Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe

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

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

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

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

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

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

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

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

Twenty-two students from across sub-Saharan Africa, the Maghreb and Egypt took part in the five-day training which was launched on 17 April 2011. Credit: Senghor University of Alexandria

In 2010 UNAIDS and the Senghor University of Alexandria signed an agreement of cooperation to include a 25 hour module specific to AIDS into the university’s Master’s degree in International Health programme.

The opening session of this new module, co-organized by Senghor University and UNAIDS, was held on 17 April 2011. Twenty-two students from across sub-Saharan Africa, the Maghreb and Egypt took part in the five-day training.

In attendance at the course opening was Jean-Elie Malkin, special advisor to UNAIDS Executive Director, whom he represented on this occasion. He was joined by other senior UNAIDS staff including the Director of UNAIDS Regional Support Team for West and Central Africa Meskerem Grunitzky-Bekele; and Director of UNAIDS Regional Support Team for Middle East and North Africa, Hind Khatib-Othman. Dr Christian MÉsenge who is the Director of the Health Department at Senghor University of Alexandria represented the University’s President Albert Lourde.

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

Dr Babatunde Osotimehin, Executive Director of UNFPA putting girls first during a side event at the 44th Session of the Commission on Population and Development. Credit: Antti Kaartinen/UNFPA

“Investing in adolescent girls benefits everyone, and when they flourish, their families and communities flourish as well. That’s why they are at the heart of our agenda.” This was the message of Dr Babatunde Osotimehin, Executive Director of UNFPA, speaking at the 44th Session of the Commission on Population and Development (CPD).

Dr Osotimehin addressed a side event called Putting Girls First during the CPD, which ran from 11-15 April at UN Headquarters in New York. It was attended by representatives of Member States, non-governmental organizations and experts participating in the CPD from around the world.

UNFPA’s Executive Director underlined the need to promote girls’ rights and gender equality and to prioritize them within national programmes for health, education, livelihoods and security. “Depending on the opportunities or choices girls have during adolescence, they can begin adulthood as empowered and active citizens, or they can be entrenched in poverty, neglected and voiceless,” Dr Osotimehin warned. “We must put girls first today to make a better tomorrow for everyone.”

Another speaker, Dr. Gill Greer, Director-General of the International Planned Parenthood Federation (IPPF), said that “until girls are seen by their families and communities to have the same inherent worth as their brothers we cannot achieve resilient, sustainable social, economic and environmental development.”

She noted that, on a global level, girls still lag behind boys in secondary school attendance, saying that 70% of the 130 million out-of-school young people are girls and highlighted young women’s particular vulnerability to HIV. According to UNAIDS, young women account for more than two-thirds of new infections among young people worldwide.

Dr Greer added, “Today, it is time to put girls first so they can make the decisions that will drive development, and enable them to stand beside their brothers, partners, and husbands to hold up half the sky.”

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

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

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

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

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

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

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

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

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

While touring the DREAM project in Conakry, UNAIDS Executive Director Michel Sidibé (centre) met an HIV-positive couple who gave birth to two HIV-negative babies. Photo credit: Mamadou Cellou Diallo/UNAIDS

President Alpha Condé and the First Lady, Ms Djene Kaba Condé, will participate in this year’s UN General Assembly High Level Meeting on AIDS. The announcement came during a two-day official visit by UNAIDS Executive Director Michel Sidibé to the West African nation of Guinea Conakry.

The High Level Meeting, from 8-10 June 2011, is widely seen as an important opportunity to revitalize the global AIDS movement and achieve the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“I commend President Condé for his commitment and leadership on HIV,” said Mr Sidibé, after a meeting with Guinea’s Head of State on Thursday. “His presence at the High Level Meeting will be critical to advancing the AIDS response here in Guinea, and globally,” he added.

Over the past decade, Guinea has made significant strides in its national response to HIV. Between 2001 and 2009, Guinea saw a 25% reduction in its rate of new HIV infections. Coverage of antiretroviral treatment in the country reached 40% in 2009, up from just 3% in 2004. Furthermore, HIV prevalence in Guinea has remained relatively low since 2006, at about 1% of the adult population.

In his discussions with President Condé, the UNAIDS Executive Director underscored the importance of shared responsibility around AIDS funding. “Ninety six per cent of the AIDS treatment in Guinea is currently funded through external sources. This situation is unsustainable,” said Mr Sidibé, adding that both domestic and international AIDS investments must increase. President Condé committed in his meeting with Mr Sidibé to creating a national fund for the purchase of antiretroviral drugs and said that his government would maintain current HIV investments.

