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The 11th International Congress on AIDS in Asia and the Pacific | 18–23 November 2013 | Bangkok, Thailand Queen Sirikit National Convention Center (QSNCC)

Heading for domestic bliss?

© Uraiwan S.

With most of the talk about ‘domestic ownership’
this week focusing on AIDS funding, you could be
forgiven for thinking that domestic responsibility
begins and ends with the question of who provides
the money for the AIDS response.
But there is clearly a much larger shift happening.
Responsibility for ensuring national AIDS
programmes are adequately funded and sustained
– and also focused, and strategic, and appropriate,
and evidence-based, and non-discriminatory,
and effective, and equitable – are all moving
from something shared with the ‘international
community’ to the ‘domestic level’.
The change was revealed by some of the
new-found honesty shown at ICAAP11. Accompanying the release of the new UNAIDS regional

report, for example, many were surprised how the
usually upbeat, positive AIDS messaging we have
grown accustomed to from international organizations was replaced by simple, hard truths about
how bad the situation really is: “Impact appears
to be slowing”; “New infections more or less
the same for the past five years, and escalating
in some places”; “Pace of progress needs to be
redoubled to sustain fragile past achievements”;
“Half of eligible people with HIV not on ART,
with long queues for MDR-TB and Hep C treatments”. How different to the messages about the
promise of an ‘AIDS-free generation’ that have
been piped out of the air conditioning at even the
most recent events. Strangely, this realism was
meted out with a simultaneous blind adherence to
the mythical three zeros mantra.

Issue 4/22 November 2013

Giving drug users a path

p.3

Community-based VCT demanded

p.4

Innovation is crucial in HIV fight

p.5

Glimpses of the HIV picture in the PICTS

p.6

Window on ICAAP11

p.7

Tweet of the day

p.8

Whatever the reason for the sudden change
of tone, one thing is certain: Our respective
governments, their policies, their actions, are the
main determinants of AIDS responses in Asia
and the Pacific. Domestic ownership is not just
about who pays the bill; it is also about who sets
the agenda now that the donors are less inclined;
who rolls up their sleeves and gets it done; and
who will carry the burden if we achieve anything
less than all we possibly can. It is about every one
of us owning what happens as part of the AIDS
response in our countries. No more demanding
what the elusive global response can do, but
insisting that we do everything we can ourselves
to make sure our national health responses – and
no longer AIDS alone – are relevant, inclusive,
robust and effective.
The call to let ‘those with a future, and not a
history’ lead the AIDS response resonates even
more with the growing realization that the right
time to pass the baton was in fact yesterday.

What did we miss while treating HIV?
By Bobby Ramakant

Expanding access to antiretroviral therapy
(ART) and HIV care services have helped
people living with HIV (PLHIV) to survive
and lead a better quality of life, but closing
our eyes to other non-HIV healthcare needs
can also reverse health benefits.

“PLHIV on ART are at an elevated risk of
cardiovascular diseases [CVDs],” said Nazisa
Hejazi, from the University of Kebangsaan,
Malaysia. “PLHIVs often have other NCD
risk factors such as high fat intake, smoking,
physical inactivity among others. We also

know that ART medications affect the liver,
potentially leading to metabolic disorders”
Noncommunicable diseases [NCDs] such as
CVDs, particularly coronary heart disease and
type-2 diabetes, were stressed as emerging
health issues in HIV by UNAIDS earlier
Continued on p.2

Host

Co-Host

Convener

Co-Convener

Organizing Partners

02 | 22 November 2013
Continued from p.1

this year, and may be associated with the
initiation or ARTs. Since 1998, data have
highlighted CVDs as one of the serious
causes of death among PLHIV. One study
of 33 countries (including Thailand) showed
that CVD rates among PLHIV were as high
as 1-in-10. Other clinical manifestations of
metabolic abnormalities as a result of ART
include: dyslipidemia, insulin resistance, and
lipodystrophy (peripheral fat loss, visceral
obesity).
Levels of ‘bad cholesterol’ (or LDL) are
higher in people taking ART, potentially
increasing their risk of high blood pressure
and CVDs. Some studies show there is at least
20% more CVD risk for PLHIV as a result.
Hejazi said that it is very important for PLHIV
to keep their viral load low as it results in less
inflammation.
Hejazi cautioned that preventing NCDs is
more important among PLHIVs because
adding to ‘pill burden’ is not going to help in
adhering to life-long regimens of ART.

