IRIN PlusNews: Lack of lube hurts HIV prevention

via IRIN PlusNews

“Key populations - such as MSM and sex workers - who need the lubricant the most, often get their health-related services from local NGOs, which are not often included in [HIV/AIDS] policies or broader [health] programmes,” explained Bidia Deperthes, a senior HIV adviser with UNFPA’s Comprehensive Condom Programming division in New York.

KATHMANDU, 21 February 2013 (PlusNews) - Safer-sex messaging on condoms is universal but the generally poor availability of lubricants, and awareness of them, is hindering HIV prevention, health activists warn.

Some personal lubricant - or “lube”- has been shown to lower the risk of HIV transmission by decreasing the risk of condoms breaking.

Despite preliminary proof of lube’s efficacy, far less of the product is procured and distributed than condoms, leading people to use alternative, sometimes harmful, substances during intercourse such as butter or petroleum jelly; oil-based lubricants weaken latex, making the condom more likely to break.

Activists say, however, that a blind spot in research on lubricants as a part of HIV prevention programmes means not enough is known about their impact on HIV risk.

Read the rest.

-------------------

*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

  *Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

  -------------------

HIV and the Law

via the Commission on HIV and the Law

The end of the global AIDS epidemic is within our reach. This will only be possible if science and action are accompanied by a tangible commitment to respecting human dignity and ending injustice.

Law prohibits or permits specific behaviours, and in so doing, it shapes politics, economics and society. The law can be a human good that makes a material diff erence in people’s lives. It is therefore not surprising that law has the power to bridge the gap between vulnerability and resilience to HIV.

We came together as a group of individuals from diverse backgrounds, experiences and continents to examine the role of the law in effective HIV responses. What we share is our abiding commitment to public health and social justice. We have listened with humility to hundreds of accounts describing the eff ects of law on HIV. In many instances, we have been overwhelmed by how archaic, insensitive laws are violating human rights, challenging rational public health responses and eroding social fabric. At other times, we have been moved by those who demonstrate courage and conviction to protect those most vulnerable in
our societies.

Many would say that the law can be complex and challenging and is best left alone. Our experience during this Commission has shown us a very diff erent perspective. We have been encouraged by how frank and constructive dialogue on controversial issues can sometimes quickly lead to progressive law reform, the eff ective defence of legislation or better enforcement of existing laws. Even in environments where formal legal change is a slow and arduous process, we have witnessed countries taking action to strengthen access to justice and challenge stigma and discrimination.

Click here for the full report.


-------------------
*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
-------------------

South Africa: Aids Response Must Be Guided By Human Rights and Justice

via allAfrica, by Festus Mogae and Stephen Lewis

In South Africa and across Africa, HIV continues to prey on women, sex workers and men who have sex with men. It is clear that to end the HIV epidemic, we must protect and support these groups.

Archaic laws and customs make women and girls more vulnerable to HIV. Legally condoned violence and oppression-including genital mutilation, sexual violence, denial of property rights and early marriage- undermine the ability of women to protect themselves. Laws urgently need to protect women, who are often the ones left to care for the sick, tend to the family and till the fields.

Laws across the continent also criminalize homosexuality. Yet, punishing men who have sex with men force them into secrecy. They are unable to access counseling and testing, making it almost impossible for HIV prevention and treatment interventions to reach them. In 2008, when the Senegalese government jailed nine gay HIV outreach workers under a law prohibiting "acts against nature," health workers went into hiding, advocacy groups disbanded and HIV treatment sites were shut down.

The time has come for African leaders to take action against bad laws that stifle our HIV response. We must challenge societal values rooted in fear and prejudice and implement laws based on human rights and sound public health.

Read the rest.



-------------------
*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
-------------------

Ethiopia to Distribute Condoms to High Risk Populations

via msmgf.org, by AHN

ADDIS ABABA, 12 June 2012 (PlusNews) - More than 100 million condoms will be distributed annually to sex workers, men who have sex with men and other groups vulnerable to HIV as part of a new five-year programme to be run by the Ethiopian government and the US President's Emergency Plan for AIDS Relief (PEPFAR).