UNAIDS announces US $60 000 grant to a foundation run by the First Lady

In a meeting on Thursday with the First Lady of Guinea, Mr Sidibé said that vertical transmission of HIV was a pressing concern for UNAIDS in Guinea. In 2009, only 17% of pregnant women living with HIV in Guinea were able to access services to prevent new HIV infections among children. That same year, just 10% of pregnant women were tested for HIV.

During the meeting, Mr Sidibé said that UNAIDS, with funds received from Cooperation française, would grant US $60 000 to a national foundation created by the First Lady focused on maternal and child health. The grant is earmarked specifically for stopping new HIV infections among children in Guinea.

Preventing vertical transmission of HIV in Conakry

Earlier in the day, Mr Sidibé visited a project in Conakry, the capital city of Guinea, that provides mothers with a complete package of services to prevent new HIV infections among children. Established in 2002, the DREAM project offers HIV prevention and treatment services as well as psychosocial and nutritional support, advanced laboratory analysis, and health education. All services are provided free of charge.

The DREAM project, supported by the Community of St Egidio (a religious association), UNICEF and UNAIDS, has two centres in Conakry and operates a mobile clinic that brings health services directly to women in the region. With support from UNAIDS, a third centre will soon be opened in Dubreka, 50 kilometres from Conakry.

Since 2006, more than 3600 people living with HIV have received antiretroviral treatment at the two centres. More than 800 mothers enrolled in the programme have given birth to HIV-negative babies.

While touring the DREAM project, Mr Sidibé met Fatoumata Sylla and Naby Bangoura, an HIV-positive couple who gave birth to two HIV-negative babies. Fatoumata received antiretroviral prophylaxis during her pregnancy; she now works at the DREAM programme and shares her experience with other women. Fatoumata told Mr Sidibé that while many women continue to receive free services through the DREAM project, some are turned away as the centre does not have sufficient funding to meet patient demand.

The DREAM project, headquartered in Italy, is working in nine other countries across Africa, including Mozambique, Malawi, Tanzania, Kenya, Guinea Bissau, Cameroon, Democratic Republic of Congo, Angola and Nigeria.

UNAIDS Executive Director Michel Sidibé (second from the left) and President of the Republic of Mali, Amadou Toumani Touré (fourth from left) at the opening of the Youth Summit in Bamako, Mali. 15 April 2011.
Credit: Kris Krug

Thirty years into the response to HIV, an estimated 3000 young people are newly infected with HIV everyday. Many young people living with HIV still do not have access to treatment and only 34% of all young people have correct and comprehensive knowledge about HIV and how to protect themselves.

That is why more than 150 young HIV activists from across the world have gathered for a three day summit in Bamako, Mali, to rally a youth-led response on HIV in lead up to the United Nations General Assembly High Level Meeting on AIDS taking place in New York from 8 to 10 June 2011.

Convened under the patronage of the President of the Republic of Mali, Amadou Toumani Touré, and co-hosted by UNAIDS, the summit provides a forum for young people to explore and commit to innovative ways to mobilize young people in the AIDS response.

“I am ready to take the call to action coming out of the Mali Youth Summit on HIV to the High Level Meeting at the UN. Young people must take the leadership of the AIDS response, and they must be given the space to lead,” said President Touré. 

Speaking at the opening of the summit, UNAIDS Executive Director Michel Sidibé urged young leaders to claim their space in the AIDS movement: “You are the most powerful engine we have for transformation and progress. Do not let anyone tell you that you are the leaders of tomorrow. You are the leaders of today.”

A Call for Action to articulate the vision of the youth movement is being developed by the delegates. It will be launched online at the closing of the summit, marking the start of an intensive period of online and offline social mobilization to get endorsement of the declaration by young people all around the world.

Participants at the Youth Summit on HIV.
Bamako, Mali. 15 April 2011. Credit: AFP

"We now feel that it is time for us to reclaim our future using every energy and power. We call on world leaders to respond to the Call for Action that will come out of this summit, but we also call on young people everywhere to mobilize for the AIDS response," Marie Tamoifi Nkom, steering committee member of the Mali Youth Summit on HIV from Cameroon.

While youth organizations and networks focusing on HIV are increasingly mobilized in the response, young people continue to face difficulties in accessing and influencing decision-makers and are not equal partners. Therefore, the Summit will also serve to link and strengthen existing youth networks across different regions and deepen their connections with the AIDS community.

