The TRAWUN included communities outside the Mapuche people and welcomed other Chilean participants from the Aimara, Diaguita and Quechua people as well as international guests.
Credit: UNAIDS

Ahead of the International Day of the World's Indigenous People, celebrated 9 August, communities and associations of indigenous people living with HIV from several Latin American countries met for the “TRAWUN HIV and traditional health from a cultural diversity approach,” in Lautaro Commune, Chile.

This ‘TRAWUN,’ the term for Great Council in Mapudungun, an indigenous language to Chile, was organized to show the advances achieved in integrating HIV as an issue within the Mapuche community. For the first time, the TRAWUN included communities outside the Mapuche people and welcomed other Chilean participants from the Aimara, Diaguita and Quechua people as well as international guests from the Zapoteca in Mexico, the Chiquitano from Bolivia and the Waranka from Ecuador.

“This is a pioneering partnership in the region,” said Dr Annabella Arredondo, UNAIDS Coordinator in Chile. “Indigenous leaders are key allies in the response to HIV in the whole of Latin America, as it is one of the populations that need a culturally appropriate work to include prevention.”

The leaders of different Mapuche groupings have acknowledged HIV as a challenge in their communities and have undertaken different activities to prevent new HIV infections. Among the Mapuche, culture, tradition and knowledge is passed on to the next generation through elderly women, and the Trawun explored if information about HIV prevention could follow the same route.

According to the participants, there is a lack of information about HIV among the indigenous peoples in Chile, a problem they share with other Latin American countries.

Indigenous people have particular vulnerabilities to acquiring HIV, as many of the key risk factors that make individuals and communities vulnerable to HIV are present in large numbers of indigenous populations around the world. Some examples of this include marginalization, poor health in general, low literacy rates, limited access to health care, as well as high prevalence of injecting drug use and alcohol consumption.

“The situation of poverty, marginalization, stigma and discrimination in which indigenous communities live, put many people at higher risk of HIV infection,” said Amaranta Gómez Regalado, from Binni Laanu Juchitán, Mexico. Other key issues raised during the TRAWUN focused on sexual and cultural diversity and identity as well as the most appropriate way to include HIV prevention among the communities.

“For many years, we have fought a long battle against HIV in the region,” said Santiago Flores, President of Smiths for Life Rancagua, an institution renowned for its advocacy for human rights for people living with HIV. “Thanks to many joint efforts and volunteer work, we have positioned HIV within public policy and helped different groups and individuals, be it people living with HIV or their family and friends.”

Rene Mauricio Valdes, UN Resident Coordinator in Guatemala, at the inaugural event of the "HIV Testing Campaign" for UN staff members.
Credit: UNAIDS Guatemala

An estimated 100 000 people took part in the Ministry of Health and Social Welfare of Guatemala’s National HIV Testing Week Campaign, now in its second year. In order to fulfill the right to health for all citizens, the Ministry, through the National AIDS Program, has established 295 HIV testing sites at national hospitals and health centers around the country.

Twenty-seven years after the first reported case of HIV in Guatemala, access to testing remains limited. According to data from the National Epidemiology Center two out of three people living with HIV were unaware of their status. Early detection of HIV infection is crucial as it enables timely access to treatment and, with it, a better quality of life for people living with HIV.  

Under the slogan "No matter who you are, get tested for HIV," an estimated 100 000 people took an HIV test the last week of July. Supported by Red Cross Guatemala, civil society organizations, and universities, the initiative promoted inclusiveness and an environment free of stigma and discrimination.

To meet the country's commitment to universal access to prevention, treatment, care and support to HIV, the Government institutionalized the annual National HIV Testing Week to offer all citizens – including key populations at higher risk – access to HIV tests over a one week period.

"This is an opportunity to stop HIV in Guatemala and get closer to UNAIDS’ vision of zero new infections, zero AIDS deaths and zero stigma and discrimination,” said Enrique Zelaya, UNAIDS Country Coordinator for Guatemala and Mexico.

