by Janine Schooley, PCI's VP for Technical Services & Program Development
August 7, 2008
Mexico City IAC
Well, actually there are 2 “Ns” in prevention so you would think that nutrition and food security would be considered in more discussions about HIV prevention at the World AIDS Conference this week. It is certainly gratifying to hear so many people now talking about food and food security in connection with treatment, care and support, but I did not hear one person mention the role that food and nutrition security (FNS) plays in prevention! When I was in Bangkok last year at a regional meeting on HIV and Food, several participants flat out told me that there was no link between food and prevention. I was astonished!
Starting with prevention of mother to child transmission, when done right in countries with infant mortality rates above 25 per 1,000 live births, PMTCT must involve the promotion, protection and support of exclusive breastfeeding to 6 months followed by clean, safe, affordable and nutritious complementary foods. Exclusive breastfeeding is the first defense against food insecurity (among other things) and is critical for child survival and the fight against malnutrition, as well as HIV.
Then there is the link between ART adherence and food. Yes, this relates to therapeutic feeding and treatment, but it also relates to prevention in the sense that people who do not have food, or do not have access to services/medication because of the high cost of food and household food insecurity, will be more likely to abandon treatment, have poorer immune status, adopt a fatalistic attitude about their health, and may adopt more risky behaviors as a result.
Livelihood security is an important part of FNS and, as such, must be linked to prevention in that households need to have sufficient funding to buy food, medications, condoms if not available for free, etc. Women, girls and boys may resort to risky sexual behaviors in order to put food on the table for themselves or their families. This does not have to result in full out commercial sex work, but sexual favors in return for help with household expenses, including “sugar daddyism” and other similar relationships could lead to infection. I once asked a sex worker in Addis Ababa why she didn’t practice safe sex and she said that she would “rather die a slow death from AIDS than die of hunger”. Hunger can make people do things that they would never otherwise do, particularly if you are a mother with hungry children.
FNS and OVC of course must go together and it is critical that children are well nourished so that they can study in school, have a full and healthy life, free from as many of the risks that lead to HIV as possible. Luckily there is more understanding of the links between children and maternal and child health/primary health care, including nutrition, but it is seldom placed in the prevention context.
Positive living and empowerment are not concepts that only apply to PLWHA. They apply to everyone and are essential for keeping people virus free. Empowerment comes with health and good nutrition, as well as with livelihood security and the ability to grow and/or buy sufficient food. There are likely even more linkages between FNS and HIV prevention, and clearly this needs to be the topic of more discussions and analysis, particularly as the cost of food rises and the world food crisis deepens. I hope that at the next meeting I go to on HIV/AIDS I will hear about a few of them.
Monday, August 18, 2008
¿Y como encontró la TB? Notas sobre la Conferencia de SIDA 2008 # 3
Había un chiste que decía –“estaba una persona en un restaurante comiendo cuando llega el mesero y le pregunta: cómo encontró su filete, señora? A lo qué la comensal responde: pues así, por accidente al mover una papa.”
La XVII Conferencia Internacional de SIDA que se lleva a cabo en la Ciudad de México entre agosto 3 al 8, se caracterizó por muchas cosas buenas, novedades, mensajes inspiradores, conferencias de tinte político, activismo admirable y la oportunidad de conocer más, compartir y regresar a casa (o al trabajo más bien) con renovados bríos y las mejores intenciones. Dentro de los cientos de conferencias, sesiones, pósteres, y etc. lo que hubo muy poco fue el tema de Tuberculosis. No obstante que la Tuberculosis es la principal causa de muerte en personas positivas, donde esta es endémica, el tema de Tuberculosis, o co-infección más bien brilló por su ausencia.
Contadas fueron las presentaciones oficiales que incluían el tema. Unas cuantas más que durante la presentación hacían tal referencia, pero incluso cuando se repetían mensajes importantes, el tema de co-infección fue rara vez mencionado.
Moviendo varias papas por decirlo de alguna manera, pude encontrar materiales, uno que otro póster, y unas cuantas referencias durante las presentaciones. Hubo incluso el día 7 de agosto, una manifestación por activistas que abogaban por el acceso a las pruebas de TB, por quimioprofilaxis y por supuesto por mejor coordinación entre programas. Había un stand de un laboratorio que vende también pruebas de TB. Y estaba afortunadamente el módulo de la Secretaría de Salud con información del programa nacional de TB.
