866 000 waiting on ARV treatment in SA - UNAIDS and WHO

Efforts to treat three million people by the end of this year are expected to fail with South Africa, India and Nigeria already falling well short of their targets.

A “3 by 5” progress report released by the World Health Organization and Joint United Nations Programme on HIV/AIDS (UNAIDS) this week revealed that South Africa had fallen short of its target by a staggering 866 000.

South Africa’s “unmet” need was by far the highest in the world followed by India (735 000) and Nigeria (598 000). Neighboring Zimbabwe had over 300 000 people waiting on treatment.

The report did praise South Africa for committing U$1-billion over the next three years to scaling up ART, by far the largest budget allocation of any low- or middle-income country.

Another positive was that the number of people receiving combination anti-retroviral therapy for HIV/AIDS in developing countries had more than doubled in the past 18 months – from 400 000 at the end of 2003 to about one million in June last year.

In sub-Saharan Africa, the region most severely affected by HIV, about 500 000 people are currently receiving ART, more than triple the number of people on the drugs in June 2004, and nearly double the number six months ago.

However, the report predicted that despite good overall progress it was unlikely to be fast enough to reach the target of treating three million people by the end of 2005.

As of June last year, 49 countries accounted for 87 percent of all adults and children living with HIV/AIDS globally, 78 percent of mortality from AIDS globally and 89 percent of people needing treatment in low- and middle-income countries.

Six countries comprised over 50 percent of treatment needs in low- and middle-income countries: Ethiopia, India, Nigeria, South Africa, Tanzania and Zimbabwe.

Leading international medical journal, The Lancet commented that South Africa in particular needed to show its commitment to treating HIV positive people with anti-retrovirals if the “3 by 5” target was to be met. “

If the 3 by 5 programme had the political clout to influence South Africa alone to implement all its recommendations, where the necessary infrastructure largely exists, then the 3 million target would be more likely to be attained. Without South Africa on board, with its leadership position within Africa, 3 by 5 is but a pipe dream,” the editorial said.

Health minister Dr Manto Tshabalala-Msimang responded at the time stating that she would not be pressured into meeting United Nations HIV/AIDS treatment targets. “I don't want to be pushed or pressurized by a target of three million people on anti-retrovirals by 2005," she said.

"WHO set the targets themselves. They didn't consult us. I don't see why South Africa must be the scapegoat for not reaching the target," she said at the time.

This week’s report highlighted human resources as a critical focus area in the push to provide treatment. It acknowledged that effective responses to the epidemic in low- and middle-income countries had been greatly undermined by specific weaknesses in the area of human resources.

The WHO was looking towards implementing novel models of ART delivery, already used in Uganda and South Africa, in 30 countries by the end of 2005. This included the simplification of treatment regimens and clinical monitoring which allowed a shift from a doctor-centred model to one that relies on an expanded clinical team including nurses, clinic workers and people living with HIV/AIDS employed and trained to perform community outreach and treatment support.

“Today’s report emphasizes that while political, financial and technical support for ART scale-up have in some cases met or exceeded expectations, in others the prerequisites of a successful response are not fully in place,” UNAIDS and WHO said in a statement.

The “3 by 5” target, endorsed by all 192 WHO member states including South Africa, was intended as an interim step toward the goal of universal access to HIV treatment for those who need it. The target was based on what could be achieved if countries, donors, and international agencies were fully successful in expanding political will, mobilizing funding resources, and building health infrastructure and systems.



Source: Anso Thom, Centre for the Study of AIDS

ICAAP Civil Society Statement

5 July 2005

The following statement presents the outcome of several meetings involving civil society organisations that took place during the 7th International Conference on AIDS in Asia and the Pacific, held in Kobe, Japan, 1-5 July, 2005.

Members of civil society represented here welcome previous statements and commitments on HIV/AIDS by our governments. In particular we are grateful for the detailed commitments made in the following:

- The UNGASS Declaration of Commitment on HIV/AIDS- The Ministerial Statement from the Second Asia-Pacific Ministerial Meeting on HIV/AIDS held in Bangkok, Thailand on 11 July 2004

Together, these commitments present the essence of what we have been discussing all this week.

Every hour more than 148 Asians contract HIV, representing an abysmal failure to adequately address the prevention needs, particularly among vulnerable groups, including men who have sex with men, injecting drug users, sex workers, women and young girls, youth and mobile populations.

In the region, the number of people receiving ARVs has increased three-fold from 55,000 to 155,000 in the past 12 months. Despite this significant progress, the overall proportion of people in the region with advanced HIV infection receiving ARVs remains pitifully low, mirroring the global average of around 15%.

Further, the individual care needs of the 8.2 million men, women and children already living with HIV in the region presents a major future challenge that we are not adequately acknowledging or even openly discussing. Our national health systems are simply not ready to absorb this scale of even basic care needs.

The current gap in all kinds of HIV/AIDS prevention, treatment and care provision in the region represents a common failure to meet the key government commitments we have highlighted.

We therefore demand that urgent action be taken by each of our governments and other leaders, to keep previous promises to provide comprehensive AIDS prevention, treatment and care services to our people, as those detailed in the UNGASS Declaration, We also demand that national health budgets adequately reflect the requirements of the national AIDS control programs.

