The Long Road Ahead...

[Guest guest]

Perspective: The Long Road Ahead... Weisenfeld, Thailand4 July 2005***********At the ICAAP Plenary: Prevention and Care in CommunityMid way into the year it looks like 3 by 5 may be more like 1 by 5 and the numbers of people needing anti-retro-viral therapies is likely to remain short of the WHO goals over the near term. By 2010 DFID aims for universal access to ARVs, an even more ambitious goal than the 2015 MDG targets. While WHO struggles to fast track access to ARV therapies they are also, wisely, stepping up prevention efforts. "Money is being shot in" said Jim Yong Kim, WHO's Director for HIV/AIDS. "The possibility of treatment has had huge benefits for prevention." Yet, he warned, rolling out a combined prevention and care package is a huge task with a huge price tag. Countries will need to develop solutions which they can sustain-long after donor's interests move on.Historically, a vaccine has been the only lasting scientific solution for successfully combating viruses such as HIV. With a glimpse to the future, Seth Berkley, CEO of the International AIDS Vaccine Initiative (IAVI) outlined the road ahead to a world without HIV. Scientific research, fueled with funds from governments, foundations and drug companies, is on an aggressive path to find a vaccine for HIV. Yet, according to Berkley, it's still a number of years before we have a vaccine and it's too soon to even say when.But HIV is not only about medicine and science. Social and cultural norms and practices greatly impact who gets HIV and how they are treated once they have the virus. Gender, sex, money and power compound the vulnerabilities of marginalized groups including sex workers, drug users, men who have sex with men and trans-gendered persons. While many organizations, such as the Blue Diamond Society in Nepal, advocate for increasing sexuality education and promotion of sexual rights, the raw reality is that beatings and rape of trans-gendered and gay men is all too common. Female sex workers regularly face violence, abuse and discrimination, with police and security personnel turning a blind eye, or worse.So why is the social crisis of HIV not being addressed with the same urgency as the medical and scientific response? There may well be a day when there is no more HIV but there is sure to be some new reproductive health calamity ahead. If the underlying social issues are not addressed, future generations are bound to be working in a world where those most likely to suffer will be the marginalized groups in societies. Stigma and shame, most hard-hitting for vulnerable populations, will continue to challenge the best technologies offered by medicine and science.Hope for change? Movements of social change are built by people, communities and institutions. In the current world of HIV, the movements calling for change and inclusion are often included by being allowed to make token presentations, dwarfed by the agendas and operations of entities such as The Global Fund and The Presidents Emergency Program for AIDS Relief. And in the case of PEPFAR, change agents working with marginalized groups are limited by an agenda which promotes abstinence and fidelity and resists proven strategies in harm reduction such as access to clean needles and condoms. Yet, in spite of their limitations and sometimes mis-guided activity, mainstream institutions have tremendous power to influence the social context of HIV work.Take the WHO proposal for a minimum package of HIV prevention and care. Clean needles, methadone, male and female condoms and lubricants must be on this list and governments should be held accountable to make it available with the programming support that will be needed to ensure their effective use and desired behavior changes. WHO and other stakeholders should be steadfast in insisting that all programmes funded by international donors-including the GFATM-include this basic minimum package.While Dr Kim may realize his hope that his 5 year old son will grow up in a world without HIV; but if he is a drug user, gay or engages in sex work, he'll be likely to face the next killer in a world wrought with stigma and discrimination. WeisenfeldAsia Regional Program ManagerThe Female Health Foundation609/106 Charoenrach RoadTambon Fa HamMuang District, Chiang Mai 50 000Thailandphone/fax: +66 53 306 568mobile: +66 7976 4045email: pweisenfeld@...www.femalecondom.orgCross posted:SEA-AIDS Forwarded by :

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