Por qué esta ausencia tan marcada? Durante el trabajo del proyecto SOLUCION TB en 13 Estados mexicanos, en los acercamientos con programas y organizaciones que trabajan en VIH/SIDA, hemos constatado que es poca la colaboración existente, que en algunas agencias incluso es bajo el conocimiento sobre TB (aún que traten, apoyen y aboguen por personas positivas). Encontramos en la realidad las mejores intenciones de colaboración, guías prácticas, documentos, y normas que indican cómo debería ser la realidad aunque esta todavía no sea como debería de ser por el bien de las personas afectadas por TB y por VIH. En las áreas donde trabaja el proyecto, como en otros países, la mortalidad en personas con TB está fuertemente ligada a la co-infección.
Cuáles son las alternativas? Además de dar seguimiento a las normas que contemplan una respuesta para esta problemática, existen cada vez más, aunque todavía en etapa incipiente, iniciativas de Abogacía, Comunicación y Movilización Social encaminadas a esta temática. En cuanto a la abogacía de políticas programáticas, la iniciativa de las tres “Is” para el control de la TB en personas positivas incluye –Infección, control de; Intensificar la detección y la Isoniazida como terapia preventiva. Se imaginarán que la iniciativa surge en inglés por eso la redacción un poco forzada.
Nos queda mucho por hacer, pero eso hace también interesante el camino. Empecemos por la mejor coordinación, por la detección, y la dotación de Isoniazida profiláctica. En materia de abogacía, tenemos un amplio margen de mejoría. Quienes trabajamos en TB, vamos a sentarnos a la mesa del diálogo y la planeación coordinada con los programas de VIH/SIDA. La TB es curable, su tratamiento es gratuito y podemos evitar muchas muertes innecesarias. Abogacía para la Acción YA! Busque información sobre la publicación ‘Think TB in peoplw with HIV” en www.aidsmap.com.
La XVII Conferencia Internacional de SIDA que se lleva a cabo en la Ciudad de México entre agosto 3 al 8, se caracterizó por muchas cosas buenas, novedades, mensajes inspiradores, conferencias de tinte político, activismo admirable y la oportunidad de conocer más, compartir y regresar a casa (o al trabajo más bien) con renovados bríos y las mejores intenciones. Dentro de los cientos de conferencias, sesiones, pósteres, y etc. lo que hubo muy poco fue el tema de Tuberculosis. No obstante que la Tuberculosis es la principal causa de muerte en personas positivas, donde esta es endémica, el tema de Tuberculosis, o co-infección más bien brilló por su ausencia.
Contadas fueron las presentaciones oficiales que incluían el tema. Unas cuantas más que durante la presentación hacían tal referencia, pero incluso cuando se repetían mensajes importantes, el tema de co-infección fue rara vez mencionado.
Moviendo varias papas por decirlo de alguna manera, pude encontrar materiales, uno que otro póster, y unas cuantas referencias durante las presentaciones. Hubo incluso el día 7 de agosto, una manifestación por activistas que abogaban por el acceso a las pruebas de TB, por quimioprofilaxis y por supuesto por mejor coordinación entre programas. Había un stand de un laboratorio que vende también pruebas de TB. Y estaba afortunadamente el módulo de la Secretaría de Salud con información del programa nacional de TB.
Por qué esta ausencia tan marcada? Durante el trabajo del proyecto SOLUCION TB en 13 Estados mexicanos, en los acercamientos con programas y organizaciones que trabajan en VIH/SIDA, hemos constatado que es poca la colaboración existente, que en algunas agencias incluso es bajo el conocimiento sobre TB (aún que traten, apoyen y aboguen por personas positivas). Encontramos en la realidad las mejores intenciones de colaboración, guías prácticas, documentos, y normas que indican cómo debería ser la realidad aunque esta todavía no sea como debería de ser por el bien de las personas afectadas por TB y por VIH. En las áreas donde trabaja el proyecto, como en otros países, la mortalidad en personas con TB está fuertemente ligada a la co-infección.
Cuáles son las alternativas? Además de dar seguimiento a las normas que contemplan una respuesta para esta problemática, existen cada vez más, aunque todavía en etapa incipiente, iniciativas de Abogacía, Comunicación y Movilización Social encaminadas a esta temática. En cuanto a la abogacía de políticas programáticas, la iniciativa de las tres “Is” para el control de la TB en personas positivas incluye –Infección, control de; Intensificar la detección y la Isoniazida como terapia preventiva. Se imaginarán que la iniciativa surge en inglés por eso la redacción un poco forzada.