We also insist that our leaders take immediate action to provide affordable, readily available care and treatment options to keep people alive while we are waiting for governments, international donors and other institutions to deliver on their ARV promises, including:

- Voluntary counselling and testing;
- Prevention and treatment of tuberculosis;
- Drugs to prevent/treat other opportunistic infections;
- Home- and community-based care services;
- Reduced HIV-related stigma, esp in health care;
- Pharmacotherapy therapy for injecting drug uses;
- Traditional healing and care approaches;
- Assured food security and micronutrient provision.

Finally, we welcome and wholeheartedly support one of the four major recommendations that UNAIDS proposed during this ICAAP Conference: Countries should increase support to civil society organizations’ involvement in national responses

- We therefore demand that our governments work in equal and meaningful partnership with civil society including people living with HIV and vulnerable populations in addressing the control of the epidemic.

In mid-2006 a comprehensive review of national performance against the specific targets laid out in the UNGASS Declaration of Commitment on HIV/AIDS will be presented by each country, finally placing each of our leaders under an international HIV/AIDS spotlight of accountability.

In support of the UNGASS goals, the UNAIDS recommendation above, and in light of the national UNGASS review process taking place this year, we demand our governments to:

Immediately establish a formal mechanism for the receipt of written and/or orally presented information and reports from civil society organizations and PWHA organizations on declaration of commitment implementation in their countries as input for the national 2006 Progress Report.

Statement By:

Asia Pacific Network of People Living with HIV/AIDS
Asia Pacific Council of AIDS Service Organization
Asia Pacific Network of Sex Workers
Asian Harm Reduction NetworkAP-Rainbow
Asia-Pacific Network of Lesbians, Gays, Bisexuals and Transgenders
AIDS Society of Asia Pacific Coordination of Action Research on AIDS and Mobility
AIDS Society of Asia Pacific

And the:

World AIDS Campaign, Massive Effort Campaign, Positive Women’s Network, and the other 250 partners of the AIDS-Care-Watch Campaign

Stop-AIDS in Asia…Keep the PROMISE. Thank you very much.


[Spoken by: Periasamy Kousalya from Positive Women’s Network, India - 5th July 2005]

Governments’ response to HIV/AIDS remains weak: A community evaluation shows a lack of access to HIV prevention and treatment and human rights prote

International Council of AIDS Service Organizations, May 31, 2006

Toronto, CANADA – The world of diplomacy and politics seems to be ignoring the fact that there has been too little progress in reversing the global AIDS epidemic. As governments and civil society come together in New York on 1-2 June, it is clear that many governments are not implementing commitments they made in 2001.

The International Council of AIDS Service Organizations (ICASO) released a report today, "Community monitoring and evaluation: Implementation of the UNGASS Declaration of Commitment on HIV/AIDS".

The report, a summary of studies carried out in 14 countries – Cameroon, Canada, El Salvador, Honduras, Indonesia, Ireland, Jamaica, Morocco, Nepal, Nigeria, Peru, Romania, Serbia and Montenegro, and South Africa - highlights the continuing failure of many governments to deliver on their commitments made in 2001.

The study, undertaken by community researchers, found that leadership at the country level is still lacking in most countries; domestic spending on HIV remains too low; and human rights abuses of vulnerable populations continue unabated, denying them access to services and effective tools for preventing HIV infection and to life-saving AIDS drugs that will keep them alive.

“Part of the problem is that many governments have become masters of the rhetoric of rights, with very little effort made in translating them into action. For example, having legal protections against the discrimination of people living with HIV, as many countries do, matters little if governments fail to enforce them. They matter even less while most people living with AIDS are allowed to die while life-saving drugs are kept out of their reach” says Kieran Daly, Director of Policy at ICASO.

This lack of progress in responding to HIV, highlighted in the summary report of the 14 community evaluations, is not a result of the lack of know-how. In 2006 - 25 years since AIDS was first reported - the world has most of the tools needed to reverse the global epidemic.

Unfortunately, many governments are refusing to use these tools. As noted in the UN Secretary General’s March 2006 report on progress in the global response since 2001, “many countries have failed to fulfill the pledges”.

The result is more than 20 million people newly infected with HIV and millions dead. The continued lack of funding and real government commitment to treatment leaves most of those with AIDS to die. People have a right to health, this means people living with HIV have a right to AIDS treatment. While access to antiretrovirals (AIDS drugs) has improved in all the countries evaluated, it is still far from what is needed.

The failure to fulfill the 2001 commitments is made all the worse because many countries have shown that infections can be averted and lives can be saved by implementing programs and interventions that are known to work.

In the recent Joint United Nations Programme on HIV/AIDS (UNAIDS) Prevention Policy paper, it was noted that the world could avert 29 million new infections between 2002-2010 by the implementation of a comprehensive HIV prevention package. However, the country evaluations in the ICASO report highlights the fact that with continued human rights abuses, HIV will continue to spread.

As the community researcher in South Africa noted “there is still a huge divide between public policy and public practice that leaves many people infected and affected by HIV/AIDS vulnerable to human rights abuses and HIV infection.”

