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The 11th International Congress on AIDS in Asia and the Pacific | 1823 November 2013 | Bangkok, Thailand Queen Sirikit National Convention Center (QSNCC)

New world: New AIDS response?

Vinai Dithajohn/UNAIDS

By Nenet Ortega

By the registration area, delegates line up to

claim their conference badge and kit. Delegates
comprise young and old alike, public and private
health workers, activists and advocates, from
donors, international organizations, medical
practitioners, researchers and representatives
from key affected populations.
There are many new faces, many new actors from
the community. Old faces and long-time advocates
are also back at ICAAP. There are distinct
differences in the way the younger delegates
are participating in this conference. They are far
more eager to share their stories, getting allies to
listen to and promote their common goal. One
young panellist paused at the start of the APCOM

preconference, and looking around at the asked:

Why do you all look so serious. Then his
reference to the intergenerational relationship
between him and his co-facilitator, sent a slightly
hesitant ripple of laughter around the room.
Listening to what the younger delegates share,
and the way they do it, the older ones may not
be so enthusiastic it could sound like the same
old story they heard ten or fifteen years ago, or
longer. They have passed through a lot in pushing
for their space, for their agendas, long ago. But the
virus is the same. The HIV that infected people
before is more or less the same as the one that does
so today. Two distinct and different generations,
with different attitudes and world outlooks, but
both affected by one and the same virus.

Issue 3/21 November 2013

Living with HIV, but dying of co-infections

p.3

ICAAP 12: Will it happen? Should it happen?

p.4

Walk the Talk: Towards an AIDS-free

generation

p.5

Getting to Zero: Country perspectives

p.6

Five things you need to know about

naloxone

p.7

Tweet of the day

p.8

Turning advocacy and evidence into action is a

continuing saga, which needs to play out in the
context of a constantly changing world. Those
longer in the tooth should realize that. They were
the ones years ago who were provided with the
information and prevention options they needed.
The past made them into what, who and where they
are now. They should try to bridge the generation
gap to make sure that prevention efforts and
advocacy are continued. They should be guiding
and mentoring the new cadre so that learning and
experiences of the past are handed on.
For their part, the fresh faces and personalities
at ICAAP must be willing to listen, not to learn
blindly but to use those previous lessons that are
needed for today and tomorrows fight. Not to
reinvent the wheel or repeat previous mistakes.
Together we need to build layers of new, strong
leaders, advocates and activists so that they can
and will continue the fight against HIV, and in
turn provide knowledge to another new generation
some day.

AIDS funding landscape in Asia and the Pacific

By Ishdeep Kohli

A number of countries in the Asia and

the Pacific are showing commitment and
leadership by increasing domestic investments
for HIV. Malaysia currently funds 97% of its
own AIDS response, China 88% and Thailand
85%; India too has committed to increase
domestic funding to more than 90% in its next
phase of the AIDS response.

Yet many countries in the region still depend

heavily on external funding. As the global
economic crisis continues, international
funding for AIDS is declining. The symposium
AIDS Funding Landscape in Asia Pacific,
brought together government officials from
Indonesia, Myanmar, Pakistan, Papua New
Guinea, Thailand and Viet Nam, along with

The Global Fund, the Asian Development

Bank and civil society representatives, to
discuss AIDS investment funding decisions
for the future.
Chairman of the session, Dr JVR Prasada
Rao, UN Secretary Generals Special Envoy
on HIV/AIDS for Asia and the Pacific,
Continued on p.2

Host

Co-Host

Convener

Co-Convener

Organizing Partners

02 | 21 November 2013
Continued from p.1

helped participants understand the current

global funding scenario, and announced
that to understand projections for the next
10 years UNAIDS, the World Bank and the
Kirby Institute have jointly embarked on a
pioneering initiative to analyse the situation.
An independent multi-stakeholder, high-level
advisory panel chaired by Dr Rao has been
convened. Panel members include leading
economists, national programme managers,
policy-makers, civil society representatives
and development partners across the region.
Dr Lei Zhang from the Kirby Institute
explained its ongoing study Evaluation &
cost-effectiveness of HIV prevention in Asia.
The objective of the study is to improve the
effectiveness of HIV prevention in Asias
concentrated HIV epidemics.The study is
providing evidence on the epidemiological
impact of HIV prevention programmes
and their cost-effectiveness, based on the
systematic design and conduct of impact
evaluation trials, collection of data, modelling,
health economic analyses and assessment
of potential mismatches that exist between
investment in targeted preventions and HIV
epidemiology.
Such studies have become important analytical
tools to understand what HIV investments
have bought, whether the interventions
averted new infections and AIDS deaths, and
at what cost.