Nos queda mucho por hacer, pero eso hace también interesante el camino. Empecemos por la mejor coordinación, por la detección, y la dotación de Isoniazida profiláctica. En materia de abogacía, tenemos un amplio margen de mejoría. Quienes trabajamos en TB, vamos a sentarnos a la mesa del diálogo y la planeación coordinada con los programas de VIH/SIDA. La TB es curable, su tratamiento es gratuito y podemos evitar muchas muertes innecesarias. Abogacía para la Acción YA! Busque información sobre la publicación ‘Think TB in peoplw with HIV” en www.aidsmap.com.
Conoce tu Epidemia y Actúa YA! – Nota sobre SIDA 2008 # 2
Para alguien que trabaja en Prevención, el mensaje a través de esta conferencia fue claro. Algunas ideas previamente conocidas:
Conoce tu Epidemia –Una y otra vez, líderes y expertos/as mundiales aclaraban, recomendaban, exigían hasta el cansancio la necesidad de que la prevención vaya siempre de acuerdo a la realidad. Es decir, se necesita saber dónde existe la necesidad de prevención, quienes están siendo afectados y afectadas, para actuar precisamente ahí, donde más se necesita. En el caso de muchos países de América Latina, la prevención no es generalizada sino focalizada y o de baja intensidad. Tal es el caso de México al menos. Una gran mayoría de personas afectadas corresponde a hombres que tienen sexo con hombres y a personas con conductas de riesgo, más evidentemente, trabajadoras y trabajadores del sexo comercial. De primera instancia el mensaje es: trabaja con estos grupos vulnerables y atiende sus necesidades ahora! Esto es por supuesto condición necesaria para un bien planeado y ejecutado programa de control y prevención de VIH. La lógica así lo indica, pues evidentemente no solo se prolonga la vida y se mejoran las condiciones de las personas afectadas sino que potencialmente, se previenen nuevas infecciones (bajan las cargas virales, se conoce el estatus, la gente puede decidir protegerse más y proteger a otras/os etc.).
La epidemia no se acaba a condonazos. Más frecuentemente de lo que quisiéramos los programas preventivos se centran en la distribución de condones, y sólo en eso. Se piensa que ‘distribuir cientos y miles de condones en las personas con prácticas de riesgo acabará o disminuirá en gran medida el riesgo de nuevas infecciones’. Bueno, muchos/as de nosotros sabemos que la problemática no es así de sencilla –si lo fuera, ya hubiéramos controlado la epidemia hace mucho tiempo. Repartir condones sin trabajar en otras necesidades de salud y sociales es un esfuerzo tal vez bien intencionado pero de poco impacto. Las personas con prácticas de riesgo son personas multi-dimensionales, que enfrentan una problemática compleja y generalmente no atendida. La manera de ayudarles a protegerse debe ser también multi-dimensional.
Los mensajes ya conocidos pero poco reconocidos incluyen:
“No podemos salir de la epidemia sólo con tratamientos” (la traducción literal sería “no podemos tratar nuestra salida de la epidemia). Es decir, no es suficiente con mejorar y asegurar el acceso a antiretrovirales para las personas positivas y evitando sus muertes como vamos a acabar con la epidemia. El punto es, se necesita hacer más y mejor prevención. Mucho más de lo que estamos haciendo.
La prevención que funciona y que tiene impacto es aquella que es ‘integrada’ es decir, que ofrece diferentes servicios, que conjuga diferentes programas, y abarca los diferentes aspectos de la vida de la persona afectada -- Una prevención basada en la persona. El mensaje de integración, si bien no es nuevo para quienes conocen de y trabajan en VIH/SIDA es frecuentemente olvidado en los programas, públicos o muy medicalizados principalmente donde se separa a la persona en ‘sistemas’ y ‘departamentos o programas’ que sólo ven al ‘cliente’ o ‘paciente’ como un órgano o sistema, y no como un ser humano integral, afectado igual que su familia.
La prevención integrada e integradora requiere asi mismo de la conjunción de diversos sectores, no solo del sector salud, sino de empleos dignos, de vivienda, de educación y acceso a información, de justicia social y de reconocimiento de derechos humanos.
Finalmente, otro mensaje poco reconocido es el de la necesidad de ver a las personas afectadas como sujetas de derecho, y no como objetos. Ni de estudios, ni de investigaciones, ni como ‘beneficiarios’ de programas, sino como personas con dignidad, sentimientos, emociones, complejidades y sobre todo derechos humanos, de salud y de reconocimiento.
