in an FDC. This includes use both as first-line ART and as a switch option in people who are stable on current ART (usually defined as having undetectable viral load for year). Of these, the single-arm treatment naive PADDLE study reported rapid reductions in viral load, including in four people with baseline viral load >100,000 copies/mL with 18/20 maintaining undetectable viral load at week-48. Results from week-96 of this study will be presented at IAS 2017.

The report says several larger phase 2 and 3 studies are ongoing including the single arm LAMIDOL and ACTG A5353 studies and the randomised ASPIRE and TRULIGHT studies. Of these, only the French ANRS 167 LAMIDOL single arm switch study has reported results. At CROI 2017, after 40 weeks of dual therapy, 101/104 participants remaining undetectable, with a single person with viral rebound (>50 – 200 copies mL) who switched back to triple ART. ACTG A5353 in 122 treatment-naive participants is due to report results at IAS 2017.

Finally, in August 2016, ViiV announced two large international randomised phase 3 studies (GEMINI 1 and 2) that will compare dolutegravir/3TC FDC to dolutegravir plus separate TDF/FTC. Together these will enrol 1,400 treatment-naive participants and will quantify whether dual-NRTIs are still needed for some integrase-based regimens, with data collection for the primary endpoint (viral suppression at week-48) expected in 2018.

If these studies produce positive results, a modelling study published last year reported potential savings of $550m in the US alone over five years if dolutegravir/3TC was used as maintenance therapy by 50% of people who suppressed viral load on triple ART and $800m if used as initial ART. This increased to $3bn if 25% of people currently on stable ART switch to dolutegravir/3TC dual therapy.

The report says it is also important that although several studies using dolutegravir as monotherapy maintained viral suppression in most participants, the unpredictable risk of viral rebound in some people with the development of integrase resistance means that monotherapy with dolutegravir is now clearly not recommended. All dolutegravir monotherapy studies should have now changed all participants back to dual or triple therapy.

Ibalizumab is a monoclonal antibody that has been in development for over a decade. Previous development names included TMB-355 and TNX-355 and phase 1 efficacy results were first reported in 2008. Ibalizumab blocks initial HIV entry by attaching to CD4 receptors and stopping conformational changes that are needed for the virus to enter a CD4 cell. It is active against CCR5 and CXCR4-tropic virus. The half-life of >3 days enables the intravenous (IV) infusion to be given every two weeks.

For much of the development programme, access was limited to an open-label expanded-access study but results from a small phase 3 study (TMB-301) were presented at CROI 2017. This study in 40 people with multidrug resistant HIV, reported a mean viral load decrease from baseline was –1.6 log copies/mL, with 55% and 48% having reductions >1 log and >2 log respectively.

Results from an intramuscular formulation were also presented at CROI 2017 but although initial viral load reductions were similar to the IV version, rebound after one week suggests greater vulnerability to drug resistance.

Ibalizumab is being developed by the Taiwanese company TaiMed but marketing and distribution rights for the US and Canada have been sold to Theratechnologies (who market tesamorelin for visceral hypertrophy). A press release from the developing companies reported that FDA had granted a priority review with an expected deadline for submission in January 2018.

The report says a further phase 3 study is also ongoing and updated results in treatment-experienced patients are due to be presented at IAS 2017. PRO 140 is a humanised IgG4 antibody that blocks HIV entry by binding to CCR5 but is active against maraviroc-resistant virus. PRO 140 has been in development for more than ten years, but that paradoxically has been designated “fast-track” status, for having potential activity against MDR HIV.

The most recent phase 3 data were presented at CROI 2017 where a small number of people (n=41 originally and 16 in a follow up phase) switched to PRO140 monotherapy after stopping ART. PRO 140 uses weekly dosing of 350 mg self-administered sub-cutaneous injections of PRO 140 and 10/16 people continued to have undetectable viral load without ART for up to two years.

