Sexual transmission of HIV

Credit: OneLove campaign

“Talk, respect, protect”

OneLove is a regional campaign running in Southern Africa that aims to get people talking about the trend of having more than one sexual partner at a time. The overall goal is change this behaviour which is a factor in the transmission of HIV in the region.

Using mass media and social mobilisation to communicate its message, OneLove encourages people to discuss multiple partnerships and come to greater understanding of the risks involved in their lifestyle choice.

Multiple partnerships and concurrent relationships

Close sexual networks are formed when men and women have multiple sexual partners or concurrent relationships—ongoing relationships with more than one intimate partner overlapping for weeks, months or years. If someone in this network acquires HIV it increases the chance of everyone else who is part of this network becoming infected.

OneLove national campaign South Africa

The South Africa OneLove campaign was launched on 14 January. With outreach to 16 million South Africans, the prime-time TV drama series “Soul City” and the “Soul City” radio drama are key vehicles to get the message out to people across the country. UNAIDS is a partner of the Soul City Institute which aims to promote healthy lifestyle choices through mass media advocacy.

The OneLove theme is also being featured on radio talk shows, through TV and radio advertisements and a number of outreach events. Over a million information booklets will also be distributed in multiple languages.

The overall goal of the campaign is to reduce the number of new HIV infections in South Africa by 10% by 2011. This will contribute to the goal set by the South African National AIDS Council (SANAC), which aims to reduce the number of new HIV infections in South Africa by half in a couple of years.

“South Africa currently has the largest number of HIV positive people in the world with some 5.7 million people living with HIV in the country and HIV prevalence in adults—age 15 to 49—is 18%. Campaigns that inform people of the potential risks of their lifestyle empowers people to make informed decisions about their sexual behaviour,” said UNAIDS Country Coordinator Catherine Sozi.

Social networking to discuss sexual networks

As well as mobilizing traditional media, OneLove is also employing social networks to highlight the issue of sexual networks. The campaign features on a range of social networking and new media fora including video sharing site YouTube, the Flickr shared photo gallery, a Facebook page and Twitter feed.

Participation and sharing of ideas is at the core of the campaign. The OneLove official website (http://www.onelovesouthernafrica.org) hosts, in addition to lots of information resources and fact sheets, a weekly competition and blog. Everyone is invited to comment on articles, add their views on a discussion board and take the online polls.

The HIV epidemic in Southern Africa

The severity of the epidemic in southern Africa—nine countries in the region account for 35 per cent of all HIV infections in 2007—underscores the need for intensified and accelerated action towards universal access to HIV prevention, treatment, care and support.

OneLove signature tune performed at the community launch of the OneLove South Africa campaign in Ubuntu Kraal in Orlando West, Soweto on the 24 January 2009.
Credit: OneLove campaign

UNAIDS has identified HIV prevention as a particular priority and it highlights the importance of reducing HIV incidence through a combination of prevention approaches. Combination strategies include education and raising awareness in relation to delayed sexual debut, increased condom use, male circumcision and reduction in numbers of concurrent relationships. The OneLove campaign is an important vehicle for this.

There is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region. Credit: UNAIDS/S.Dragborg

Judging by the official statistics, cases of HIV infection amongst men who have sex with men (MSM) in Ukraine, as in much of Eastern Europe and Central Asia, are so rare as to seem scant cause for concern.

“No statistics means no problem,” says Zoryan Kis of the All-Ukrainian Network of PLHIV (People Living with HIV). “The fact that the official numbers are very low is a danger for our work because we know that the epidemic exists but it is hidden.”

But there is no doubt in the minds of health experts and activists that the official figures hugely underestimate the numbers of MSM living with HIV and newly acquiring HIV infection in Ukraine and elsewhere in the Region.

In the 20 years since the first case of HIV infection was detected in Ukraine, only 158 MSM have been officially registered as living with HIV in a country with a total population of some 46 million people.

According to the 2007 UNGASS country report Ukraine has the most severe HIV epidemic in Europe, with just over 1.6 percent of the adult population estimated to be living with HIV. In 2007, 17,687 people were reported as newly infected with HIV, up 10 percent from 2006. Among them, the official number of new cases amongst MSM was just 48.

Together with the high degree of stigma attached to MSM in Ukraine, something the country shares with other countries in Eastern Europe and central Asia, this understating of the problem has contributed to authorities’ reluctance to back campaigns of prevention among MSM, activists say.

Beyond the official statistics, there is considerable data on MSM which paints a different picture. Various organisations, including UNAIDS, WHO and the International HIV/AIDS Alliance in Ukraine estimated that in 2006 there were between 177,000 and 430,000 MSM in the Ukraine, of whom between 3 and 15 percent of live with HIV, which is several hundred times the figure reflected in the official studies.

Stigma and discrimination

Official HIV figures in Ukraine, as elsewhere in the region, are based on the results of voluntary HIV testing during which people should normally be asked why they have sought a test.