on the level of funding available, while still

encouraging countries to clearly express how
much funding they need to effectively treat
and prevent HIV and AIDS, tuberculosis and
malaria.

vulnerable to, or affected by, HIV. This

includes activities that can be appropriately
integrated into ADB programmes and projects
and are consistent with ADBs country
strategy.

The new model allows the Global Fund to

focus on countries with the highest disease
burden and least ability to pay. Transition to
the new funding model is already underway.
Access to funding in the transition phase
is by invitation, and special consideration
will be given to countries in a position
to achieve rapid impact, those at risk of
service interruptions, and those currently
receiving less than they would under the new
funding models allocation principles. Full
implementation will begin in late 2013, once
the level of available funding for the 2014
2016 cycle is clear.

Roy Wadia, Vice Chair of APCOM, shared

an innovative fundraising initiative, End
AIDS India being launched under the
auspices of the International HIV/AIDS
Alliance and its linking organizations across
India. The campaign shares a bold vision an
end to AIDS in India. It is a direct marketing
approach, targeted to the general population,
inspired by polio-free India, and other
sensitive approaches such as for cancer, girl
children and education. It is about resource
mobilization at the people level.

The Asian Development Bank explained

its Cooperation Fund established for
fighting HIV. Its main goal is to assist ADB
developing member countries (DMCs) in their
fight against the epidemic. The objective is to
support and strengthen the efforts of DMCs
in developing comprehensive responses to the
HIV/AIDS epidemic with a focus on current
and new areas where partnership with ADB
will be of strategic value. Priority is given to
activities that occur in sub-regions, countries,
or communities that are especially poor and

Moi Lee Liow, Executive Director of

APCASO, described the CAI-IF project.
The AIDS Investment Framework (IF) is
a model for HIV and AIDS investment
and prioritization for maximum impact.
The IF advocates for a short-term increase
in HIV funding in order to reduce
funding requirements over the long term.
Community Advocacy Initiative (CAI) is a
regional partnership programme that aims
to strengthen the advocacy capacity of
HIV civil society groups and networks in
Asia and the Pacific with funding from the
Australian Government.
Countries in the Asia and the Pacific need
to urgently explore innovative sources of
funding to bridge the gap in global resources
for AIDS, including a financial transaction
tax to fund critical health and development
programmes. Countries also need to revise
and reprioritize AIDS investment as well as
national AIDS strategies to deliver maximum
results and value for money.

Dr Osamu (Sam) Kunii from The Global

Fund explained the new funding model that
allows more strategic investments, achieves
greater impact, and engages implementers and
partners more effectively. The new funding
model provides countries that implement
grants with more flexibility around when they
apply for funds, as well as more predictability

TB/HIV: Why is ICAAP silent?

By Sugata Mukhopadhyay

I am infected with HIV and not scared of AIDS,

but definitely of TB. I know TB can knock me
down at any time.
Space to discuss crucial issues of TB/HIV
co-infection and management appears to
be extremely limited in the current ICAAP.
Surprisingly, community advocates and activists
are also not very vocal on what should be a
burning issue for the region.
According to recently published Global TB Report
(2013), 15.3% of all co-infected people (currently
estimated to be 170,021) are from South-East
Asia. Each of the high TB-burden countries of the
region, such as India, Indonesia, Myanmar and
Thailand, carry almost all of this burden.

The estimated annual number of HIV-associated

TB deaths in the region is more than 50,000.
The figure might have been more if it were not
for the fact that only 40% of people with newly
diagnosed TB cases know their HIV status.
According to the same report, only 39% of the
people living with HIV are screened for TB,
overlooking a large proportion of potential
co-infected cases.
Drug-resistant TB (DR-TB) has already made
its presence felt across the globe and Asia and
the Pacific are not spared. China and India have
the highest national numbers of DR-TB cases
globally.

