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.”

The global economic downturn is having an adverse effect on migrants as they are excluded from stimulus packages and AIDS programmes are threatened, concludes a UN report released at the 9th International Congress on AIDS in Asia and Pacific (ICAAP). As in the 1997 Asian crisis, negative impacts on health and migration are set to become graver as donor funding and government programmes are cut.

Entitled The threat posed by the economic crisis to Universal Access to HIV services for migrants, the report is issued by the UN Development Programme (UNDP), the International Labour Organization (ILO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). It draws parallels between the current crisis and that of the Asian downturn of 1997 when the economies of Hong Kong, Indonesia, Japan, Korea, Malaysia, Singapore and Thailand were engulfed in turmoil after the collapse of Thailand’s stock market. The report argues that trends in migration policies and AIDS programmes now mirror those of 1997; a worrying development.

“It is critical that policy makers don’t make the same decisions that were made in ’97 vis-à-vis cuts to essential HIV/AIDS programmes, and adverse policies that worked against migrant workers. In contrast to the massive stimulus packages that countries are launching to boost their economies, AIDS spending for a comprehensive response represents a mere 0.01% of such programmes”, says Caitlin Wiesen, UNDP Regional HIV Practice Team Leader for Asia and the Pacific.

According to JVR Prasada Rao, Director of UNAIDS Regional Support Team, Asia and the Pacific, “Even before the financial crisis, HIV programmes and services for migrants and mobile populations often fell through the cracks in national programmes. Besides, we had seen from the past financial crisis that HIV prevention programmes were first to face budget cutbacks. Issues related to migrants are critical in a region with fast economic growth like Asia. We must strongly advocate with governments and donors not to cut resources on migrant HIV programmes.”

In the face of crisis, countries often introduce policies to cut migration, such as deporting workers or making migrant work permits more difficult to obtain. The 1997 downturn showed that this simply does not work. Instead, denied formal avenues for migration, many people find back door, unsafe channels that often make them vulnerable to HIV. According to the paper, governments have stopped issuing work permits, are cracking down on undocumented migrants (Malaysia) and many foreign workers in manufacturing and construction are being laid off (Indonesia, China). In a number of countries there are increasing reports of worsening working conditions (in Hong Kong, Malaysia and Singapore).

“In times of economic downturn, we cannot forget the needs and rights of migrant workers who are such an integral part of so many economies, especially in our region” says Dhannan Sunoto of the ASEAN Secretariat. “It is critical to ensure that potential migrants are not barred from working abroad based on their HIV positive status, and that migrants working abroad are not deported because of their positive status.”

As Dr Sophia Kisting, Director of the ILO Programme on HIV/AIDS and the world of work has it, “In the context of the current economic crisis we have reports of increased human rights violations, and pressure on migrant workers to move from formal to informal employment or to return to their countries of origin. These trends are likely to exacerbate vulnerability to HIV.”

She adds that her organization is moving forward with urgency in this area. “The ILO is in the process of formulating an international human rights instrument on HIV/AIDS and the world of work. If adopted in 2010, this standard…will give new impetus to anti-discrimination policies at national and workplace levels.”

The report outlines key recommendations:

1. Establish protective mechanisms like welfare funds, social insurance schemes and training programmes to help migrants returning home or to relocate on site;
2. Translate regional and national strategies for HIV that include migrants and mobile populations into budgets and services that are designed to reach people on the move;
3. Maintain prevention programmes and budgets: every $1 invested in prevention can save up to $8 in averted treatment costs;
4. Support civil society organizations to monitor the health-seeking behaviour of migrants so they do not have to sacrifice treatment for other basic necessities.

 

The paper was released at the symposium, The impact of the financial crisis on labour migration and HIV, organized by UNDP, ILO, UNAIDS and JUNIMA.

 

 

Reaffirming their commitment to the elimination of female genital mutilation, 10 United Nations bodies including UNAIDS, have expressed their commitment to support governments, communities, and women and girls to abandon the practice within a generation.

There are a growing number of examples in countries around the world where the prevalence of female genital mutilation has declined. The interagency statement “Eliminating female genital mutilation” is a joint initiative to support the scaling up of good examples to become common practice.