The key populations that are at most risk of being exposed to HIV are still being denied access to the services that will allow them to protect themselves and to maintain their health. Sex workers, women, injecting drug users, youth and men who have sex with men, and others are facing government sponsored and/or condoned discrimination with policies and laws that continue to undermine the response to HIV.“

ICASO categorically opposes any laws or policies that undermine best practice in public health and/or that violate human rights. This includes, but not limited to, ICASO’s opposition to the US Government’s anti-prostitution legislation that restricts funding and support for sex workers, and to other ideologically-based prevention policies such as abstinence-only approaches and restrictions on the availability of comprehensive sex education, condoms and harm reduction programs”, says Richard Burzynski, Executive Director of ICASO.

He adds that "such policies and restrictions only serve to undermine the response to HIV and to increase the fear, stigma and discrimination of those most vulnerable to exposure to HIV and those most marginalized in society."

The ICASO summary report concludes with 24 recommendations to UNAIDS, governments and civil society organizations on what needs to be done to improve the implementation of the Declaration of Commitment. It is possible.

With added political commitment to address the funding gap, fully implementing what we know works, and properly addressing human rights, the epidemic can be reversed.

A copy of the full report is available at www.icaso.org For more information or to arrange an interview, please contact: Kieran Daly, Director, Policy & Communications International Council of AIDS Service Organizations (ICASO) Tel: +1 416 275 8413 Email: kierand@icaso.org

Moving Towards Universal Access: Asia Pacific Regional Civil Society Forum Meeting Notes

UNAIDS, Bangkok, 25 August 2006

INTRODUCTION

The Regional Consultation in Pattaya and the High Level Meeting recognized and acknowledged that civil society is a critical partner in efforts towards achieving the goal of moving towards Universal Access. UNAIDS Regional Support Team for Asia and the Pacific (RST-AP) organized a Civil Society Forum on 25 August in Bangkok to follow up on the above-mentioned meetings leading up towards universal access. A total of 42 representatives of Regional Networks and NGOs working on HIV/AIDS in the region and some civil society partners from countries, attended the one-day meeting (please see participant list). Specifically, the consultation explored approaches and mechanisms for stronger participation of civil society.

Countries in Asia and the Pacific are in the process of developing national strategic plans and targets, as well as costing their operational plans. Once missed, this opportunity may not occur again within the next five years. These processes can be seen as a window of opportunity for meaningful involvement of the civil society to partner with the national authorities in setting ambitious targets to increase coverage for HIV prevention, treatment, care and support and achieving the goals of universal access.


KEY DISCUSSION POINTS AND RECOMMENDATIONS

The consultation focused on the following core areas.

1. The process of moving towards meaningful participation of civil society at the country level

A key concern shared and discussed at this consultation is the question of how to create an enabling environment and a suitable platform that will allow the civil society at the national and grassroots level to participate meaningfully in developing national strategic plans and setting targets at the country level. Below are the key recommendations.

1.1 Develop a framework for strong and meaningful civil society participation. This framework should address:

· minimum standards for civil society involvement (the forum proposed that the civil society develop the framework, and that this exercise be driven by in-country civil society).

· systematic and equitable representation of civil society, including people living with HIV and vulnerable groups[1] in the official mechanisms (e.g. national AIDS authority, CCM) and process of setting targets and developing national strategic plan, as well as operational plan including monitoring and evaluation.

1.2 Strengthen capacity of the civil society in both knowledge and skills.

· Knowledge – civil society at all levels need to fully understanding the concept and implications of Universal Access, and their roles

· Skills – skills for grassroots organizations to carry out effective interventions with vulnerable groups on a long term basis; skills to effectively advocate and to express their concerns and perspectives, and to negotiate, etc.

Participants noted that strengthening the capacity of civil society needs to be a long-term and on-going process that requires sufficient allocation of resources and technical support on an ongoing basis. Technical Support Facility (TSF) and AIDS Strategy and Action Plan Service (ASAP) of World Bank could be a resource which civil society can utilize to get technical assistance in capacity building.

1.3 Provide adequate preparation for civil society participation.

The forum raised the issue of pressure to perform and inadequate preparations and lead time given to civil society. For example, the civil society is expected to work with national authorities in setting targets but yet there is little preparation and unclear mechanisms as well as a tight deadline for civil society involvement at the country level.

Specific suggestions include:

§ translation of global policy, declarations and commitments into the local context and languages
§ briefing of civil society including familiarizing the civil society on relevant issues

1.4 Develop indicators to measure civil society participation.

It is important to measure civil society involvement in order to prove their accountability. The capacity of civil society must be strengthened so that they can be effectively involved in the monitoring and evaluation process, and take part in the national M&E mechanism.

1.5 Document structured case studies of how civil society organizations have been involved at the country and regional levels to help assess progress made and lessons learned.

Key follow up actions:

- Civil society representatives to initiate a country-led process to develop minimum standards for civil society involvement (Participants to identify lead person/s)
- Follow up with TSF Manager to utilize technical assistance in building capacity of civil society
- Communicate with civil society organizations at all level on the concept and implications of universal access, and their potential roles


2. Key targets for 2010

A working group of participants was tasked to identify a set of recommendations on targets, to be considered by the forum. A list of quantitative targets was prepared and discussed, according to the indicators listed in the annex to SG’s report and the 9 indicators for low and concentrated epidemic countries. A representative of the group reported back to the forum after lunch.