Early detection and treatment of TB are key to

reducing HIV-associated TB mortality. But with
continuing stigma and discrimination, and when
access to services and information is denied,
early TB detection and treatment remains a real
challenge. Low focus on TB sensitization in HIV
programmes and regional networks, insufficient
linkages between the two services, and a lack
of sustained advocacy to strengthen TB/HIV
collaborative initiatives are major barriers that
dilute efforts and disrupt the partnership between
the old bacteria and new virus.
So where is the scope to achieve zero
discrimination and zero-death without adequately
addressing the issues of TB/HIV co-infection in
the region? Is anyone in ICAAP listening?

21 November 2013 | 03

Living with HIV, but dying of co-infections

By Bobby Ramakant

According to Tripti Tandon of the Lawyers Collective, HCV drugs are

expensive because of patents on pegylated interferons. But despite a court
decision revoking the patent, no generic drug manufacturer came forward
to deliver HCV medicines to those in need. Better quality drugs are in
pipeline and expected to reach the people in-need by 2015, she added.

Bobby Ramakant

HIV co-infections were in the spotlight at a few sessions on the second day
of ICAAP. Neglecting infections with hepatitis C virus (HCV), hepatitis B
virus (HBV), visceral leishmaniasis (VL), tuberculosis (TB), among other
HIV co-infections and co-morbidities, threatens to reverse gains made by
remarkable scale up of HIV-specific services.
Speaking at a UNITAID/UNAIDS/Indian Harm Reduction Network/
WHO session, Dr Nick Walsh said that 10 million people who inject drugs
(PWID) are exposed to HCV in 77 countries globally. The number of
PWID with HCV is thought to be 3.5 times higher than those infected with
HIV. An estimated 6.4 million PWID are thought to be infected with HBV,
with 1.2 million developing chronic HBV infection.
In Asia and the Pacific, the majority of the countries are estimated to have
more than 50% HCV prevalence among PWIDs. This includes countries
such as Cambodia, China, India, Indonesia, Japan, Macau, Malaysia,
Myanmar, Nepal, Pakistan, Philippines, Thailand and Viet Nam, among
others.
In Indonesia, HIV prevalence among PWIDs is estimated to be 36%, HCV
prevalence is estimated to be 77.3% and HBV prevalence 57.6%, said Edo
Agustian from Indonesia, who is also a board member of Asian Network
of People who Use Drugs (ANPUD). Yet there are no national clinical
guidelines for diagnosis, treatment and care for HCV-HIV co-infection or
HBV-HIV co-infection in Indonesia.
In India, HCV rates among PWIDs are up to 90% in Manipur, ranging
between 30 and 50% among PWIDs in cities such as Delhi and Chandigarh,
said Sutapa Deb of NDTV.

Evidence shows reducing (or eliminating) HCV among PWIDs requires

full harm reduction services, which can reduce HCV rates by 80% if
opioid substitution therapy is combined with high coverage needle and
syringe exchange programmes (NSP). Antiviral therapy can further reduce
HCV prevalence by 50%. But there is appalling access to NSP across
the region as a whole.
Dr Homa Mansoor of Medicins Sans Frontieres (MSF) said that in her
clinical experience of treating HIV and HBV: Viral suppression of both
co-infections is important for better treatment outcomes. Ignoring one or
the other will impact the co-infected person adversely. She called for
mandatory HBV screening for PWIDs in guidelines of the India National
AIDS Control Organization (NACO). HBV vaccination has only been
recently introduced in the national immunization schedule for children but
does not cover adults in India, said Mansoor.
Bihar state in India is home for half of the worlds cases of visceral
leishmaniasis (also known as Kala Azar). Petros Isaakidis of MSF said
that VL is fatal in 90% cases if left untreated, although cutaneous infection
usually heals by itself. 350 million people are at risk of VL in 88 countries.
1.52 million new VL cases occur every year.
Leishmaniasis is an opportunistic AIDS-defining disease, said Isaakidis.
MSF data shows that HIV and short-term mortality rates are very high
in VL-infected patients, although number of patients in the study is small.
Still this may be the largest cohort of HIV-VL co-infected people in the
world, said Isaakidis. Despite trends to show alarmingly high HIV rates
among VL patients, HIV voluntary counselling and testing services are not
routinely offered to VL patients. There are no national guidelines to deal
with HIV and VL in India. MSF is offering HIV-related VCT to all VL
patients in its project in Bihar.

Hepatitis
How is it transmitted?

