ICAAP round up

[Guest guest]

ICAAP round up

By Ranjita Biswas

HIV estimates have fallen but there is no room for complacency.

Ranjita Biswas reports on discussions at the eighth ICAAP held in Sri

Lanka recently

The theme of the recent 8th ICAAP (International Congress on AIDS in

Asia and the Pacific) held in Colombo (19- 23 August, 2007)

was " Waves of Change, Waves of Hope. " The theme was carried through

the plenary sessions and various symposiums summing up what has been

learnt in the last two years since the last ICAAP in Kobe while

emphasising steps to be taken to tackle the problem of HIV/AIDS in

the Asia Pacific (AP).

True, the latest findings show that the number of people affected by

HIV in the region, 5. 4 million, has been lower than the previous

estimated figure of 8.3 million but it is dangerous to be complacent

about it, warned experts. " Nearly 1 million infections have occurred

in the last two years, 50 per cent of which are among young people

who are our most productive asset. In addition, 640,000 people died

despite the efforts of scaling up treatment of services by countries

in the region, " said J V R Prasada Rao, regional director, UNAIDS,

AP, at the opening plenary session. There have also been rising

number of new infections in China, Vietnam, Indonesia, Nepal,

Bangladesh and Pakistan, he said. Sounding a note of caution, Rao

regretted that condom promotion has not taken off upto the

expectation in the region. He also expressed frustration over a

retrogressive step like the debate over introduction of sex education

in India's schools and wondered, " Why isn't the civil society

responding with more vigour on this issue? "

However, there has been some good news too. Thailand and Cambodia are

good examples of steadying the infection rate; the Philippines and

Sri Lanka have not shown any sharp increase in the epidemic. But

the " most exciting news " has been from India, the highest prevalence

country in Asia. The latest estimate announced by NACO (National AIDS

Control Organisation) at 2.47 million is almost half of the previous

estimate of 5.7 million .

There have been minor victories too. In June 2006, countries across

the region called for Universal Access to prevention and treatment

for all those who need it by 2010. In this resolution adopted by the

UN General Assembly emphasising planning from the grassroots saw the

Asia Pacific region taking the lead. Nine countries have launched

National Strategic Plans (NSP) to achieve this target and are trying

to identify resources for funding them. Other countries are in the

process of doing so. Political leaders of many countries have also

displayed more sustained commitment to tackle the epidemic which can

create havoc all across the socio-economic structure.

Another issue widely discussed at various forums was the infection of

married women in the region due to unsafe sexual behaviour of their

spouses. This also adds to societal pressure and gender violence in

as a rippling effect. A UNDP study in South Asia shows that as much

as 40 per cent of women are coerced into leaving their homes by in-

laws after the death of their husbands and 80 per cent of these

women who are infected by their husbands are denied property rights.

Annmaree O'Keeffe, AusAID, speaking in the opening session

on " Leadership and Partnerships: Invigorating our Response " pointed

out that gender is often ignored in HIV/AIDS prevention programmes.

This is " just a symptom that shows how women are treated by society.

Unless gender equality is ensured , the situation can only get

worse, " she said. Sophia Kisting , International Labour

Organisation, suggested using the workplace, where women also form a

large chunk, for dissemination information and discussion on AIDS.

In Geneva this June, at the ILO/AIDS conference, she said,

representatives of SAARC countries came forward to discuss the

issue, " which is a very encouraging sign. "

On the second day of the plenary, speaking on Mother-to-Child

Transmission (MTCT), a problem that is a major concern of countries

like India, Dr McIntyre, regretted that the success story of

Thailand is not evident in other countries of the region. " Every

day, an estimated 100 children get infected by HIV in the Asia

Pacific region, " he pointed out. At the moment, 2 to 3 million

children are living with AIDS all over the world, majority of whom

are in the developing world and majority cases (90 per cent) are due

by MTCT. (In India, Health Secretary Naresh Dayal announced recently

that " There may be 70,000 children infected with HIV in India with

nearly 21,000 new infections occurring every year. " ) However, the

good news is that, advances made in recent years show that MTCT can

be controlled and children treated successfully even in poor

countries. For this, McIntyre suggested a four-pronged strategy among

which access to and continued treatment of the mother is crucial.

A less known factor in the fight against AIDS is the role of

infrastructure. In its presentation the Asian Development Bank (ADB)

said that infrastructure projects can impact the control and spread

of the disease. Infrastructure development should not be looked in

isolation ; areas like health, environment etc. are closely linked to

it too. Ursula Schaefer-Preuss of ADB pointed out the Injecting Drug

Users (IDU) is a critical component in HIV infection in Asia and now

new connection between large road projects and IDU is emerging . For

example, four recent case studies from ADB-supported highway projects

in China, Cambodia, Laos and Vietnam drew attention to this problem

though much more research is needed to bring out the extent of the

linkage. With India's projected need for US$350 billion to build

infrastructure in the transport sector, perhaps this point deserves

more attention. Meanwhile, international agencies are acknowledging

the linkages between infrastructure projects and HIV/AIDS and

a " Joint Initiative " has been initiated by bringing together some of

these agencies.

Stigma and discrimination against HIV positive people was widely

discussed at various sessions. Since the Asia Pacific region has a

broadly similar social pattern, especially in rural areas, the `fear'

and ignorance about the disease are common problems despite

widespread awareness campaigns. The campaigns have either not

reached the wider populace or , the material have not been

imaginatively designed to reach the target audience.

An interesting observation was made by well-known AIDS activist from

South Africa, Supreme Court judge Edwin Cameron ( " Future Agenda for

HIV activists " ) who observed that specific laws in some Asian

countries, deprive people of access to AIDS treatment, access to

education and access to HIV prevention. " Laws such as consensual sex

between adult men in private, are irrational, unjust and they foster

discrimination, " he said. Anand Grover of Lawyers' Collective, India,

agreed: " Our laws are not adequate in terms of protection…if we have

to battle this disease it is going to be through empowerment. If you

have laws that don't protect the rights of people who are affected or

infected, then AIDS will remain a concentrated epidemic. "

Other major issues like trafficking, young people and communication,

migration, MSM (men having sex with men)/LGBT (Lesbian, Gay,

Bisexual, and Transgender) , availability of Anti Retroviral Drug ,

religious beliefs, blood safety, all of which have relevance to

HIV/AIDS were focused in different platforms and augmented through

poster presentations mainly by NGOs.

A significant development announced at the ICAAP was that by the end

of 2007, an independent group of experts will make specific

recommendations to Asia policy makers, government agencies, civil

society and international organisations about how to address the

regional epidemic more effectively.

The Commission on AIDS, chaired by Chakravarthi Rangarajan, among

the chief economic advisers to India's Prime Minister, said it is

now compiling a set of specific guidelines relating to national HIV

prevention, treatment, care and impact mitigation as well as other

areas closely related to them, like availability of essential

financial resources and human rights issues. Though national

governments have shown commitment, they must be armed with expert-

reviewed action plans , Dr Rangarajan observed. For example, in

countries like India " where the resource requirements to meet health

care and prevention needs will be so large that some decision will

need to be taken. We can provide some guidance regarding that. "

It will be interesting to see how the Colombo platform for

discussions on the problems relevant to Asia Pacific, and the sharing

of lessons learnt, will provide scope for taking forward efforts to

curb the onslaught of HIV/AIDS and be available for scrutiny during

the next ICAAP (2009) in Bali.

InfoChange News & Features, September 2007

http://www.infochangeindia.org/analysis225.jsp