Dubbed MULU, the Amharic word for comprehensive, the US$70 million programme - implemented by the NGOs Population Services International and World Learning - will also target day labourers in the booming construction industry, migrant workers and their partners.

"Over the five-year life of MULU prevention, 100 million free condoms per year will be distributed, 2 million counselling and testing sessions will be conducted, and half a million sexually transmitted infection cases will be treated," said Donald Booth, US Ambassador to Ethiopia, launching the programme on 31 May 2012 in the capital, Addis Ababa.

"This programme is going to focus on… getting services for people who practice high-risk behaviours such as having multiple sex partners concurrently," Renee DeMarco, a senior technical advisor to HIV/AIDS Prevention and Social Services at the US Agency for International Development (USAID)-Ethiopia, told IRIN/PlusNews.

Read the rest.

-------------------
*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
-------------------

High HIV Prevalence Among Sex Workers In Swaziland

via observer.org.sz, by Winile Mavuso

UNADJUSTED HIV prevalence among sex workers stands at 70.3%.

This is contained in the Swaziland HIV Bio-Behavioral Surveillance Study and Qualitative Study among Most At-Risk Populations (MARPS) conducted by the Population Service International (PSI) in conjunction with the John Hopkins University based in the United States.

The findings of the study were released by Director of Health Services, Dr. Simon Zwane at Mountain Inn yesterday.

It was observed that around the world, men who have sex with men (MSM) and female sex workers have a higher risk of HIV infection than the general population. Until now, little had been known about HIV prevalence or risk factors among these population groups in the country, hence the study was commissioned.

The study shows that HIV prevalence increased with age, with older sex workers having higher rates of HIV.

However, even the youngest group of sex workers had an HIV prevalence rate of 44%. Sex workers were more likely to be HIV infected if they were older, had lower education, married, or were ever pregnant.
Just 4% of sex workers had active syphilis.

Despite the high HIV prevalence among this group, some clients are still daring and sleep with sex workers without a condom.

Out of the 325 sex workers who participated in the study only 23.5% reported always using condoms with all partners in the past month.

More than half (55.3%) reported condom breakage/slippage in the past month. About 74% reported always using condoms with new clients in the past month.

However, condoms were used less often with regular clients and non-commercial partners; 48.2% reported always using a condom in the past month with regular clients and 33.5% reported always using a condom in the past month with non-commercial partners. 

Read the rest.


-------------------
*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
-------------------

The Impact 'Harm Reduction Strategies' Has on Sex Workers

via The Jurist, by Elizabeth Hand

Shohagi was only fourteen when her father arranged her marriage. Sent away from her home, family and friends to marry an unknown man who was much older, she quickly discovered her partner's violent nature. The abuse sent her fleeing back home to a family that rejected her for disobeying her father, threatening her with death. No longer possessing any support system or income, she was shepherded into a brothel in Calcutta. Western perspectives on sex work require such a tale to be met with horror and sympathy. However, Shohagi describes her experience as a sex worker with hope and empowerment. Working in a brothel gives her the chance to earn an income and support herself. Distanced from the violence of both her husband and family, she prefers her life of autonomy.

Shohagi's story is far from unusual, yet it does not conform to the usual cautionary tale that accompanies debates about sex work. Too often the narrative is one of woe and misfortune that leaves a woman with no choice but to become a prostitute, and her life rapidly decays. Adopting this typical western, feminist criticism of prostitution leaves no room for the possibility that a person chooses sex work, and is also pursuing his or her best interests. While many second-wave academics, like Catharine MacKinnon in her article Prostitution and Civil Rights, draw a distinction between indentured servitude and sex work by making the argument that a condition entered into voluntarily, prostitution, is different than one entered into involuntarily, servitude. However, functionally they are both treated as a type of slavery. This approach fails to validate a person's choice to work as a sex worker. In the name of protecting women, MacKinnon fails to acknowledge the agency of women who choose sex work. A viewpoint like this highlights the shortcomings of western ideologies that tend to equate morality with legality. To the contrary, harm reduction strategies can offer protection to sex workers, who are at a high-risk of contracting HIV or facing sex-related violence. However, rather than focusing on harm reduction, generally criminalization is preferred, which strips sex workers of valuable protections and condemns them as immoral.