Ongoing phase 3 studies include a monotherapy switch study in 300 participants with viral suppression >48 weeks on ART and in addition to ART as part of salvage combination in 30 participants with multidrug resistance to other classes. No new results are expected at IAS 2017.

Fostemsavir (GSK3684934) is an attachment inhibitor that binds to gp120 that is active against nearly all HIV-1 subtypes, though not sub-type AE or group O and has no in vitro cross resistance to drugs from other classes. This compound is being developed by ViiV but was previously a BMS compound (BMS-663068).

Results from a phase 2b randomised dose-ranging study in 251 treatment-experienced participants that used atazanavir/r in the control arm were presented at the Glasgow conference in 2016. Rather than using 2 NRTIs as background drugs, all participants used raltegravir (400 mg twice-daily) plus TDF (once-daily) as the background drugs. At 96-weeks, 61% vs 53% had undetectable viral load <50 copies/mL (GSK934 vs atazanavir) with no difference by baseline subgroups.

Ongoing research is in a large international phase 3 study (enrolled, no longer recruiting) in treatment-experienced patients with drug resistance and who are sensitive to only two or fewer drug classes. This study was launched in 2015 with an estimated end date in 2020. Although no new clinical data are due to be presented at IAS 2017, two drug interactions studies are due to be presented as posters.

UB-421 is a broadly neutralising mAb that targets CD4 binding with in vitro data suggest comparable or greater potency compared to other compounds, including VRC01 and 3BNC117.

A phase 2 study in 29 virally suppressed participants on ART who used UB-421 monotherapy during an 8-week ART interruption had no cases of viral rebound during the monotherapy phase. UB-421 was given by infusion either 10 mg/kg weekly or 25 mg/kg every two-weeks. Two current phase 3 studies in people with MDR HIV are listed but not yet enrolling. No new data are expected at IAS 2017.

VRC01 is another broadly neutralising mAb that targets the CD4 binding site that can be given by infusion or sub-cutaneous injection and that is in phase 1/2 development with multiple indications: for treatment, as part of cure research and for prevention.

One study at CROI reported no additional impact on reducing the latently infected viral reservoir from adding VRC01 to ART. Other studies in cure research are ongoing. This includes using a single injection in infants after birth to limit risk of vertical transmission and a potential role of additional injections for breastfed infants.

Two large international phase 2 PrEP studies PrEP are already ongoing.

Although new clinical data are expected at IAS 2017, a study on lack of effect on reservoirs will be presented, similar to published results from last year.

ABX464 is a molecule thought to work by blocking the end stages of viral assembly. A phase 2a dose-ranging study presented at CROI 2016 in 80 treatment-naive participants in Thailand reported modest antiviral activity (~0.5 log copies/mL) but only in 4/6 people using the highest 150 mg dose (with no responses in 2/6).

The compound is also being studied for impact on viral reservoir and whether it can limit viral rebound in absence of ART, included a related study due to be presented at IAS 2017 in Paris.

As many companies do not widely publicise pre-clinical work, this section is restricted to a few studies.

MK-8591 is a very interesting NRTI now in phase 1 development by Merck that is notable for high potency (currently using a 10mg oral daily dose), a long plasma half-life that allows once-weekly oral dosing, a slow-release removable implant that might only require annual dosing and ongoing studies looking at use for both treatment and PrEP. MK-8591 is active against both HIV-1 subtypes and HIV-2, including against NRTI mutations K65R and Q151M (although the M184V variant conferred 10-fold resistance).

EFdA reaches good drug levels in vaginal and rectal tissue – supporting further PrEP studies.

IAS 2017 is expected to include important new results for both use as treatment and prevention.

GS-9131 was reported ten years ago at CROI 2006. Other published studies highlight the potential for low risk of toxicity in animal studies and retains in vitro phenotypic sensitivity to broad NRTI resistance including mutations at K65R, L74V and M184V and multiple TAMS. The poster at CROI 2017 confirmed results from previously published studies into the activity against common NRTI mutations. No new data are expected at IAS 2017.