Female genital mutilation, also called female genital cutting and female genital mutilation/cutting, violates the rights of women and girls to health, protection and even life as the procedure sometimes results in death. Although decades of work by local communities, government, and national and international organizations have contributed to reducing the prevalence of female genital mutilation in many areas, the practice remains widespread.

Damages public health and human rights

Between 100 and 140 million women and girls in the world are estimated to have undergone female genital mutilation and 3 million girls are estimated to be at risk of undergoing the procedures every year.

The statement points out that female genital mutilation is a manifestation of unequal relations between women and men with roots in deeply entrenched social, economic and political conventions.

The practice is believed to enhance a girl’s chastity and chances of marriage by controlling her sexuality. As such, it not only infringes on women’s sexual and reproductive health; it also perpetuates gender roles detrimental to women.

"We recognize that traditions are often stronger than law, and legal action by itself is not enough,” said all the agencies involved. “Change must also come from within. This is why it is critical for us to join hands and work closely with communities and their leaders so that they can bring about sustainable social change.”

Health complications of female genital mutilation

The statement highlights the damaging effect of female genital mutilation on the health of women, girls and newborn babies. Immediate risks of the practice include severe pain, shock and even death through hemorrhaging. The use of the same surgical instrument without sterilization could increase the risk for transmission of HIV between girls who undergo female genital mutilation together.

Long-term health risks include chronic pain, reproductive tract infections, birth complications and psychological consequences. An increased risk for bleeding during intercourse may increase the risk for HIV transmission. The increased prevalence of herpes in women subjected to female genital mutilation may also increase the risk for HIV infection, as genital herpes is a risk factor in the transmission of HIV.

The UN said, “We are becoming increasingly concerned about the medicalisation of female genital mutilation. This is where the mutilation is performed by health professionals in health facilities. The argument that a mild form performed by medically trained personnel is safer is commonly heard in countries where female genital mutilation is practiced. But this should never be considered as an option."

The statement argues that the treatment and care of the adverse health consequences of female genital mutilation should be an integral part of health services, such as safe motherhood and child survival programmes, sexual health counselling, psycho-social counselling, prevention and treatment of reproductive tract infections and sexually transmitted infections including HIV and AIDS, prevention and management of gender-based violence, youth health programmes and programmes targeting traditional birth attendants (who may also be traditional circumcisers).

New evidence and lessons learned

The interagency statement is based on new evidence and lessons learnt over the past decade. It highlights the wide recognition of the human rights and legal dimensions of the problem and provides current data on the prevalence of female genital mutilation.

It summarizes findings from research on the reasons why the practice continues, highlighting that the practice is a social convention which can only be changed through coordinated collective action by practising communities. It also summarizes recent research on its damaging effects on the health of women, girls and newborn babies.

Drawing on experience from interventions in many countries, the new statement describes the elements needed, for both working towards complete abandonment of female genital mutilation, and caring for those who have suffered, and continue to suffer, from its consequences.

The Interagency Statement on Eliminating Female genital mutilation was signed by the Joint UN Programme on HIV/AIDS (UNAIDS), the UN Development Programme (UNDP), The UN Economic Commission for Africa (UNECA), the UN Educational, Scientific and Cultural Organizations (UNESCO), the UN Population Fund (UNFPA), the Office of the High Commissioner on Human Rights (UNHCHR), The UN Refugee Agency (UNHCR), UNICEF, the UN Development Fund for Women (UNIFEM) and the World Health Organization (WHO).

Every morning Buddhist Monk Maytryjit gets up at 3:45 am to meditate for one hour. Afterwards, he walks through the streets of Vientiane in the Lao Peoples Democratic Republic to collect his food alms.

However, this October he took time out of his usual routine to catch a flight to Pakse to attend a workshop convened by UNAIDS Cosponsor the United Nations Development Programme (UNDP) entitled Leadership for Results, which brought together more than 100 representatives from several provinces including Buddhist monks, government ministries and people living with HIV.

UNDP’s Leadership for Results training workshops aim to develop the capacity of local leaders to transform the response to AIDS by promoting leadership at all levels. A series of workshops were held, the final one in Pakse where the leaders attending formed seven “break through” groups in charge of developing proposals for a transformed response to AIDS in the country. The “break through” initiatives focused on increasing HIV prevention among women living in rural settings, improving access to condoms within the Army and increasing access to information on HIV through radio.