While no federal law exists that bans all prostitution across the board, Nevada is the only state that, in a few counties, has legalized some forms of prostitution. Many states enforce punishments exceeding a year in prison for this line of sex work. In essence, with the exception of a few counties in Nevada, prostitution is illegal in the US. The reasons cited for why prostitution should remain illegal range from the argument that it is degrading and base to the idea that it is a form of violence against women, or that banning it deters violence against women. Are these compelling enough reasons to justify the continued criminalization of many forms of sex work? Looking to other countries' approaches to monitoring sex work, the US has a lot to gain from legalizing prostitution as a means to ensure sex workers' safety, health and protection from abuse. If the US were to legalize prostitution, the government could more closely regulate it, implementing harm reduction strategies that could be pivotal in tackling HIV/AIDS, STIs, and violence towards sex workers.

The US has traditionally disfavored the implementation harm reduction strategies, preferring to take the moral high road. From needle exchanges to the regulation of sex work, the US chooses hardline stances against these activities at the cost of abandoning citizens that could be offered partial protection. Needless to say, HIV and AIDS are significant concerns when it comes to sex work, and US policy continually uses HIV/AIDS as a guise for providing a motive for eradicating sex work, specifically prostitution. However, when the government steps in to monitor and regulate commercial sex, as opposed to prohibiting it, HIV incidence is likely to go down. Without the government stepping in to police the sex trade, sex workers will continue to be at high risk of infection, while also lacking access to health care and prophylactic resources. Policies aimed at regulating brothels for public health reasons have had tremendous success in lowering not only the incidence of HIV infections in sex workers, but also the overall incidence in the population by altering behavior when it comes to practicing safer sex methods. A UNAIDS case study evaluated Thailand's 100 percent condom use program and found that the government's mandate of condom use within brothels, a policy aimed at combating rapidly rising HIV at the onset of the global AIDS epidemic, made sex work safer and altered cultural norms surrounding sexual practices for the entire nation.

Read the Rest.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

High HIV Prevalence Found Among Ugandan Sex Workers

via New Vision, by Joyce Nyakato

New research published in The Lancet, an international medical journal, has revealed that commercial sex workers in Uganda have one of the highest rates of HIV infections in the world.

Some 99,878 female sex workers in 50 countries (14 in Asia, four in Eastern Europe, 11 in Latin America and the Caribbean, one in the Middle East and 20 in Africa), were subjects in the study conducted between January 1, 2007 and June 25, 2011. Results of the study, which was led by Dr. Stefan Baral of the US-based John Hopkins School of Public Health, were released on Thursday.

The study, which assessed the burden of HIV compared to that of other women of reproductive age, found that the burden is disproportionately high and concluded that there is an urgent need to scale up access to quality HIV prevention programs for sex workers.

State minister for ethics and integrity Fr. Simon Lokodo agrees that like all Ugandans, sex workers have a right to HIV treatment and attention.

“However, giving them the leeway to operate as a business is too much to ask from the Government,” he said.

The four-year survey funded by the World Bank and the United Nations Population Fund ranked Uganda as one of the countries where sex workers had a higher HIV prevalence than other women.

Women who sell sex came sixth among the 20 African countries after Malawi, Zimbabwe, South Africa, Kenya and Benin.

An average of four sex workers in ten will have HIV.

This rate is about five times more than other women of reproductive age, who have 7.7% prevalence, according to the recent AIDS indicator survey released by the Ministry of Health last week.

In addition, the likelihood of new HIV infections among sex workers stands at 15%.

“These findings suggest an urgent need to scale up access to quality HIV prevention services among female sex workers because of their heightened burden of disease and the likelihood of onward transmission through the high number of sexual partners as clients,” Stefan wrote.

Read the Rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Johns Hopkins: Studies Show the Likelihood of HIV Infection in Female Sex Workers

via Johns Hopkins School of Public Health

Female sex workers in low- and middle-income countries are nearly 14 times more likely to be infected by HIV compared to the rest of country’s population, according to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings suggest an urgent need to scale up access to quality HIV prevention programs in these countries. The study was published online in The Lancet Infectious Diseases.