The maturation inhibitor GSK3640254 (previously BMS-986197) is in pre-clinical stages of development with GSK with a molecule acquired from BMS. An earlier maturation inhibitor, BMS-955176, also acquired from BMS was discontinued in October 2016 due to GI toxicity and drug resistance. New data on tolerability and side effects will be presented at IAS 2017.

Combinectin (GSK3732394) is a combined adnectin/fusion inhibitor that stops viral entry by targeting multiple sites of action on gp41 and CD4. This compound has the potential for self-administered once-weekly injections. This compound was in pre-clinical development with BMS and was acquired by ViiV in late 2015. Latest data presented at Glasgow 2016 summarised, in vitro activity and resistance data and virologic data from mouse studies.

GS-PI1 is a once-daily un-boosted protease inhibitor with high potency and a long half-life, and in vitro sensitivity against some second-generation PI resistance, in pre-clinical development by Gilead. An oral presentation at CROI 2017 reported a high barrier to resistance both after in vitro passaging and against multiple resistance complexes from multiple PI-resistant clinical isolates, and pharmacokinetic data from rat and dog studies.

GS-CA1 – capsid inhibitor First data was presented on GS-CA1, the first compound in a new class of HIV capsid inhibitors, with a formulation that can be used for slow-release injections, with monthly or longer dosing.

Capsid is the cone-shaped structural core within the virion that protects HIV RNA and related enzymes. As part of a dynamic process, the capsid protein (p24) first breaks down to release viral contents into the CD4 cell to enable reverse transcription and also needs to reassemble inside new virions as part of the maturation process at the end of the lifecycle.

GS-CA1 acts in both the early and late stages by binding at a site that blocks both disassembly and assembly leading to defective new virions that are non-infectious.

Although the following compounds are not being developed for use in high-income counties, they are progressing though clinical research.

Albuvirtide is a second-generation fusion inhibitor similar to T-20 (enfuvirtide) that is being developed by Frontier Biotechnologies as an alternative second-line combination in China. The long half-life enables once-weekly intravenous infusion (rather than twice-daily sub-cutaneous injections with T-20) and a side effect profile that does not include injection site reactions (ISRs). Partial interim phase 3 results from 175/389 participants were presented in Glasgow in October 2016 included approximately 80% viral suppression at 24 weeks and generally good tolerability.

Based on these results, albuvirtide has already been submitted for conditional approval in China and there are plans to run additional international studies in other countries next year, especially with other long-acting drugs. A sub-cutaneous formulation of albuvirtide is also in development that would allow self-injections at home, rather than weekly clinic visits needed in the current version.

Elsulfavirine (a pro-drug of VM-1500A) is an NNRTI being developed by Viriom for registration in some middle-income countries. 48-week results from a phase 2b study at CROI 2017 reported similar viral suppression compared to efavirenz (81% vs 73% <50 copies/mL) using TDF/FTC background NRTIs. A long-acting injectable formulation is being used in ongoing studies for treatment and PrEP with new results due at IAS 2017.

The report says several other compounds that featured in earlier pipeline reports have not lead to new data being presented over the last year.

GS-9695 and GS-9822 were promising integrase inhibitor compounds that were discontinued due to unpredictable kidney/urothelial toxicity in monkeys. The decision to end the development programme for BMS-955176 due to gastrointestinal intolerability was mentioned earlier in this report. The follow-on compound GSK3640254 is still in development.

The report reiterates that this is still an exciting time for HIV drug development. It says this year the HIV pipeline is remarkable for a potential range of drugs that could improve many aspects of the traditional approach to treating HIV using three-drug oral therapy.
It includes responses to the changing situation in which all countries now have access to some generic anitretrovirals – and drug pricing will continue to drive access in all countries. It also includes some compounds that are only developed for low- and middle-income countries, and coformulations that will not be available in high income-countries.

