Ministers of Education and Health in Latin America and the Caribbean and other officials during the First Meeting of Ministers of Health and Education to stop HIV/AIDS in Latin America and the Caribbean. Mexico City, 1 August 2008.
Photo credit: agencialibrefoto

A year ago Latin America and the Caribbean Ministers pledged to provide comprehensive sex education in schools. The historic Prevention through education declaration was signed at the end of the First Meeting of Ministers of Education and Health to prevent HIV in Latin America and the Caribbean.

The Ministers committed to promoting concrete actions for HIV prevention among young people in their countries by implementing sex education and sexual health promotion programmes.

The declaration noted that “Sexuality is an essential part of being human and it is expressed throughout ones lifetime. Childhood and adolescence are important periods for the development of people and their countries, and for this reason, it is necessary to provide quality education that includes comprehensive education on sexuality both as a human right, as well as one that contributes to present and future quality of life.”

The Ministers also committed to two specific targets:

1. By the year 2015, we will have reduced by 75% the number of schools that do not provide comprehensive sexuality education, of schools administered by the Ministries of Education.
2. By the year 2015, we will reduce by 50% the number of adolescents and young people who are not covered by health services that appropriately attend to their sexual and reproductive health needs.

The 1 August meeting took place in Mexico City and was co-hosted by Dr José Ángel Córdova Villalobos (México), Minister of Health and Lic. Josefina Vázquez Mota (Mexico), Minister of Public Education in collaboration with Canciller Patricia Espinosa Cantellano (México), Minister of Foreign Affairs.

The event led to renewed commitment to education to prevent HIV in both Latin America and the Caribbean regions. Thanks to the declaration a new agreement was signed earlier this year in San Jose by the Government of Costa Rica which will lead in the sharing of sexual health information among young people, aged 15 – 25 years in two provinces. The young leaders will provide education on a wide range of issues such as modes of HIV transmission and how to use a condom.

Dr César Nunez, UNAIDS Regional Director for Latin America, points out that young people aged 15-24 accounted for 45% of all new HIV infections in 2007, however only 40% of young people aged 15-24 had accurate knowledge about HIV and transmission.

“Effective sexuality education can provide young people with age-appropriate, accurate and sensitive information equipping them to make informed decisions. Governments in Latin America and Caribbean are showing increasing leadership in this area.”

The United Nations Economic and Social Council (ECOSOC) has for the first time awarded consultative status to a Latin-American non-governmental organization representing the rights of lesbian, gay, bisexual and transgender communities. The organization, the Brazilian national Lesbian, Gay, Bisexual and Trans Association (ABGLT), will now be able to present oral and written reports at UN meetings and organize events on UN premises.

The ABGLT has said that its primary goal will be to highlight injustices around the world faced by the lesbian, gay, bisexual and transgender community, particularly in the 80 countries in the world have legislation that prohibits same sex behaviour.

UNAIDS welcomes the decision by ECOSOC and fully supports the rights of the lesbian, gay, bisexual and transgender community. UNAIDS works closely with such organizations in the AIDS response and will continue to promote human rights and fundamental freedoms for people living with HIV and those more vulnerable to HIV infection.

May 17 marks the International Day Against Homophobia which is an initiative to end discrimination and demand respect for the rights of homosexuals, transsexuals and lesbians.

Many countries in Latin America have planned activities to celebrate the Day such as marches, festivals, awareness raising workshops and campaigns to promote respect for sexual diversity.

UNAIDS Regional Director Dr Cesar Antonio Nuñez highlighted the need for all Latin American countries to observe the International Day Against Homophobia and Transphobia as an opportunity to strengthen the work being done around human rights to create a more effective response to AIDS in the region.

One of the new initiatives of this year’s celebration is an on-line campaign displaying messages against homophobia and transphobia. The campaign, which runs under the theme “For sexual rights and sexual diversity” was produced by the regional offices of UNAIDS and UNDP in collaboration with the Latin American Network of Transsexual People (REDLACTRANS), the Association for integral health and citizenship in Latin America (ASICAL) and the Latin American and Caribbean Council of AIDS Services Organizations for LAC (LACCASO).

“Let’s put an end to violence, let’s overcome the indifference” or “Homophobia accelerates the spread of HIV” are some of the campaign messages being displayed on web sites and played on YouTube. UNAIDS Brazil has adapted these spots into Portuguese.