“Echocardiographic abnormalities were found
in 50% children living with HIV and 37% had
left-ventricular dysfunction,” said Dr Rewari.
“There is increasing incidence of cardiac
involvement in children after initiating ART,
but it is less documented.”
Dr Hongjie Liu shared data from China
highlighting that the proportion of PLHIV
aged 50 years or older has risen dramatically,
from 2% in 2000 to 21% in 2011. Whether
AIDS programmes are attending to agerelated issues is not clear.

University in Thailand, said: “Although
human papilloma virus (HPV) rates in
Thai women were 8.7%, among MSM and
transgender people in northern Thailand anal
HPV rates shot up to 80%. There are more
than 40 types of ano-genital HPV.” HPV
infection is associated with cervical cancer
and anal cancer.
Recently HPV vaccination has been
implemented for young women in Thailand
but is not available for MSM or transgender
people.

In Nanning, capital city of Guangxi province,
a cross-sectional study showed significant
increases in mental health issues among
older PLHIV. “Intervention programming
that focusses on improving mental health
and quality of life is greatly needed for older
PLHIV in China,” said Dr Liu.
“In our experience, adherence was a major
challenge among older PLHIV in Myanmar.
Mental health issues and alcoholism can
adversely impact PLHIV,” said Khine
Mar Aung, Programme Support Officer
of the International HIV/AIDS Alliance
in Myanmar. “We also need to strengthen
health systems. Long waiting times, nonprivacy or small waiting areas in hospitals
make PLHIV uncomfortable and compromise
confidentiality.”
Dr Taweewat Supindham from the Research
Institute for Health Sciences in Chiang Mai

Dr BB Rewari

© Bobby Ramakant

Dr BB Rewari from the India National
AIDS Control Organization (NACO)
added: “Cardiac abnormalities are directly
responsible for deaths in 11% of children
living with HIV.” In a study of 100 children
(i.e. below the age of 18 years) living with
HIV (but with no pre-existing congenital or
acquired heart disease) ECG and other CVDrelated indicators were monitored. 4% were
found to have palpitations, one patient had a
breathing difficulty, 2% had grade-II systolic

murmur, 1% had muffled heart sounds and
3% had cardiomegaly.

A message of thanks from Mr Wilas Lohitkul,
Chair of the Local Organizing Committee
On behalf of the Local Organizing Committee,
I would like to thank all of you for joining us
at ICAAP11. I would also like to express my
gratitude to all the people and organizations
that worked tirelessly to make the Congress
possible, especially our donors, sponsors and
supporters.
I hope that you found our sessions detailed,
thought-provoking and inspiring, and that you
leave Bangkok with renewed vigor and belief
that we can reach the ‘Triple Zero’ targets.

© Jeanne Hallacy/ICAAP11

Mr Wilas Lohitkul

Ahead of the Congress, we knew that the AIDS
response in Asia and the Pacific had made
many positive strides. What we now all agree
is that there is still a lot of work to be done.
Rates of infection among people from key
affected populations are on the rise in this

region and now, more than ever, we must stand
by the communities most at risk.
Having witnessed the wonderful work done by
our community and youth programmes, and the
sincere engagement from some of the region’s
foremost scientific and political leaders, I have
faith that together we can end AIDS.
At the start of the epidemic almost 30 years
ago, Thailand played a leading role within Asia
and the Pacific to stem the number of HIV
infections.
It is my hope that with ICAAP11, Thailand can
be a starting point for the future of the response
in Asia and the Pacific.