But in countries where MSM face widespread discrimination and where there is a high degree of stigma attached to male to male sex, there is understandable reluctance on the part of MSM to give the true reason.

“Most of MSM are not open. They would not go and say: ‘I have had sex with men’. They would say ‘I have had risky behaviour, I have been injecting drugs or even I have visited the dentist and I am worried,” says Kis.

And often officials do not press for answers. “I have been tested four or five times, but I have never been asked for my sexual orientation,” Kis adds.

According to the European Centre for the Epidemiological Monitoring of HIV/AIDS, only 1,828 cases of HIV infection in MSM have been officially reported between 2002 and 2006 years in the 15 former Soviet countries making up the World Health Organisation’s Eastern European health region.

Turkmenistan and Tajikistan, report none, while Azerbaijan has only 10 and Belarus 29. The highest number is reported by Russia; but its 1,245 cases over the 5 years compares with more than 38,000 in Britain and 11,000 in Germany in the same period, countries with smaller overall populations.

Prevention services for MSM have improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine.
Credit: UNAIDS/P.Carrera

Ambitious goals

In 2006, Ukraine set ambitious national goals for scaling up towards universal access to HIV prevention, treatment, care and support for groups at high risk of HIV. However, HIV prevention activities in the Ukraine, as in most of the rest of the region, are carried out by NGOs with financial backing from international donors, mainly the Global Fund for AIDS, Malaria and Tuberculosis.

For example, a two-year project called “Men Who have Sex with Men: HIV/STI Prevention and Support” was implemented in Kiev by the AIDS Foundation East-West, the Gay Alliance NGO and Noah’s Ark-Red Cross Sweden, with financial support from the Elton John AIDS Foundation amongst others.

The International HIV/AIDS Alliance in Ukraine, which is co-holder of the Global Fund grants, is currently undertaking 14 projects aimed at HIV prevention among MSM. They include outreach services, provision of information and education around HIV and sexually transmitted infections (STIs), behavioural change communication, promotion of safer sex, condom and lubricants distribution, counselling and rapid-testing for HIV, testing and treatment of STI, self-help groups and anti-stigma trainings.

“The scale and scope of prevention services for MSM has improved in the last few years, but they remain significantly inadequate to impact and sustain behavioural change and thus reduce HIV transmission among this group of men in Ukraine,” says Dr. Ani Shakarishvili, UNAIDS Country Coordinator in Ukraine.

The situation is similar elsewhere in Eastern Europe and Central Asia. For example, there are no state-funded HIV prevention programmes for MSM in Russia.

“Governments everywhere are reluctant to spend money on sex workers, on drug users, but MSM comes at the top of the reluctance list. It is probably the last programmes that the governments will start,” says Roman Gailevich, UNAIDS Regional Programme adviser.

The new programme marks an encouraging change of stance by the government.
Credit: UNAIDS/S.Dragborg

For the first time

Under pressure from international donors and an increasingly vocal and better organised local MSM community, the Ukrainian Government recently agreed to include and set targets for HIV prevention and treatment for MSM as a priority in its National AIDS Programme for 2009-2013.

“This change stems from comprehensive surveys in the community which show the real role of MSM in the HIV epidemic in Ukraine,” says Anna Dovbakh, head of team: policy & programme development at the International HIV/AIDS Alliance in Ukraine.

“Since 2005, activists of the LGBT (Lesbian, Gay, Bisexual and Trans-sexual) community have become more active and professional in their HIV advocacy and response,” she adds.

Activists and health experts say that the new programme, which is currently before the Parliament, marks an encouraging change of stance by the government.

But the jury is out on what real difference it will make, not least because the money for HIV prevention will continue to come from the Global Fund and other donors.

“The lack of Governmental commitment to provide resources, support and services for MSM and to address the existing legal, financial and administrative barriers to service access for MSM indicates that the Government of Ukraine is still not fully prepared to address the HIV epidemic in MSM,” says Shakarishvili.

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China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM)
Credit: UNAIDS

China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM), in the latest sign that the country may be starting to face up to a crisis which long seemed taboo.

Announcing the MSM campaign, the ministry of health said that risky sexual behaviour was the biggest single factor behind the spread of HIV in mainland China, excluding Hong Kong, and that men who had sex with men were now the group most likely to become infected with the virus. In China there are around 700,000 people living with HIV, and 11.1 percent of these are MSM.

“In the past between 1 and 3 percent of MSM on the mainland had HIV; Now it is anywhere from 2.5 to 6.5 percent”, Hao Yang, deputy chief of the ministry’s disease prevention and control bureau, was quoted as saying by the China Daily.

The campaign involved targeted prevention measures for the estimated 5-10 million- Chinese MSM, including stronger promotion of condom use, expanded coverage and quality of HIV prevention activities, increased access to voluntary HIV counselling and testing services, and improved access to treatment for sexually transmitted infections.