Young people are still at risk of HIV, with about 40% of all new HIV infections among adults occurring among young people aged 15-24. Young women are particularly vulnerable, accounting for 64% of new infections among young people worldwide.

(From left) Ambassador Aharon Leshno-Yaar, Permanent Representative of Israel to the United Nations in Geneva; Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme. Geneva, 13 April 2011.
Credit: UNAIDS

Israel signed its first-ever multi-year cooperation agreement with the Joint United Nations Programme on HIV/AIDS (UNAIDS) on 13 April 2011.

Ambassador Aharon Leshno-Yaar, Permanent Representative of Israel to the United Nations in Geneva, signed the agreement on behalf of Israel’s Agency for International Development Cooperation (MASHAV). Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme, signed the agreement on behalf of UNAIDS.

The signing, which took place at UNAIDS headquarters in Geneva, was attended by Professor Alex Leventhal on behalf of the Israeli Ministry of Health and by Ron Adam, Deputy Permanent Representative of the Mission of Israel to the United Nations in Geneva

Prior to this agreement, in cooperation with UNAIDS, MASHAV, Israel’s international development cooperation agency, organized training courses on aspects of the HIV response for public health and welfare representatives from developing countries in Africa and Central Asia. This agreement of cooperation with UNAIDS will enhance Israel’s relationship with the organization.

Also on Wednesday, Israel signed an Agreement of Cooperation with the World Health Organization.

A man receiving opioid substitution therapy as part of a harm reduction programme in the Islamic Republic of Iran. Credit: UNAIDS/P.Virot

Injecting drug use and the growing HIV epidemic in the Middle East and North Africa were the focus of the Harm Reduction 2011 conference that took place in Beirut, Lebanon from 3-7 April 2011

Some 1000 scientists, researchers, drug users, doctors and politicians from 80 countries participated in the first international drugs-related conference to be held in the Middle East and North African (MENA) region.

Discussions during the conference centred around the existence of legislation in the region that hinders the implementation of harm reduction programmes. Nearly one million people in the Middle East and North Africa (MENA) inject drugs. Injecting drug use is already the major mode of HIV transmission in Afghanistan, Pakistan, the Islamic Republic of Iran (more than 67% of registered cases) and Libya (up to 90% of cases). It is also significant in Oman and Bahrain and has growing incidence in Morocco and Egypt.

The region is slowly increasing availability of harm reduction programmes although countries are at different stages of introducing the different components of the harm reduction package. The Islamic Republic of Iran is a model—with a rapidly scaled-up plan to make available needles and syringes, opioid substitution therapy (OST), HIV testing and counseling, and sexually transmitted infection services. Morocco also has integrated harm reduction policies into its national AIDS strategic plan. Pilot drop-in centres with needle and syringe exchange are in place, and preparations for introducing OST are underway.

The Lebanese Minister of Health announced during the conference the launch of a pilot programme consisting of the first ever legal sale of Buprenorphine in government hospitals for people who inject drugs. “The government’s support for harm reduction measures such as the provision of Buprenorphine is based on our belief that the evidence for such a public health measure is irrefutable—its implementation has helped to contain HIV and Hepatitis infections amongst injecting drug use communities in every country it has been introduced,” said Dr Walid Ammar, Director General of the Lebanese Ministry of Public Health.

Despite positive changes occurring in some countries, repressive measures and criminalization of drug users are still predominant in the region. This discourages people at higher risk of transmission from accessing HIV services.

Funding harm reduction

The uptake of harm reduction in most of the region has been slow mainly due to governments and civil society organizations lack of awareness as well as capacity to implement effective harm reduction activities.

To try reverse this situation, the Global Fund to fight AIDS, Tuberculosis and Malaria has granted $US 8.3 million to a multi-country project. Its aim is to raise awareness, advocate and build capacity of civil society organizations to scale up the provision of harm reduction services in 12 countries over the next three years. The 12 countries included in the project are Iran, Pakistan, Libya, Lebanon, Syria, Jordan, Bahrain, Morocco, Egypt, Afghanistan, Oman and West Bank and Gaza.

The project will begin in July 2011 and will be coordinated by the Middle East and North Africa Harm Reduction Association (MENAHRA), based in Beirut.  

The UNAIDS Reference Group on HIV and Human Rights has issued a statement encouraging UN Member States to reaffirm the focus on human rights that has driven 30 years of progress in the global HIV response. The statement outlines five key priorities for Member States as they negotiate the outcome document for the High Level Meeting on AIDS between now and June 2011. 