Desde mi personal trinchera, envío un saludo especial y una felicitación a los colegas de ONGs que trabajan incansablemente en la lucha por los derechos de las personas afectadas, y que hacen hasta lo imposible por apoyar de manera integral, sus necesidades. Mi respeto a todos y todas.
Conoce tu Epidemia –Una y otra vez, líderes y expertos/as mundiales aclaraban, recomendaban, exigían hasta el cansancio la necesidad de que la prevención vaya siempre de acuerdo a la realidad. Es decir, se necesita saber dónde existe la necesidad de prevención, quienes están siendo afectados y afectadas, para actuar precisamente ahí, donde más se necesita. En el caso de muchos países de América Latina, la prevención no es generalizada sino focalizada y o de baja intensidad. Tal es el caso de México al menos. Una gran mayoría de personas afectadas corresponde a hombres que tienen sexo con hombres y a personas con conductas de riesgo, más evidentemente, trabajadoras y trabajadores del sexo comercial. De primera instancia el mensaje es: trabaja con estos grupos vulnerables y atiende sus necesidades ahora! Esto es por supuesto condición necesaria para un bien planeado y ejecutado programa de control y prevención de VIH. La lógica así lo indica, pues evidentemente no solo se prolonga la vida y se mejoran las condiciones de las personas afectadas sino que potencialmente, se previenen nuevas infecciones (bajan las cargas virales, se conoce el estatus, la gente puede decidir protegerse más y proteger a otras/os etc.).
La epidemia no se acaba a condonazos. Más frecuentemente de lo que quisiéramos los programas preventivos se centran en la distribución de condones, y sólo en eso. Se piensa que ‘distribuir cientos y miles de condones en las personas con prácticas de riesgo acabará o disminuirá en gran medida el riesgo de nuevas infecciones’. Bueno, muchos/as de nosotros sabemos que la problemática no es así de sencilla –si lo fuera, ya hubiéramos controlado la epidemia hace mucho tiempo. Repartir condones sin trabajar en otras necesidades de salud y sociales es un esfuerzo tal vez bien intencionado pero de poco impacto. Las personas con prácticas de riesgo son personas multi-dimensionales, que enfrentan una problemática compleja y generalmente no atendida. La manera de ayudarles a protegerse debe ser también multi-dimensional.
Los mensajes ya conocidos pero poco reconocidos incluyen:
“No podemos salir de la epidemia sólo con tratamientos” (la traducción literal sería “no podemos tratar nuestra salida de la epidemia). Es decir, no es suficiente con mejorar y asegurar el acceso a antiretrovirales para las personas positivas y evitando sus muertes como vamos a acabar con la epidemia. El punto es, se necesita hacer más y mejor prevención. Mucho más de lo que estamos haciendo.
La prevención que funciona y que tiene impacto es aquella que es ‘integrada’ es decir, que ofrece diferentes servicios, que conjuga diferentes programas, y abarca los diferentes aspectos de la vida de la persona afectada -- Una prevención basada en la persona. El mensaje de integración, si bien no es nuevo para quienes conocen de y trabajan en VIH/SIDA es frecuentemente olvidado en los programas, públicos o muy medicalizados principalmente donde se separa a la persona en ‘sistemas’ y ‘departamentos o programas’ que sólo ven al ‘cliente’ o ‘paciente’ como un órgano o sistema, y no como un ser humano integral, afectado igual que su familia.
La prevención integrada e integradora requiere asi mismo de la conjunción de diversos sectores, no solo del sector salud, sino de empleos dignos, de vivienda, de educación y acceso a información, de justicia social y de reconocimiento de derechos humanos.
Finalmente, otro mensaje poco reconocido es el de la necesidad de ver a las personas afectadas como sujetas de derecho, y no como objetos. Ni de estudios, ni de investigaciones, ni como ‘beneficiarios’ de programas, sino como personas con dignidad, sentimientos, emociones, complejidades y sobre todo derechos humanos, de salud y de reconocimiento.
Desde mi personal trinchera, envío un saludo especial y una felicitación a los colegas de ONGs que trabajan incansablemente en la lucha por los derechos de las personas afectadas, y que hacen hasta lo imposible por apoyar de manera integral, sus necesidades. Mi respeto a todos y todas.