22 November 2013 | 03

Giving drug users a path
By Sumita Thapar

Oral substitution therapy (OST) saves lives, improves quality of life, and
helps people who use drugs to lead functional lives, advocates say. It is
like “insulin for a diabetic,” argues Dr M Suresh Kumar, a psychiatrist
from Chennai, India, who has worked on substance use disorder for over
30 years. Beneficiaries of OST agree that it turns drug use into a chronic
condition, which can be managed with medical and psychosocial help. “By
taking care of withdrawal, it saves them from doing ‘desperate’ things.”

Though OST is offered in South Asian countries (except Sri Lanka), the
coverage is low. While pilots have been done in Afghanistan and Pakistan,
Bangladesh has just a small intervention restricted to Dhaka. In India, OST
is going from pilot to scale, with the next phase of the national programme
in 2014 and aiming for a coverage of 40%.
Project ORCHID has done pioneering work on harm reduction and OST
in Manipur and Nagaland in North-East India for over 10 years. Lessons
from the project are now being used in the national programme.

© Daily Telegraph

OST involves replacing a short acting opioid such as heroin with a long
acting substitute drug – methadone or buprenorphine. Taken orally once
a day in a clinical setting, dose and adherence are critical to effectiveness.
By taking care of withdrawal it helps users to lead functional lives. Drug
users living with HIV are also able to adhere better to long-term treatments
for HIV, tuberculosis or hepatitis. It reduces the risk of acquiring new
infections by doing away with injecting.
“Equity in service delivery is a major challenge since beneficiaries must
visit the centre every day to receive the dosage,” says Melody Lalmuanpuii,
Project ORCHID. “The population is dispersed, there are a large number
of users in rural areas, and women drug users are hidden since they are
stigmatized more.”
Although buprenorphine costs over 10 times more than methadone,
countries such as India use it because it does not carry any risk of overdose.
Advocates of OST say beneficiaries can be on OST as long as they need to,
and this can vary considerably between users.

SCAN ME!

Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.
Implement the ILO Recommendation on HIV and AIDS (No. 200)

Universal access to health care should
be provided to all, including PLHIV and
key affected populations, in both
the formal and informal
economies.
© Nafsiah Mboi

Nafsiah Mboi
www.ilo.org/zero

(Indonesia)
Minister of Health and Chair of the
Board of the Global Fund to Fight AIDS,
Tuberculosis and Malaria

04 | 22 November 2013

Positive impact of Commission on HIV and the Law
Interview with Dr Mandeep Dhaliwal, by Lwin Lwin Thant

© Bobby Ramakant

Since the report of the Global
Commission on HIV and
the Law was published just
over a year ago, there have
been significant positive
outcomes shaping the AsiaPacific region.
“Today there are 82 countries
across the world where UN
partners and civil society organizations have been working together and
followed up on the recommendations of this report. This includes reviewing
legal environments in the country, working with judiciary, police and
parliamentarians, and increasing access to justice programmes. There has also
been very interesting follow-up in the Asia Pacific region on a range of issues
including key populations, intellectual property (IP) and treatment access,”
said Dr Mandeep Dhaliwal, Director of HIV, Health and Development
Practice at the United Nations Development Programme (UNDP).
“Cambodia is reviewing its IP laws. This report has also influenced
expansion of the ‘police-community partnership initiative’ in five
provinces of Cambodia, so that key populations can have better access
to services. We also have been doing sensitization of the Royal Thailand
Police on issues of laws and human rights for key populations. In
Bangladesh, the National AIDS Programme held a country-level multistakeholder consultation on HIV and the law, which was attended by
parliamentarians and representatives from the government and judiciary.
They looked at laws that need to be changed in Bangladesh for improving

