GLOBAL PUBLIC HEALTH GOALS THWARTED BY HUMAN RIGHTS VIOLATIONS, GENDER INEQUALITY AND STIGMA
(Condensed from the official press release of AIDS 2008)
9 August 2008 - As the XVII International AIDS Conference drew to a close yesterday, HIV experts from around the globe highlighted the dramatic negative impact that stigma and the denial of human rights, including gender inequality, continue to have on the effectiveness of HIV treatment and prevention scale up. Fear of violence and discrimination prevent many people living with or at risk for HIV from seeking testing and treatment.
“The voices of those who bear the brunt of this pandemic have been loud and clear in Mexico City this week,” said Pedro Cahn, International Co-Chair of AIDS 2008. “If the world does not heed the call to ensure the human rights and dignity of every person affected by HIV, we will not achieve our goal of universal access.” “Those most at risk, including injection drug users, men who have sex with men and sex workers, as well as women and youth, must never be seen simply as patients or prevention targets,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008. “Their experiences and contributions are central to the development and implementation of effective programmes.”
Tuberculosis is closely linked with the death of people living with HIV. At least one-third of the 33 million people living with HIV worldwide are co-infected with TB, and these individuals have up to a 15% risk of developing active TB every year. Dr. Chakaya Jeremiah (Kenya) gave an overview of the challenges presented by the dual epidemics of HIV and TB. He noted good progress being made to decrease the burden of HIV in TB patients through HIV testing of TB patients and the initiation of preventive therapy for HIV-positive TB patients. Jeremiah also profiled the emerging threats of multidrug-resistant and extensively drug-resistant TB, both a consequence of sub-optimal TB control and inadequate infection control practices in health care settings.
In his plenary remarks, Bruno Spire (France) identified reducing stigma, combating prevention fatigue, and diversifying HIV testing as key steps to prevent sexual transmission of HIV in concentrated epidemics. Spire proposed a “triple therapy” strategy to combat stigma and discrimination rooted in evidence of stigma’s negative impact on HIV risk reduction. The strategy includes fighting for better acceptance of PLHIV, improving laws and policies to protect those most vulnerable to infection, and implementing prevention programs that incorporate community mobilization and peer support. He cited examples of efforts in India, Chile and France as important examples of this successful strategy. He pointed to data showing that access to antiretroviral therapy and perceived good health have a positive impact on consistent risk reduction among PLHIV. Spire also emphasized the importance of a variety of HIV testing approaches as well as increased access to voluntary counseling and testing, particularly in community settings. In addition to facilitating earlier access to care, learning one’s HIV status enables earlier adoption of safer behaviors.
According to Edwin Cameron (South Africa) the enactment of laws that criminalize transmission of or exposure to HIV has become so widespread that they have become a crisis in efforts to deal rationally and effectively with HIV. Citing examples from locations as diverse as the US, Sierra Leone and Singapore, Cameron highlighted the irrational nature of these laws and their ineffectiveness in achieving their purported goal. They radically increase HIV stigma and become barriers to testing and treatment. Prosecutions often single out already vulnerable groups such as sex workers, MSM and others exposing them to ostracism and further stigma. Cameron stated that one of the outcomes of AIDS 2008 should be a major international pushback against such misguided criminal laws and prosecutions.
Citing violence against women as both a cause and consequence of HIV infection, Zonibel Woods (Canada) highlighted the fear of violence from partners as a reason that some women do not seek treatment for HIV. Woods declared that providing access to treatment must be linked with ensuring a woman’s right to live free from violence. Scaling up HIV treatment and working against stigma and discrimination must go hand in hand. The legal and policy environment to address violence against women must be strengthened along with the commitments to enforce, monitor and evaluate such policies. The three priorities Woods outlined were confronting gender-based violence, ensuring women’s right to sexual and reproductive health, and investing in women’s organizations so that women can participate effectively in decisions that affect their lives. She emphasized that success in gender transformative programs depends on the engagement of women’s organizations in setting in-country priorities, and the inclusion of experts in gender equality and women’s empowerment on review panels.
Conference Closes With Calls to Action
At the Closing Session, delegates heard summary remarks from AIDS 2008 Co-Chairs, Dr. Pedro Cahn and Dr. Luis Soto Ramirez, as well as from community representatives. Incoming IAS President, Dr. Julio Montaner, gave an inaugural address. At the end, Mexico City Mayor Marcelo Ebrard and Co-Chair Luis Soto Ramírez officially transferred the International AIDS Conference glass globe from Mexico City to Vienna, Austria, the host of AIDS 2010. Representatives from Vienna were happy to accept the challenge of hosting the next major gathering two years hence.