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Scientists Hail 'Promising Cure' for HIV After Study in Mice. 3/5/2017

Published by INDEPENDENT

A “promising cure” for HIV and Aids has been discovered, according to scientists who managed to almost entirely eliminate the devastating immune disease from infected mice.

The researchers said they had demonstrated the “feasibility and efficiency” of removing the HIV-1 provirus using a gene-editing technique called Crispr.

They admitted there were still some practical problems to be overcome, but suggested their work was a “significant step” towards carrying out clinical trials of the technique on human.

Writing in the journal Molecular Therapy, the scientists described how some of the mice had been “humanised” after being given some human immune cells.

In these animals, “successful proviral excision was detected … in the spleen, lungs, heart, colon, and brain after a single intravenous injection” of the gene-editing protein.

Apparent breakthroughs in animal models often encounter problems later in the process of developing a treatment for humans.

Nonetheless, the researchers, from Temple University and Pittsburgh University in the US, wrote in the journal that this type of genome editing “provides a promising cure for HIV-1/Aids”.

“Here, we demonstrate the feasibility and efficiency of excising the HIV-1 provirus in three different animal models,” they wrote.

“Excision of HIV-1 proviral DNA by [this method in a living animal] in solid tissues/organs can be achieved … [which is] a significant step toward human clinical trials.

“To our knowledge, this study is the first to demonstrate the effective excision of HIV-1 proviral DNA from the host genome in pre-clinical animal models [using this method].”

However, they added that “gene delivery efficiency … remains an obstacle to overcome” in a living animal. 

The researchers told the Daily Mail that the next step would be to repeat the study in primates, described as a “more suitable animal model where HIV infection induces disease” before the “eventual goal” of human clinical trials.

Dr Wenhui Hu, of Temple University, told the Mail the new study built on earlier research but was “more comprehensive”.

“We confirmed the data from our previous work and have improved the efficiency of our gene-editing strategy,” Dr Hu said.

“We also show that the strategy is effective in two additional mouse models, one representing acute infection in mouse cells and the other representing chronic, or latent, infection in human cells.”

Professor Jonathan Ball, an expert in molecular virology at Nottingham University, told The Independent that gene editing was seen as a potential way to effectively cure people of the disease.

At the moment, drugs can stop HIV from replicating inside the body and producing Aids, but a latent reservoir of the virus remains.

This means that if the patient stops taking the drugs for whatever reason, they are likely to get the full-blown disease.

Professor Ball said the new study showed the technique “can effectively deliver the Crispr/Cas gene-editing machinery in order to target/excise HIV sequences”.

“They claim that by combining a number of the tools necessary for gene editing in a single delivery vector they have increased the efficiency of gene targeting,” he added.

“This undoubtedly shows promise but some big questions remain – how much of the latent reservoir do you need to target and will it work in humans?”

It is possible that reducing the dormant HIV to a low enough level would provide an effective cure – some HIV would remain but not enough to cause Aids. 

But it could also be that HIV would have to be eradicated entirely from the body to prevent it from “bouncing back” after treatment was stopped, Professor Ball said.

“I’m pretty sure that these targeting approaches will be able to deplete at least some of the HIV reservoir, but at the moment I think most researchers in the field worry that it might not be enough to bring about cure,” he added.

Dr Nicola Patron, synthetic biology group leader at the Earlham Institute, said: “Retroviruses like HIV integrate a proviral DNA into the genome of the host cells during infection to enable replication.  

"Although drugs currently used to treat HIV can suppress replication, they cannot remove the proviral DNA from the infected cell's genome.

"This work uses CRISPR/Cas9 genome editing technology to excise proviral DNA from infected human cells embedded in the tissues of experimental animals.

"If similar techniques can be made to work in primates and humans, it could potentially lead to a permanent cure.”

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A New Gene-Editing Technique Has Eliminated Acute HIV Infection in Living Animals. 4/5/2017

Published by SCIENCEALERT

For the first time, researchers have used gene-editing to eliminate HIV DNA from the genomes of three different animal models to ensure that replication of the virus was completely shut down. 