“Although female sex workers have long been understood to be a key affected population, the scope and breadth of their disproportionate risk for HIV infection had not been systematically documented,” said Stefan Baral, MD, MPH, MBA, lead author of the study and associate director of the Bloomberg School’s Center for Public Health and Human Rights. “In addition to antiretroviral treatment and ongoing HIV prevention for sex workers, considerations of the legal and policy environments in which sex workers operate, and the important role of stigma, discrimination, and violence targeting female sex workers globally will be required to reduce the disproportionate disease burden among these women.”

For the study, Johns Hopkins conducted a meta-analysis of 102 previous published studies representing almost 100,000 female sex workers in 50 countries. Overall, HIV prevalence in female sex workers in low- and middle-income countries was found to be about 12 percent, which equated to an increased risk of infection for sex workers 14 times that of other women in these countries. In 26 countries where background levels of HIV were considered “medium” to “high,” approximately 31 percent of the female sex workers were found to have HIV and were 12 times more likely to be infected compared with women from the general population. Sex workers in Asia had a 29 percent increased risk for HIV infection compared to other women, which was the greatest disparity among the regions studied. Sex workers in Africa and Latin America were 12 times increased risk compared to other women in these regions.

This analysis was conducted as part of a larger project entitled, "The Global Epidemics of HIV among Sex Workers: Epidemiology, prevention, access to care, costs, and human rights" led by Johns Hopkins researchers Deanna Kerrigan, PhD, MPH, and Chris Beyrer, MD, MPH. The larger project assesses not only the epidemiology of HIV among sex workers in low- and middle-income countries, but also documents the current state of HIV prevention interventions and the social context surrounding sex work in different settings, and uses mathematical modeling and cost-effectiveness analysis to assess the potential impact and resources necessary to scale up of comprehensive HIV prevention, treatment and care services among sex workers.

“Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis” was written by Stefan Baral, Chris Beyrer, Kathryn Manning, Tonia Poteat, Andrea L. Wirtz, Michele R. Decker, Susan G. Sherman, and Deanna Kerrigan.

 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Anal Intercourse in Nigeria

via Nigerian Tribune, by Muda Oyeniran

Not less than 12 percent of public secondary school students in Nigeria practise anal sex while 12.1 per cent of university students and 15.2 per cent adolescents in northern Nigeria engage in the act.

Morenike Ukpong, the coordinator of the New Vaccine and Microbicide Advocacy Society, a Lagos-based non-governmental organisation, who disclosed this to the Nigerian Tribune said the role of anal sex in driving the HIV epidemic away from Nigeria could no longer be ignored.

She further said there were evidences to show that about 10 per cent of women and 14 per cent of men in the general populace practised anal sex, adding that the use of condom during this sexual act was low because of the erroneous belief that anal sex was safer than vagina sex.

“Request for anal sex by clients of female sex workers is high with men paying higher to have anal sex for many reasons,” she stated.

According to Ukpong, anal sex is known to be the highest risk form of sexual transmission of HIV infection with approximately 14 times higher risk of HIV transmission when compared to penile-vagina sex.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

‘Confront legal and policy barriers to HIV’: Sub-Saharan Africa Regional Dialogue on HIV and the Law

Via UNAIDS.

In Sub-Saharan Africa, the region most heavily affected by HIV, legal, policy and social barriers, including stigma, discrimination, gender inequality and the criminalization of key populations at higher risk of HIV infection, continue to make people vulnerable to HIV and hamper the ability of individuals, communities and states to respond to the epidemic. This was the conclusion of the Regional Dialogue for sub-Saharan Africa, part of the Global Commission on HIV and the Law, held at the beginning of August in Pretoria, South Africa.

No taboo should be left unchallenged

A significant breakthrough came from the pledge of participants to highlight and discuss all aspects of the legal environment relating to HIV, including laws and practices related to stigma and discrimination, access to affordable treatment, children and adolescents, women’s rights and gender-based violence.

“This regional dialogue is a great opportunity for us, as Africans, to confront the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV,” said Bience Gawanas, African Union Commissioner for Social Affairs.