As a starting point for its new large-scale campaign to reduce HIV among MSM, China is aiming for some 21,000 MSM to be HIV-tested in order to be able to establish a clearer statistical baseline for the infection rate. This is the largest such study undertaken anywhere in the world and the first of its kind in Asia.

Its prevention effort will involve MSM community based organizations (CBOs) and civil society at all levels. Community-based organisations are carrying out AIDS awareness campaigns, VCT referrals, peer education, safer sex promotion and condom distribution; hot-lines are being run and internet chat rooms and websites used.

UNAIDS, the joint United Nations programme on HIV/AIDS, sees the empowering of MSM and other marginalized groups to protect themselves from HIV as one of the main elements of the global AIDS response.

"The Chinese government has made addressing HIV prevention among MSM a priority and that is something which UNAIDS welcomes," said Bernhard Schwartlander, UNAIDS Country Coordinator in China.

In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent.
Credit: UNAIDS

But despite progress in China, a number of shortcomings remain, with stigma and discrimination still all too prevalent amongst the general population and even within the MSM community itself.

It is estimated that by late 2007, only 8 percent of MSM had been reached by comprehensive HIV prevention interventions. Furthermore, more than half of China's MSM have more than one sexual partner but only between 10 and 20 percent of them use condoms, according to health ministry estimates.

“It is critical that the government and the many MSM working groups find ways to improve their ability to work together in open and nondiscriminatory partnerships", said Schwartlander.

Largely ignored

Developments in China come amidst indications that governments elsewhere in the Asia-Pacific region are also becoming more willing to acknowledge an epidemic that many had previously largely ignored.

In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent. As a result, there has been little in the way of specific support for programmes for MSM.

“A lot of attention is being drummed up, but a lot more needs to happen,” said Paul Causey, a Bangkok-based consultant working with the Asia Pacific Coalition on Male Sexual Health (APCOM) and the United Nations on MSM-related issues.

Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences; for many others, their sexual practices with other men may only be a small part of social roles they play or their sexual lives. Given that many men who have sex with men also have sex with women, high HIV rates among MSM can also translate into substantial numbers of women at risk of exposure to HIV.

The combination of high numbers of partners with high-risk behaviour such as unprotected anal intercourse has been a key factor behind the accelerating HIV infection rate in many Asian cities.

It said that hardly any Asian country is devoting significant resources to MSM, despite the fact that prevention costs a lot less than treatment. According to the commission, $1 invested in effective prevention can save up to $8 in treatment expenditure for expanding epidemic countries.

Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences.
Credit: UNAIDS

Engaging community groups

The tipping point in awakening to the dimension of the MSM crisis was the convening of a special conference in New Delhi in September 2006 entitled “Risks and Responsibilities: Male Sexual Health and HIV in Asia and Pacific”.

The conference was truly tripartite, bringing together governments, donors and 380 members of community groups. As important as the event itself was the run-up, with 16 countries holding UNAIDS-sponsored preparatory meetings. In some cases, including that of China, it was virtually the first time that government officials and representatives from the wider MSM community groups met to assess the situation and discuss solutions.

One of the other lasting achievements of that conference was the decision to launch APCOM, which brings together civil society groups, government sector representatives, donors, technical experts and the United Nations to push for an effective response to the rising HIV incidence amongst MSM.

Its efforts complement those of a United Nations technical working group on MSM and HIV/AIDS in China launched in mid-2006. The group is led by the United Nations Development Programme (UNDP).

“The technical working group is working with government, MSM community groups and donors to improve co-ordination and communication, build government capacities to involve civil society organisations (CSOs) in policy-making and public service delivery, and develop the institutional and professional capacities of CSOs,” said Edmund Settle, HIV manager for UNDP in China.

From Cape Town to Lagos, several new studies are starting to provide a better understanding of men who have sex with men (MSM) within the context of HIV in Africa.

“Homosexuality is very much understudied in West Africa, and in Nigeria it is criminalized, making it difficult to reach MSM,” said Sylvia Adebajo, a researcher at the University of Lagos, Nigeria. “As a result, the lives of MSM are characterized by denial, violence, and stigmatization”.

Ms Adebajo was speaking at an ICASA session held yesterday on men who have sex with men and HIV infection in Africa. She said that a significant hurdle in reaching out to MSM in Africa, and in particular in West Africa, is criminalization; few MSM come forward for fear of stigma, discrimination, and legal repercussions.

At this forum researchers presented several findings, some preliminary, that shared similar conclusions: HIV prevalence for MSM is many times higher than ‘background populations’, few self-identified MSM seek medical support or identify themselves in their communities, startling numbers do not wear condoms when having sex, many engage in bisexual behaviour, and few get tested to know their HIV status.