the impact of HIV programmes and human rights in the context of key
affected populations,” explained Dr Dhaliwal.
“We have also done a regional judicial sensitization for judges of high
courts in 16 countries of the region. Similarly there was a follow up
consultation in the Pacific, which included governments, civil society, and
judiciary from Fiji, Kiribati, Papua New Guinea, Samoa, Solomon Islands,
and other parts of the Pacific, to help look at HIV, laws and its impact in
the region. In India, there has been a follow up too to decriminalize samesex behaviour.”
“A lot has become possible in the region as a result of the leadership
of UN Economic and Social Commission for Asia and the Pacific, or
UNESCAP. Its resolution and political commitment from leaders to
remove discriminatory laws that are impeding effective HIV responses in
the region have brought in real positive change.”
“The Commission also brought together people who make the law
[governments] and enforce the law [judiciary, police] with the communities
and the service providers in ministries of health. There is a dialogue to
develop solutions now. Political commitment is really important because
changing laws is a political process.”
Dr Dhaliwal pointed out that laws alone are not a magic wand: “It is not
just about the laws. The law is an important tool but we also have to think
whether the policing is right, people have access to justice, and that people
know about their rights and the law, so that in case of a violation they can
access available legal recourses. We also need to change social attitudes in
society and ensure there is acceptance of key affected populations.”

Community-based VCT demanded
Civil society networks, United Nations
agencies and other partners in Asia and
the Pacific are urging a rapid increase of
voluntary confidential community-based HIV
testing and counselling for key populations
at higher risk in the region – including men
who have sex with men, transgender people,
sex workers and people who use drugs – to
help ensure more people in need are able to
access life-saving antiretroviral treatment.
Low levels of access to HIV testing and
counselling for key populations remains a
serious cause for concern in Asia and the
Pacific. Across the region, less than half
of the key populations know their HIV
status, which can lead to late diagnosis, late
initiation to care and treatment services, and
can result in unnecessarily high morbidity
and mortality for people living with HIV.
This also means the benefits of the prevention
impact of antiretroviral therapy (ART) are
not being fully maximized.
Although countries have made significant
strides to expand coverage of ART in recent
years, in 2012 only around half of people
eligible for ART were receiving it. If access
to antiretroviral treatment is to be increased,

there is an urgent need to change current
approaches to HIV testing and counselling.
This can only be achieved by ministries
of health partnering with community
organizations who are trusted by their peers
to provide life-saving HIV prevention, care
and support, and who understand how to
deliver services that are ethical, convenient,
acceptable and effective.
Access to HIV testing of any kind has been
low among key populations in Indonesia,
for example. Between a third of female sex
workers and three quarters of transgender
people have tested. Earlier this year,
the Minister of Health signed a circular
distributed to health departments in all
provinces and districts in the country, as
well to the directors of every hospital. The
circular recommended that people from key
populations living with HIV should be started
on ART regardless of their CD4 cell count.
This is “Test and Treat” for key populations;
a major step forward in increasing access
to treatment. Even the most conservative
estimates for Indonesian key populations
are 800,000 people. A major barrier to them
exercising their right to health was removed
with the stroke of the Minister’s pen.

Tackling stigma and
discrimination together
By Nenet Ortega

Stigma and discrimination concerns are largely
the same today as ten or twenty years ago. The
main difference today lies in the responses
to them. Previously reactive and piecemeal,
inclusive and engaging approaches are now
more often the norm.
For instance, health care providers and client
trainees may each both go through a baseline
assessment of their HIV-related knowledge, or
a pre-test using a specific stigma index. Results
may be used to develop training materials for
health workers and clients. Training is usually
held separately in order to provide more time
for clients to interact with their peers, and to
foster support and sharing. Health providers
and their clients can then craft their plan of
activities together. Clients trained as trainers
in this way can handle sessions educating their
peers, while health providers attend to the
clinical needs. Services are comprehensive,
similar to a ‘one-stop shop’. Those given by
health workers cover maternal care, ART and
opportunistic infection treatment, while trained
clients provide essential psychosocial services,
all under one roof.