Sex between men is the main mode of HIV transmission in Latin America and homophobia and stigma remain significant stumbling blocks to an effective response to the epidemic. Stigma and homophobia increase the isolation of gays, bisexuals and transgender people making them more reluctant to come forward, be identified and get advice and HIV services.

Many Latin American countries have laws that defend sexual freedom and orientation. For example with law reform in Nicaragua and Panama over the past 12 months, there are now no states in Latin America which criminalize homosexual relations.

Yet Latin America is widely regarded as having a long way to go to successfully counter homophobia, or “fear or hatred of homosexuals.” According to the UN, homosexual and trans people are frequently insulted, fired from jobs, and barred from community activities. .

The Miller School of Medicine of the University of Miami and the Fogarty International Training Programme on AIDS and TB organized in collaboration with UNAIDS the ‘Health Research in the Americas V’ Conference on 7 and 8 May 2009, in Miami, Florida.

The aim of the conference was to highlight current evidence on HIV prevention, discuss the sustainability of comprehensive HIV prevention efforts as well as to debate how HIV prevention is situated within the broader discussion of ‘health in the Americas’ and other international development strategies.

Sir George Alleyne, Special Envoy of the United Nations Secretary General for HIV/AIDS in the Caribbean, was invited as a keynote speaker on the second day of the conference.

Numerous local and national achievements in curbing the epidemic have created a body of evidence about what works, but these successful approaches have not yet been fully applied.

At the conference, scientists, HIV prevention practitioners and policy makers explored scientific and programme experiences for prioritizing comprehensive, evidence-informed HIV prevention approaches and discussed effective solutions that could bridge the interface between HIV and other health and development issues.

The conference was open to behavioral scientists and researchers who work in the area of HIV prevention in the Americas, with a special focus on Guyana, the Dominican Republic, Jamaica, Brazil, Colombia and Peru.

(L to R): Dr Jose Luis Sebastian Mesones, Technical Secretariat of the Horizontal Technical Cooperation Group and National AIDS Coordinator from Peru, UNAIDS Regional Director for Latin America, César Antonio Núñez, Minister of Health of Peru, Dr Oscar Raúl Ugarte Ubilluz, Minister of Labour, Jorge Elisban Villasante Aranibar, Director of Health Services of Peru, Dr Edward Cruz Sánchez and Mrs. Guiselly Flores Arroyo, representing the Latin American network of people living with HIV.
Credit: Ministry of Health of Peru/J.E.Castro Varillas

The V Latin American and Caribbean Forum on HIV/AIDS and STD’s, FORO 2009 was officially announced on Thursday 16th April in Lima. The Forum will take place in Peru’s capital from 22nd to 26th June under the theme “Health is our right, universal access is our goal, no discrimination our challenge”.

FORO 2009 was officially launched by the Minister of Health of Peru, Dr Oscar Raúl Ugarte Ubilluz together with the Minister of Labour, Jorge Elisban Villasante Aranibar, Director of Health Services of Peru, Dr Edward Cruz Sánchez, UNAIDS Regional Director for Latin America, César Antonio Núñez, Mrs. Guiselly Flores Arroyo, representing the Latin American network of people living with HIV, and Dr Jose Luis Sebastian Mesones, Technical Secretariat of the Horizontal Technical Cooperation Group and National AIDS Coordinator from Peru.

Health Minister Ugarte invited all stakeholders working in Latin America and the Caribbean to come to Lima and engage in an open discussion about universal access to HIV prevention, treatment, care and support in the region and single out the gaps in the response. This was reinforced by Labour Minister Villasante, who also raised the importance of reducing stigma and discrimination in the workplace in particular.

During the launch, UNAIDS Regional Director for Latin America, César Antonio Núñez stressed that FORO 2009 “offers an opportunity to governments and civil society to review progress made in the region towards universal access to HIV prevention, treatment, care and support under a human rights perspective.”

Dr Núñez pointed out to the audience that there are close to 500 new HIV infections in the region every day and highlighted the urgency to prioritize HIV prevention efforts as well as the need to reject all forms of stigma and discrimination against people living with HIV and people most at risk of HIV infection.