“Many MSM when they finally had a HIV test and it was positive, had not known their status and had continued to engage in high-risk behaviour for some time,” said researcher Earl Ryan Burrell of the Desmond Tutu HIV Foundation. “HIV programmes in South Africa are heavily heterosexual and female focused… more recognition of MSM as a risk group is needed,” he added. His ongoing study in Cape Town and its surrounding townships showed that many MSM are not aware of the risks associated with certain sexual acts, despite self-identifying as MSM and having varying levels of access to HIV prevention information.

A study completed in 2006 in Nigeria revealed that little is known about the link between HIV prevalence and MSM in the country. But of those surveyed nearly all reported having multiple concurrent partnerships with both male and female sexual partners. Condom use was low and when condoms were worn, many men used saliva or soap or oil-based lubricants, such as domestic cooking oil which can damage the surface of  condom.

The researchers ended the session by encouraging African governments to invest more resources in supporting HIV prevention and, most importantly, to recognize MSM as a group that requires tailored programmes. “More is needed to be known. Each of these communities have their unique prevention and treatment needs,” said Ms Adebajo.

As 5000 delegates from across Africa and the world gather in Dakar this week, condoms are being made freely available for delegates in hotels in the city as part of a HIV prevention drive.

The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) and UNAIDS have teamed up with the Senegal Hotel Industry around an HIV awareness initiative.

The 15th International Conference on AIDS and STIs in Africa which runs until Sunday this week has drawn aapproximately 5000 delegates and several hundred journalists from all over the world to Dakar. The event presents an opportunity to engage the local hotel industry on issues related to HIV. The hotel industry is a key player in the response to AIDS as it reaches a wide and diverse audience, including employees, with HIV prevention information.

A kit has been distributed in all hotels which includes condoms provided by the United Nations Population Fund (UNFPA); a flyer to present the initiative; and a copy of a short prevention film directed by Accor and Air France for broadcast in hotel rooms or lobbies.

Partnering hotels

The 18 ICASA-accredited hotels were approached to voluntarily take part and they have the option to customize the content according to their specific needs. Additional hotels in Dakar are also free to join.

Two fold initiative

As well as a specific HIV prevention campaign during ICASA, the initiative also will develop an HIV action plan over the long term. This will focus on delivering workshops for senior management (such as hotel managers and human resource managers) to help participating hotels develop a practical plan to respond to AIDS in their own organization.

Training sessions for staff will also be developed and will focus on the risks of HIV in the hotel industry. These sessions will help them understand their respective roles in the practical implementation of an HIV action plan within their organization. UNAIDS is providing seed money for the initial trainings.

Technical Partners

Three local non-governmental organizations ENDA Tiers Monde/Santé, Sida Services and ACI Senegal are the technical partners for the implementation of the training process and the follow up with hotels. These NGOs will conduct an initial mapping of the HIV vulnerability of each hotel. The analysis will be conducted with the participation of hotel personnel.

Background

This is a continuation of the HIV awareness initiative by UNAIDS and the hotel industry during the International AIDS Conference held in Mexico City in August 2008 which reached out to over 5000 employees within 50 hotels.

It’s also part of a global HIV prevention campaign conducted by the GBC within their tourism and travel platform: disseminating HIV awareness videos in airport lounges and on TVs via TV5 Monde, developing a prevention campaign online with a fun quiz on the website of Europe Assistance, conducting voluntary counselling and testing mobile clinics at the Sofitel Terenga, Novotel and Club Med Cap Skirring.

Next steps

On 2 December, a meeting took place at the Sofitel Dakar with 6 hotel managers to gather their suggestions and define the scope of the project and the roadmap. The analysis of hotels’ specific needs, as well as the workshops and training sessions will start after ICASA and spread over 2009.

UNAIDS Executive Director Dr Peter Piot is visiting India this week. Thanks to government leadership, enhanced cooperation between civil society and the police could make a difference in communities across India.

A group of police and paramilitary personnel and representatives from State AIDS Control Societies and civil societies make action plans for implementation at the State level and district level. Credit: UNAIDS

Although adult HIV prevalence rate in India is low at 0.3%, still an estimated 2.4 million people are living with HIV in this the second most populous country in the world. Those most at risk of contracting the virus are people who engage in certain behaviours including buying and selling sex, injecting drugs and men who have sex with men. A complex range of social issues means they can be the people hardest to reach in society.

As they may also be criminalized by the legal system, their paths often cross with the police. This contact presents a unique opportunity for the police to act as facilitators for the provision of HIV related services to people most-at-risk.

Safer sex and drug injecting

Safer sexual and injecting practices are vital for the successful control of the HIV epidemic in India. Most HIV outreach for marginalized people is led by non-governmental (NGOs) and community based organizations. Traditionally, the police force did not work formally with civil society in India, although there have been excellent examples of police men and women coordinating with NGOs but this was on an ad hoc and personal basis.