22 November 2013 | 05

Innovation is crucial in HIV fight
By Swapna Majumdar

India has the world’s third-largest population of
people living with HIV – 2.4 million. Nevertheless,
it has been able to make significant progress in
recent years – by thinking out of the box. Over
the past decade, this has led to a 50% decline in
the number of new infections. For a country that
was once feared could eventually house the largest
number of people living with HIV in the world,
this is no mean feat.
One such innovative programme is the ‘link
worker scheme’ (LWS) designed to bridge the
gaps in rural India caused by a lack of awareness
of the infection, reduce stigma and discrimination
associated with HIV and link people to quality
health care services.
Realizing that greater attention was required in
the rural areas where many of the 120,000 new
people diagnosed as HIV-positive in 2011 live,
the National AIDS Control Organisation (NACO)
initiated the LWS to reach marginalized groups in
districts across the 18 states known to be hot spots
of the epidemic.
One male and one female link worker work
together as a team. Pairs are responsible for a
cluster of five vulnerable villages, each with a
population of over 5,000, including people living
with HIV and sex workers practicing sex work

in the village. It was the strategy to choose link
workers from the community, many of who are
themselves living with HIV, that has helped bring
change at the grassroots level.
Bihar State, which is home to over 100,000 HIVpositive people, is rapidly emerging as one of the
high HIV prevalence states in the country. High
rates of migration for work from tribal and poor
communities combine with low levels of literacy
and skill in this hot spot of the epidemic. A
number of studies have documented that migrants
encounter more HIV risk through sexual behaviour
than non-migrants, potentially spreading HIV
from high prevalence areas to lower ones.
All these factors coupled with high percentage
of early marriage, little or no awareness of HIV,
unsafe sexual practices, a poor health care system
and gender inequality, have made rural Bihar
highly vulnerable to the epidemic. The link
workers are therefore crucial in the government’s
bid to prevent HIV transmission as well as creating
an enabling environment for people living with
HIV to seek treatment and other care services.
Sitamarhi is one of the five districts where the
LWS has been launched in Bihar State. It has the
highest HIV prevalence rate in the state (3.7%),
shares its borders with Nepal and five other high

risk districts in Bihar. The presence of a red-light
area has increased its vulnerability to cross border
and inter-state trafficking. Reaching out to sex
workers, primarily female, is critical. One of the
facts behind the LWS was conclusive evidence of
a strong presence of sex work in rural areas, and
the need to reach out to them.
This is where the women link workers are making
a difference. Mostly in their mid-twenties and from
the same communities where the programmes are
launched, they are creating awareness about HIVrelated risks. Although difficult to discuss sex
and sexuality in relatively conservative Bihar, the
persistence and commitment of the link workers
has paid off.
They have won the trust of sex workers. Rama,
a sex worker in Radhaur said that a specific link
worker helped her to understand the importance
of protecting herself. “I make sure that the
condoms she gives me are used by the clients. I
also got myself tested after she convinced me that
treatment would enable me to lead a normal life,
in case I had acquired HIV. Thankfully, I tested
negative. At least now I don’t have to live in fear.
I am happy that I listened to her.” Understanding
the specific needs of affected women and girls
different communities, whether housewives or sex
workers, is key to combating HIV. This concern
has been overcome by the cadre of link workers in
Bihar, who have managed to increase the number
of referrals to testing centres by adopting inventive
ways of convincing vulnerable communities to
access treatment.

SCAN ME!

Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.
Implement the ILO Recommendation on HIV and AIDS (No. 200)

We need to support programs that get
health workers to reach the people who
need prevention, care and treatment. We
know how to do it. But we have to
work together to succeed.
© The Global Fund

Mark Dybul
Executive Director, The Global Fund to Fight
AIDS, Tuberculosis and Malaria

www.ilo.org/zero

06 | 22 November 2013

Glimpses of the HIV picture in the PICTS
By Shobha Shukla

Beginning with the Lord’s Prayer, HE Ratu Epeli Nailatikau, President of
Fiji began the ‘Pacific Islands Voyage’ with a celebration of the united efforts
of the 22 countries comprising the Pacific Island Countries and territories
(PICTS) in response to HIV and other sexually-transmitted infections (STIs).
With a population of around 10 million, the region is home to one third of
the worlds languages and a rich cultural diversity. PICTS has a low HIV
prevalence rate of < 0.1% (with the exception of Papua New Guinea, which
has prevalence of 0.9%) with three countries reporting no HIV at all.
However, STIs rates are among the highest in the world and an estimated
25% of the Pacific Islanders below the age of 25 suffer from an STI.
“Gender inequality and traditional gender roles in the region adversely impact
the sexual and reproductive health of women. Condom use is inconsistent
and alcohol consumption and drug use are other risky behaviours increasing
the individual’s risk to STIs and HIV,” the President conceded. “Also many
countries have legislation that is discriminatory against sex workers, MSMs,
TGs and PLHIV.”
And yet, the responses towards HIV/STI have improved tremendously over
the past few years. A Rapid Diagnostics of HIV Testing Algorithm has been
rolled out in countries. Specimens were previously shipped to Australia or
New Zealand for testing. These rapid tests have reduced the turnaround time
from >4 weeks to less than 48 hours. This has increased the number of people
tested, with some countries testing >50% of their population.
A five-country study (in Fiji, Guam, Kiribati, Samoa and Solomon
Islands) revealed that more than 50% of the respondents on ARTs had
stopped treatment at least once. Poverty, stigma and discrimination, little

Community involvement in
implementation research
By Shobha Shukla

Community engagement is central to any
implementation research done at the community
level, asserted Naveen Kumar Mattipalli,
Yadavendra Singh and Abheena Aher of the
India HIV/AIDS Alliance, in a press conference
on engagement and facilitation as research
strategies with sexual minorities.
The study helped to identify and train researchers
from the community and helped in breaking
barriers to reaching respondents, particularly
those living in closed environments. Interacting
directly with community members and peers
gives deeper insights about current behavioural
patterns and helped in exploring sensitive issues
like internalized stigma, disclosure of identity
and marital status, sexual reassignment surgery
and violence.
Researchers may be sceptical about the capacities
of community members, but often have to change
their opinion. A judicious mix of mainstream
researchers and community members helps in
sharing of ideas and improving sensitivities by
bringing both to a common platform. Such research
gives an identity to invisible sections of society
and help community system strengthening by
giving the communities ownership of programmes
from which they may one day benefit.

knowledge about treatment, and lack of family support are major barriers
to adherence and often result in PLHIVs quitting treatment. Some are also
overwhelmed with the side-effects. In many cases the simple gesture of
being reminded by a family member to take the medicine was enough
incentive to continue treatment.
Rebecca Kubu Navanua of the Pacific Positive Group of Women felt that
PLHIV, who are trained as community and outreach workers, play an
important role by way of community outreach, advocacy and governance.
They facilitate education sessions in the community focusing on safe sex,
the need for acceptance and love from family and friends, ensuring that
people can live normal lives on treatment and can have children free of
HIV. The outreach workers also give inputs in drafting HIV laws/policies;
work with church leaders; and do training on human rights including
right to treatment without discrimination so that people with HIV get the
respect they deserve. They have meaningful involvement in governance
as members of several decision-making bodies like national AIDS
committees, national HIV boards and national networks.
Dr Moale Kariko, of the PNG National AIDS Council Secretariat,
summed up the way forward. Since 2011, access to testing, treatment and
information on HIV has improved considerably. HIV is now concentrated
in certain geographical regions and in key populations such as sex
workers. However risk factors exist with the potential for the virus to
spread more widely. Rates of STIs are very high and gender inequality,
stigma and discrimination add fuel to fire. 26% of those in need of ART
are still not accessing it, loss-to-follow up is high and condom use is low.
More investment is required for prevention interventions in most at risk
populations.