Innovative proposal in the UN

The UN system in Guatemala also took part in the weeklong campaign. Under the guidance of the UN system-wide workplace programme on HIV, UN Cares, with both human and material resources from the Red Cross and the Guatemala National AIDS Program, HIV testing was made available at different offices of the UN System in Guatemala.

"It is a privilege, an opportunity and a right to have this national initiative and to take it closer to our workplaces," said the UN Resident Coordinator in Guatemala, Rene Mauricio Valdes.

The HIV epidemic in Guatemala

An estimated 65 701 people are living with HIV in Guatemala. Each year, there are an estimated 7 557 new infections, the equivalent of 21 people newly infected each day. The country’s epidemic is concentrated among key populations at higher risk, such as transgender people, people with tuberculosis, men who have sex with men, female sex workers, youth at risk, and prisoners.

Credit: Patricia Leiva/OAS

A new resolution adopted by the General Assembly of the Organization of American States (OAS), condemns discrimination against persons based on sexual orientation and gender identity. The same resolution urge states to adopt the necessary measures to prevent, punish and eradicate such discrimination.

Under the theme of “citizen security in the Americas,” the 41st General Assembly brought together Ministers of Foreign Affairs and delegates representing 34 countries to El Salvador from 5-7 June 2011.

“This is a success for us and our work,” said German Rincon-Prefetti, lawyer and human rights activist from Colombia and member of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations. The Coalition had been advocating over the past five years to strengthen the resolution to protect their human rights.

The General Assembly provided the opportunity, for the first time ever, to a transgender person to address the members present. Speaking on behalf of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations, Monica Hernandez shared the Coalition’s concerns about to the wave of violence and hate crime experienced by sexual minorities in the region. “Acts of violence, human rights violations and discrimination practiced against us because of our sexual orientation and gender identity is the reality of our every day life,” she said.

The HIV epidemic in Latin America remains concentrated among men who have sex with men and transgendered persons. The latter group has reported HIV prevalence rates of 27.6% in Argentina and of 29.6% in Peru. At the same time the region has experienced an alarming increase in violence and intimidation towards transgender and other sexual minorities. “All forms of discrimination and violence—including transphobia—block access to HIV prevention programmes and impact the quality of care for people living with HIV. Working for the respect of human rights is at the core of the HIV response in Latin America,” said Edgar Carrasco, UNAIDS Country Coordinator in Venezuela who represented the joint programme at the General Assembly.

UNAIDS has been working with the Inter American Commission on Human Rights (IACHR) since 2010 to support the development of a Hemispheric Report on Sexual Orientation and Gender Identity. The IACHR is a principal organ of the Organization of American States (OAS), mandated by the OAS Charter to promote the observance and protection of human rights in the region.

German Rincon- Prefetti is optimistic of the impact this resolution will make. “Now we have an instrument to document the human rights violations we are facing and to make changes for the better,” he said. “The new resolution requests IACHR to prepare the Hemispheric Report in time for the next General Assembly to take place in Bolivia in 2012, with the member states full participation and in collaboration with civil society.”

In follow-up to the new resolution, UNAIDS regional office in Latin America, in collaboration with the Pan American Health Organization (PAHO), supported the first of five expert meetings to establish the foundations for the Hemispheric Report on 17-18 June. 

The expert meeting developed a network of resource people linked to HIV and health issues for lesbians, gays, transgender, bisexual and intersex populations that will elaborate a roadmap for the Hemispheric report including the draft State and non-State questionnaire. This will provide the comprehensive and standardized information for the report to be implemented in the 35 countries.       

Organization of American States

The Organization of American States is a regional international organization whose members are the 35 independent states of the American Continent. It is headquartered in Washington, D.C., United States.

Credit: UNAIDS

In the sidelines of the World Health Assembly, taking place in Geneva from 16-24 May, UNAIDS Executive Director Michel Sidibé and Brazilian Minister of Health Alexander Padilha met to discuss the global AIDS response and promote South-South cooperation.