Thursday, August 7, 2008
Gender Based Violence
by Janine Schooley, PCI's VP for Technical Services & Program Development
“It’s important to shoot for the moon; Even if you miss, you will still be among the stars…”
-- Anonymous
It has been very gratifying to see so many presentations that mention or focus on the need to address gender-based violence as a growing social driver of the epidemic, particularly in a country such as South Africa. Not only was this featured in President Clinton’s keynote address, including his announcement of support for a UN agency dedicated to women, but it was discussed during several mainstream panel presentations. PCI and others have been focusing attention lately on developing an effective social mobilization approach to changing norms that fuel gender-based violence. While this approach is comprehensive and not prescriptive in the least, it struck me, when listening to some of the presentations, that we should more proactively include a few additional elements into our thinking:
1) Involvement and engagement of groups that work with men and boys. Although of course our approach engages men who are police, policy makers, media influentials, among others, and targets men as part of general society through social change amplification campaigns, perhaps we could be more overt in our promotion of an ethic of responsibility among men and boys by engaging groups already involved in this effort. There are male-oriented civil society groups in South Africa, for example, who are fighting against “risky masculinities” -- dangerous conceptions about what it means to be a man and how manhood should be proven. These groups will have much to offer to the process of changing social norms.
2) Women aren’t just victims; they are key actors in social change. Rather than think of women as being a somewhat passive ultimate beneficiary of our social mobilization work against gender based violence, we should think of ways of empowering women to be active agents of social change. One way of doing this would be to incorporate an economic empowerment component into the process so that their self esteem is increased and their ability to engage actively in the process of social change is enhanced. It’s not enough to modify the attitudes and behaviors of all the social actors and processes that influence behaviors that impact women; the women themselves need to be mobilized.
3) There is a critical subset of women that deserves some special focus. Hate crimes against certain women are apparently on the rise in much of Southern Africa. This includes horrific acts of violence against lesbian girls and women, sex workers, and others. Many of these women are imprisoned and then raped (“state violence”). Many suffer a double stigma of being HIV and lesbian or sex worker. Many suffer psychological violence/abuse as well as physical. This is clearly a small, but increasingly ugly subset of vulnerable women and there are undoubtedly key groups that work with and on behalf of these women that we could partner with.
“It’s important to shoot for the moon; Even if you miss, you will still be among the stars…”
-- Anonymous
It has been very gratifying to see so many presentations that mention or focus on the need to address gender-based violence as a growing social driver of the epidemic, particularly in a country such as South Africa. Not only was this featured in President Clinton’s keynote address, including his announcement of support for a UN agency dedicated to women, but it was discussed during several mainstream panel presentations. PCI and others have been focusing attention lately on developing an effective social mobilization approach to changing norms that fuel gender-based violence. While this approach is comprehensive and not prescriptive in the least, it struck me, when listening to some of the presentations, that we should more proactively include a few additional elements into our thinking:
1) Involvement and engagement of groups that work with men and boys. Although of course our approach engages men who are police, policy makers, media influentials, among others, and targets men as part of general society through social change amplification campaigns, perhaps we could be more overt in our promotion of an ethic of responsibility among men and boys by engaging groups already involved in this effort. There are male-oriented civil society groups in South Africa, for example, who are fighting against “risky masculinities” -- dangerous conceptions about what it means to be a man and how manhood should be proven. These groups will have much to offer to the process of changing social norms.
2) Women aren’t just victims; they are key actors in social change. Rather than think of women as being a somewhat passive ultimate beneficiary of our social mobilization work against gender based violence, we should think of ways of empowering women to be active agents of social change. One way of doing this would be to incorporate an economic empowerment component into the process so that their self esteem is increased and their ability to engage actively in the process of social change is enhanced. It’s not enough to modify the attitudes and behaviors of all the social actors and processes that influence behaviors that impact women; the women themselves need to be mobilized.
3) There is a critical subset of women that deserves some special focus. Hate crimes against certain women are apparently on the rise in much of Southern Africa. This includes horrific acts of violence against lesbian girls and women, sex workers, and others. Many of these women are imprisoned and then raped (“state violence”). Many suffer a double stigma of being HIV and lesbian or sex worker. Many suffer psychological violence/abuse as well as physical. This is clearly a small, but increasingly ugly subset of vulnerable women and there are undoubtedly key groups that work with and on behalf of these women that we could partner with.
Why Do Pendulums Have to Swing?
by Janine Schooley, PCI's VP for Technical Services & Program Development
For every 2 persons starting anti-retroviral therapy (ART), there are 6 new infections. Clearly we cannot treat our way out of this epidemic….