eHealth tools as game-changers
By Swapna Majumdar

If you can’t beat them, join them. When FHI360,
a nonprofit organization, found that people who
inject drugs (PWIDs) in Viet Nam typically did
not test for HIV, they had to think of way to get
them interested.With 145 phones for every 100
people, Viet Nam has cashed in on the popularity
of mobile gaming to reach out to people who use
drugs (PWIDs). A game was designed that used
the short message system (SMS) to indicate when
PWIDs had undergone voluntary HIV testing.
The phone of all such PWIDs were topped up by
a small amount as an incentive.
“In the six-month period of this initiative, 56%
went in for testing and half of those who tested
were firt time testers,” said Caroline Francis,
from FHI360, in Viet Nam. Sharing her experince
of how new techologies could be used to reach
key populations, Francis added that success had
brought political committment from the local
government to scale up the initiative in three more
districts, demonstrating that the innovative use
of information and communication technologies
to provide services for key affected populations
can help achieve better coverage with fewer
resources.
Another key population, female sex workers, are
now better equipped to protect themselves thanks
to an inovative use of the geographic information

system (GIS) and global positioning system
(GPS) in Indonesia. This programme, piloted by
FHI360 in the country, uses the data generated
to indicate gaps in access and availabilty of
condoms, thus boosting prevention efforts.
While men who have sex with men (MSM) in
China can access sexual health information and
seek help anonymously through a dedicated
website, MISTER is a geolocation-based social
networking site that reached out to one million
MSMs within two years of its launch in 2011.
According to its founder Carl Sandler, apps are
an cost-effective way to reach out to this key
population”. Apps are a powerful resource and
when customised can be a game-changer,” he
said.
This is exactly what B-Change, a social
enterprise group promoting social change
through technology, is doing in four counties in
the region.
“As a gay man living with HIV, I needed an app
that I could use and that is how this was born.
This helps members of the gay community to
seek and get medical and mental health services
without discrimination,” said its founder L.
Garcia. “It also gives researchers the opportunity
to study its efficacy and that has contributed to
its success.”

Window on ICAAP11

22 November 2013 | 07
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Senior Writers: Bobbie Ramakant
Shobha Shukla

Citizen News Service
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@bobbyramakant

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

Photo thanks: Vinai Dithajohn/UNAIDS and Uraiwan S.

08 | 22 November 2013

Legal protection needed for women
and girls affected by HIV
Serious gaps exist in the legal protection of HIV-affected
women and girls in health care settings. According to a new
study presented at ICAAP11, human rights violations include
discriminatory treatment by medical workers, breaches of
confidentiality, forced sterilization and abortions, denial of
services and care, and misinformation.
Protecting the rights of key HIV-affected women and girls
in health care settings: A legal scan offers strong evidence from Bangladesh, India,
Pakistan and Nepal that some health care institutions are sites of discrimination, violence
and abuse towards HIV-affected women and girls who seek service.
The study examines constitutional provisions and legal means in those countries to
provide protection or redress for violations of rights at health care facilities.
“Many HIV-affected women continue to face extreme discrimination, neglect and
abuse from health professionals. This leads women to avoid health care services, which
compromises the health of both women and children,” says Nukshinaro Ao, Coordinator
of Women of Asia Pacific Plus.
According to the research, the laws that do exist like the Pakistan Reproductive Healthcare
and Rights Act, lack effective implementation measures or penalties. Codes of Conduct
for physicians in these countries, as in the Bangladesh Medical and Dental Council Act,
also afford some level of protection, but remain largely ineffectual given the limited
resources allocated for monitoring.
“This research shows that large numbers of women whose rights have been violated
at health care settings do not have any recourse to justice,” says Clifton Cortez, UN
Development Programme (UNDP) Team Leader for HIV, Health and Development in
Asia and the Pacific.
The study was conducted jointly by Women of the Asia Pacific Plus (WAP+), the Asia
Pacific Network of People Living with HIV (APN+), the South Asian Association for
Regional Co-operation in Law (SAARCLAW) and the UN Development Programme
(UNDP).
Download the report at http://bit.ly/KAWG_AP