Mr Sidibe and Mr Padilha talked about the participation and role of Brazil during the upcoming General Assembly High Level Meeting on AIDS that will take place in New York from 8-10 June 2011.

HIV treatment for prevention was highlighted as one of the country’s success stories and an area where Brazil could drive the push for innovation and transfer of technologies between countries. Both leaders also reflected the sports and HIV advocacy opportunities provided by the FIFA World Cup that will be hosted by Brazil in 2014.

Some of the participants at the initial meeting to undertake a study on the “vulnerabilities of women living with HIV in Latin America and the Spanish speaking Caribbean”.

Women living with and affected by HIV in Latin America met recently in Panama to identify tools and methodologies to undertake their own study on the “vulnerabilities of women living with HIV in Latin America and the Spanish speaking Caribbean.”

The group of 20 women who took part are members of the Latin American and Caribbean Movement of Women Living with HIV (MLCM+) and they refuse to have their realities reflected only in graphs and numbers. Therefore, they have embarked on a qualitative investigation around the vulnerabilities and the diversity of women living with HIV in 13 countries in Latin America as well as Cuba.

“We want this qualitative study to tell the stories that numbers do not tell,” says Marcela Alsina, the Director of Movement of Women Living with HIV. “It’s a study by us and for us to demand policy change, funding and participation of women. We are tired of being objects of investigation for studies ending up on shelves. The success of this study depends on us. If we shelve the study, we shelve our life.”

The study will consist of three parts. First, there will be a mapping of the existing policies and legislation promoting and protecting women. The second part will take stock of women living with HIV participating in national AIDS responses. Finally in-depth interviews will be conducted with women living with HIV from different age groups and life situations including those at higher risk of infection such as migrant and displaced women, women in prisons and women using drugs. These interviews will establish the different conditions that make women vulnerable and exposed to HIV.

The study developed by MLCM+ is being supported by UNAIDS as part of the regional efforts to implement the Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV which addresses the rights and needs of women and girls and highlights opportunities to work with networks of women living with HIV.

“This study will give us strategic information and evidence and make us the agents of change in our national responses,” said Gracia Violeta Ross from the Bolivian Network of People Living with HIV (REDBOL).

Ms Alsina is one of an estimated 550 000 women living with HIV in Latin America. There has been a reported increase in new HIV infections among women in the region. Participants at the meeting expressed the need to complement the current standards on HIV prevention which focus on the reduction of personal risk behaviours with approaches that seek to reduce vulnerabilities to HIV infection.

According to MLCM+ members, personal risk reduction approaches such as reducing the number of partners and increasing condom use are insufficient. The HIV response lacks programmes that reduce conditions of vulnerability to HIV among women, including poverty reduction, increased access to education for women, integrated sexual and reproductive health services, non-discriminatory services for HIV positive women and the elimination of gender-based violence in all its forms. Tackling these underlying conditions requires more long-term and integrated strategies. 

“We need a movement for social justice, a place at the table to change the conditions that are creating the vulnerabilities of all women,” said Nadine Gasman, Director of the United Nations Secretary-Generals’ Campaign UNITE To End Violence Against Women which aims to prevent and eliminate violence against women and girls in all parts of the world.

The new UNAIDS Strategy 2011-2015 promotes zero tolerance of gender-based violence and discrimination. UNAIDS Regional Director César Núñez stressed the need to place women and men living with HIV at the centre of the AIDS response.

Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe

Mounting an effective challenge to HIV in prison settings is a key part of the AIDS response at national, regional and global levels. To define standards for HIV prevention and treatment and the protection and promotion of prisoners’ human rights, it is important to consolidate as much data as possible about the epidemic in this environment. The newly established Monitoring Centre for HIV and Prisons in Latin America and the Caribbean is set to become the key regional repository for such vital information. 

The Monitoring Centre—called the Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe in Spanish—gathers data from 23 countries which is accessible via a web site. Its primary aim is to help governments and civil society define and implement national HIV prison policies based on international standards. Up and running in Spanish since mid-February, an English language version will be launched 30 April 2011.