The technique has been demonstrated in animals with both acute and latent HIV, and was successful in human immune cells transplanted into mice. The team calls it a "significant step" towards human clinical trials.

A team led by researchers from Temple University and the University of Pittsburgh used the revolutionary gene-editing technology, CRISPR/Cas9, to eliminate HIV-1 DNA from the T cell genomes of mice with various stages of the disease.

The technique works by guiding 'scissor-like' proteins to targeted sections of DNA within a cell, and prompting them to alter or 'edit' these sections in some way.

CRISPR refers to a specific repeating sequence of DNA extracted from a prokaryote - a single-celled organism such as bacteria - which pairs up with an RNA-guided enzyme called Cas9.

This 'guide RNA' latches onto the Cas9 enzyme, and together they'll search for the virus that matches the code they've been programmed to find. Once they locate it, the Cas9 gets to cutting and destroying it. 

In early 2016, the team first demonstrated how CRISPR/Cas9 could 'cut out' the HIV-1 virus from rats and mice with HIV-1 DNA inserted into the genome of every tissue of their body.

This time around, they were able to show that the technique worked on various forms of the disease: an acute infection of EcoHIV, the mouse equivalent of human HIV-1; and an inactivated form of HIV-1.

"Our new study is more comprehensive. We confirmed the data from our previous work, and have improved the efficiency of our gene-editing strategy," says Wenhui Hu from Temple University.

"We also show that the strategy is effective in two additional mouse models, one representing acute infection in mouse cells and the other representing chronic, or latent, infection in human cells."

In a third animal model, the researchers transplanted human immune cells into mice before infecting them with a latent HIV-1 virus.

The fact that the technique appears to work on both the active and dormant forms of the disease is important, because even if the virus isn't actively replicating in the body's immune cells, that doesn't mean it won't suddenly kick into gear at any given moment. 

As opposed to the acute form of the disease, where HIV actively replicates, the latent form is much harder to keep track of in the cells, because once the virus is inactivated by medication, it can hide out in secret reservoirs in the immune system for months, or even years, waiting for the right conditions to reemerge.

That's why patients have to remain on medication for their entire lives - latent HIV can activate within weeks if treatment stops.

After applying the CRISPR/Cas9 technique to acute and latent models of the virus, the team used a newly developed imaging system to confirm that they had successfully shut down replication in both.

"The imaging system ... pinpoints the spatial and temporal location of HIV-1-infected cells in the body, allowing us to observe HIV-1 replication in real-time and to essentially see HIV-1 reservoirs in latently infected cells and tissues," says one of the team, Kamel Khalili from the Temple University.

The team now aims to progress to primate models of the disease, and hopefully to human clinical trials. 

"The next stage would be to repeat the study in primates, a more suitable animal model where HIV infection induces disease, in order to further demonstrate elimination of HIV-1 DNA in latently infected T cells and other sanctuary sites for HIV-1, including brain cells," says Khalili.

"Our eventual goal is a clinical trial in human patients."

They'll be faced with at least one big challenge along the way - research published last year found that HIV could outmanoeuvre certain CRISPR/Cas9 techniques - so lots more verification and replication is needed before we know if the strategy can hold up long-term.

But this is definitely a study to keep an eye on in the coming months.

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Huge Breakthrough Puts Scientists ‘One Step Closer’ to HIV Vaccine. 29/3/2017

Published by PINKNEWS

Researchers have said humanity is “one step closer” to a vaccine for HIV after the latest breakthrough.

Scientists at the University of Nebraska-Lincoln have engineered an on/off switch on to a weakened strain of HIV.

This would allow them to spread the virus throughout someone’s body, before deactivating the strain after it has immunised the host.

Around 35 million people have died of AIDS since the epidemic began, while 36.7 million are still living with HIV, according to the World Health Organisation.