HIV and social
protection
By Swapna Majumdar

Documented and undocumented migrants in
Thailand are eligible to receive social security
services provided by the Government.
Considering that the country attracts one of
the largest number of migrants in the region,
many of them without the requisite passport,
visa or work permit, the Government’s social
protection schemes has helped 1.7 million
migrants living in Thailand to access health
services, including antiretroviral therapy
(ART).
The Compulsory Migrant Health Insurance
Scheme (CMHIS), earlier limited to just
documented migrant workers, now allows
workers and their dependents from Laos,
Cambodia and Myanmar to avail of the scheme.
Although they have to undergo a medical
examination and pay an annual fee (2200 Baht
per person) to register for the scheme, ART is
free for pregnant women. Others pay a nominal
fee for their hospital visit.
Documented migrants working in the formal
sector are however more privileged. They
can register for the national Social Security

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APCOM @apcom
21Nov
Joint statement on scaling up voluntary community-based
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Benefits Scheme (SSBS) and can access free
health care services including ART in all
public and some private hospitals. According
to Dr Chanvit Tharathepm, Deputy Permanent
Secretary at the Ministry of Public Health,
they have leveraged the monthly contribution
made by the employer, government and
employee under this scheme to provide social
protection to a key population.
“Social protection has been identified as a
strategic priority because of its importance in
preventing HIV and providing HIV treatment
care and support,” said Ms Jan Beagle,
UNAIDS Deputy Executive Director.
She said Thailand’s universal health coverage
scheme, which now covers ART and HIV
prevention services such as methadone
maintenance therapy for people who use
drugs, had shown the potential impact of
social protection programmes in the context
of HIV.
“Social protection floors are a critical first
level of social protection, with a basic set
of social entitlements,” she said. “HIV has
been integrated into the mainstream social
protection schemes run by the Government,
and protects people throughout their lifespan,
not only at one point in their lives.”

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Cook Islands Minister launches Diversity Plan at AIDS
Conference - eepurl.com/JejZD #ICAAP11
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Angela D’Souza @angelajdsouza
RT @GloriaLai1 Only 2% of PLHIV who use drugs get
antiretroviral treatment: @IDPCnet session
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21Nov

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@ICAAP11

First rectal microbicide
study in Asia-Pacific
By Bobby Ramakant

The first ever phase-II study of a rectal
microbicide in Asia and the Pacific is expected
to begin soon in Thailand.
“One of the most promising researches taking
place on new HIV prevention technologies
for MSM and transgender people is on rectal
microbicides,” said Dr Timothy H Holtz,
Director of the HIV/STD Research Programme
at the US Centre for Disease Control and
Prevention (CDC) Collaboration, in Bangkok.
Every study participant will have the same
duration of exposure to each of three regimens:
oral Truvada pre-exposure prophylaxis (PrEP),
as well as daily and sex-dependent rectal gel
(reduced glycerin and tenofovir gel). The
study is taking place at two sites in Thailand:
Bangkok and Chiang Mai.
“This is the first phase II rectal microbicide
clinical study outside of US. We have been
operating a MSM-centred clinic in downtown
Bangkok for over six years now,” said Dr
Holtz. “We think it is a very MSM-friendly,
warm and inviting clinic space that respects
confidentiality and also provides services to
those who might opt to stay anonymous”.