The United Nations Office on Drugs and Crime (UNODC) is spearheading the initiative with support from the UN Educational, Scientific and Cultural Organisation (UNESCO), the Pan American Health Organization (PAHO), the World Bank, the UN Development Programme (UNDP) and UNAIDS.

According to José Vila del Castillo, UNODC Regional Advisor, “The Monitoring Centre shows the United Nations system ‘delivering as one’. Addressing HIV in the region’s prisons has become a priority. The centre is an important tool to catalyze prison reform processes and HIV penitentiary programmes.” 

Providing a permanent public space for informed reflection and dialogue, the virtual centre develops methodologies for collecting, processing, analysing and validating the scientific data gleaned on what works, and how best to proceed, in addressing HIV in prisons. It will highlight existing information and encourage ongoing research. Training and technical support are also offered through reference directories, online consultations, discussion forums and virtual classrooms.

In Latin America and the Caribbean, as elsewhere, many prisoners are vulnerable to HIV due to a number of factors, including the relative lack of knowledge about the virus among this population, overcrowding, lack of access to protection and good quality health services and violent conditions.

Across the region, where data are available, several countries have higher HIV prevalence in the prison population than in the general population. For example, according to data collected by UNODC this year, in Peru there are more than eight times as many people living with HIV in prison than outside (4.03% versus 0.4%). In Bolivia the situation is even starker; the same source documents show that in nine prisons in the country, 10% of prisoners are reported as HIV positive, compared to 0.2% prevalence in the wider society. 

César Antonio Núñez, Director of UNAIDS’ Latin America Regional Support Team, believes the Monitoring Centre will provide a valuable insight into the lives of a neglected population, “The Centre will really help us to know the true HIV situation in the penitentiary system, and shed light on human rights-related issues. It is probably in the environment of HIV and prisons where UNAIDS’ commitment to being ‘the voice of the voiceless’ is most needed and appropriate.”

Children and adolescents from rural communities of Guatemala participating in the 5th Rolling Fair called More information, less infection.

More than 1000 indigenous children and adolescents aged 9 to 15 years old from rural communities of Guatemala learned about HIV in the 5^th Rolling Fair called More information, less infection.  The initiative, which took place in San Pedro Yepocapa, was organized by the non-governmental organization (NGO) Comunicares, with support from local authorities, the ministry of education, the municipality, public schools, and the children’s parents.

"Before I came to the fair I knew nothing about HIV. Now I have learned that HIV and AIDS are not the same thing, and also that we are very young for sex," said a 10 year old student looking to her friend as she tried to recall more information, "Ah! And that our body is only ours and no one can touch it.”

The event was part of a broader project “HIV prevention for vulnerable populations: rural, indigenous and sexually diverse” supported by UNAIDS with financial grants from the Kingdom of the Netherlands.

UNAIDS Project Coordinator Ms Pilar Marín highlighted that the project is a great opportunity to reach people, especially children and youth in the rural areas of Guatemala who have not had access to HIV information. "In Guatemala and specifically among the rural and indigenous populations, HIV is often perceived as a taboo.  Through the project we are enhancing skills and knowledge to achieve a change in the behaviour of young people, to avoid risky practices," said Ms Marín.

From 8 am until 6 pm students travelled through an educational and creative journey to learn about HIV. The Rolling Fair is an innovative initiative that consists of a train with 11 illustrative wagons. Each wagon provides information, entertainment and fun games related to themes such as modes of HIV transmission and ways to prevent HIV infection, sexual education, understanding of stigma and discrimination, as well as prevention of violence towards children, especially girls.

"The aim is that children learn through teenagers living in their own community and speak their own language. This fair also includes training for teachers and parents," remarked Oneida Rodas, Director of Comunicares.

The Dutch Ambassador Jan-Jaap van de Velde and UNAIDS Country Coordinator Enrique Zelaya also participated in the fair. They then traveled to San Juan Comalapa to take part in another event organized by the Association of Community Health Services (ASECSA). This initiative brought together 200 young students between 15 and 18 years of age from public institutions to participate in dynamic workshops and HIV awareness-raising talks as well as a play.