Ms. Setsuko Yamazaki, UNDP Resident Representative, a.i. said, “The rationale behind the Leadership for Results programme is to encourage the formation of strong leadership on AIDS related issues within all sectors, beyond those traditionally involved in the epidemic’s response.”

“This involves stimulating a deep-rooted shift within individuals, organizations and communities, to enable them to see AIDS from a new perspective, identify new possibilities and take action,” she added.

As a follow up to the workshop, the group committed to carrying out ten HIV prevention pilot projects at bus stations, markets and villages, with the aim of reaching out to thousands of people. Using radio programmes and loudspeakers, Monk Maytryjit and his group will also begin disseminating AIDS information during religious ceremonies, including one of Laos’ most significant religious festivals, the Pha That Luang (The Great Stupa or Sacred Reliquary) that is held in November.

“According to Buddhist philosophy one needs to follow the right path and an important part of our life-skills is to treat every person equally. It is important therefore to reduce stigma against people living with HIV in Laos and to help their families,” said Monk Mayrtyjit.

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For more information: Ms. Yasmin Padamsee Forbes or Ms. Soukphaphone Thongsavanh
+ (856 21) 213390-5 ext. 187 or 210, yasmin.forbes@undp.org , soukphaphone.thongsavanh@undp.org
This story first appeared on the UNDP Lao web site www.undplao.org

All photo credit : Yasmin Padamsee/UNDP

The Haitian civil society organization SEROvie was one of the 10 community-based organizations who won a Red Ribbon Award this week for its work in the prevention of sexual HIV transmission.

During its 14 year existence the group has repeatedly switched strategy. First they cast themselves as HIV educators, raising awareness everywhere from schools to church groups. Gradually they began talking gender, explaining to Haitians how prejudice and power-dynamics upped some people’s HIV risk. This ground-work was necessary to venture where they really wished to work—with the neglected gay, bisexual, sex worker and transgender communities.

“There was nothing for them then,” reflects executive director Steeve Laguerre. “Before we started, the men who have sex with men (MSM) didn’t know where to go to get HIV services. When they went to the usual sites they were not welcome at all so they were afraid to go. They were dying at home, alone.”

SEROvie conducts HIV prevention, health referrals, and psychological and social support, as well as home-based care visits, vocational training and a micro-credit programme. Today, 10% of the organization’s 4 000 beneficiaries are living with HIV and are accessing antiretroviral treatment and connecting with others through support group systems. Over the years SEROvie has fostered relationships with a range of community-friendly services. These are places where MSM and transgender people can get non-judgmental care along with information that is relevant to their lives. For Laguerre the key to serving this hard-to-reach community is, above all else, listening.

“We had to learn not to impose activities, interventions and services that we thought were a good idea. You need to listen to the community. Your programme interventions need to come from them and then you will be successful. What we did at first was think to ourselves ‘Let’s have such and such training. I am sure they need it’. Then you are asking yourself why they are not showing up,” Laguerre reasons.

It’s through this approach that the organization came up with its most recent incarnation. Today SEROvie supports the development of a lesbian gay, bisexual and transgender (LGBT) network throughout Haiti while providing MSM with education opportunities and job training. One man might want help to pursue a degree. Another may wish to set up a hairdressing service in his village. Some would like to fix computers, cook or drive cars. More than 500 persons have been trained in this way. But what do hairdressing and driving have to do with HIV?

“We were providing sensitization regarding HIV and sexually transmitted infections (STIs) and then we asked ‘What’s next?’ We asked the men and they said ‘We are not working. We would like to work’,” Laguerre recounts. By empowering the community economically, the men are more empowered about their sexual decision-making as the vulnerabilities MSM face everywhere are intensified by poverty.

Asked what advice he would offer other Caribbean non-governmental organisations (NGOs) on pressing the political class for action on behalf of marginalized and vulnerable groups, Laguerre stresses the importance of obstinate persistence.

“It takes constant work to build a relationship. You need to invite them within the institution so they can see what exactly you are doing. You need to send reports to them. You have to force communication with them,” he says.

That strategy is paying off. Recently Haiti’s Ministry of Health approved funding and asked SEROvie to help them implement activities for the LGBT community and sex workers in ten districts throughout the country.

“That,” Laguerre says with a satisfied smile, “is a first.”

