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Overcoming barriers to aid HIV prevention

 Written by Ron Hughes  28 April 2011

The global approach to HIV prevention must include overcoming so-called 'social barriers' that prevents strategies reaching their target audiences.

That's the message leading Australian HIV/AIDS researcher, Professor Sue Kippax, wants to convey at the International AIDS Society Conference 2011 (IAS 2011) this July.

Kippax believes the IAS focuses too narrowly on biomedical issues and not enough on the social sciences.

"I think the conference is very important and tries very hard to ensure the latest research is discussed and debated," Kippax told City Voice.

"But one of the things that concerns me, is that we have been urging for years that social science is included in the programs, which it's not, even though they've asked me to do a plenary this year."

Kippax will deliver a paper The Social Barriers to Effective HIV Prevention at IAS 2011.

"What I would like to say to the IAS is that so-called 'barriers' to HIV prevention and treatment are not really barriers at all; they're not something to get around, they're something you have to engage with," Kippax said.

"If you want to deliver whatever you're delivering, be it post-exposure prophylaxis, or condoms or whatever, you actually have to engage with the social issues if you're going to have any uptake of the technologies or tools you're trying to get people to use," she said.

Kippax believes changing attitudes is the key, in places like Russia where it's "almost impossible" to get needle exchange programs running, or parts of Africa where homosexuality is illegal.

"One has to change opinion at government levels, at the level of politics, but at the same time one has to engage with homosexuals or injecting drug users on the ground. That can occur, but it's extremely difficult. It's a huge issue.

"There are people genuinely attempting to deal with these issues, like Michael Kirby who spends a lot of time advocating and talking at quite high levels to countries, trying to get them to change their attitudes. But it comes very slowly," she said.

"I guess what I'll be saying is Rome is, please don't think just about the biomedical, think about delivery; don't think about 'barriers' but about engaging communities. You have to have both the biomedical tools and the delivery, so you have to engage with the social aspect or you'll fail."

IAS 2011 will take place in Rome , July 17-20, 2011.

Immigration officials have turned HIV patients into prisoners, claims hospital

NHS consultants say that the UK Border Agency's security measures have turned Hillingdon hospital into a prison

Diane Taylor

guardian.co.uk, Friday 29 April 2011

HIV patients at a London hospital have in effect been imprisoned following a move by immigration officials to secure the sexual health unit, NHS consultants claim.

Hillingdon hospital in west London treats detainees at two immigration removal centres near Heathrow alongside other patients. The problems began when doctors refused to treat an HIV-positive detainee because the guard to whom he was handcuffed refused to uncuff him. An incident report was filed and sent to the medical director.

Officials from the UK Border Agency then installed restraints on the windows at the hospital's sexual health clinic to ensure that detainees could not escape.

HIV specialist Ben Holden, a consultant at the hospital, said: "The unit is now a prison for us all. Our windows only open two inches but UKBA have installed chunky locks on them. We were told they would bring removable window restraints but these are permanent.

"No detainee has ever absconded or attempted to abscond. As doctors we believe that to keep immigration detainees restrained or locked in is discriminatory. I don't want to be part of a process that treats people in a less than human way."

Doctors are angry that immigration detainees who have committed no crime, approximately half of whom are later released, are treated in this way.

An audit conducted by the hospital revealed that none of the detainees removed from the UK were dispatched with a full three month supply of anti-retroviral drugs (in accordance with British HIV Association/National Aids Trust guidelines) because in many cases doctors at the hospital were not notified by UKBA prior to their removal. UKBA frequently cancelled appointments and some HIV-positive patients were removed before they were seen at the hospital.

Professor Jane Anderson, chair of the British HIV Association, said: "BHIVA and the National Aids Trust have developed advice on appropriate HIV treatment and care for people in the immigration removal system, and we are disappointed to hear that this advice is not always being followed. We want to see the highest standards of care for everyone with HIV in the UK . Any factors that make the provision of high quality clinical care difficult give us cause for concern."

Emma Ginn, co-ordinator of the charity Medical Justice – which recently published Detained and Denied, a report cataloguing examples of poor medical treatment for HIV-positive detainees – said: "Along with the potentially lethal medical abuse they suffer in detention centres detainees are suffering sub-human conditions in hospital."

The UK Border Agency said: "We have agreed the installation of window locks for detainee treatment with Hillingdon hospital and are working with them to address the concerns now raised. Detainees are only handcuffed when absolutely necessary and they are not handcuffed during treatment.

"The welfare of detainees is important but this must always be balanced with the security of the detainees and the public. Detainees have round-the-clock access to healthcare services to discuss their medication needs."

A spokesman for the Hillingdon hospitals NHS foundation trust said: "The UK Border Agency has told us that they do not believe our open ward environment is suitable for the treatment of individuals who may be failed asylum seekers and under restraint. However, a large proportion of the patients who are brought to our sexual health department by the agency are later discharged into the community and are not subject to the criminal law.

"We have agreed a temporary measure with the Border Agency to put discreet bars on windows in the unit, but we are continuing to negotiate an agreement with the agency that will offer a solution that allows us to treat all our patients with respect."

High-risk groups fail to heed HIV advice

HCM CITY — After five years, a nationwide campaign of harm reduction and HIV prevention among sex workers has not proven effective, a review conference heard yesterday.