These activities have provided young people in this municipality with information about HIV prevention which is complementing the sexual and reproductive education received at school. According to government data, in 2009 only 23% of young people age 15 – 24 years old knew how to correctly identify ways of preventing sexual transmission of HIV and reject major misconceptions about HIV transmission.

Participants in the workshop learn how to engage youth in the development, implementation and monitoring of Global Fund proposals. Panama City, Panama. 2-4 April 2011

Young people working on AIDS issues in Latin America are learning how to engage youth in the development, implementation and monitoring of Global Fund proposals through national mechanisms.

“We want to be able to speak on our own behalf. This workshop will give us tools to advocate at country level to ensure the creation of youth-centred programmes that reflect our needs,” said Ivens Reyner from the Youth Coalition—an international organization of young people committed to promoting adolescent and youth sexual and reproductive rights—and one of the young people responsible for organizing a training.

The event, which took place in Panama City from 2-4 April, is part of a series of regional workshops organized by the Youth Coalition and the Secretariat of the Global Fund to fight AIDS, Tuberculosis and Malaria.

The Global Fund Board of Governors recognized in its meeting in late 2009, the need to include more young men and women in the various processes both at global and national level. In recent months youth representatives from the Africa and Asian Pacific regions have been attending similar workshops in Cape Town and Bangkok respectively.

The young people who participated in the South Africa and Thailand workshops subsequently joined the Country Coordinating Mechanisms in their countries. They also participated in the proposal development and even become sub-recipients of the Global Fund grants.

“Young people taking ownership and demanding involvement in national programmes and Global Fund processes is core to ensure we reach universal access to HIV prevention, treatment, care and support in Latin America,” said UNAIDS Regional Director, Dr Cesar Nuñez.

Over three days, participants learned about how the Global Fund works. From the perspective of their fictional country “Youthland”, and using interactive methods and role play, young participants simulated all the processes involved in grant implementation from proposal development to disbursement of funds. They also developed advocacy and communication plans to be able to engage with their national partners.

“UNFPA is supporting this joint initiative between the Youth Coalition and the Global Fund because it is strategic to ensure that youth and their sexual and reproductive rights and health are adequately incorporated in the Global Fund programmes,” said Cecilia Maurente, Youth Regional Focal Point on behalf of Ms Marcela Suazo, Regional Director of UNFPA for Latin America and the Caribbean.

There are an estimated 1.8 billion adolescents and youth in the world today aged 10 to 24 years, accounting for more than a quarter of the world's population. Some 18% of the total population in Latin America is young people.

“Now we have 20 knowledgeable young people going back to their countries ready to engage with their Country Coordinating Mechanisms and national programmes to take the lead in developing new HIV prevention efforts for youth,” said Ricardo Baruch from the Youth Coalition and organizer of the training. “With young people on board we can make it, we can reach zero new infections in Latin America.”

More than 90 delegates participated in the Latin America consultation to review progress made towards achieving universal access to HIV prevention, treatment, care and support. Mexico City, 2-3 March 2011.

The Secretary of Health of Mexico, Dr José A. Córdova, called on countries in Latin America to continue efforts to counter stigma, discrimination and homophobia in the region.

Dr Córdova was one of seven Ministers and Vice Ministers of Health among more than 90 delegates contributing to the review of progress made towards achieving universal access in the AIDS response. The consultation, held in Mexico City from 2-3 March 2011, made regional recommendations and developed a roadmap on how to achieve universal access to HIV prevention, treatment, care and support by 2015.

“We need to strengthen the human rights approach in our response to AIDS and establish mechanisms to ensure that both public and private services are free of stigma and discrimination or homophobia,” said Dr Córdova.

Persistent homophobia, gender-based violence, persecution and even killings of most-at-risk populations such as men who have sex with men (MSM) and transgender people were identified as some of the main obstacles to ensuring access to HIV-related services in the region. Strengthening health systems that do not discriminate people living with HIV and key populations at higher risk of infection was seen by participants as a priority to achieve universal access. Improving access to legal services for human rights violations, discrimination and gender-based violence was also highlighted.