The criminalization of drug use, sex work and same-sex sexual relations was also confronted by the participants in a bid to challenge all taboos. This is remarkable as recent punitive legal and policy developments in a number of countries in sub-Saharan Africa relating to the situation of members of key populations has raised concerns about the readiness of stakeholders in the region to confront this issue. Some 31 countries in the region criminalize sex work, and same-sex sexual relations constitute a criminal offence in at least 30 countries.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Laws fail to protect HIV patients, says advocate

Via The Fiji Times, by Frederica Elbourne.

PACIFIC political leaders have remained silent over the protection of the rights of people vulnerable to and affected with HIV, an organisation that champions AIDS awareness said.

The Pacific Islands AIDS Foundation said laws governing those infected with the virus failed to protect their privacy.

The existing legal frameworks condemned behaviour such as anal sex, sex between men, and sex work, the PIAF report launched by Minister for Women Doctor Jiko Luveni in Nadi last month said.

Such denunciation drives these practices underground, the PIAF said in a report that highlighted the plight of HIV positive women in Fiji and Papua New Guinea.

"Public Health Acts also reflect mentalities of the colonial periods and these acts usually provide wide powers to public health authorities, impose heavy duties on infected people and others who must notify and take precautionary measures," the report pointed out.

The acts rarely gave privacy to people who are subject to these provisions, PIAF said.

"These legal frameworks are outdated and are in many instances inappropriate for HIV. Most legal systems in the Pacific lack legislation that protects the rights of people living with HIV," PIAF said.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAC 2012: No Progress on Visas for Drug Users or Sex Workers

Via Housing Works.

One year from the International AIDS Conference in Washington, D.C., prospects are looking dim for sex workers and drug users who want to attend.

The International AIDS Society has announced that it will release a document in August that details the U.S. visa process for IAC 2012. That document will describe entry restrictions for sex workers and drug users, and it will provide instructions on how to apply for a waiver if a delegate’s visa is denied. IAS will post that information here.

Still no obvious solutions

Strict U.S. regulations that block entry for people who admit to sex work or drug use could keep hundreds from participating in the world’s largest gathering on HIV/AIDS. Recognizing the key role these individuals play in charting the future of the fight against the disease, the IAS formed a working group to troubleshoot avenues for getting marginalized groups into the country.

The working group, however, has already explored—and discarded—a number of options. In June, it released a document stating that it will not lobby to change U.S. immigration policy before the conference.

The group did meet with U.S. officials to ask the federal government to issue a blanket waiver for all conference delegates who are denied a visa. The U.S. government rejected that proposal, and immigration authorities will have to review each waiver individually—a process that will cost delegates both time and money.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

New Light Shed on Male Sex Work

Via PlusNews.

Commercial sex work, dominated by a focus on women, could be redefined as new research launched today in Nairobi, Kenya, sheds light on the complicated HIV prevention needs of what may be Africa’s most deeply underground group at high risk of HIV - male sex workers.

The report co-authored by the United Nations Development Programme (UNDP) and South Africa's Sex Workers Education and Advocacy Taskforce (SWEAT) seeks to better understand the social contexts, sexual practices and risks, including that of HIV, among these men.

The professional debut of many of the 70 male sex workers surveyed in Kenya, Namibia, South Africa, Uganda and Zimbabwe was often prompted by the family rejecting the men’s sexual orientation; for others, it was a way to survive in a foreign country.

Men reported being at risk of HIV in many ways, including the unavailability of speciality health services, the premium clients placed on unprotected sex, violence and the lure of substance abuse. Although the work often placed them at risk of substance and physical abuse as well as HIV infection, the researchers found that it also provided the men with a sense of freedom and empowerment.

The report cautions that mitigating these risks may require specialised HIV prevention services unlike those targeted at female commercial sex workers or men who have sex with men (MSM).

A series of interviews with male sex workers at a five-country workshop in Johannesburg, South Africa, and country visits to Kenya and Namibia has produced a significant addition to the paucity of data on male sex workers, according to Paul Boyce, a UNDP researcher.

While data on MSM from Malawi, Namibia and Botswana indicated that about 17 percent were HIV positive - almost twice the national prevalence rates of their respective countries - not much has been written on the specific HIV risks of male sex workers, which may be higher than those of MSM.

