Global Public Health Goals Thwarted by Human Rights Violations, Gender Inequality and Stigma
More Than 24,000 Participants From 194 Nations Contribute to Success of Conference
August 8, 2008
Mexico City -- As the XVII International AIDS Conference drew to a close, 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, discrimination and unwarranted prosecution prevent many people living with or at risk for HIV from seeking testing and treatment, and drive others to place themselves at risk for infection.
"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 and President of the International AIDS Society and Fundación Huésped in Buenos Aires, Argentina. "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 and Head of the Molecular Virology Unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Coordinator of the Clinical Care Committee of CONASIDA, Mexico's National AIDS Council. "Their experiences and contributions are central to the development and implementation of effective programmes. As we strive for universal access we must once and for all commit to the ideal that every life is worthy of respect."
Speakers in the final plenary session underscored the connection between public health and human rights, and also addressed the intersection of HIV and Tuberculosis (TB).
Confronting TB/HIV In the Era of Increasing Anti-TB Drug Resistance
Dr. Chakaya Jeremiah (Kenya), Chief Research Officer of the Centre for Respiratory Diseases Research at Kenya Medical Research Institute, gave an overview of the challenges presented by the dual epidemics of HIV and TB. To reduce the burden of TB in people living with HIV, he urged the HIV community to take greater responsibility for implementation of the 3 "I"s recommended by the World Health Organization. The three "I"s include: intensified case finding; isoniazid preventive therapy; and TB infection control. Jeremiah 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 (MDR/XDR-TB). The experience with XDR-TB in South Africa paints a bleak picture with very poor patient outcomes. According to Jeremiah, both MDR/XDR-TB are the consequence of sub-optimal TB control and inadequate infection control practices in health care settings.
HIV Prevention Lessons From Community Experiences in Concentrated Epidemics
To combat prevention fatigue, Spire called for pragmatic solutions for those who do not consistently use condoms, including risk reduction programmes adapted to individual and community needs. He pointed to data showing that access to antiretroviral therapy and perceived good health have a positive impact on consistent condom use among people PLHIV. Spire also emphasized the importance of a variety of HIV testing approaches. This includes routine testing with opt-out options, which Spire said demonstrates higher rates of HIV detection, 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. Spire noted that rates of unprotected intercourse are more than 50 percent lower among those who know their HIV status.
Criminalization of HIV is Costing Lives and Increasing Suffering
Cameron stated that one of the outcomes of AIDS 2008 should be a major international pushback against such misguided criminal laws and prosecutions. He urged delegates -- strengthened in their resolve to fight against stigma and discrimination -- to return home committed to persuading lawmakers and prosecuting authorities of the folly and distraction of criminalization.
Road Map for Action on Women, Girls and HIV/AIDS
Confronting gender-based violence is one of three priorities in Wood's roadmap for responding to HIV in women. She also outlined the importance of 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. Policies and budgets must support the full range of reproductive health services, including quality pregnancy and delivery care, and access to contraception. In addition, research and investment in technologies that put control of prevention in women's own hands also remain critical. In closing, Woods welcomed the recent decision by the Global Fund to Fight AIDS, TB and Malaria to invest in gender transformative programs. However, she emphasized that success in this regard 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 funding on proposal review panels.
Conference Closes With Rapporteur Reports, Calls to Action
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.
During the conference, a team of 50 rapporteurs prepared written summaries of conference sessions to record what was discussed and identify next steps on a range of issues. Prior to the Closing Session, chief rapporteurs from eight topic areas presented weekly summaries. All reports and summaries are available online at www.aids2008.org.
This article was provided by International AIDS Society. Visit International AIDS Society's website to find out more about their activities, publications and services.