The group divided the key targets into two components: the Program itself and the Contributing factors. Prevention and Treatment, Care & Support fall under the program and Capacity building and Enabling environment fall under the Contributing factors.


2.1. The participants endorsed the following overall broad targets as most critical in making major impact.

Note: The following targets endorsed by participants at the regional civil society forum have been regrouped in line with the UNGASS targets and those indicated in the annex to the note by UN Secretary General on assessment by UNAIDS on universal access.
Please find attached the list of core targets as annex at the end of this report.

2.1.1. Prevention for most at-risk populations (MARPs) including children and young people
2.1.1.1.Service coverage - target 80%
2.1.1.2.Behaviour change - target 60%
2.1.2. ARV Treatment for those who need it - target 80% coverage of eligible population.

Recognizing the diversity of the epidemic and country realities, participants agreed that target setting should be a country led process. This principle also applies to the following indicators.

2.2. The participants proposed that the targets listed below need to be worked further at country level.

2.1.1. Prevention:
2.1.1.1. Coverage of Voluntary Counseling and Testing (VCT)
2.1.1.2. Coverage of prevention services to vulnerable population such as young people, women and children including access to PMTCT

2.2.2.Treatment, Care & Support:
2.2.2.1. Second and third line ARV
2.2.2.2. Treatment of Opportunistic Infections (OI)
2.2.2.3. Paediatric AIDS Treatment

2.2.3. Enabling Environment:
2.2.3.1. Civil society involvement/engagement (indicators to be suggested by civil society)
2.2.3.2. Accountability – Independent “watchdog” system
2.2.3.3. Resources – % of national budget for HIV/AIDS (UNAIDS to provide funding gap to Civil Society Organizations)
2.2.3.4. Earmarked budget for NGO capacity building
2.2.3.5.Stigma and discrimination – National policy and practice
2.2.3.6.The participants further felt that one of the key priorities for target setting is the need to establish baseline surveillance (both HSS and BSS) and size estimation of MARPs.

Note: All the above indicators under point 2.3. (except ‘resources’) are captured under the ‘National Composite Policy Index’ which reflect government’s support to the respective components.

Follow up actions:
- Through their country contacts, civil society representatives encourage grassroots and community-based organizations to participate in country universal process at all level.

- UNAIDS to synthesize what had been discussed at the forum in regards to target setting and share this with participants for their final feedback.

- Participants to give their final feedback on the list of targets within one week after receiving the meeting document.

3. Accountability

The Forum noted the need that all partners governments, civil society, UN, donors and other stakeholders - must be held accountable, and that in doing so, mutual accountability must be ensured. It is crucial that civil society organizations consult with and report back to their constituencies and be accountable to the communities they serve.

In order to perform effectively and to be accountable, civil society would require ongoing capacity building to empower themselves with the necessary skills and resources.

It was noted that civil society is by nature, representative of a diverse group that is not homogeneous, independent and autonomous, and that these values cannot be compromised. In addition, civil society must maintain transparency in its participation and operations.

3.1.Develop a mechanism to benchmark the capacity of civil society, to set own targets against minimum standards for civil society participation as well as the capacity of the civil society organizations. This process should build on the existing code of conduct for NGOs.

Follow up action:

- Identify/develop tools to measure civil society’s capacity in meeting the targets, and how they are being met.

4. UNAIDS role in promoting civil society engagement

The Forum made the following recommendations for the role of UNAIDS.

At the country level

4.1.Facilitate partnership between the national authority and civil society at the country level

· facilitate the establishment of autonomous civil society forums for discussion/ collaboration, linked with government forums, involving as many and as diverse civil society organizations as possible
· support, if and as necessary, civil society consortium or similar mechanism to collectively identify representatives through inclusive and transparent process to express their shared voice and concerns in dialogue with government
· bridging with the government, ensuring that civil society representatives are involved meaningfully in consultation and decision making mechanisms as well as implementation level
· encourage the national authority to create mechanisms for civil society involvement in the national process (e.g. representation in official mechanisms such as the Country Coordinating Mechanism)
· support civil society in developing a framework and guiding principles for civil society involvement

4.2.Share information and facilitate actions following meetings, consultations and other developments among the civil society through ongoing communications.

The Forum suggested that UNAIDS appoints a staff to be a focal point for follow-up with civil society (Social Mobilization Officer or staff member who is covering the area).

4.3.Support resource mobilization efforts by and for civil society and to coordinate with donors and government to make sure civil society get equitable access to funds

4.4.Facilitate involvement of civil society in M&E and capacity building among national NGOs and community-based organizations

Regional level

4.5. Advocate with and build capacity of government partners about engaging with civil society in scaling up towards universal access

4.6.Advocacy with donor agencies for development of evidence-based policy and priorities

4.7.Support resource mobilization efforts by and for civil society

Follow-up

§ UNAIDS RST will send information on the division of labour among the UN agencies to the participants.

§ UNAIDS RST will communicate with its Country Coordinators and national authorities to support civil society participation at the country level.