The main objective of the forum is to promote coordinated national and regional efforts to achieve universal access to HIV prevention, treatment, care and support in the region. The meeting will also serve as a platform to share lessons learned to improve practices on HIV interventions, prevention, research and access to information.

Furthermore, the meeting will review the response to AIDS through analysis of progress made in the fulfilment of the International HIV commitments made by governments in the region. The forum will highlight recent successes, as well as outlining the challenges faced in the region and ways to overcome them. Finally, it will promote the greater participation of all the social actors in response to the epidemic.

Some 4,000 people are expected to attend this year’s Latin American and Caribbean Forum on HIV/AIDS and STD’s. Participants will include people living with HIV, civil society groups, non-governmental and governmental institutions, academia, the media, UN agency representatives and the private sector.

A version of this story is also published at UNODC.org

The first national consultation on HIV in prison settings took place in Brasilia 31 March to 2 April 2009.
Credit: UNODC

Much more needs to be done to improve AIDS prevention, treatment and care services in Brazil’s prisons. This was the major conclusion emerging from the first national consultation on HIV in prison settings which took place in Brasilia between 31 March and 2 April.

Organized by Brazil's Ministry of Health and Ministry of Justice in partnership with the United Nations Office on Drugs and Crime (UNODC), the objective of the consultation was to discuss and propose an agenda with an action plan to provide prevention, treatment, care and support services aimed at addressing HIV, other sexually transmitted infections and co-infections such as tuberculosis and hepatitis in prisons.

"UNODC is committed to supporting the Government of Brazil in the provision of HIV prevention and care services to the prison population," said UNODC Representative for Brazil and the Southern Cone, Giovanni Quaglia.

The national consultation was attended by around 150 professionals. These included specialists from the key ministries, representatives from all 26 states of Brazil and the Federal District (where the capital is located), health professionals working in prison settings, members of the national harm reduction network, representatives of the Brazilian segment of the International Commission for Catholic Prison Pastoral Care and members of the National Network of People Living with HIV/AIDS.

As in most countries, Brazil has a higher HIV prevalence in the prison population than among the general population. According to the most recent research, a local study published in 2007, found rates of 5.7% among certain prisoners. In contrast, UNAIDS reports that by the end of 2007, general adult prevalence was 0.6%.

It is estimated that the country has approximately 420,000 prisoners living in often violent conditions where overcrowding, lack of access to medical services and unsanitary surroundings can lead to greater vulnerability to HIV and other infectious viruses such as tuberculosis and hepatitis. These conditions can also increase AIDS-related deaths and undermine attempts to implement an effective response to the epidemic in prisons.

Liliana Pittaluga, Technical Adviser at the Prevention Unit of the National STD and AIDS Programme, said that the consultation was a symbol of the solid partnership between the Government of Brazil and UNODC. "The cooperation between sectors is crucial to improve the health care and prevention services made available inside prison settings. We are confident that the results of this consultation will not only result in an exchange of experiences, but also in building a process of actions that will have a positive effect in the prison system at the country level."

The main outcome of the consultation was the commitment made by the Ministry of Health, the Ministry of Justice and UNODC to form a working group which will design a national operative plan with guidelines, targets and deadlines. In addition, civil society organizations, the Pan-American Health Organization (PAHO) and UNAIDS will be part of this group.

As well as UNODC, UNAIDS and PAHO/World Health Organization, also participating in the meeting were the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the United Nations Population Fund (UNFPA). Health and justice experts from the Southern Cone region also attended as observers, at the invitation of UNODC.

Dr. Guillermo Maza, Minister of Health of El Salvador signing the ministerial decree on 5th March 2009.

The Ministry of Public Health and Social Assistance of El Salvador approved, as part of its National Plan on HIV prevention, a set of actions to reduce homophobia and any type of discrimination based on sexual orientation in the health services.

In its 2008 country progress report El Salvador identified human rights violations as a major barrier to an effective response to the AIDS epidemic. The ministerial decree signed on 5th March 2009 by the Minister of Health Dr. Guillermo Maza, guarantees access to health services and respect of human rights to men who have sex with men, transgender, transvestites and lesbians.

The ministerial order states that all public health services such as hospitals, health clinics, etc. and their staff must facilitate, promote and support actions to eradicate discrimination based on sexual orientation. The decree also calls for all health institutions in the country to report back on the actions taken to reduce homophobia and discrimination.

