Why Do Pendulums Have to Swing?

by Janine Schooley, PCI's VP for Technical Services & Program Development

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.

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.

La conferencia SIDA 2008 en México ha sido principalmente, la razón que 25 mil personas, científicos/as, activistas, miembros de la sociedad civil, visiten la Ciudad de México por unos días, escuchen lo último sobre los avances, el progreso y el futuro de la epidemia. La energía continúa siendo impresionante. Las conexiones humanas, y las baterías de todos y todas recargadas, lo mejor de todo.

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

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.

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!

FOCUS! The Girls at Risk on the Streets of Zambia

The Africa KidSAFE program (a PCI-led effort to provide a safety net for Zambia’s vulnerable children) faced challenges in addressing the needs of female street children, specifically, which remains a common obstacle in global efforts to help street children.

This is primarily because of the unique experiences, motives and problems that street-active children face when female, including escalated verbal, physical and sexual abuse, increased vulnerability to HIV/AIDS and other STIs, exclusion, and the turbulence of pregnancy.

This greater trial and tribulation paradoxically makes female street children more resistant to aid from outreach workers and shelters, and there is a higher incidence of female street children leaving the structured care of temporary and permanent shelters. In an effort to revise our approach to increase success rates, the Africa KidSAFE Network has recognized a need to specialize care. To do this, we have increased facilities directed specifically towards female street children, including exclusively female shelters, staffed by female professionals, shelters for new and expecting mothers, and assurance of high-quality care within shelters and for outreach worker training.

These efforts will serve to foster trusting relationships and provide an environment conducive to addressing the emotional, mental and physical needs of female street-active children. The network plans to improve these facilities in close consultation with the girls’ feedback and further research and negotiations are being pursued this quarter to maximize services provided exclusively to girls.

Building Back Better

Earthquake Resistant Housing for Peru’s Rural Families

Nearly a year ago, an earthquake measuring 7.9 on the Richter scale rocked the Peruvian regions of Pisco, Chincha, Alta, Ica, and Canete, leaving more than 90,000 families without homes. Since then, PCI has been working to create long-term, forward thinking solutions to help people in Peru deal with these kinds of disasters by building earthquake-resistant housing.

In partnership with Food for the Hungry, PCI has convened some of the world’s foremost experts in earthquake resistant building technology, non-governmental organizations, government officials, and international donors to pioneer an effort to help families rebuild with earthquake resistant adobe.

PCI is hosting visits from government officials of surrounding communities and other organizations, in hopes of expanding and developing the program. The vision is to create a local effort based on this technology to ultimately benefit tens of thousands of Peruvians.

Easing Burdens for Orphan Caregivers

Goats Provide Nutrition and Income

Ethiopia has one of the largest populations of persons living with HIV/AIDS in the world and, as the number of children losing parents to HIV/AIDS increases, an enormous burden is placed on extended families to meet the needs of these children.

Lack of food is often a major obstacle to improved health and nutrition, as well as recovery from tuberculosis and other debilitating infections for adults living with HIV/AIDS. For children, the lack of food leads to greater health problems due to weakened immune systems, poor school performance, and diminished quality of life.

With funding from Alternative Gifts International, PCI is providing HIV/AIDS-affected and vulnerable families in Ethiopia with goats and sheep to ease their burdens, help avert their deteriorating nutritional status, and generate income.

Goats are considered optimal for families affected by HIV/AIDS because they are small and can be easily handled by the sick, young, and elderly. The milk from goats is improving the quality of children’s diet and can also be sold for $0.44 US per liter to generate vital income for families. As of June 30, 2008, PCI expected to distribute over 2,500 goats and sheep to 1,700 caretakers of orphaned and vulnerable children.