“Commitment to human rights is a cornerstone of the success we have seen. It unites us, drives results, and is critical for our future progress,” said Jonathan Cohen, Co-Chair of the Reference Group and Director of the Law and Health Initiative of the Open Society Foundations.

The statement issued by the Reference Group asks governments to reaffirm the emphasis on a human rights based approach that obliges nations “to fulfill the human right to health and that respects, protects and fulfils the human rights of people living with, affected by and vulnerable to HIV.” 

It also underlines that a central challenge of the next five years will be to make HIV treatment available to all who need it but are not receiving it. Among other steps, the Group notes that this will require maximum use of flexibilities under the TRIPS agreement to ensure the competition needed to lower the price of second-line and third-line treatments and their production in generic form. 

The statement also asks Member States to reaffirm their commitment to the removal of laws, policies, practices, stigma and discrimination that block effective responses to AIDS. This includes several types of laws, policies and practices such as those that criminalize people living with HIV; those that permit violence and discrimination against women; or those that impede access to HIV services, including treatment, prevention and palliative care.

Michaela Clayton, Reference Group Co-Chair and Director of the AIDS and Rights Alliance for Southern Africa noted that the apparent flat-lining of financial resources for HIV is of significant concern and threatens the gains that have been made. “The crisis we are seeing today is not an economic crisis, but a crisis of priorities. What we need is solidarity for the right priorities and to push a standard of commitment that should be expanded and replicated for other health, development and human rights imperatives.”

The international community must renew its commitment to place people living with HIV at the centre of the AIDS response, states the group. According to the statement, people living with HIV must be empowered to live successfully with HIV, maintain their health, dignity and security and prevent the onward transmission of HIV. People living with HIV must participate meaningfully in all aspects of the response to HIV.

The UNAIDS Reference Group on HIV and Human Rights was established in 2002 to advise UNAIDS on all matters relating to HIV and human rights. The Group speaks with an independent voice and its views and recommendations do not necessarily reflect the positions of the UNAIDS Secretariat or its Cosponsors.

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

Faith carries and bags maize from her farm before storage. Credit: ILO/AIDS

“I learnt that you need money or a business to generate enough income to be able to travel to town for regular check-ups and to collect antiretroviral drugs. We do not have these services at our village dispensary.”

These are the words of Faith who is 61 years old and one of the estimated 730 000 women living with HIV in Tanzania, where national prevalence is around 5.6%. In her village in the northern Kilimanjaro region, she is a member of a women’s dairy cooperative which also provides financial services such as savings and credit through the village community bank.

With support from an International Labour Organization (ILO) programme funded by the Swedish International Development Cooperation Agency, the cooperative organizes entrepreneurial skills-building and HIV awareness-raising activities. This is a seen as a real source of empowerment for rural women like Faith, who live far from the towns where most HIV services are located.

Faith keeps three healthy dairy cows with good yields. She makes up to US$ 250 a month from the milk she sells through the women’s dairy cooperative. “It is a lot of money for me,” she says. “The cooperative trained me and provided a market for my cow’s milk.”

She is one of the 1600 women and men who participated in the ILO/Sida Start and Improve Your Business training programme in Tanzania in 2009. The programme has a specific focus on cooperatives as structures that can help reach workers in the informal economy with the aim of preventing HIV, mitigating its impact and improving conditions for workers living with, and affected by, the virus.

When she tested HIV-positive in 2005, Faith decided to accept her status and be open about it, despite the high level of stigma and discrimination in her community. After initial difficulties, Faith says she has found acceptance and has become a peer educator, supporting other HIV-positive people who want to start their own businesses.  

She has now been able to diversify her sources of income and grows maize and other vegetables. “I get all the nutritious food recommended by doctors from my own farm. I use part of the money to pay for school fees for my two nieces.”

According to Faith, her acceptance of her HIV status has given her a long life. Her self-confidence, sense of dignity and economic independence have grown immeasurably with the opportunities created by the cooperative.

Dr Luc Barriere-Constantin, the UNAIDS Country Coordinator for Tanzania, agrees that cooperatives can play a key role in boosting prospects for HIV-positive people. “It is essential to re-build the capacities of people living with HIV through the restoration of self-confidence and hope. To do that we don’t necessarily need millions of dollars, but simply to be convinced, and to convince those living with the virus, that they can  make a valuable contribution. This project shows it is possible.”