§ UNAIDS to share focal point for civil society contact at the country level (Social Mobilization Officers and staff members who are taking a similar role)

§ UNAIDS requested participants, particularly those who work at the regional level, to support national and grassroots civil society organizations to participate as partners at the national level.

Conclusion

The process: The participants were engaged on the issue of participation of civil society in the target setting process at the countries. Many expressed the lack of confidence in governments engaging them as equal partners in the target setting and the NSP preparation process, as evidenced by the experiences they shared.

Many of them are apprehensive about the process and feel that their participation will still be tokenistic and one of routine consultation at some stage in the whole process. The participants believe that the onus is on governments to establish mechanisms and provide opportunities for civil society to be meaningfully engaged.

Many of them strongly expressed that unless UNAIDS plays a supporting role and that of an honest broker, this process will end up in tokenism. UNAIDS should relook at its role in a new light and emphasize the process as much as the targets themselves in this entire exercise.

The representatives from the Pacific cited the low representation and participation from the Pacific in the regional processes related to UA. They expressed the need to address this gap in future regional consultations and meetings especially those covering the Asia-Pacific region.

Target setting: Target setting appeared to be of secondary concern for the civil society participants - the entire emphasis placed on the extent of civil society involvement in the consultation process.

A list of quantitative targets was prepared and discussed in the meeting. This list was prepared keeping in view the indicators listed in the annex to SG’s report and the nine indicators for low and concentrated epidemic countries. The participants have agreed to give their final feedback on the list in a week’s time after receiving the meeting document.

It was agreed that target setting would be a country led process, but some broad indicators on coverage of vulnerable populations for behavior change, coverage of eligible HIV positive persons by ARV treatment and the extent of scale up of resources for national programmes would be agreed at the regional level in keeping with the consensus arrived at in the Regional consultations at Pattaya in February 2006.

Capacity building:

If the scale up of prevention and treatment interventions have to reach the scale that is needed for Universal Access, one of the main impediments is the lack of sustainable and ongoing capacity building of people living with HIV, grass roots NGOs and community organizations, to implement HIV programmes as well as participate in national and regional consultation processes.

The participants felt that very little was done to build capacity at that level by Governments, the various UN agencies involved and also the INGOs and other stakeholders operating at national level. The participants identified this as a major obstacle which needs to be overcome and UNAIDS need to keep this as a priority in their future planning of work.

******************
ANNEX

Targets for Universal Access by 2010

-Low and Concentrated Epidemic Countries in Asia and Pacific region

1. 80% of most-at-risk populations reached by prevention programmes (eg: outreach services, condom promotion, drug substitution treatment, needle exchange, etc).
2. 60% of behavioural change of most-at-risk populations
a) Percentage of most-at-risk populations who both correctly identify ways of preventing the transmission of HIV and reject major misconceptions about HIV transmission
b) Percentage of female and male sex workers reporting the use of a condom with their most recent client
c) Percentage of men reporting the use of a condom the last time they had anal sex with a male partner
d) Percentage of injecting drug users who have adopted behaviours that reduce transmission of HIV, i.e., who avoid using non-sterile injecting equipment or use methadone substitution treatment and use condoms, in the last 12 months (for countries where injecting drug use is an established mode of HIV transmission)
3. 80% of eligible people living with AIDS to be receiving antiretroviral combination therapy. Follow-up with second and third line ARVs to be fully covered.
4. Resource mobilized by Government (both from domestic and international sources) fully meets the prevention and treatment targets, or at least 3 times increase from that in 2005.
5. Enabling environment
a) Civil society engagement
i. Percentage of members in National AIDS Coordinating body (including CCM) who represent sectors of civil society
ii. Percentage of National AIDS Response budget earmarked for programmes partnering civil society, including capacity building and management support
b) Fight against AIDS related Stigma and Discrimination
i. National legislation to address stigma, discrimination, rights of infected and affected population.
6. % of HIV+ pregnant women receiving a complete course of ARV prophylaxis to reduce the risk of MTCT
7. % of orphan and vulnerable children (OVC) who received a basic external support package (eg: School fee, shelter and food)
8. Reduction of new infections in the next five years as an outcome


Note: No.1-3 are non-negotiable quantitative targets as agreed in the Regional Consultation on Universal Access at Pattaya in February 2006 and the civil society consultation in August 2006 in Bangkok

[1] sex workers, MSM, drug users, transgender, and other vulnerable groups

Kenya: Progress On HIV Parent-to-Baby Transmission, But UNGASS Target Still Elusive

UN Integrated Regional Information Networks, May 24, 2006

NAIROBI- The comprehensive HIV/AIDS care clinic at Kenya's Machakos District Hospital buzzes with activity as nurses call out the names of the tens of women waiting - proof, according to the hospital's staff, that their efforts to reduce the number of children born with the virus are paying off."

As you can see, the clinic is full of people - uptake of VCT [voluntary counselling and testing], ARVs [antiretroviral treatment] and PMTCT [prevention of mother-to-child HIV transmission]are all on the rise," said Dr Simon Mueke, the hospital's medical superintendent.

Machakos, a town about 50km east of the capital, Nairobi, on the Nairobi-Mombasa highway, has been badly affected by the ongoing drought.

At the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS five years ago, world leaders committed to ensuring that 80 percent of pregnant women would have access to HIV prevention services.