In Australia, HCV treatment has been free since 2005 but only 8.6% of
eligible PWIDs attending needle syringe exchange programmes have ever
had HCV treatment.

Infected body fluids

including blood
Mother-to-child
during birth

In Myanmar, there is little data reported on HCV-HIV co-infection

although community evidence suggests alarming rates, said Willy de
Maere of the Asian Harm Reduction Network in Myanmar.
In Thailand, HIV rates among PWIDs are estimated to range between
30 and 35%, but HCV rates are 3-fold higher at 90%, said Paisan
Suwannawong of the Thai Treatment Action Group (TTAG). The Thai
government had initially excluded HIV and HCV treatment when rolling
out the 30 Baht health insurance scheme, but since 2003 HIV treatment
was covered after pressure from treatment activists grew. But HCV
treatment is still not covered, even though the Thailand Government
considered including HCV drugs in the national essential medicines list.
Evidence exists that providing antiretroviral therapy (ART) to HIVHCV co-infected people is cost-effective and makes public health sense.
Otherwise advancing HIV related illnesses leads to HCV progression,
said Dr Swarup Sarkar of UNITAID. It is not possible to get to zero HIV
deaths without addressing HIV-HCV co-infection, said Sarkar.

Unsafe injection/
sharing needles

Unsafe sex

How is it prevented?
Vaccine for Vaccine for
Hep B
Hep B

Get vaccinated for

Hepatitis B

Universal
precautions

Avoid sharing
toothbrushes,
razors, nail clippers
Never share needles
and syringes

Use condoms

04 | 21 November 2013

Waking up: Eliminating parent-to-child HIV transmission

By Shobha Shukla

According to the new UNAIDS report on HIV in Asia and the Pacific,
mixed progress has been achieved in eliminating new HIV infections in
infants. Cambodia, Malaysia, Myanmar and Thailand have over 50%
coverage of all services to prevent PTCT (parent-to-child transmission)
of HIV, while Pakistan, Nepal and Sri Lanka lag behind at less than 30%.
All countries in the region are introducing WHO-recommended PPTCT
treatment option B to provide early and immediate ARV treatment to all
HIV+ positive mothers. Yet overall, there has been only a 9% reduction in
new infections among infants between 2010 and 2012. Cutting down the
number of such infections by 90% requires much greater effort.
Thailands National Early Infant Diagnosis (EID) programme has been
working towards achieving this goal, as shared by Thananda Naiwatanakul.
Since 2007, HIV testing has been provided free of charge through the
National Health Security office. In 2012, HIV prevalence in pregnant
women was 0.6% in Thailand. Results of a cluster sampling of 2711 mothers
and 2733 infant charts from 20082011 revealed that EID coverage among
HIV-exposed children increased by nearly 80% from 53% in 2008 to
73% in 2011 and rates of PTCT dropped as a consequence.
Wang Ailing from China told the meeting that the iPMTCT (integrated
prevention of mother-to-child transmission of HIV, syphilis and hepatitis
B) programme of China is an essential part of HIV prevention and control.
By the end of 2012, HIV testing rates during pregnancy had increased to
63.5%, and 79% of pregnant women with HIV were put on ART. More
than 95% pregnant women were tested for syphilis and HBV in 2012. But
specific province-based challenges remain in high risk areas. In south-east

China, focus is on migrants and improving follow-up of pregnant women

and children, whereas in south west China it is on early detection and
infant/young child nutrition.
Anandi Yuvraj lamented the gap of 56% between pregnant HIV+ women
in India needing ARV for PPTCT in 2011 and those actually receiving it.
India has an estimated 29 million pregnant women each year, out of which
0.42% were estimated to have HIV in 2011. Dr Raghuram Rao, National
Programme Officer, shared the countrys strategy of scaling up HIV testing
for pregnant women and its integration with maternal and child health. The
national strategic plan is being rolled out in a phased manner, and envisions
detection of more than 80% of HIV-infected pregnant women; providing
access to PPTCT services to more than 90% of detected pregnant women;
providing access to early infant diagnosis to more than 90% HIV exposed
infants; providing ARV prophylaxis to 100% of HIV-exposed infants; and
ensuring >95% compliance with ART among HIV women and exposed
children. In the two states that have implemented this through the WHO
option B, more than 90% of pregnant women were tested and started on
ARV prophylaxis between September 2012 and September 2013 and for the
women under the programme, the transmission rate had gone below 5%.
Scaling up effective interventions for PPTCT will not only reduce rates of
transmission and avert new infections in children, but will also improve
overall maternal and family health. Reaching the goal of total elimination
of PTCT has been endorsed, but new technologies have to be coupled with
leadership and political will. The way forward lies in early detection; early
linkage to care and early ART initiation for HIV-infected infants; standard
treatment and high quality follow-up.