Through successful advocacy, UNAIDS in India has proposed to the Ministry of Home Affairs to consider the value of enhancing cooperation and proactive support between the police and the agencies working with people at higher risk of HIV. With support from the police, the protection of community workers, their outreach and successful implementation of measures like condom distribution and needle exchange programmes are more assured.

In December 2007 the Ministry of Home Affairs issued an official order to all Directors General of Police to designate a Nodal officer for NGO Coordination at the state and district level. This officer is specifically tasked with engaging more closely with NGOs.

This has already been fully implemented across India in all twenty-eight states and seven Union Territories and is already seen as a major contribution to National HIV programming. By engaging with the issue of HIV and supporting prevention initiatives as part of their regular work, the police will automatically get sensitized for their own protection from the risk of HIV infection.

Nodal officers in charge of NGO coordination at the State and district level took part in a regional police conference on the role of police in HIV programming and formulated action plans. 7 August 2008 Credit: UNAIDS

“The Ministry of Home Affairs, Government of India has shown an extraordinary commitment to respond to HIV by introducing this unique intervention. At almost no cost, this ensures long term coordination between police and civil society in an institutionalized manner for supporting communities with prevention, treatment, care and support services and in achieving the targets of universal access,” said Mr Ranjan Dwivedi, Technical Advisor, Uniformed services and Civil Society partnerships, UNAIDS India.

This intervention by the Ministry removes the administrative cost of setting up initiatives by officers locally. As well as demonstrating the positive contribution of the police, community groups hope the measure will go a long way in assisting NGOs, not only in HIV prevention, but in other social programmes such as in the response to child abuse and violence against women.

Beyond law enforcement to proactive community support

Recently the Ministry of Home Affairs, in partnership with UNAIDS, organized four regional conferences for the newly identified nodal officers for NGO Coordination who would facilitate in rolling out of the strategy for HIV programming for uniformed services in all states. The events were an opportunity to sensitize the state police leadership as well as representatives from health departments and State AIDS control societies to plan HIV prevention initiatives in police departments together through new strategies evolved by the Ministry Of Home Affairs.

The role of the police to proactively support agencies working with most-at-risk populations was underlined, as well as their sensitive role in HIV prevention among people who buy and sell sex, inject drugs or men who have sex with other men.

Enhancing relations with the police

The community based organizations present emphasized the importance of police support in their local outreach efforts.

Kusum Jain from Gram Bharati Samiti (GBS), an NGO in Rajasthan, works closely with Rajput tribal community who by tradition practice sex work. When her organization first began to interact with the community they were chased with dogs as the people thought they had come to stop their business. With help from the local police, GBS workers over the years have built up the trust of the community who now see their only aim is to make them aware of HIV prevention that now they can work closely together.

Ms Jain believes that formalizing the role of the police in community support has enhanced their relations with the police, helping the police to be accessible and provide proactive support to agencies working on HIV prevention among most at risk populations.

A recent Asia Commission report concluded there is a vital need for political engagement and support to drive an effective AIDS response. Through this new initiative with the police, the Indian government is demonstrating such leadership.

With support from UNAIDS, 2 public service
announcements broadcast in English,
French and Chinese are being shown in
waiting area in Olympic Polyclinic. These
feature German soccer player and UNAIDS
Special Representative Michael Ballack,
and Chinese Basketball player Yao Ming.
Credit: UNAIDS

As part of a joint HIV prevention campaign, some 100,000 high-quality condoms are being made available to athletes free of charge in health clinics in the Olympic Villages of Beijing, Qingdao and Hong Kong. Athletes are also able to find useful information on HIV from thousands of posters and leaflets in English, French and Chinese.

In the waiting room of the polyclinics, HIV prevention videos with UNAIDS Special Representative and German footballer Michael Ballack and Chinese basketball star Yao Ming are being shown in three languages. In addition, all athletes competing in the 2008 Olympic Games have received flash sticks that include fact sheets on HIV.

These HIV prevention and anti-discrimination efforts are part of the 2008 Olympics HIV campaign “Play safe – Help stop HIV” launched by UNAIDS, International Olympic Committee (IOC), and the Beijing Organizing committee of the Olympic Games (BOCOG). The objective of the campaign is to educate athletes participating in the Beijing Games about HIV and encourage them to be ambassadors of AIDS response.

IOC President, Dr. Jacques Rogge (left)
greets Dr. Bernhard Schwartländer, UNAIDS
Country Coordinator (centre) during the
launch of the Beijing Olympics HIV and
AIDS Campaign "Play safe – Help stop HIV".
Credit: UNAIDS 

“Athletes should know about how HIV can be transmitted, how it does not transmit and how HIV can be prevented. This will help them educate their peers and fight discrimination against people with HIV. It really is a topic relevant to sport,” said Campaign Ambassador and Egyptian swimmer Rania Elwani.