While male sex workers reported working at a range of venues, including Namibian truck stops and Zimbabwean mines, most of the available information on male sex work has come from those operating in the sex tourism hot spot of Mombasa, Kenya, with limited data from a 2009 study in South Africa that showed male sex workers were twice as likely to engage in anal sex than MSM who were not selling sex.


Not necessarily the same old risks:

Unprotected receptive anal sex carries almost 20 times the HIV risk associated with unprotected vaginal sex.

Interviewees told researchers that the unavailability of water-based lubricant, which reduces the risk of condoms breaking during anal sex, and the higher financial reward of unprotected anal sex, made consistent condom use difficult.

Some clients forced unprotected intercourse on sex workers, while others admitted to practicing unsafe sex due to the disinhibition often brought about by the drug and alcohol abuse that is reportedly part of the social scene in sex work. Drugs and alcohol also helped the men mentally cope with the omnipresent risks of this lifestyle, including police harassment.

South African male sex workers said substance abuse - not HIV infection - was the greatest threat to their health.

Those who tried to access health services for HIV testing and treatment, or the diagnosis of sexually transmitted infections (STIs), reported being ridiculed and stigmatized by health workers, even in countries like Kenya, where the Ministry of Health has introduced new guidelines on MSM and sex work, and health and HIV.

"[At the] government hospital, the nurses just [stand] in front of everyone and shout out loud to the people waiting for assistance: 'If you have HIV, go to room nine, TB room 12, STD [sexually transmitted disease] room 8,'" said one man quoted in the report.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

AIDS Summit at the UN: Not Enough Talk About Sex

Via the Huffington Post, by Evelyn Leopold.

World leaders gathered at the United Nations to mark the 30th anniversary of the HIV/AIDS epidemic and put out a 102-paragraph declaration. Adrienne Germain, the president of the International Women's Health Coalition (IWHC), has been working on women's issues all her adult life and was active in the 1994 Cairo conference on women, also known as the CPD (International Conference on Population and Development). In an interview with the Huffington Post, Germain and Alexandra Garita, an international policy program officer at IWHC, discuss the declaration and the controversies that arise whenever sex is on the agenda. The declaration, produced every five years, gives U.N. agencies a mandate for their programs and advises governments where best to spend monies.

Q: What about access to family planning, to birth control?

AG: We lost reproductive rights and reproductive health language from the 1994 Cairo document and from early drafts here. Reproductive rights, for example, also includes the right to freely and responsibly decide on the number and spacing of one's children. If you lose that and you have no reference to family planning services in the document, then you basically have no reference to contraception for women. You also don't have protection for women living with HIV who are sterilized without their consent and who are forced to have abortion. It is not a rare occurrence in southern Africa (including South Africa).

Q: And how about the new studies on early intervention of Antiretroviral drugs (ARV) to reduce transmission, which are welcomed as a major breakthrough?

An important development is using ARV treatment much earlier in a person's life in order to reduce the amount of virus in the body. Therefore the person will be less able to transmit the virus to someone else and you can use treatment as prevention. In this document, it is treated as a miracle breakthrough. We don't look at it that way. Probably about half the people in the world who are living with HIV don't know it. You are most infectious right after you have been infected. But at that time you have no symptoms at all so why would you go forward with testing? So to think that a medicine, a drug, is going to end this epidemic when we don't even know how to get more people to come forward for testing -- is really foolish. But debates on how best to end the epidemic go on all the time -- how we should all be giving much more time to prevention. Yet this document ends up with four paragraphs -FOUR!-on prevention. Does that make much sense? No. Not in our book.

Q: Homosexuals and prostitutes were a big issue five years ago, even among some delegates from the Bush administration. Has this changed?

They are in the document for the first time. There was one paragraph that names the community of drug users, men who have sex with men and sex workers. That is very good. But this listing is used once only and then there is UN mumbo-jumbo in other paragraphs where you should have specific references about the kinds of interventions needed to reach this population and what they face in their lives. And there is nothing on human rights for these people (despite the UN secretary-general's speech).

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

What's preventing prevention?