At the first World AIDS Conferences, the discussions were all about prevention because, well, there wasn’t much else to talk about. There was no ART; there were no vaccine trials; there was only prevention. Then for years the focus became almost exclusively on treatment. At this year’s conference however, there is a lot of talk about prevention and, more importantly, there is a lot of talk about there being no one silver bullet, about the need for an integrated, comprehensive approach. Peter Piot, Director of UNAIDS, was philosophical about this development. He said that paradoxically perhaps we had to go through this process of veering from one to the other before we could finally come back to the realization that we need it all. He said that we left prevention in the dust of treatment, but that perhaps we couldn’t truly do what was needed in prevention until we had figured out the ART side of things. I don’t know about that (smacks a bit of a rationalization to me), but the change sure is welcome.
Not only are people this year talking about the need for both treatment and prevention, but thankfully, they are talking about something called “combination prevention” which means the kind of prevention that works on multiple levels, using multiple strategies, with none of them working in isolation – a larger, more systematic response that effectively combines biomedical, behavioral, and structural interventions and matches that combination to the particular situation and nature of the epidemic..
Oversimplification is out and context, finally and thankfully, is in. A new paradigm for monitoring, evaluation, and documentation of evidence will be needed and there must also be a realization that social change is messy and takes time. We need to focus more on the “how” and less on the “what” and we need to take into account the interplay between treatment and prevention. New partners in social and behavioral change will need to join the rank and file of HIV/AIDS combatants. In addition, prevention must be seen not as stopping something, not as preventing something, but actually as something more positive, allowing hope and sexuality to flourish and bringing out the best inour humanity and in our protection and promotion of health and wellbeing.
This theme of integration is winding its way through discussions about prevention of mother to child transmission (PMTCT), the need for family-centered approaches to care and support, and the need to focus on good primary health care and social protection when addressing the needs of vulnerable children. This is all music to my ears and is in keeping with my tongue-in-cheek suggestion of a new definition for the acronym PMTCT: Promotion/protection of Mother Together with Child Total health, as opposed to just stopping vertical transmission of one virus.
Someone joked that if we think in more integrated terms, perhaps we will all have less meetings to attend. There are of course many more compelling reasons why this pendulum swing is most welcome, not the least of which is that it means that we will finally have a good chance of making a dent in this still raging pandemic and do so in a way that is as cost effective and lasting as possible.
August 6, 2008 :: Mexico City IAC
For every 2 persons starting anti-retroviral therapy (ART), there are 6 new infections. Clearly we cannot treat our way out of this epidemic….
At the first World AIDS Conferences, the discussions were all about prevention because, well, there wasn’t much else to talk about. There was no ART; there were no vaccine trials; there was only prevention. Then for years the focus became almost exclusively on treatment. At this year’s conference however, there is a lot of talk about prevention and, more importantly, there is a lot of talk about there being no one silver bullet, about the need for an integrated, comprehensive approach. Peter Piot, Director of UNAIDS, was philosophical about this development. He said that paradoxically perhaps we had to go through this process of veering from one to the other before we could finally come back to the realization that we need it all. He said that we left prevention in the dust of treatment, but that perhaps we couldn’t truly do what was needed in prevention until we had figured out the ART side of things. I don’t know about that (smacks a bit of a rationalization to me), but the change sure is welcome.
Not only are people this year talking about the need for both treatment and prevention, but thankfully, they are talking about something called “combination prevention” which means the kind of prevention that works on multiple levels, using multiple strategies, with none of them working in isolation – a larger, more systematic response that effectively combines biomedical, behavioral, and structural interventions and matches that combination to the particular situation and nature of the epidemic..
Oversimplification is out and context, finally and thankfully, is in. A new paradigm for monitoring, evaluation, and documentation of evidence will be needed and there must also be a realization that social change is messy and takes time. We need to focus more on the “how” and less on the “what” and we need to take into account the interplay between treatment and prevention. New partners in social and behavioral change will need to join the rank and file of HIV/AIDS combatants. In addition, prevention must be seen not as stopping something, not as preventing something, but actually as something more positive, allowing hope and sexuality to flourish and bringing out the best inour humanity and in our protection and promotion of health and wellbeing.
This theme of integration is winding its way through discussions about prevention of mother to child transmission (PMTCT), the need for family-centered approaches to care and support, and the need to focus on good primary health care and social protection when addressing the needs of vulnerable children. This is all music to my ears and is in keeping with my tongue-in-cheek suggestion of a new definition for the acronym PMTCT: Promotion/protection of Mother Together with Child Total health, as opposed to just stopping vertical transmission of one virus.