ICAAP 12: Will it happen? Should it happen?

Discussions and split opinions about the next
ICAAP are swirling around the corridors of the
Queen Sirikit Convention Center. On Wednesday, they crystallized in the form of debate
session entitled: The future of ICAAP: Do we
need one in 2015?
That the question is being openly asked is
healthy. The AIDS community must be confident that investment of collective time, attention
and resources is made for the best impact. And
even though the decision about ICAAP2015 will
most likely be made behind firmly closed doors,
such a debate should be welcomed.

and share with each other, and together we could

fight and win against AIDS.
Some are not convinced it will happen. Sipping
cups of coffee, some delegates let out long sighs
and lament that this may be the last in a long
line of ICAAPs. They fear Bangladesh may be
preparing for a conference that will never take
place.
The overlap with the upcoming International
AIDS Conference (IAC) is being raised as a specific reason to question if an ICAAP is needed
in 2015.

The slated 2015 host country sees it slightly differently: Bangladesh is speeding its preparations.
They have a substantial delegation here in Bangkok, and have a booth brimming with attractive
information and promotional materials. The
country is clearly taking the current conference
as the best opportunity to introduce itself as the
destination of the 12th ICAAP.

Why do we need a bi-annual Asia-Pacific meeting while at the same time we have an annual
worldwide conference about the same subject
here? one delegate asked.

We are all ready. Our Prime Minister, Government and Congress are so committed to the
successful organization of ICAAP 12, said Professor Dr. A.K.M. Nurun Nabi, Vice Chancellor
of Begun Rokeya Univeristy in Rangpur, Bangladesh. The next ICAAP in Bangladesh will
be very exciting and unique as we focus on the
young leaders, the next generations of cultures.
It should be the hub for every culture to gather

The Future of ICAAP satellite was one of

the most open and intense sessions this week,
with the audience asking presenters some tough
questions. After 11 ICAAPs, questions remain
unanswered regarding the costs and use of
resources around the event. Can anyone assess
whether funds are wisely invested in ICAAP
when the budget is still opaque?

In another possible congress overlap, the next

South-East Asian Lung Health conference,
which includes a TB/HIV focus, is slated to take
place in early 2014, also in Dhaka.

One comment from Rico Gustav of the Asia

Pacific Network of People Living with HIV
(APN+) was applauded by most in the room,
when he proposed there should be no more
ICAAPs until those accounts were made clear.
Professor Nurun Nabi strongly objected to the
whole idea, saying that Asia-Pacific is the largest
region in the world, and affected most seriously by HIV and that it is also easily neglected
when we put our problems into the same pot with
other continents.
So ICAAP 12 the congress about and for our
Asia-Pacific must go on, he said.
The responsibility for ICAAPs fate presumably
lies with the conference convenors and organizing partners and ultimately with the sponsors
who provide the money required to organize
such an event.
Putting questions about the overlap with next
years IAC and calls for budget transparency
aside, a contradiction exists between ICAAP
hesitations and calls made here for no more
business as usual: How can those with a future
the new generation of young people, activists
and committed key affected populations take
over and drive the regional AIDS response without a venue like ICAAP where they can learn
from the mistakes of the coffee lounge lizards?
(Session coverage by Le Nguyen)

20 November 2013 | 05

Walk the Talk: Towards an AIDS-free generation

By Sumita Thapar

Leaders from different walks of life politics, bureaucracy, private sector, gay activism,
entertainment who have demonstrated shared
responsibility to the 3 Zeros, shared their diverse
perspectives on the way forward.

The time has come not just for uplifting women from where they are, but uplifting men. How
do we get women to demand her partner uses a
condom, he said. Its not enough to tell your
son to treat women with equality, Bose added.
Parents will have to lead by example. We need
to challenge patriarchy, gender stereotypes and
redefine what it means to be macho.
The President of Fiji, HE Ratu Epeli Nailatikau
spoke of his personal involvement in reaching out to schoolchildren with HIV prevention
information: Ive taken the battle to the young
people, past the parents and grandparents, he
said. Partnering with the church has been very
effective, the President said.