“This ministerial decree reflects the fundamental principle of respect for the human rights of all those who suffer from stigma and discrimination and it reaffirms the spirit of the universal access to HIV prevention, treatment, care and support under a human rights frame,” said César Antonio Nuñez UNAIDS Director Regional Support Team for Latin America.

The decree also encourages multilateral cooperation agencies and International financing institutions to provide funds and technical support directed to effectively respond against discrimination.

According to UNAIDS, El Salvador has an HIV prevalence rate of 17.8% amongst men who have sex with men (MSM).

Aside from the individual pain homophobic attitudes inflict, the continuing stigma attached to same-sex relations is complicating the task of slowing the spread of HIV in the Latin America region in general where sex between men is a leading mode of HIV transmission according to national reports. Stigma and homophobia increase the isolation of gays, bisexuals and transgender people making them more reluctant to come forward, get advice and access HIV services such as treatment, testing and counseling.

By signing the ministerial decree, El Salvador builds on the country’s commitment to seriously expand efforts to address stigma and discrimination in health settings which will facilitate the intake of HIV services by one of the key populations at higher risk of HIV infection

UNAIDS Executive Director Michel Sidibé (right) met with Minister of Foreign Affairs, Mr Celso Amorim.
Credit: UNAIDS/M. Silva

The upcoming Group of Twenty (G20) meeting in London, the global financial crisis, and universal access were some of the main topics Mr Michel Sidibé and Brazilian Government counterparts discussed during his first official visit to Brazil as the Executive Director of UNAIDS.

UNAIDS Executive Director Michel Sidibé (left) greets Minister of Health of Brazil, Mr José Gomes Temporão.
Credit: UNAIDS/M. Silva

Mr Sidibé met with the Minister of Foreign Affairs, Mr Celso Amorim, the Minister of Health, Mr José Gomes Temporão, the Minister of Human Rights, Mr Paulo Vanucchi, and the Minister of Women’s Affairs, Ms Nilcéa Freire.

A meeting also took place between Mr Sidibé and the HIV/AIDS Parliamentarian Group, the LGBTT (lesbian, gay, bisexual, transgender and transvestite) Citizenship Group and the Human Rights Commission. The forum which took place at the National Congress in the capital Brasilia, was an opportunity for lively exchange of ideas and viewpoints on a range of issues at the heart of Brazil’s efforts to respond to the HIV epidemic and address human rights. These issues were also underlined in meetings Mr Sidibé had with the President of the Congress and the Senate President.

Civil society share challenges and barriers in responding to diverse epidemics

UNAIDS Executive Director Michel Sidibé meets representatives of group Arco-Iris.
Credit: UNAIDS/D. Ramalho

Two separate meetings with civil society groups in Rio de Janeiro provided Mr Sidibé an overview of the challenges facing several populations most affected by HIV, including sex workers, transgenders, gay adolescents and indigenous peoples in the Amazon region.

With ten national representatives of the Brazilian Interdisciplinary Association of AIDS (ABIA), Mr Sidibé was informed of the difficulties in responding to the many faces of Brazil’s epidemics.

HIV prevention was underscored by many representatives as an urgent issue to address, with a lack of resources to reach out to the groups most-at-risk from HIV seen as the biggest hurdle in preventing new infections.

With Grupo Arco-Íris (Rainbow Group), Mr Sidibé heard from several representatives of diverse lesbian, gay, bisexual, transgender and transvestite groups. They explained the concerns and challenges faced by them as LGBTT living in Brazil.

Grupo Arco-Íris is advocating for a change in the law in the federal senate that would make homophobic acts a criminal offence. So far, the group has collected more than 40,000 signatures in support of the law. The group also launched a HIV prevention campaign called “entre garotos” (between boys) that targets gay adolescents between the ages of 16 and 22 through tailored advertising and information displays at cafes, bars, dance halls, and other venues popular with young men who have sex with men.

Mr Sidibé pledged his continuing support to the LGBTT community and encouraged its members to mobilize and rally around efforts to achieve universal access to HIV services in Brazil.