The AIDS epidemic in the region has remained stable for the last 10 years with an HIV prevalence of 0.5%. Antiretroviral therapy coverage is at 51%, which represents the highest in the world. However, young people, sex workers, MSM, and transgender people still have limited access to sexual and reproductive health programmes that provide information, skills, services and commodities to prevent HIV infection.

“We can only improve HIV prevention for the transgender community in Latin America through the respect for their identity in the health services,” said Marcela Romero from REDTRANSLAC, Argentina.

Participants identified a need to strategically position HIV within broader political agendas—including education, justice, equality, labour, and social development. This, it was felt, would secure political commitment and financial sustainability. According to the participants, investment from different sectors would have a multiplier effect that will contribute not only to achieve universal access goals but support the achievement of the broader Millennium Development Goals.

The need to strengthen relations between governments, civil society organizations and networks of people living with HIV throughout the region was another recommendation from the meeting. It was also proposed to jointly purchase antiretroviral drugs for the region rather than as individual countries to achieve economies of scale and to increase HIV treatment coverage. Additional strategies included enhancing production of locally produced antiretroviral drugs.

“Working together we can ensure a unified regional response to the epidemic and set the path towards sustainability in Latin America,” said UNAIDS Regional Director Dr César Núñez.

A version of this story was first published at UNHCR.org

Lucilda, a young mother of two, recently discovered that her husband had infected her with HIV. He recently died and the Colombian refugee finds herself alone in an area where people living with HIV are stigmatized.
Credit: UNAIDS/V. Rodas

Ten years ago, a teenager called Lucilda* ran away from her home in Colombia because she feared her mother's rage after going to a party without permission. At the age of 25 she got married and fled to Ecuador with her husband to escape the conflict in southern Colombia's Putumayo department. Her husband was violent to her and unfaithful. He has since died of an AIDS-related illness and Lucilda is struggling to raise two children alone as a refugee in Ecuador.

"He was very ill, but he didn't want to go to see a doctor. I took him and they told us what was going on. They also said that I was infected," she added. "He knew that he had AIDS, but he never told me."

Lucilda is receiving antiretroviral treatment and both her children are HIV negative. She is one of a small, but growing, number of people living with HIV in northern Ecuador's Sucumbios province and its capital, Lago Agrio, where some 20% of the population of 60,000 are Colombian refugees. At least 30 people here were known to be living with HIV as of the end of last year, double the number for 2009.

"This figure is certainly just the tip of the iceberg with regard to the number of people who are infected with HIV," said Paul Speigel, head of UNHCR's Geneva-based Public Health and HIV Section.

But the lack of openness about HIV is difficult to tackle in a conservative, male-dominated society, where those living with HIV, especially women, face stigmatization. With understanding key to preventing new infections, UNHCR and its partners are trying to counter this mindset and to spread awareness about the virus.

A special UNHCR programme to prevent HIV has been implemented by community health workers, and is helping to educate refugees and host communities in isolated areas of the jungle surrounding Lago Agrio. They also give lessons on sexual health, family planning and general health services, explaining the importance of safe sex and ensuring that people have the knowledge and freedom to keep themselves safe from HIV. Tackling gender-based violence is also a major concern in attempts to halt the spread of HIV.

Lucilda has firsthand experience of such violence. When she found out that her husband had been having sex with other women his reaction was harsh.

"I didn't want him to touch me, but he took a knife and forced me," she recalled. "I felt as if I had been raped."

The new UNAIDS strategy 2011-15, promotes zero tolerance of gender-based violence and discrimination. It recognizes that such violence is a human rights violation. It can also hamper people’s ability to adequately protect themselves from HIV infection and make healthy decisions about how, when and with whom they have sex. To successfully challenge the AIDS epidemic it is seen to be of paramount importance that Lucilda and other women live their lives free from the threat of violence.  

*Name has been changed to protect her identity