Ten community-based organizations, which have shown exceptional and inspiring action on AIDS were honoured with the 2012 Red Ribbon Award in a special session of the XIX International AIDS Conference (AIDS 2012) on Wednesday. The Red Ribbon Award is the world's leading award for innovative and outstanding community work in the response to the AIDS epidemic.

The Global Forum on MSM and HIV (MSMGF) organised a fifth biennial gathering of activists, researchers, global donors and other key stakeholders to focus on HIV and human rights concerns of gay, other men who have sex with men (MSM) and transgender people.

Planned as a pre-conference ahead of the 19^th International AIDS Conference, this year's theme was "From Stigma to Strength: Strategies for MSM, Transgender People and Allies in a Shifting AIDS Landscape".

Since its inception in 2006, the pre-conference has grown to become the largest global gathering of activists, researchers, implementers and donors focused on the health and human rights of men who have sex with men. It provides a platform for participants to exchange the most recent research, best practices, and advocacy strategies that advance the overall goal of universal access.

The 2012 event welcomed more than 850 participants who focused their discussions around the implications of treatment as prevention, shifts in global financing, HIV criminalization, and the on-going barriers in addressing the global HIV epidemic among gay, MSM and transgender people.

MSMGF Executive Director Dr George Ayala noted that, “With the prevention potential of treatment confirmed and major shifts in the global financing architecture expected, the international HIV landscape is changing rapidly. Our Pre-Conference [addresses] the impact of these changes on MSM and transgender people and aims to identify the best steps forward."

Although there has been tremendous progress in the scale up of HIV treatment, and to a lesser extent HIV prevention, the goal of universal access remains elusive and coverage of prevention, treatment and care services for MSM and transgender people remains insufficient. Stigma, discrimination and human rights violations continue to be significant impediments to an effective HIV response.

“The meaningful inclusion of key affected populations in the AIDS response—specifically men who have sex with men and transgender people—is the only way we will achieve our vision of zero new HIV infections, zero discrimination and zero-AIDS related deaths,” said Ernest Massiah, Director of the UNAIDS Caribbean Regional Support Team. “We cannot achieve an effective HIV response among key populations unless we simultaneously respect, protect and defend their human rights in every country in the world,” he added.

The event comes at a time when HIV rates among men who have sex with men in countries like Mexico, Jamaica and Zambia have reached 25%, 31% and 32%, respectively. In the United States, MSM account for more than half of all people living with HIV and more than 60% of new infections.

Earlier this month, in a landmark report, the Global Commission on HIV and the Law called for the removal of laws that criminalize people on the basis of their sexual orientation and gender identity. It cited extensive evidence of how such criminal laws exacerbate risk of HIV infection among men who have sex with men and transgender people. According to the report, such laws drive people underground and into the margins of society away from health and HIV services.

Speaking about laws criminalizing lesbian, gay, bisexual and transgender people, Maurice Tomlinson, Legal Advisor for Marginalized Groups of AIDS-Free World said, “The report is important to our work because it provides irrefutable proof of the negative consequences of punitive laws on the HIV response and examples of good practice for legal reform.”

UNAIDS has long called for the removal of such punitive laws and their replacement with protective ones. Yet, countries across the world still maintain laws, policies and practices that infringe upon human rights, fuel discrimination and prevent global and national efforts to address HIV.

Ahead of the pre-conference event, the Global Forum on MSM and HIV released the Robert Carr Doctrine, which calls on all stakeholders to recognize that HIV is not just a public health issue, but rather a symptom of underlying societal inequities and injustices. Named after the well-respected international AIDS activist who passed away one year ago, the Carr Doctrine represents the first time that the global networks of key affected populations have come together to forge a shared strategy.

Recognizing the critical role that local organizations play in the response to HIV, five community organizations from Ghana, India, Iran, Malawi and Mexico were presented with Red Ribbon Awards at the International AIDS Conference (AIDS 2008) last night.

The UN, Beijing Youth League, China Red Cross and MSI join forces with people living with HIV to train Olympic volunteers on HIV prevention and anti-discrimination

The World AIDS Campaign has selected “leadership” as the 2007 World AIDS Day theme highlighting the need for innovative and visionary leadership in response to the epidemic. It calls on all of us to renew our commitment at the individual, family, community, national and international level to support empowering leadership on AIDS.

UNDP press release on World AIDS