Those who have seen the epidemic over the decades, spoke of generational shifts. Ashok Row
Kavi, pioneer gay rights activist from India, said
the new generation takes rights and entitlements
for granted they dont realize how hard we
fought for this, he said.
Bose spoke of losing friends to AIDS in the 80s.
We were terrified, everyone was falling like
nine pins. Twenty five years ago we thought that
was the end. Communities working alongside
the government have made remarkable success
possible, where today we are talking about the 3
Zeros, he said.
Bose, who runs a foundation working on issues
of child sexual abuse and education for marginalized children, said the use of celebrities for

SumitaThapar

Mumbai-based Indian film and stage actor Rahul

Bose, known for his commitment to issues of
gender and injustice, spoke of the need to raise
boys differently in order to address gender
inequality.

The private sector must contribute to the AIDS

response not just through funding, but also
through involving its staff in awareness programmes, said Lyn Kok, President and CEO,
Standard Chartered Bank in Thailand. Through
workplace interventions the bank has trained
more than 2 million people worldwide. In one
initiative, in India, the bank used sports to give
life-skills education to young women.
Rahul Bose

causes is often seen with cynicism that it does

little more than raise the brand equity of the person themselves. A celebrity or an ambassador
for a cause should be able to take the conversation further, for instance in the case of AIDS,
talk about the next challenge such as seeking
testing, Bose pointed out. Awareness of HIV status is central to HIV prevention. An estimated
25% of HIV-infected people are unaware of their
status. Speakers spoke of the need to make testing services friendly and non-judgmental.

SCAN ME!

Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.

Implement the ILO Recommendation on HIV and AIDS (No. 200)

UNAIDS

Everyone has the right to live a dignified,

healthy and productive life. People
living with HIV must be allowed to
work without any fear of discrimination.
Getting to Zero should be the
goal of every workplace.
Aung San Suu Kyi
Nobel Peace Prize 1991

www.ilo.org/zero

(Myanmar)

06 | 21 November 2013

Look Inside: Do not neglect self-stigma among

young MSM and transgender
By Bobby Ramakant

Delegates have heard two words a lot this week: stigma and discrimination.
Often the reference has been to external contributing factors and
discrimination against key populations.
We also need to look at stigma and discrimination keeping the self
factor in mind in particular how young men who have sex with men
(MSM) and transgender people absorb external stigma and discrimination
for instance, said Tung Duy Bui from Viet Nam. Bui is also the Regional
Coordinator of Youth Voices Count (YVC), a regional network of young
MSM and transgenders.
Young MSM and transgender people face unique self-issues, including
intense self-stigma. YVC defines self-issues as the set of concerns that
positively or negatively impact self-acceptance, self-perception, selfefficacy, self-esteem and self-confidence. Self-stigma often results when
self-issues interact with external causes (such as discrimination or violence
in family, school, social or work settings etc.), resulting in depression, low
self-esteem, anger and self-harm, even suicidal intent.
Self-stigma contributes to bridging behaviours such as injecting drug
use, that can increase a young persons sexual risk-taking, added Bui.
Self-stigma appears to decrease condom use, as the need to feel love or
affection outweighs long-term health consequences of unprotected sex.

Also if you have a low self-esteem, you are less likely to have the power
dynamics to negotiate condom use with your partner.
Bui argues that addressing self-stigma in young MSM and transgender
people will drive them to a better life where they take care of their own
health. We do not want to use the big words: internalized homophobia
or transphobia although that might be the right scientific word for selfstigma, because we prefer a term with self factor and a term which is about
young people themselves, he explained. We are not complaining here
in this session, but rather encouraging each other to love ourselves, help
ourselves and to go to health services, seek support, join our communities
and open up for love.
Referring to a YVC policy brief entitled I feel like I do not deserve
happiness at all, Bui summarised some recommendations to address selfstigma. Addressing self-stigma should start from the self. Interventions
addressing self-stigma and its linkages to HIV are needed for young MSM
and transgender people. We also need mass media and communication
campaigns to educate the public about sexuality and gender, schools must
create safe environments for young MSM and transgender people to pursue
their education, and we must push for legal reforms for supportive policies
that protect human rights and health of young MSM and transgender
people.