How national AIDS responses are failing in prevention efforts for key populations – an analysis of available data

via International HIV/AIDS Alliance

Several decades after the start of the global AIDS pandemic, data confirms that most low- and middle-income countries still do not adequately focus their HIV prevention efforts on the key populations of sex workers, men who have sex with me, transgender people, and people who use drugs.

Of all low- and middle-income countries that report standard information to the United Nations on their AIDS responses, more than half fail to include timely data concerning these key populations.

According to the International HIV/AIDS Alliance, which has conducted a review of 132 country reports, this is a strong indicator of the current level of national AIDS efforts devoted to reaching populations that are most affected by HIV.

Read more.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations

IRMA Steering Committee member Jerome T. Galea is lead author of this fascinating paper. Here he provides an overview of the study.

Click here to access the full paper.

"The study examined pre-exposure prophylaxis acceptability (PrEP) among female sex workers, male-to-female transgendered persons and men who have sex with men in Lima, Peru.  Focus groups explored social issues associated with PrEP acceptability and Conjoint Analysis – a consumer research market technique – assessed the preferences participants had with regards to eight hypothetical PrEP “scenarios”.  This was the first study of it's kind to apply this technique.

"Each scenario was made up of the same characteristics but differed slightly (for example, higher cost versus lower cost; daily dosing versus non-daily dosing; some side effects versus no side effects, and so on).  Participants had to rank the scenarios in order of preference taking into account all of the product’s chacteristics, and in doing so expressed the value they placed on the various characteristics.  Focus groups helped to explain the reasons behind the preferences made.

"There were some unexpected findings. For example, cost trumped effectiveness; a low-out-of pocket cost had the single greatest impact on PrEP acceptability. While we expected cost to be an important factor we were surprised that it was more important than the ability of the product to actually prevent HIV infection. 

"Another surprise was that in the focus groups we learned that participants preferred that PrEP be dispensed in health centers as opposed to pharmacies. This surprised us as we hypothesized that pharmacies would provide faster, easier and more widespread access, but participants cited privacy concerns with PrEP being dispensed by pharmacies.

"The next step is to replicate this sort of research to more populations at risk in different settings. We have learned that the existence of an effective product does not guarantee its use (recent studies on the female condom, for example, highlight the challenges of understanding the needs and perceptions of the target user and also the necessity of dispelling myths that often arise when new products are introduced). 

"We cannot generalize our findings to all persons at risk for HIV, in Peru or elsewhere, but do propose it as a model for future exploration of the topic now that oral PrEP has been shown to work but has not yet been scaled up for widespread use."

*Read AIDSmeds coverage of this study here.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

VIDEO: Melvin and his sister: A gay Kenyan's struggle to survive

via guardian.co.uk

As discrimination against homosexuals in Africa reaches a new murderous peak, Guardian Films travels to Mombasa, Kenya, to hear from a male prostitute who risks his life to support his younger sister.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Kenya: How discrimination is a barrier to good health

via guardian.co.uk

Complex issues, such as health and poverty, are often best illustrated by following individuals and showing how the issues affect their lives. That is why the Guardian is producing a series of films about some of the global issues that feature in Christian Aid's manifesto for change, Poverty Over.

The first film – on sexuality-based discrimination, human rights and HIV in Kenya – is available to view here on the Guardian's Christian Aid website from Monday. Same-sex relationships are illegal in the country, but prejudice and fear about them go far deeper than that. This film shows how hatred has a negative impact on the health of gay people in Kenya.

Anti-gay feeling is common in Kenya. Some politicians, religious leaders and sections of the media have stirred up this hatred. In November last year, for instance, the prime minister, Raila Odinga, called for a nationwide crackdown on gay people. Odinga ordered the police to arrest anyone found having sex with someone of the same gender and said that the country's constitution made it clear that homosexual activity was not to be tolerated.

This has obvious implications for men who have sex with other men, as they are often unable to access care if they become infected with HIV. Clinics that are known to treat gay men are threatened, medical practitioners may be unwilling to help them, they are often isolated and unable to access any kind of information. Many of these men are married, and risk infecting their wives with HIV.