Someone joked that if we think in more integrated terms, perhaps we will all have less meetings to attend. There are of course many more compelling reasons why this pendulum swing is most welcome, not the least of which is that it means that we will finally have a good chance of making a dent in this still raging pandemic and do so in a way that is as cost effective and lasting as possible.
Wednesday, August 6, 2008
La Importancia de la conferencia Internacional SIDA 2008
by Blanca Lomeli, MD (PCI's Regional Director of North America Programs)
Son las 5:00 am del día 4 de la Conferencia, escribo esta nota por la necesidad de compartir, mientras pienso en cómo haré para empacar todos los papeles, folletos, documentos y etc (si, algunos souvenirs) en mi pequeña maleta. Muchas cosas para compartir con los colegas que no pudieron acudir.
Pensando en la importancia para México de esta conferencia: Los ojos del mundo puestos en México:
- Indudablemente el país ha sido analizado en diferentes niveles, y con diferentes resultados, respecto a la pregunta que se hacen muchos/as (sobre todo gente de México) de porqué fue seleccionado. El estigma y la discriminación, la homofobia son prevalentes. La epidemia es de ‘baja intensidad’ (comparada con otros países) o concentrada, y el acceso a los antiretrovirales es aún muy limitado. La prevención ha sido durante los últimos años casi inexistente.
- La conferencia ha servido para que el Gobierno preste más atención al problema, de primera instancia, para hacer cambios cosméticos y superficiales y poder ‘aparecer’ como un país más comprometido de lo que está, con la epidemia. El Secretario de Salud, por primera vez en la historia (y su historia) participó en una marcha contra la homofobia, caminando al lado de personas que seguramente no forman parte de su círculo profesional y/o social muy frecuentemente.
- La cobertura de los medios nacionales y locales ha sido diaria, con diversas notas y frecuente. A pesar de que ningún tema se toca tanto como las próximas olimpiadas, la Conferencia, las protestas de la sociedad civil, temas como derechos de trabajadoras sexuales, de niños y mujeres se han cubierto con una intensidad nunca antes vista. La gente piensa en SIDA y piensa en Derechos, al menos al escuchar o leer las notas periodísticas.
- De manera importante, el presidente Calderón inauguró la Conferencia y además anunció que se abría el mercado para explorar la producción o venta de medicamentos antiretrovirales ‘genéricos’ y se ha negociado una baja del costo de los precios con 5 de 7 laboratorios que los producen y venden en el país. Este es un cambio importante, substancial que ayudará a que el país pueda adquirir y asegurar el acceso a medicamentos a más personas durante más tiempo.
A million deaths is a statistic; one death is a tragedy
by Janine Schooley, PCI's VP for Technical Services & Program Development
“Imagination is more important than knowledge”
--Albert Einstein
--Albert Einstein
There are many statistics being presented here at the Mexico City IAC 2008. They are presented via power points, through poster presentations, in graphs, in pie charts and in handouts galore. But somehow all these facts and figures keep going in one ear and out the other, not really sticking and not really bringing the HIV/AIDS epidemic to life.
Fortunately there are a few other ways that information is being presented. For example, in the entrance to the grand exhibit hall, there is an old shack made up of roofing materials, cardboard and other miscellaneous junk. Hanging on the outside of the shack are large photos of people living with the co-infection of TB and HIV. A brief story is written in their own handwriting below their photo. If the handwriting is in a language other than English, then there is a translation into English written in magic marker below the photo and story. People can enter the shack and walk through the small living area, the smaller bedroom and out the other end.
For those of you who have been to Tune Town in Disneyland, it is kind of like walking through Mickey or Minnie’s houses, but not really. This house is filled with additional photos and stories, and none of them are cartoon character happy and peppy, although there is hope and dignity in this house. Even in the shabby furniture (the sofa is an old car or truck bench seat, the tables and chairs are mismatched and look like they were taken from a land fill) there is hope and dignity. There is an old wheel chair in the corner and various personal items here and there. It feels real, almost too real to bear. It looks like so many of the homes we have been invited into around the world, only this one echoes with the stories and voices of many families, many people living with these mutually reinforcing diseases, making it even more powerful.
There are many positive people here, like the 16 year old young woman who moderated a session I attended, introducing the scientific/medical presenters from around the world. She has been HIV positive since birth and she thanked all of us for the chance to express her pride in being HIV positive because, in her native country of Australia, she cannot be so open because of stigma and discrimination. She also brings the issues of HIV/AIDS to life in a way that all the power points in the world could never do.