Although Kenya has not met the 2001 target, the government feels they have improved access to PMTCT services."

We now have between 40 and 50 percent of all HIV-positive expectant mothers accessing PMTCT, and have trained thousands of health workers," said Dr Robert Ayisi, PMTCT coordinator at the Kenya's National AIDS and Sexually Transmitted Infections Control Programme (NASCOP).

Mueke noted that HIV testing at the Machakos antenatal clinic was now a standard part of the package, unless a woman specifically declined.

According to Margaret Kibutu, a PMTCT nurse at the hospital, "This year, since January, we have tested more than 600 women at the antenatal clinic, the highest figure since we started in 2003."

Despite these advances, challenges remain. "We need to develop the community component of PMTCT - we have services at the district level, but need them at the lower levels to ensure that all women have access to them," Ayisi commented.

MORE ACTION NEEDED

More health workers, particularly in the rural areas, were required if a higher PMTCT uptake was to be achieved. "We are currently training traditional birth attendants in PMTCT," Ayisi said."

We want them to be our agents of change and pass the messages to mothers."

Ahead of the UNGASS review in June, the Kenyan government has recommended that donor countries take into consideration local traditions and cultural practices, such as traditional birth attendants, and make their policy documents more Afro-centric in order to incorporate valuable service providers.

Traditional birth attendants are more often present at deliveries than trained medical staff, and the government is encouraging them to join the fight against HIV by reducing the levels of stigma faced by HIV-positive women, among other services.

The stigma attached to HIV/AIDS often causes infected women not to follow the PMTCT guidelines, such as not breastfeeding, with which an infant has a 15 percent to 30 percent chance of contracting HIV.

"If you don't breastfeed your child, people wonder why, and conclude that you must be positive - this leads many women to carry on breastfeeding and putting their children at risk," said nurse Kibutu.

Poverty also led women to carry on breastfeeding because they could not afford replacement foods. Parts of Kenya are still gripped by a drought brought on by several failed rainy seasons, and baby formula is often unaffordable to the 56 percent of Kenyans living on less than US$1 per day.

Formula feeding reduces the risk of transmission via breastmilk by one-third. But this option presents another obstacle, as it requires a constant supply of clean water and firewood to ensure sterile feeding. Family pressure to breastfeed is strong, and mothers who formula feed are viewed with suspicion.

The alternative is solely breastfeeding for the first three to six months, followed by quick weaning, as mixed feeding can damage the baby's fragile gut lining, increasing the risk of infection."

We now tell these women to try to breastfeed exclusively for six months if they cannot afford the [formula] milk - that way they do not introduce foreign foods that might disagree with the baby and increase the risk of infections," Kibutu said.

Stigma also heightened the lack of male participation in mother-child healthcare, further hindering the development of PMTCT. "Most men are very arrogant and do not want to hear about testing," she observed. "We only get men in the clinic once in a while, but PMTCT is really a family issue - the men should be involved."

Kibutu said many women failed to take their ARVs because they had not disclosed their HIV status to their spouses, which put them and their families at even greater risk. In response to the need for greater male participation, Machakos hospital has started including a 'Men As Partners' component in their PMTCT services."

Men need to be involved in PMTCT, since they have more say in what happens in their homes," said Alice Wambugu, an HIV-positive behaviour-change volunteer with Population Services International (PSI), an AIDS prevention NGO.

Another factor preventing women from continuing their treatment, Kibutu said, was that many came from remote, rural areas and could not afford the bus fare to the district hospital for follow-up.

Ultimately, PSI's Wambugu said, all women needed to hear the message of PMTCT if they were to understand its importance."

When I tell women that I found out I was HIV-positive at the antenatal clinic and went on to have an HIV-negative baby boy, they often say they didn't believe that a positive woman could have a healthy baby," she said. "We need an even bigger media campaign to let all of them know it is possible for them to have healthy children."


[ This report does not necessarily reflect the views of the United Nations ]

TAC woman calls on UN for action rather empty promises

June 1, By Sapa, Cape Argus

South Africa- South African woman has become the first person living with HIV to address the UN General Assembly, urging countries to action rather than "empty promises" in the global fight against Aids.

Speaking in the opening session of the UN General Assembly Special Session on HIV and Aids (Ungass) yesterday, Nkhensani Mavasa, 27, made a special appeal to the governments of African countries, where women make up 77% of new infections.

"I call on African leaders sitting here to protect and promote the human rights of all people in vulnerable groups, particularly women and girls," said Mavasa, the deputy chairwoman of the Treatment Action Campaign (TAC). "We ask you do not fail us yet again."

Mavasa addressed the conference as a representative of the International Women's Health Organisation after the TAC had declined an invitation to be part of the formal South African delegation.

The TAC turned down the invitation after the government intially refused to allow them and the Aids Law Project to join the delegation.

The TAC's Sipho Mthathi was billed to speak yesterday, at a massive street protest to mark the 25th anniversary of the first Aids diagnoses. Minister of Health Manto Tshabalala-Msimang also addressed a roundtable discussion at the UN.