“The voices of those who bear the brunt of this pandemic have been loud and clear in Mexico City this week,” said Pedro Cahn, International Co-Chair of AIDS 2008. “If the world does not heed the call to ensure the human rights and dignity of every person affected by HIV, we will not achieve our goal of universal access.” “Those most at risk, including injection drug users, men who have sex with men and sex workers, as well as women and youth, must never be seen simply as patients or prevention targets,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008. “Their experiences and contributions are central to the development and implementation of effective programmes.”
Tuberculosis is closely linked with the death of people living with HIV. At least one-third of the 33 million people living with HIV worldwide are co-infected with TB, and these individuals have up to a 15% risk of developing active TB every year. Dr. Chakaya Jeremiah (Kenya) gave an overview of the challenges presented by the dual epidemics of HIV and TB. He noted good progress being made to decrease the burden of HIV in TB patients through HIV testing of TB patients and the initiation of preventive therapy for HIV-positive TB patients. Jeremiah also profiled the emerging threats of multidrug-resistant and extensively drug-resistant TB, both a consequence of sub-optimal TB control and inadequate infection control practices in health care settings.
In his plenary remarks, Bruno Spire (France) identified reducing stigma, combating prevention fatigue, and diversifying HIV testing as key steps to prevent sexual transmission of HIV in concentrated epidemics. Spire proposed a “triple therapy” strategy to combat stigma and discrimination rooted in evidence of stigma’s negative impact on HIV risk reduction. The strategy includes fighting for better acceptance of PLHIV, improving laws and policies to protect those most vulnerable to infection, and implementing prevention programs that incorporate community mobilization and peer support. He cited examples of efforts in India, Chile and France as important examples of this successful strategy. He pointed to data showing that access to antiretroviral therapy and perceived good health have a positive impact on consistent risk reduction among PLHIV. Spire also emphasized the importance of a variety of HIV testing approaches as well as increased access to voluntary counseling and testing, particularly in community settings. In addition to facilitating earlier access to care, learning one’s HIV status enables earlier adoption of safer behaviors.
According to Edwin Cameron (South Africa) the enactment of laws that criminalize transmission of or exposure to HIV has become so widespread that they have become a crisis in efforts to deal rationally and effectively with HIV. Citing examples from locations as diverse as the US, Sierra Leone and Singapore, Cameron highlighted the irrational nature of these laws and their ineffectiveness in achieving their purported goal. They radically increase HIV stigma and become barriers to testing and treatment. Prosecutions often single out already vulnerable groups such as sex workers, MSM and others exposing them to ostracism and further stigma. Cameron stated that one of the outcomes of AIDS 2008 should be a major international pushback against such misguided criminal laws and prosecutions.
Citing violence against women as both a cause and consequence of HIV infection, Zonibel Woods (Canada) highlighted the fear of violence from partners as a reason that some women do not seek treatment for HIV. Woods declared that providing access to treatment must be linked with ensuring a woman’s right to live free from violence. Scaling up HIV treatment and working against stigma and discrimination must go hand in hand. The legal and policy environment to address violence against women must be strengthened along with the commitments to enforce, monitor and evaluate such policies. The three priorities Woods outlined were confronting gender-based violence, ensuring women’s right to sexual and reproductive health, and investing in women’s organizations so that women can participate effectively in decisions that affect their lives. She emphasized that success in gender transformative programs depends on the engagement of women’s organizations in setting in-country priorities, and the inclusion of experts in gender equality and women’s empowerment on review panels.
Conference Closes With Calls to Action
At the Closing Session, delegates heard summary remarks from AIDS 2008 Co-Chairs, Dr. Pedro Cahn and Dr. Luis Soto Ramirez, as well as from community representatives. Incoming IAS President, Dr. Julio Montaner, gave an inaugural address. At the end, Mexico City Mayor Marcelo Ebrard and Co-Chair Luis Soto Ramírez officially transferred the International AIDS Conference glass globe from Mexico City to Vienna, Austria, the host of AIDS 2010. Representatives from Vienna were happy to accept the challenge of hosting the next major gathering two years hence.
With more than 24,000 participants from over 190 countries, AIDS 2008 was the second largest in the history of the International AIDS Conference, and the first to be held in Latin America. The conference theme, Universal Action Now, emphasized the need for continued urgency in the worldwide response to HIV/AIDS, and for action on the part of all stakeholders.
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