And finally, every once in a while during a presentation filled with statistics, filled with the problems we are all here trying to address, someone will make a statement that makes us all sit up pay attention just a little bit more. Last night that statement was about the new phrase that the presenter has been hearing recently in Haiti to describe the terrible food crisis there. I don’t speak French so I won’t get that right, but basically it was that people have coined the term “Clorox hungry”, meaning the level of hunger that feels like they have been bleached dry, bleached of everything. I had heard about the riots in Port Au Prince and I had seen the statistics about the cost of food and the rising levels of malnutrition in Haiti, but somehow just the fact that this new term is being used made my blood run cold.
Statistics are important of course, but when this conference is over, it will be these and other such memories that will stick with me, will go in both ears and stay in my mind, probably for a very long time.
Tuesday, August 5, 2008
How Big is Too Big?
Reflections on the Mexico City IAC 2008
by Janine Schooley, PCI's VP for Technical Services & Program Development
This conference is huge! I’ve never been to such an event. They say there are 25,000 people here, but it feels like more when you are trying to make your way anywhere in the conference center, buy a sandwich, use the rest room, or get on a shuttle bus back to one of the hundreds of hotels participants are using all over this huge city. It is rainy and grey here in Mexico City, but the conference participants don’t seem to mind. There is an energy and a critical mass-ness about such a large group of people all coming together for a common purpose, to Stop AIDS Now!
But is the meeting too large? It’s so gargantuan that they can only hold it every other year. In 2 years it will be held in Vienna. Two years ago it was Toronto. The logistics are mind boggling and so I choose not to boggle my mind with them, simply thanking my lucky stars that it isn’t MY job to organize this monstrosity. The program book (and that’s without the supplemental program which is quite large itself) is the size of a good sized city’s phone book.
But it is the World AIDS Conference and the world’s eyes are upon us. The size and scope is a good thing when you have President Clinton speaking and the paparazzi’s cameras buzzing, sending images and messages around the globe. This conference may be too big for me, but it isn’t too big for the topic of HIV and AIDS. HIV and AIDS needs a meeting of this size to attract the attention of the media and the politicians. The energy and the scale of the conference is helping to ensure that this unprecedented humanitarian crisis does not go unnoticed, does not fall off the headlines, and does not fade from the consciousness of the planet.
So is this monstrosity too monstrous? NO! It is just the right size for the job, the job of helping us all tackle HIV and AIDS, raise awareness, keep the funding flowing, keep the folks in the trenches motivated and uplifted, and keep us all reminded that size does matter, particularly when the dragon we are trying to slay is as huge and monstrous as it is…
Let’s just hope Vienna is big enough for IAC 2010!
by Janine Schooley, PCI's VP for Technical Services & Program Development
This conference is huge! I’ve never been to such an event. They say there are 25,000 people here, but it feels like more when you are trying to make your way anywhere in the conference center, buy a sandwich, use the rest room, or get on a shuttle bus back to one of the hundreds of hotels participants are using all over this huge city. It is rainy and grey here in Mexico City, but the conference participants don’t seem to mind. There is an energy and a critical mass-ness about such a large group of people all coming together for a common purpose, to Stop AIDS Now!
But is the meeting too large? It’s so gargantuan that they can only hold it every other year. In 2 years it will be held in Vienna. Two years ago it was Toronto. The logistics are mind boggling and so I choose not to boggle my mind with them, simply thanking my lucky stars that it isn’t MY job to organize this monstrosity. The program book (and that’s without the supplemental program which is quite large itself) is the size of a good sized city’s phone book.
But it is the World AIDS Conference and the world’s eyes are upon us. The size and scope is a good thing when you have President Clinton speaking and the paparazzi’s cameras buzzing, sending images and messages around the globe. This conference may be too big for me, but it isn’t too big for the topic of HIV and AIDS. HIV and AIDS needs a meeting of this size to attract the attention of the media and the politicians. The energy and the scale of the conference is helping to ensure that this unprecedented humanitarian crisis does not go unnoticed, does not fall off the headlines, and does not fade from the consciousness of the planet.
So is this monstrosity too monstrous? NO! It is just the right size for the job, the job of helping us all tackle HIV and AIDS, raise awareness, keep the funding flowing, keep the folks in the trenches motivated and uplifted, and keep us all reminded that size does matter, particularly when the dragon we are trying to slay is as huge and monstrous as it is…
Let’s just hope Vienna is big enough for IAC 2010!
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