Getting to Zero: Country perspectives

By Nenet Ortega

Getting to Zero is UNAIDS strategic mantra for attaining zero new

infections, deaths and discrimination. To get there, countries are expected
to adopt innovating preventive approaches, scale up and scale out treatment
care and support, and advance human rights while capitalizing on gender
equality to mitigate discrimination and stigma.
At ICAAP on Wednesday, three countries shared different approaches in
getting to a specific zero: deaths among positive clients attending treatment
care and support in their facilities. A medical team in Yunnan (China)
initiated scaling up of antiretroviral therapy (ART). The team worked
collaboratively with a community heavily affected by the epidemic. In
2010, only 5,000 people were on ART and by end of 2011 it rose to more
than 7,000. Part of the zero deaths treatment package is counselling to
make sure that clients understand what it is to initiate and enrol on ART,
its benefits and potential side-effects. The community is a constant partner
in providing the psychosocial services and family members are trained on
provision of home-based care support services to assist family member on
ART. Clients on ART are constantly followed up to monitor the health
and have tests to make sure that they are responding to the treatment. By
the end of 2012, clients on ART increased to about 38,000. Average CD4
counts have increased from 200250 to 650. In six months, average viral
load reduction was 70%. Annual deaths were reduced to 3 per 100. This
is a two-year pilot initiative with a potential of larger roll-out if and when
resources are made available.
A similar initiative was implemented in Karnetaka, in South India.
Intensifying AIDS-related care and support at the community level,
involving families and community support systems proved to be beneficial
to clients initiated on ART, as well as treatment for opportunistic infections.
Mortality due to opportunistic infections was reduced.

Thailand, known for its progressive and pro-active approach to providing

comprehensive care through a government financing scheme, embarked on
detecting early warning signs of ARV resistance, which could potentially
lead to avoidable deaths.
A related initiative has been rolled out in Indonesia focusing on prevention
ART stock-outs, ensuring that clients on ART get sustained supplies of
medication. Skipping ARV doses may lead to resistant virus. Indonesia
previously obtained their supplies from the national health office. This
mechanism delayed drug distribution, leaving provincial ART hubs without
timely supplies for distribution. To avoid stock outs, ART provision was
decentralized to the provincial level directly. Numbers of clients lost to
follow up because of lack of ART availability was reduced by almost 90%.
CD4 counts increased and improvements in the health status of clients were
achieved.
These are three different approaches for providing treatment and care
services that lead to improved lives and adherence, better prognosis and
fewer deaths. Three different countries with different approaches of
contributing to zero deaths, all engaged families and communities, with
services provided holistically.
Each of these countries recognize that in order to achieve zero deaths,
treatment, care and support must be addressed by a team approach, including
medical staff, families and community support systems.
Intensified information and education within the community, and engaging
community support systems, creates an enabling environment that leads
towards zero discrimination. These actions, coupled with scaled-up
treatment, care and support ultimately leads to zero new infections.

21 November 2013 | 07

Five things you need to know

about naloxone

Platinum Sponsors

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By Naloxone Ninja

Bronze Sponsors

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You may think that superheroes only fight

crime, but they can also fight serious public
health issues like drug overdose a major
and often overlooked cause of death among
people who inject heroin or other opioids.
Armed with naloxone the safe, effective,
and easy-to-use antidote to opioid overdose,
I travel the world fighting the overdose
epidemic. And Im not the only superhero
with naloxone. Drug users, their families,
outreach workers, and police around the
globe have been trained to use naloxone to
save lives.
You can help too. Here are the five main
things you need to know about naloxone:
1. Used in emergency rooms for decades,
naloxone saves lives and should be
available at the scene of any overdose.
Naloxone is extremely safe, cheap and
easy to use. With overdose as a leading
cause of death for drug users around the
world making naloxone easily available
to them and those around them is a
no-brainer.
2. Naloxone attracts participants to other
life-saving public health services,
including HIV treatment and harm
reduction programmes. For many
people who use drugs, overdose is a
much more immediate problem than
HIV or hepatitis. By offering drug
users what they need i.e. naloxone
programmes find that they often are
able to engage new people in their other
services, like HIV testing and treatment.
3. Naloxone is empowering. People who
rescue friends using naloxone can feel