A weakened virus is generally preferred by scientists because it has the potential to produce a stronger and longer-lasting immunity in patients.

However, weakened viruses – as opposed to deactivated viruses – still possess the ability to replicate and spread disease instead of an immunity.

The Nebraska researchers began tackling this problem in 2014, and the technique they’ve developed and written a study about earlier this year could be one of the safest anywhere.

“Safety is always our biggest concern,” said Wei Niu, associate professor of chemical and biomolecular engineering, who was one of six researchers on the study.

“In this case, (it means) we’re one step closer to generating a vaccine.”

Qingsheng Li, professor of biological sciences, said the method could also be expanded to potentially eradicate an array of viruses other than HIV in the future.

So far, the group has only tried out its technique in a petri dish, but hopes to start testing it on small animals in the next year.

Li said that would be “the big milestone. If that works well, we need to go to the pre-clinical animal model before going to a clinical trial. That’s our goal and road map.”                                      

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Scientists Zoom in on AIDS Virus Hideout. 17/3/2017

Published by TIMESLIVE

French scientists said Wednesday they had found a way to pinpoint elusive white blood cells which provide a hideout for the AIDS virus in people taking anti-HIV drugs.

Being able to spot, and one day neutralise, these "reservoir" cells has long been a holy grail in the quest to wipe out AIDS and the human immunodeficiency virus (HIV) that causes it.

The discovery "paves the way to a better fundamental understanding of viral reservoirs," said France's CNRS research institute, which took part in the study published in Nature.

"In the longer term, it should lead to therapeutic strategies aiming to eliminate the latent virus," it added in a statement.

There is no cure for HIV, and infected people have to take virus-suppressing drugs for life.

This is because a small number of immune system cells, in a category of cell called CD4 T lymphocytes, provide a haven for the virus, enabling it to re-emerge and spread if treatment is stopped --  even after decades.

In tests using the blood of HIV patients, the researchers managed to spot a protein, dubbed CD32a, on the surface of virus-infected reservoir cells.

It was absent from healthy cells.

Such a "marker" has proved very difficult to find, explained AIDS researcher Douglas Richman from the University of California San Diego, who did not take part in the study.

A person infected with HIV has about 200 billion CD4 T cells, of which only one in a million act as virus reservoirs.

Two percent of the body's CD4 T cells (some four billion) are found in the approximately five litres of blood in an adult human, said Richman.

This means that a 100-millilitre blood sample would contain about 80 million CD4 T cells, of which around 80 would be virus reservoirs.

Whether CD32a plays an active part in enabling the virus to hole up in CD4 cells is a big question.

If so, it could throw open a tempting target for drugs to block the stealthy process.

While describing the study as "potentially seminal", Richman cautioned that CD32a was a marker found in only about half of CD4 T reservoir cells.

To eradicate latent HIV would require the targeting of a much larger proportion.

It also remains to be seen whether CD32a is as good a marker for non-blood CD4 T cells in the lymph nodes, bone marrow, gut and other tissues which could be reservoirs, he added.

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HIV Vaccine Prompts Five People to Largely Control Virus Without Antiretrovirals. 28/2/2017

Published by POZ

Combined with the drug romidepsin, the HIV Conserv vaccine has allowed them to stop HIV meds without a major viral rebound.

When combined with the drug romidepsin, the HIV Conserv vaccine has allowed 38 percent of HIV-positive participants in a small trial to go off antiretrovirals (ARVs) and avoid a major viral rebound, aidsmap reports.

This is the first human study of a therapeutic vaccine to yield such success in prompting lasting immune control of the virus—for a maximum of 28 weeks of post–ARV treatment interruption thus far.

The United Kingdom’s The Independent erroneously reported that the five participants in the study whose immune systems ultimately gained control of HIV while they were off treatment were “free of the virus.” These individuals still have virus in their bodies and are not cured. The British press has quite a track record of making exaggerated reports about progress in HIV cure science.