Sub-Saharan Africa is home to two-thirds of all people living with HIV. The UN meeting of 10 heads of state and government, as well as 80 cabinet ministers, aims to adopt a blueprint to reach the goal of "universal access" to Aids care and prevention by 2010.

Mavasa told the assembly: "Your big task now is making sure this ... is not a document of empty promises, not a mere restatement of principle, but a platform for target based action. I ask that as you deliberate over the next two days, you'll be guided by the pain and hope which sits in our hearts as people of the world."

General Assembly president Jan Eliasson said Mavasa had brought the reality of HIV/Aids into the hall: "If we multiply her face, multiply, multiply, multiply we might get a slight notion of what this all means."

Yesterday the Health Ministry commended Mavasa's address.

Spokesman Sibani Mngadi said Mavasa had highlighted the challenges of poverty and the work being done in South Africa to make HIV treatment available."

She acknowledged that efforts have been made in her home town in Limpopo, as well as in other parts of South Africa to make the HIV/Aids prevention, care and treatment programme available," said Mngadi.

He said that Mavasa had contradicted a statement by TAC chairman Zackie Achmat that the government had lied to the UN about its treatment programme."

The spirit of her statement ... was in contrast to an unbecoming behaviour of TAC chairman, Zackie Achmat, during the TAC march in Pretoria on Tuesday."

During the march Achmat said the government had lied that South Africa had the biggest treatment programme in the world. "

The truth is that we have the biggest need in the world and we are not meeting that need," Achmat said.

Meanwhile, Tshabalala-Msimang told a roundtable discussion that she was pleased that prevention was at the centre of discussions at the conference.

She urged Ungass to build from commitments made in 2001, the ministry said in a statement."

The 2001 declaration on HIV/Aids acknowledges prevention as the mainstay of the response and recognises that poverty, underdevelopment and illiteracy are among the contributing factors to the spread of HIV," Tshabalala-Msimang said.

She said some of the challenges faced in the prevention of HIV/Aids included sustainable financing of programmes, overcoming the stigma and discrimination and a shortage of health workers. Governments and civil society should be encouraged to work together to overcome these challenges, Tshabalala-Msimang said.

In a statement from her spokeswoman, Charity Bhengu, the minister specified five focus areas for the South African delegation during discussions.

One was: "The importance of prevention, and the need to use various strategies and not be limited to a medical model approach which focuses on ARVs only."

The other areas were:

Poverty and status of women in society.

Challenges presented by vertical interventions when the health system as a whole wais weak.

The importance of food security as well as nutritional supplementation.

The importance for countries to determine their own strategies linked to their own "peculiarities".

International civil society denounce UN meeting on AIDS as a failure

(June 2, 2006)

NEW YORK- Civil society groups from around the world denounced the final UN Political Declaration on HIV/AIDS, released after marathon negotiations during the UN High Level meeting on AIDS this week.

“Once more we are disappointed at the failure to demonstrate real political leadership in the fight against the pandemic” said The Most Revd Njongonkulu Ndungane, the Anglican Archbishop of Capetown. “Even at this late stage, we call on the world’s political leaders to rise up and meet the challenges that the pandemic presents and to set ambitious targets at a national level to guarantee universal access to treatment, care, support and prevention.

”UN Member States refused to commit to hard targets on funding, prevention, care and treatment. They rejected frank acknowledgement that some of the today’s fastest growing HIV epidemics are happening among injecting and other drug users, sex workers and men who have sex with men. “The final outcome document is pathetically weak. It is remarkable at this stage in the global epidemic that governments can not set the much needed targets nor can they can name in the document the very people that are most vulnerable” said Sisonke Msimang of the African Civil Society Coalition.

“African governments have displayed a stunning degree of apathy, irresponsibility, and complete disrespect for any of the agreements they made in the last few months” said Leonard Okello, Head of HIV/AIDS for Action Aid International. “The negotiation processes was guided by trading political, economic and other interests of the big and powerful countries rather than the glaring facts and statistics of the global AIDS crisis, seventy percent of which is in Sub-Saharan Africa.”

African government delegations reneged on their promises in the 2006 Abuja Common position agreed to by African Heads of State. South Africa and Egypt, in particular, took a deliberate decision to oppose the setting of targets on prevention and treatment, despite the fact that both participated in the Abuja Summit that endorsed ambitious targets to be reached by 2010. “The continent that is most ravaged by AIDS has demonstrated a complete lack of leadership. It is a sad, sad day as an African to be represented by such poor leadership” said Omololu Faloubi of the African Civil Society Coalition.

But the African governments were not alone. The United States was particularly damaging to the prospects for a strong declaration. Throughout the negotiations they moved time and again to weaken language on HIV prevention, low-cost drugs and trade agreements and to eliminate commitments on targets for funding and treatment. “It’s death by diplomacy,” said Eric Sawyer, veteran activist and 25-year survivor of HIV/AIDS. “Hour after hour, my government fought for its own selfish interests rather than for the lives of millions dying needlessly around the globe”

There has however been a strong recognition in the declaration of the alarming feminization of the pandemic. Commitments were made to ensure that women can exercise their right to have control over their sexuality and to the goal of achieving universal access to reproductive health by 2015.