an increased sense of self-efficacy and

pride. This may translate into people
taking better care of their own health.
4. Advocates for HIV and hepatitis C
prevention and treatment should be
advocates for naloxone. People who use
drugs have a 74 percent greater risk of
overdose if they are HIV-positive. One
Australian study found that 72 percent
of deaths among subjects with hepatitis
C were from drug overdose or suicide
not from advanced liver disease as
a result of hepatitis. Naloxone is
especially vital as a safety net for drug
users living with these viruses.
5. You can start your own naloxone
programme. In fact, naloxone is
probably already legal in your country,
and used in most operating rooms and
emergency departments. To learn more,
and to get the tools you need to start
distributing naloxone to drug users,
visit naloxoneinfo.org.

C 100
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ministry of industry

What is Naloxone?
Naloxone (also known as Narcan) is a
medication called an opioid antagonist
used to counter the effects of opioid
overdose, for example morphine and
heroin overdose. Specifically, naloxone is
used in opioid overdoses to counteract
life-threatening depression of the central
nervous system and respiratory system,
allowing an overdose victim to breathe
normally. Naloxone may be injected in
the muscle, vein or under the skin or
sprayed into the nose.
Source: Harm Reduction Coalition

Senior Writers: Bobbie Ramakant

Shobha Shukla

Citizen News Service

www.citizen-news.org
@bobbyramakant

Editor:
Tim France
Coordinator: Baralee Meesukh
Designer: Benya Rattanawichai
www.iniscommunication.com
@InisCom

08 | 21 November 2013

Will there be funds to continue

community work?
By Nenet Ortega
The Global Fund has helped governments and civil society organizations to jump
start their programmes by funding national HIV, tuberculosis (TB) and malaria
initiatives. This has included support to community work, and ART provision
etc. This has also helped stimulate domestic health spending, as governments are
expected to provide counterpart funds, and eventually to address issues of longerterm sustainability.
Ongoing sustainability at any level including community work is a major
challenge in the current financial environment. Community work and its
contributions may be widely acknowledged for their impact, but funding such
initiatives is not always on the radar of governments. In light of the current
recession, donors such as the Global Fund need to find ways to ensure the
continued implementation of country-level programmes. With this and other
objectives in mind, a new funding model has been adopted by the Global Fund for
implementation from 2014.
The new model of securing funds requires a greater ownership of initiatives and
programmes by all stakeholders in a given country, including communities and
civil society organizations. Communities of key affected populations own the
problem, they need support and funding to continue their work. During the current
ICAAP, many groups have demanded that governments and donors should put key
populations at the centre of all decision-making, providing them with core, needsbased funding to sustain project implementation.
International organizations, such as UNAIDS, are regarded by civil society
organizations as the coordinating body that helps to leverage funds for core funding
and continuing technical assistance to key populations. Likewise, communities
and affected populations must commit to learning and engagement in government
and donor processes for allocating resources in order to ensure that real, needsbased activities are the ones that get funded. In this sense, respective communities,
civil society organizations and networks should be held accountable to the key
populations they represent.

ICAAP12:
ICAAP

2

ICAAP12 .
Begun Rokeya
ICAAP

#ICAAP11 on Twitter
Ryan Figueiredo @ryanippfsaro 20Nov
Susan Paxton - 2/3 women with #hiv are coerced to have
#cesarian births and sterilised. Keep women on the
HIV agenda #ICAAP11#IPPFSAR
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Jeff Acaba @jpacaba 20Nov

ASAP does not actually know how much does ICAAP
cost. No financial accountability on value for money?
#ICAAP11#ICAAPnomore?
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Ann Fordham @AnnFordham

20Nov
@ICAAP11 Edo from PKNI: overview of #hepatitis C situation in
Indonesia. Poor treatment coverage.#supportdontpunishpic.twitter.
com/JMWIIhfP6N
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Gloria Lai @GloriaLai1

20Nov
#Malaysia drug control agency promotes voluntary treatment
centres, and national target of a drug-free country. Contradiction?
#ICAAP11
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budi s @boeds001
Indonesian govt claimed to have policies and practices in
place for young people, but is it true or just another empty
promises? @ICAAP11

ICAAP

ICAAP

ICAAP

ICAAP :
2558

ICAAP

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20Nov

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@ICAAP11

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