Health officials said several programmes have been carried out to protect sex workers from HIV and other STDs (sexually transmitted diseases), but these have suffered from many problems including a lack of co-ordination between agencies fighting HIV/AIDS.

Nguyen Trong Dam, deputy Minister of Labour, Invalids and Social Affairs, said prostitutes were among the population groups most vulnerable to HIV infections in Viet Nam , besides intravenous drug users.

The situation has become more and more serious, Dam said. He said despite the implementation of several awareness programmes, condom use among sex workers, including males, was very low.

He said stronger co-ordination was needed between public security forces, health agencies and the labour sector to help sex workers remain safe from diseases like HIV/AIDS and also facilitate their reintegration into the community after rehabilitation.

"A few years ago, it was easy to see female sex workers in public places like bus stations and pavements, but most of the now go online or adopt more sophisticated forms of services," Dam said.

Prostitution has become one of the main causes of HIV transmission, health workers said. According to recent statistics, the rate of HIV infections among sex workers was pretty high in major cities, 20 per cent in Ha Noi, 23 per cent in Hai Phong and 16 per cent in HCM City .

HIV infection among sex workers was as high as 30 per cent, the conference heard.

Duong Van Dat, an officer with the United Nations Population Fund (UNFPA, said very few sex workers were able to access HIV prevention services like free condoms and treatment for sexually transmitted diseases.

This situation had to change drastically, he added.

Dat noted that the Minister of Labour, Invalids and Social Affairs, Nguyen Thi Kim Ngan, had recently said that it was not possible to get rid of prostitution totally and that intensified focus was necessary on harm reduction among sex workers.

He said that in Cambodia , up to 80 per cent of the sex workers were using condoms and the incidence of HIV and other STDs had fallen sharply.

In Viet Nam , there was a large number of sex workers who don't use condoms because they cannot access it, he added.

Condoms were not easily available in public places in Viet Nam like hotels, and there were cultural barriers that prevented both the sex workers as well as their clients from purchasing them, he said.

According to the HIV/AIDS Prevention Department under the Health Ministry, as of September 30, 2010, the country had 180,312 HIV positive people, 42,339 AIDS patients and 48,368 people had died of AIDS.

The epidemic has spread widely with HIV populations in all provinces, 97 per cent of the districts and 70 per cent of communes nation-wide, department officials said.

Eighty per cent of the HIV positive population in Viet Nam were males, they added.

Dr Nguyen Minh Tam of the department said the rate of HIV transmission was particularly high among males who had sex with males (MSM).

She cited a survey in 2009 that found just 47.4 per cent of the MSM population in HCM City used condoms regularly with their partners. The rate was higher in Ha Noi and Hai Phong.

The Ministry of Labour, Invalids and Social Affairs said at the conference that it would expand the programme for harm reduction and STD prevention among sex workers in the country over the next five years.

It said it was important to improve the knowledge and awareness among local governments of the crucial importance of providing free condoms, especially to high-risk populations.

Local officials with low awareness have made it very difficult to promote the use of condoms, ministry officials told the conference.

The two-day conference that ends today drew the participation of UN officials, foreign experts from NGOs based in Viet Nam as well as experts from Thailand, the country that has achieved 100 per cent condom use among sex workers. — VNS

‘33.3M people live with HIV’

Thursday, April 28, 2011

 Nuha Ceesay, the UNAIDS country officer in The Gambia, says that global estimates complied jointly by UNAIDS and WHO indicate that  HIV  infected close to 60 million people and killed nearly 25 million in the course of the quarter of a century. He said it is also estimated that 33.3 million people were living with HIV as at December 2009, with almost half of them women.

Ceesay made this remarks recently during a media briefing on UNAIDS gender agenda on the high-level meeting on universal access to HIV prevention, treatment, care and support held at Tango. He also revealed that it is estimated that nearly 7,000 people are newly infected with HIV everyday.

Ceesay informed the gathering that the forthcoming high-level meeting on universal access on AIDS is scheduled to take place from 8-10 June 2011 at the UN headquarters in New York . “This high-level meeting has come at a crucial moment for global AIDS response in that deadline for achieving key goals and targets unanimously set by the member states in other to revise the pandemic, including the goal to achieve universal access to HIV prevention, treatment, care and support expired at the end of 2010,” he stated.

According to him, it is apparent that without urgent and long-term action, the epidemic will continue to take an unacceptable toll of death and suffering in countries and communities throughout the world. He continued: “The universal access is a dream that must be met and we shall not relent until the day we are all collectively able to ensure that, no one living with HIV is stigmatised, excluded, shut out, all young people know how to protect themselves from infection.

“No infant is born infected with HIV and no mother dies of AIDS-related illness, children orphaned by AIDS have the same prospect as other children, Antiretroviral therapy is essential care for anyone living with HIV and is accessible universally and an affordable vaccine is available for all.” The UNAIDS country officer disclosed that recent data from parts of the world and Africa show encouraging signs of reduction in the prevalence of HIV. 22 of the countries most affected by HIV in sub-Saharan Africa , with the number of new infections reducing by more than 25 percent.

Alieu Jammeh, the director of National AIDS Secretarial (NAS), described the press briefing as very important. He said such endeavours should continue so that journalists will keep on informing on what UNAIDS is doing. “We are planning to send delegates to the high-level meeting at UN. It is important for the people of the country to be aware of what we are doing in terms of our level of preparation and what we are contributing in the response,” he added.

Author: by Omar Wally

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