The campaign not only aims to benefit the many athletes taking part but also members of the national delegations and the more than 100,000 volunteers.

Today about 33 million people are living with HIV worldwide. Young people, 15–24 years of age, account for around 45% of all new HIV infections in 2007. However, many young people still lack accurate, complete information on how to avoid exposure to the virus.

Many young people are involved in sport, either as spectators or participants. Through this global sport gala of the Beijing Olympics, messages about AIDS can reach out to communities, especially to youth, to promote safer sexual behavior and to stop stigma and discrimination.

The objective of the 2008 Olympics HIV
campaign “Play safe – Help stop HIV” is to
educate athletes participating in the
Beijing Games about HIV and encourage
them to be ambassadors of AIDS response.
Credit: UNAIDS

“Famous athletes can play an important role to bring across messages about HIV prevention, care and support as they are regarded as role models by young people," said IOC President Jacques Rogge. UNAIDS Country Coordinator Dr Bernhard Schwartländer said, “We know that sport and the Olympic Games are universal languages that can play a very important and positive role in raising AIDS awareness and reducing stigma and discrimination of people living with HIV.”

In 2004, UNAIDS signed a Memorandum of Understanding with the IOC, combining efforts to enhance the role of sports organization in the AIDS response at community and national levels, and to organize AIDS awareness activities with coaches, athletes and sport personalities.

UNAIDS is involving the Mexican hotel industry in a prevention campaign around the International AIDS Conference in August 2008 and in the longer term through the development of sustainable long term HIV workplace policies & programmes Photo: UNAIDS/R.Castillo

The International AIDS conference (AIDS 2008) will bring to Mexico approximately 20,000 delegates and 2000 journalists from all over the world from 3-8 August 2008. AIDS 2008 presents a unique opportunity to engage the local hotel industry on issues related to HIV.

UNAIDS and the Mexican hotel industry are launching an HIV prevention campaign entitled “The Life Initiative – Hotels addressing AIDS”. Aimed at hotel guests and staff the initiative will raise awareness about HIV prevention and non-discrimination of people living with HIV. The initiative will also promote the development of sustainable long- term HIV workplace policies and programmes in the hotels. The hotel industry is a key player in the response to AIDS as it can reach a wide and diverse audience with HIV prevention information including its large workforce.

A first inaugural meeting of all the participating hotels took place at the Hotel Marquis in Mexico City on July 4th 2008. Photo: UNAIDS/R.Alion

The prevention campaign will include the display of AIDS related leaflets, posters and brochures, art exhibitions, distribution of free male and female condoms, and showing of AIDS related films in all participating hotels. Condoms will be distributed at all participating hotels via the “condom project” which has been financed with the support from the United Nations Population Fund (UNFPA).

Sustainable long term HIV workplace policies and programs in hotels

One of UNAIDS’ partners in this initiative, IMPULSO - a network of NGOs experts on the provision of technical assistance on HIV in the workplace – will provide capacity building trainings which include situational analysis, stigma and discrimination program and HIV policy and program development. IMPULSO’s specific workshops in hotels also include training in the use and implementation of a software called Workplace Policy Builder designed to assist companies in developing their own AIDS policies.

Condoms will be distributed at all participating hotels via the “condom project” which has been financed with the generous support from UNFPA. Photo: UNAIDS/R.Castillo

More than 5,100 hotel employees have already been trained, covering 7,738 rooms in hotels in Mexico City. They received education information on HIV prevention, an overview of the epidemic in Mexico, and were sensitized on issues related to stigma and discrimination in the workplace.

“In Mexico, we note that nearly 200,000 people are living with HIV and around 5,000 people died in 2006 from diseases related to AIDS. The XVII International AIDS Conference presents a unique opportunity to involve the local hotel industry on issues related to HIV,” said UNAIDS Director of Regional Office for Latin America and the Caribbean, Cesar Nuñez.

All partners will announce the launch of the initiative around a press event on 06 August 2008 at 09:00- the International AIDS Society’s press center. For further information please contact UNAIDS Chief of Private Sector Partnerships, Regina Castillo (castillor@unaids.org)

The condoms factory uses natural latex
collected by local rubber tappers and it
will be able to supply the Brazilian
government with 100 million condoms a
year. Photo credit: UNAIDS/J.Spaull

The use of condoms in Brazil is preventing the spread of HIV and it might also be helping to save the rainforest thanks to a condom factory opened in April in the Amazon region. This unique factory uses natural latex collected by local rubber tappers and it will be able to supply the Brazilian government with 100 million condoms a year.

The company which runs the factory – Natex - is a joint venture between the local state of Acre, the Ministry of the Environment and the Ministry of Health. It represents Acre’s new vision for the Amazon - “Florestania” - which seeks to increase the living standards of its inhabitants whilst also preserving the rain forest, through increasing the value of the products extracted from it.