Researchers in the ongoing BCN02 vaccine trial recruited 15 people who started HIV treatment within 5.5 months (an average of three months) of their estimated time of infection. Initially, participants were given a single dose of the Conserv vaccine, which is composed of various HIV antigens. The corresponding antigens on the virus itself are unlikely to change as the virus mutates and remains a viable virus. These viral proteins were selected in hopes they would prompt an immune response—specifically from CD8 cells—that is more potent and does not waste resources by attacking portions of the virus subject to evasive mutations.

Findings from that single-dose trial, called BCN01, were presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

The investigators then began a second trial, BCN02, with the same 15 participants, in which they gave them two doses of the vaccine nine weeks apart as well as doses of romidepsin at weeks three, four and five. Romidepsin is used in HIV research to reverse the latent, or non-replicating, state of certain HIV-infected cells in an attempt to ultimately drain the viral reservoir, the existence of which prevents standard ARV treatment from curing the virus.

Using these two interventions together was intended to prompt bursts of viral replication among participants still taking ARVs so that the vaccine-prompted immune response could essentially program itself according to the virus to which it is exposed.

The researchers assessed the level of HIV DNA in participants’ cells at week zero, during weeks three to five and at week nine. They also tested the proportion of CD4 cells that were sensitive to HIV at weeks zero, one, three, nine, 10 and 13. Participants, who had been taking ARVs for more than three years but less than four years, were taken off them at week 17 of the study and put back on them if they experienced a significant viral rebound.

Interim findings from this second study were presented at the 2017 CROI in Seattle.

The participants experienced mild flu-like side effects as a result of the vaccine, most commonly headache, fatigue and muscle aches. In all but one participant, their viral loads blipped while they were receiving romidepsin, mostly to between 50 and 400 and to 1,000 in a few of them. For the first few days after each infusion, CD4 cell levels rose by about 200.

The size of the reservoir according to the amount of HIV DNA in cells remained unchanged.

HIV-specific CD8 cell responses rose and became more specialized, that is, more geared to the viral regions to which the vaccine sought to prompt a response.

Thirteen of the 15 participants have stopped their ARVs thus far. Eight of them saw their viral loads rapidly rebound within four weeks, to an average level of about 100,000; these individuals went back on ARVs.

For five other participants, representing 38 percent of the overall group, their viral load has not shot up dramatically. They have remained off ARVs for a respective six, 12, 19, 20 and 28 weeks. While none of them has maintained an undetectable viral load for their entire time off ARVs, they have experienced blips that for the most part involve viral loads rising to around 200, although one person experienced ones as high as 2,000 before resolving and returning to undetectable levels.

The researchers found associations between having a smaller level of viral DNA as well as a more specific CD8 cell response and control of the virus after stopping ARVs.

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Ray of Hope for Fresh Method to Beat HIV. 26/2/2017

Published by TMESLIVE

HIV researchers have a ray of hope that there may be a way to teach the human immune system to control HIV without needing medication – what is known as a "functional cure".

About 50 failed trials have been conducted using vaccines and drugs to boost the immune system and help people control HIV. Now one has actually worked. Spanish researchers have reported they took 15 HIV-positive patients off treatment and gave them two vaccines and a drug named Romidepsin.

Four of the triallists were able to stay off ARV medication‚ with the virus not replicating‚ for between four and 22 weeks.Teaching the body's immune system to control the virus is a method often punted by the co-discoverer of HIV‚ Françoise Barré-Sinoussi.

Speaking to Times media‚ Sharon Lewin‚ director of the Peter Doherty Institute for Infection and Immunity in Melbourne‚ said: "This study is exciting because it is the first to demonstrate post-treatment control – that is‚ the virus is present but doesn’t rebound after stopping antiretroviral therapy."However‚ we also need to be cautious – there was no control group in the study and we don’t know which part of the intervention was important. Was it the early vaccine? The second vaccine? Romidepsin (the drug)? Or all of the above?"

"At the same time‚ until now in every other study involving treatment interr