PAHO HIV News. Number 17, October 2008
Editorial: A lesson I learned from AIDS 2008
There is no magic bullet for HIV prevention.” This phrase, repeated frequently at the International AIDS Conference in Mexico, sharply contrasts to the experience of the Vancouver Conference, 12 years earlier, when participants marveled at the news that treatment with antiretroviral drugs could save the lives of people with HIV. The fact that this critical assessment of prevention marked the first AIDS Conference in Latin America and the Caribbean should be a lesson for everyone working on HIV in the Region. Instead of a myriad of isolated solutions, we need to develop multi-pronged programs, implement interventions that also address the determinants of the epidemic, scale up proven strategies, and focus on the most vulnerable groups. “Combination prevention” works. Latin America and the Caribbean have the necessary conditions to demonstrate that to the global community.
Gottfried Hirnschall, Project Coordinator, HIV/STI, PAHO
PAHO Director Mirta Roses has assumed the charge as chairperson of the Regional Directors Group (RDG) from July 2008 to July 2009, succeeding the previous agency chair, the World Food Program. In July, the RDG approved a work plan for 2008/2009 and adapted the global Division of Labor document to reflect the mandates and strengths of the UNAIDS co-sponsors in Latin America and the Caribbean. The group examined UN technical support for national responses to HIV and agreed to strengthen the Joint Teams, which will become the primary mechanism through which coordination of UN technical support is organized at the country level. The RDG was created in 2003 to enhance the synergy of the UN response to HIV in the Region. It brings together nine agencies and programs and the World Bank, all of which are co-sponsoring organizations of UNAIDS. The vice-chair for this term will be Nils Kastberg, UNICEF’s Regional Director for Latin America and the Caribbean.
It is possible to eliminate the vertical transmission of HIV and syphilis in the Caribbean by 2015. That’s the conclusion reached by public health authorities and HIV and maternal and child health experts during a technical meeting convened by PAHO and UNICEF and attended by PAHO Director Mirta Roses. Zero transmission rates are not possible now, but mother-to-child transmission of both infections can be reduced to very low levels with simple and affordable interventions. During a satellite session of the XVII International AIDS Conference, experts proposed criteria to certify countries as elimination of the two conditions as public health problems. Countries with incidence rates of less than two HIV cases per 100 infected mothers could be certified as having eliminated vertical transmission of HIV, and countries with incidence rates of 0.5 or fewer cases of syphilis per 1,000 live births could be certified as having eliminated vertical transmission of syphilis. Key elements of the elimination initiative include scaling-up primary prevention services for HIV and syphilis and strengthening health systems, particularly maternal and child health services, surveillance, monitoring and evaluation. The Caribbean Initiative for Elimination of Vertical Transmission of HIV and Syphilis will be formally launched in 2009, after regional consultations that will be convened by the PAHO HIV Caribbean Office (PHCO) and UNICEF. More information
PAHO has launched a new area of technical cooperation aimed at evaluating national health systems’ response to the HIV epidemic. The methodology is being applied for the first time in the Dominican Republic, where it identified achievements, gaps in coverage, funding needs and missed opportunities, as well as their financial cost. Based on an analysis from the perspective of health system functions, the evaluation methodology provides recommendations for management and public policy. These recommendations seek more effective use of resources and support the achievement of the universal access goals to which the country has committed. The publication Evaluation of the National Health System Response to HIV in the Dominican Republic reports the results of the first evaluation, undertaken with participation of different levels of the national health system, as well as cooperation agencies and civil society representatives. More information
PAHO published two new sets of regional guidelines aimed at facilitating and expanding antiretroviral therapy for children, adolescents and adults. Produced with support of the support of the cooperation agencies of Spain and Norway, the PAHO guidelines are an adaptation of global guidelines published by the WHO in 2006, based on recommendations offered by regional experts. They aim at helping countries of the Region formulate or review national antiretroviral therapy guidelines for children, adolescents and adults. More information: is available at: Children - Antiretroviral therapy for children in Latin America and the Caribbean (Spanish) Adults and adolescents - Antiretroviral therapy for adults and adolescents in Latin America and the Caribbean (Spanish)
New PAHO guidelines on HIV testing describe the actions needed to deliver HIV testing services in client-initiated settings (voluntary testing and counseling -- VCT) and in clinical settings (provider-initiated testing and counseling -- PITC). Guidelines for the Implementation of Reliable and Efficient Diagnostic Testing: Region of Americas promotes simple, standardized strategies for testing that serves as an entry point to HIV health care services, treatment and prevention. This approach helps define national algorithms for HIV diagnostic tests in conventional laboratories and other centers. More information
A new PAHO publication aims at improving surveillance of HIV, hepatitis C, and other infections in high-risk drug users. Behavioral Surveys in High Risk Drug Users contains a model questionnaire for face-to-face interviews with injecting and non-injecting drug users in various contexts (street or other "natural environments," dependency treatment programs, harm reduction programs, and prisons). It also includes a detailed interview manual, as well as information on how to conduct surveys with hidden populations. These tools, produced with the support of the Spanish Agency for International Cooperation and the Ministry of Health, are directed at public health professionals, planners, epidemiologists, and researchers. More information is available at:
Workbook 1 - Design of the study, adaptation of the questionnaire and indicators (Spanish)Workbook 2 - Interview and application of questionnaire C-CODAR (VI-8) (Spanish) http://www.paho.org/spanish/ad/fch/AI/Codar_cuaderno2.pdf Workbook 3 - Questionnaire C-CODAR (Spanish)
Between 2002 and 2005, four mass media campaigns against homophobia in Latin America offered an unprecedented response to stigma and discrimination against homosexual men. The campaigns included print, radio and TV advertisements that presented non-heterosexual people in a positive light and challenged perceptions that they should be treated differently. They also took advantage of the controversy that the subject generated to promote a public dialogue among different sectors of civil society. A PAHO report describing and analyzing these initiatives, Campaigns against Homophobia in Argentina, Brazil, Colombia, and Mexico, is now available in English. More information
PAHO supported several applications for Round 8 of the Global Fund and is already supporting applications for Round 9. This work is done in collaboration with UNAIDS, the International Center for Technical Cooperation on AIDS (CICT), the International AIDS Alliance, the Civil Society Action Team (CSAT) and other partners (GTZ, DFID, USAID, CDC and UN agencies). Most of these institutions participated in a meeting in São Paulo, Brazil, in May, to coordinate technical cooperation. Future plans include a workshop on community systems strengthening, direct technical cooperation at the local level (using resources locally available and additional experts), and development of a roster of experts who can be instrumental in Global Fund issues, including experts in gender, ethnicity, medicines management, health system strengthening, and community system strengthening. These institutions are also considering forming a Latin American and Caribbean peer review panel to examine and make suggestions to strengthen proposals on AIDS, TB and malaria before their submission to the Global Fund.
Central America: study on human rights finds progress and gaps
A PAHO report on human rights and HIV finds that, El Salvador, Guatemala, Honduras, Nicaragua, and Panama all have adequate legal frameworks to develop policies that address human rights and fundamental freedoms in the response to HIV. Despite this important progress, some of those countries still require an HIV test from people seeking authorization for entry into the country or permanent residence in the national territory, according to the study. In almost all countries, people filed complaints after their rights to work were limited as a consequence of their HIV status. Often, people with HIV and those belonging to the most vulnerable groups did not have access to the services that form part of the response to HIV, and did not formally demand their rights out of fear of discrimination. Those and other findings are available in Human Rights and HIV: legislation, policy, and practice in the five countries of Central America (available only in Spanish). There study was funded by the Swedish International Development Cooperation Agency.
More information: Report and Power Point Presentation
Argentina: manual for health care of trans people published
The Ministry of Health of Argentina, PAHO and UNAIDS have produced a new manual, Health Care of Transvestite and Transsexual People, that contains information about sexuality and other characteristics of “trans” people and makes recommendations for their first visit to a health provider, hormone treatment and clinical care. The publication, which is based on work previously produced by the AIDS Coordination of the City of Buenos Aires, includes a study on HIV prevalence among “trans” people in the country. In August, PAHO representatives in Argentina participated in the First Consultation on Sex Work and HIV, in which civil society members and public health officials produced recommendations for action by the government and organizations providing support to sex workers in the areas of human rights, HIV prevention and access to the health system. More information (Spanish only)
PAHO is supporting efforts by the government of Mexico to increase access to antiretroviral drugs through price negotiations with the pharmaceutical industry. The negotiations are led by a multisectoral working group, which is also reviewing the regulatory framework for procurement of medicines in the country. In August, national authorities announced that Mexico was abolishing its requirement that pharmaceutical companies had to have a manufacturing plant in the country in order to sell their drugs there. The change, announced by President Felipe Calderon during the opening ceremony of the XVII International AIDS Conference, removed an important barrier to entry of generic antiretroviral drugs to Mexico. Historically, the pharmaceutical industry has charged Mexico higher prices that most countries in the region of the Americas. More information
Suriname: campaign generates unexpected demand for female condoms
The results of a successful campaign to promote female condom use in Suriname were disseminated at the XVII International AIDS Conference. In 2006, 10,000 female condoms were distributed in three months – twice as fast as foreseen by the organizers. Prior to distribution, the organizers, aware of the small uptake of female condoms in other countries, focused on communication initiatives to familiarize the population with the female condom. One of the most popular activities of the campaign, a joint effort of PAHO, UNFPA and other institutions, was a booth set up at fairs and public events, where people could try to insert condoms in a model of the female genitals and ask questions to the organizers. The first phase of the campaign included distribution of coupons that could be exchanged for female condoms at distribution sites. Currently, 140 outlets, including pharmacies, primary care clinics, NGOs, escort services, and motels distribute 100,000 female condoms a year in Suriname.