The factory is located in Xapuri, made famous by the environmentalist and rubber tapper Chico Mendes who was assassinated there twenty years ago, and it is a direct legacy of his life’s work. Threatened with the destruction of their livelihood by the cattle ranchers who were clearing the forest, Mendes’s great achievement was to forge an alliance between the interests of the rubber tappers and the environmentalists. Mendes saw the rubber tappers as the natural custodians of the forest.

The factory provides employment for around 100 people and the latex is supplied by around 700 rubber tappers. As well as payment for the latex, the rubber tappers receive a fee for “environmental services”, recognising their importance in safeguarding the forest. This has greatly improved the living conditions of rubber tappers such as Chico Mendes’s cousin Sebastiao Teixeira Mendes who gets a guaranteed income for his latex which is higher than he could get elsewhere. He sees the rubber tappers as the “soldiers of the forest – patrolling and managing the forest”.

At the opening of Natex, the then Minister of Environment Marina Silva - the daughter of rubber tappers herself – was in no doubt of the significance of the factory: “This is a project where high technology will help to preserve the soul of the forest”. Adding, “The forest will remain the forest and the rubber tappers will remain rubber tappers through a new way of working and producing”.

As well as the environmental and social aspects of the factory, the other main driver of the project has been the Government’s need for an increasing supply of good quality condoms. The distribution of free condoms coupled with a national campaign for their usage has been at the core of the Brazilian Governments AIDS prevention strategy.

The distribution of free condoms coupled
with a national campaign for their usage
has been at the core of the Brazilian
Governments AIDS prevention strategy.
Photo credit: UNAIDS/J.Spaull

Since 1994, 1.5 billion free condoms have been distributed and it is projected that 557 million will be distributed this year reaching out to 52% of the population. The change in people’s attitudes can be seen from a national study, which showed that the percentage of those who used condoms during their first sexual encounter rose from 10% in 1986 to 47.8% in 1998 and 65.8% in 2005. In another study in 2004 showed that 96% of the adult population cited the use of condoms as the best method of preventing HIV transmission.

In 2007, the Government of Brazil imported one billion condoms and plans to purchase an additional 1.2 billion by the end of the year. It is expected that the factory will eventually increase its annual production from 100 to 200 million condoms and diversify into female condoms, therefore greatly reducing the Government’s reliance on importing condoms.

Whilst the condoms will be slightly more expensive to produce than importing from Asia, it is a cost that the director of the National AIDS Programme Dr Mariangela Simao believes is well worth paying as it “reflects the social benefits of increasing the income of the autochthonous population and a sustainable way of managing the native rubber trees”.

UNAIDS Country Director Mr Pedro Chequer, who was previously the National AIDS Director and as such was involved in the planning stages for the factory believes that it “represents the Government’s high level political commitment to maintain HIV as a priority agenda for the Country”. The world, he notes, faces a huge shortage of condoms. “As far as male condoms are concerned the annual deficit would be around 30 billion if we consider half of the world male population using a condom once a week. Of course the initial production of 100 million condoms will not have much affect on the world scenario, but it will help the country have guaranteed access to the production of condoms”.

It is a model that he believes Brazil could export through joint ventures with other Latin American Countries.

Sebastiao Mendes and the local community have a name for Natex that sums up how they feel about the factory - “The love factory”. It is easy to see why there is such enthusiasm for the factory - a factory that is helping in the response to AIDS, but also helping to improve the living conditions of the local population whilst at the same time preserving the endangered rain forest.

Research in many African countries
indicates higher HIV prevalence among
men who have sex with men and higher
incidence rates from male to male sexual
activity compared to the general
population.

“Like many gay men in Kenya I am married,” said Peter (not his real name) a taxi driver in Nairobi who was busy ferrying partygoers to and from the third party attended by several hundred gay-identifying men and their friends to be held in the Kenyan capital in the last six months.

“We have to hide our sexuality from the rest of society. It’s not like in Europe. But I have a good life, good family, and good friends and really I cannot complain.”

Peter, who has two young children and has always lived in Nairobi, decided to work rather than attend the party held just outside the city centre: “I would have liked to be at the party but we have had fewer visitors to Kenya this year and I need the money. It is fun to be in an environment when you can relax knowing that everyone is the same. There is no way that people can be themselves like that in the bars in town”.

“Sometimes a bar does become popular with a gay crowd but then, a point will come that the bar owner will ask them not to come back because he is afraid of the law and afraid that people might think he is also gay.”

The latest party in the fledgling Nairobi scene was organized on the eve of the International Day against Homophobia. In addition to providing an opportunity for dancing and socializing it also provided space for support groups to distribute HIV prevention information and safer sex packs including condoms and lubricants to a group of men often described by public health officials as ‘hard to reach’.