UNAIDS Executive Director, Michel Sidibé visiting the Association Viva Cazuza which cares for orphans and adolescents living with HIV in Rio de Janeiro, Brazil, 26 March 2009
Credit: UNAIDS/D. Ramalho

Viva Cazuza has been working for nearly two decades in Rio de Janeiro to give orphaned children and young people living with HIV a safe haven, antiretroviral treatment and access to programmes to gain confidence and build leadership skills.

The society was created in 1990 in the memory of Brazilian rock star Cazuza who died of an AIDS-related illness in the same year. It’s a non-profit organization that provides a home for 20 children and adolescents, aged 2 to 16, who are living with HIV. Many of the home’s residents were abandoned at birth or left in the care of the Society at a later stage in their life.

Click on the image to start video

Cazuza’s mother, Maria Lucia da Silva Araujo, established the society with the support of the musician’s friends and the broader artistic and philanthropic communities. Since its founding, the society has helped more than 80 children.

UNAIDS Executive Director Mr Michel Sidibé took the opportunity to visit the Viva Cazuza Society on 26 March during his official visit to Brazil.

UNAIDS Executive Director, Michel Sidibé visiting the Association Viva Cazuza which cares for orphans and adolescents living with HIV in Rio de Janeiro, Brazil, 26 March 2009
Credit: UNAIDS/D. Ramalho

During Mr Sidibé’s visit of the residence, he was impressed by the passion and committed displayed by Maria Lucia da Silva Araujo in helping children living with HIV and advocating for broader prevention awareness. He said that her work is “more than just helping, but recreating life” for its residents.

Many of the older children are engaged in peer HIV prevention and sex education groups. Fifteen-year-old Leonardo is a member of a group that meets monthly to talk about prevention. He aims, through dialogue, to break down the prejudices of others that are the root of stigma and discrimination.

Viva Cazuza was established by Maria Lucia da Silva Araujo (centre) in memory of her son, Brazilian rock star Cazuza, who died of an AIDS-related illness in 1990.
Credit: UNAIDS/D. Ramalho

Beyond providing assistance to children and adolescents, Viva Cazuza also offers HIV treatment support to adults from the surrounding neighbourhood. Each Wednesday, more than 100 people stop by to get their antiretroviral medicine and, if they need support, have a chat with a counsellor.

The next step for Viva Cazuza is to help its growing young residents prepare for adulthood and their coming independence. Empowering them with a range of skills will help ensure their continued health and well-being after they leave the centre, including management of their treatment.

Michel Sidibé, UNAIDS Executive Director met with National Tuberculosis Programme Managers and Civil Society representatives at the 3rd Stop TB Partners Forum in Rio de Janeiro, Brazil, on 24 March 2009. Credit:UNAIDS/D. Ramalho

Mr Michel Sidibé, the Executive Director of UNAIDS, met with managers of national TB programmes and civil society representatives at the 3rd Stop TB Partners Forum to hear their views on ways to improve the joint response to TB and HIV.

One participant, in sharing his experience of addressing TB and HIV co-infection in Zambia, urged Mr Sidibé to use his position to mobilize greater leadership in confronting the twin epidemics of TB and HIV and to bring the AIDS and TB movements closer together. He stressed that the epidemics of TB and HIV can no longer be addressed in isolation. To illustrate the point one participant from Malawi gave a simple example of how, until recently, the TB movement was rarely visible at international AIDS conferences, and vice versa. This was emphasized when a participant from India asked, “When the virus and the bacteria work so well together, why can’t we?”

The participants agreed that TB is undermining the recent successes made in responding to HIV, reiterating the findings of the recent WHO World TB Control report that revealed that the impact of TB among people living with HIV is much greater than previously understood, as a result of better data coming from countries.

More TB screening for people living with HIV—through fully integrated TB/HIV services—would be an important and an essential step to reduce TB’s burden on people living with HIV. Additional points raised by the group were more funds, better trained staff and research to allow for better TB screening and prevention for people living with HIV and more advocacy and public awareness initiatives on TB and HIV co-infection.

Mr Sidibé asked TB programme managers and TB civil society to work closer with their peers in the HIV response to better “reach affected people out in the communities”. He closed this first conversation with TB programme managers and TB civil society by stating that “it is not acceptable that people living with HIV die from TB”—a key message he repeated throughout the three-day Stop TB Partners’ Forum.