The red-light areas of large cities in Kenya also show that, despite the rhetoric, there is a thriving gay sex industry. Many of the male sex workers have been thrown out of their family homes for their sexuality; they report that they are often compelled by clients to have sex without condoms.

Yet a growing gay community, and some inspiring gay rights and HIV activists, are doing their best to ensure that more people in Kenya are made aware of safer sex, condoms are made available, and prejudice against men who have sex with other men is addressed.

To find out more, view the film online from Monday, March 14. The site also has other interesting content that will engage, outrage, inspire and inform you, including Thursday webchats (1pm-2pm) when you can post questions for Christian Aid advisers. Additional films will be uploaded every week.

Source.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

New Report: World’s Premier AIDS Event Neglects Populations Most at Risk for HIV

 via Global Forum on MSM and HIV

Independent assessment indicates severe underrepresentation of gay men, transgender people, sex workers and people who use drugs at the biennial International AIDS Conference

A new report indicates that the International AIDS Conference (IAC), a biennial event convened by the International AIDS Society (IAS) that has become the world’s premier gathering for people working in the field of HIV, suffers from gross underrepresentation of populations most at risk for HIV infection, including men who have sex with men (MSM), transgender people, sex workers and people who use drugs.  The independent audit, conducted by the Global Forum on MSM & HIV (MSMGF), confirms suspicions long-held by activist groups and calls for a comprehensive review of IAC governing structures.

Produced in response to growing concern among community groups that the IAC has repeatedly neglected these key populations, the report focuses on program content at the most recent IAC, held in Vienna, Austria in July 2010.  The analysis reveals that the percentage of all sessions at the conference exclusively focused on these groups was limited to 2.6% for MSM, 1.1% for transgender people, 3% for sex workers and 4.5% for people who use drugs.

“While the International AIDS Society turns a blind eye, HIV rates among these populations continue to climb around the world,” said Dr. George Ayala, Executive Officer of the MSMGF.  “The IAC is the world’s most important opportunity for international exchange and collaboration on HIV and AIDS.  Such abysmal representation of most-at-risk groups only serves to reinforce the invisibility, discrimination and disregard that drive the epidemic among these communities.”

Research has shown that these four populations are at higher risk for HIV infection than the general population in nearly every country context where reliable data exist.  MSM represent more than a quarter of HIV infections in Latin America and the Caribbean, people who inject drugs account for more than half of HIV infections in Eastern Europe,  and sex workers across Sub-Saharan Africa experience HIV prevalence rates of up to 50%.  Infection rates among transgender people in El Salvador, Indonesia and India are as high as 25%, 35%, and 42% respectively. 

The IAC takes place in a different city every two years, gathering tens of thousands of experts and advocates from around the world to share the field’s most recent developments and engage in strategic collaboration.  The most recent conference hosted an estimated 25,000 people.

“Ostensibly, the IAC offers chances for local healthcare providers to learn ways to improve their services, provides channels for advocates to engage in dialogue with powerful decision-makers, and creates opportunities for community members to shape global funding and research agendas,” said Dr. Mohan Sundararaj, Policy Associate at the MSMGF.  “This really is a phenomenal platform, but how useful can it be when those who need it most are locked out?”

The report recommends a number of steps to bring the IAC’s program coverage of these key populations up to a level proportionate to their epidemiological burden.  Among these recommendations are efforts to ensure transparent processes for abstract review and program design, the development of targeted support to authors developing abstracts focused on key populations, and open representation of civil society on the committees responsible for developing conference programs.

“The International AIDS Conference has unparalleled potential to impact the global AIDS epidemic,” said Dr. Ayala.  “It is incumbent upon the organizers to ensure that the IAC becomes a vehicle for change, shifting the global landscape so that funding, research and programs are directed to those who need them most.  Right now it’s part of the problem.”

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Sex Work, Criminalization, and HIV: Lessons from Advocacy History

via San Francisco AIDS Foundation's BETA,  by Anna Forbes

Sex workers are frequently omitted from discussions about the links between criminalization, marginaliza­tion, and increased HIV transmission. We talk a lot about the effects of this dynamic on men who have sex with men, injection drug users, and peo­ple living with HIV—as we certainly should—but not about sex workers. Why is this group not like the others?

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]