The following day, the Kenya Human Rights Commission, the International Gay and Lesbian Human Rights Commission and the Gay and Lesbian Community of Kenya booked a half page advertisement in a leading national newspaper promoting the International Day against Homophobia and rights for gay and lesbian people in Kenya.

Despite signs that gay and other men who have sex with men (MSM) are better organized and more visible than ever before in both Kenya and the rest of the continent the words ‘overlooked’ and ‘sidelined’ are currently being used to describe the HIV epidemics that are thriving unchecked among men who have sex with men across sub Saharan Africa.

Research in many African countries indicates higher HIV prevalence among men who have sex with men and higher incidence rates from male to male sexual activity compared to the general population. Furthermore consistently higher levels of infection among men who have sex with men and formidable cultural, social and legal barriers, combined with high levels of stigma and discrimination and the need to address AIDS within the general population, have inhibited the provision of MSM-targeted HIV prevention, care and treatment services.

Various African research projects and
initiatives indicate that many men who
have sex with men in Africa also have
female sexual partners and do not
necessarily identify themselves as gay.

In order to address this situation, the Kenya National AIDS Control Council co-hosted a meeting with the Population Council in May 2008 to bring together researchers, advocates and national AIDS programme managers from other African countries to review the status of research and evidence around HIV and men who have sex with men in Africa.

Opening the meeting Professor Miriam Were, Chairperson of the Kenya National AIDS Control Council, recognized the many social and cultural challenges involved in addressing the increased HIV risk of male to male sex and encouraged participants to face facts and develop constructive responses to address HIV among men who have sex with men.

Evidence on HIV prevalence, risk and behavior within groups of men who have sex with men was presented from several studies in Kenya and studies from Namibia, Uganda, Tanzania, Nigeria, Malawi and South Africa.

Meeting organizer and Associate with the Population Council, Scott Geibel, said: “In recent years there has been an increase of research focusing on the HIV needs of African men who have sex with men. The research is helping stimulate an increase in programmatic responses. In Kenya we particularly appreciate that the National AIDS Control Council has considered our research results and allowed it to inform their decision and policy making”.

“Through sharing lessons learned with other African National AIDS Programmes we hope to see an acceleration of targeted HIV responses for men who have sex with men in the region.”

In April 2008, the Open Society Institute in Southern Africa (OSISA), OSI’s Sexual Health and Rights Project (SHARP) and John’s Hopkins Bloomberg School of Public Health, hosted a meeting in Cape Town, South Africa, of organizations working on research and advocacy on HIV prevalence among men who have sex with men in Botswana, Namibia, Malawi and South Africa.  

The OSISA/SHARP research partnership was initiated in response to the lack of funding and programmes addressing access to HIV prevention and AIDS treatment services targeting MSM despite overwhelming anecdotal evidence that MSM are a high risk community within the region. 

The meeting was intended to evaluate community based studies, managed by national organizations of men who have sex with men, assessing HIV-related risk behaviors and describing the epidemiology of HIV infection among black MSM in urban sites in the four focus countries.

“Stigma and discrimination, even among
AIDS programmers and policy makers,
remains a real barrier to scale-up,” said
Andy Seale, Senior Regional Adviser for
UNAIDS Regional Support Team East
and Southern Africa.

In addition to revealing higher levels of HIV, other key themes emerging from the various African research projects and initiatives indicate that many men who have sex with men in Africa also have female sexual partners and do not necessarily identify themselves as gay.

In all studies, unprotected receptive anal sex was reported as highest risk for HIV transmission. Reported condom use, although often higher than sexually active heterosexuals, was often inconsistent and remains relatively low.

Andy Seale, Senior Regional Adviser for UNAIDS Regional Support Team East and Southern Africa, said: “Despite strengthening evidence that men who have sex with men are disproportionately affected within the generalized and hyper endemic HIV epidemics of Africa there is still poor targeting within national strategic AIDS plans and through programmes and services.

“Stigma and discrimination, even among AIDS programmers and policy makers, remains a real barrier to scale-up.”

Health Development Networks and SAFAIDS (the Southern Africa AIDS Information Dissemination Service) have been hosting an e-forum among AIDS practitioners in Southern Africa entitled ‘Sidelined in Prevention’ to identify barriers to scale-up.

“The discussion so far has been illuminating – during the first few weeks several postings were made anonymously by people fearful of being associated with work focused on men who have sex with men and those who feel unable to engage with the issue on religious and moral grounds,” said Seale.

The e-forum has mobilized a useful exchange between AIDS practitioners and LGBTI organizations (lesbian, gay, bisexual, transgender and intersex) with the sharing of tools, resources, strategies and approaches including to scaling up targeted prevention at a community level.

“Clearly we still have a long way to go – we need to put aside tensions between public health and rights based approaches and any personal issues around morality. All of us in the region working on AIDS should ensure that all people – regardless of their sexual preferences - are able to access the prevention, care and treatment services they need,” said Seale.