The XVII International AIDS Conference was Conference of many “firsts.” It was the first one held in Latin America and the Caribbean; the largest ever in a developing country, with over 22,000 participants from more than 100 countries; the first to have plenary sessions about sex work and men who have sex with men; and the first to hold an international march against homophobia. The conference was also marked by an unprecedented declaration by Ministers of Health and Education from the Region, in which they committed to scale-up comprehensive sex education and sexual health in their countries, and by a meeting of the Coalition of First Ladies and Women Leaders, which approved an important document on the need to protect women against HIV. Here are highlights of PAHO’s contribution to the Conference and satellite events:
Most recent press releases, news articles and videos:
Coming up: HIV and TB colleagues to meet separately and jointly
A series of back-to-back meetings of national AIDS programs in Latin America and PAHO HIV personnel will take place in San Jose, Costa Rica, in the first week of November. Representatives of the national AIDS programs will meet with PAHO HIV focal points and regional advisers to analyze the challenges and opportunities for the health sector to reach the Universal Access goals by 2010, and to agree on actions to strengthen the health sector response. In addition, they will examine some critical themes, like PMTCT, HIV surveillance, and programs for vulnerable groups. The HIV meeting will happen in parallel with a meeting of TB managers and focal points with heads of health services of correctional facilities to discuss TB in prisons. At the end of the week, the HIV and TB groups will be integrated to discuss progress in implementing collaborative activities, with emphasis on the 3 “I”s. For more information contact firstname.lastname@example.org
The expansion of HIV prevention services for young people, using gender, sexual reproductive health, and human rights approaches, is one of the expected results of a grant from the Norwegian Agency for Development Cooperation (NORAD) to PAHO. The cooperation agreement, to be signed in 2008, will provide US$5 million over five years. Sixty-five percent of the funds will go toward expansion of services in El Salvador, Guatemala, Haiti, Honduras, the Dominican Republic, Nicaragua, and Panamá, while the other 35 percent will be used in regional and subregional initiatives. Specific activities will include development of a positive legislative and policy environment, development of human resources, and strengthening nations’ capacity to generate and use strategic information to develop and monitor programs for young people. Norway allocates 0.95% of its Gross National Income to international cooperation. More information about NORAD can be found at: http://www.norad.no/
Coming up: PAHO Caribbean HIV Office to move in November
The PAHO Caribbean HIV Office (PHCO) is moving to new premises. PHCO develops and coordinates PAHO’s technical cooperation in the Caribbean (English, Spanish, French and Dutch-speaking) and is the primary interface with regional partners such as PANCAP, UNAIDS-Caribbean, and CRN+. PHCO works in collaboration with PAHO’s Caribbean Program Coordination (CPC) and with PAHO’s HIV Team in Washington. A team of experts covering areas including prevention, care and strategic planning is already in place, headed by Amalia Del Riego, formerly PAHO’s 3 by 5 coordinator. Starting in November, their address will be Farma Building, 112-114 Duke Street, Port of Spain, Trinidad and Tobago. The office will also be reachable by phone at + 1(868) 622 5937 and +1(868) 628 4266 and by email at email@example.com.
Coming up: work on drug resistance, pediatric AIDS and PMTCT to be strengthened
PAHO is working to provide stronger technical cooperation in the area of HIV Drug Resistance. Dr. Giovanni Ravasi, an Italian physician specializing in infectious diseases who has previously worked with the WHO’s Drug Resistance program, joined the HIV Team. Dr. Ravasi is based in Brazil and will work at a regional level. At the same time, PAHO will reinforce the work in the areas of pediatric AIDS and PMTCT. A new team member, Dr. Raúl González-Montero, a Spanish physician specializing in HIV infection among children, will be based in Washington, DC, also covering the Region. Dr.González-Montero comes from the pediatric service of the University Hospital of Sant Joan d’Alacant, in Valencia. More information: firstname.lastname@example.org
Most frequently-used HIV acronyms: http://www.paho.org/English/AD/FCH/AI/Acronym_hivAIDS.pdf
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