This progress was undermined however by regressive governments. “Syria, Egypt, Yemen, Iraq, Pakistan and Gabon blocked efforts to recognize and act to empower girls to protect themselves from HIV infection” said Pinar Ilkkaracan, President of Women for Women’s Human Rights. “Their failure to commit to ensuring access to comprehensive sexuality education for young people, and promote and protect sexual rights will undermine the response to the HIV pandemic.”

This was compounded by the declaration failing to acknowledge that some of the today’s fastest growing HIV epidemics are happening among injecting and other drug users, sex workers and men who have sex with men, despite strong support from the Rio Group of countries. For example, governments have ignored the needs of injecting drug users by not stating the need for substitution drug treatment, putting them at further risk. “Failing to fully address the needs of these groups, and particularly to counter stigma and discrimination by decriminalizing drug use and sexual behaviors, will render them more invisible and ultimately lead to even higher rates of HIV/AIDS” said Raminta Stuikyte of the Central and Eastern European Harm Reduction Network.

Again the US, along with other governments, ensured that the final declaration text contains a substantially weaker reference to the AIDS funding need. It now only acknowledges that more money is needed, rather than committing to raising the needed funds. An estimated $23 billion is needed per annum by 2010 in order to fund AIDS treatment, care, prevention and health infrastructure. “At this stage in the pandemic, we expected government commitment to close the global funding gap,” said Kieran Daly of the International Council of AIDS Service Organizations. “Instead they have tried to let themselves off the hook.”

While there has been a failure of governments to face the realities of HIV/AIDS, civil society will be holding them to account. Civil society will hold governments to account to deliver on universal access. Civil society will make sure governments recognize and support vulnerable populations. The failure of governments to commit will not be accepted.

EDITORS NOTE: “Vulnerable populations” includes women and girls, youth, older people, men who have sex with men, injecting and other drug users, sex workers, transgenders, people living in poverty, prisoners, migrant laborers, orphans, people in conflict and post-conflict situations, indigenous peoples, refugees and internally displaced persons, as well as HIV/AIDS outreach workers and people living with HIV/AIDS.

Supporting organizations:
AAHUNG
ACT UP NY
Action Aid International
Advocates for Youth
AfriCASO
African Committee Services
AIDS Access Foundation
Aids Fonds
AIDS Foundation East-West
AIDS Law ProjectAIDS Task Force,
Africa Japan Forum
Asia Pacific Council of AIDS Service Organizations (APCASO)
Australian Federation of AIDS Organisations (AFAO)
Blue Diamond Society
CALCSICOVA (Cordinadora de Asociacia Ves de Lucha Contra el SIDA de la Cournida Valenciana Catolicas por el Derecho a Decidir (Brasil)
Center for AIDS Rights, Thailand Center for Health and Gender Equity Central and Eastern European Harm Reduction Network (CEEHRN)
CESIDA - Coodinadora Espanalu en Sida Colectivo Juvenil Decide/ Bolivia European AIDS Treatment Group
GAT-Grupo Portugues de Activistas Sobre Tratamentos de VIH/SIDA
Gender AIDS Forum
Global AIDS Alliance
Global Youth Coalition on HIV/AIDS
Eastern Africa Region Global Network of People Living with HIV/AIDS (GNP+)
Health & Development Networks
Health GAP (Global Access Project)
HelpAge
International HIV Association
Netherlands Housing Works, Inc
ICW Latina International Council of AIDS Service Organisations
International HIV/AIDS Alliance
International Women's AIDS Caucus & FEIM
International Working Group in Social Policies and Sexuality
International Parenthood Planning Federation (IPPF)
Journalists Against AIDS (JAAIDS/Nigeria)
Namibia Network of AIDS Service Organizsations (NANASO)
National AIDS Trust (UK)
National Association of PLWHA in Namibia (Lironga Eparu)
National Empowerment
Network of PLWHA in Kenya
Nepal HIV/AIDS Alliance
New Ways
NNIWA OSISA Positive Action Movement,
Nigeria Positive Women's Network
Red Latinoamericana y Caribena de Jevenes pro la Derecliora Sexuales y Reproduction (REDLAC)
Red Tra SexRED2002 (Spain)
RSMALC
Rutgers Nisso Group, The Netherlands
Sensoa V2WSEICUSShare - NetStop Aids Liberia
Student Global AIDS CampaignTenemos Sida (Spain)
Treatment Action Group (TAG)
Treatment Action Movement, Nigeria
UK Coalition of People Living with HIV and aids
Unitarian Universalist
United Nations Office
United Nations Association in Canada
VSO Women for Women's Human Rights (WWHR)
World AIDS Campaign
World Population Foundation, Netherlands

Rage Against the Machine: Anti-Politics and the AIDS Epidemic

By Gregg Gonsalves, Gay Men's Health Crisis, April 22, 2006

By political I mean having to do with power: whose got it, who wants it, how it operates; in a word, whose allowed to do what to whom, who gets what from whom, who gets away with it and how
.…..Margaret Atwood's Second Words

We're so busy putting out fires right now, that we don't have the time to talk to each other and strategize and plan for the next wave, and the next day, and next month and the next week and the next year. And, we're going to have to find the time to do that in the next few months. And, we have to commit ourselves to doing that. And then, after we kick the shit out of this disease, we're all going to be alive to kick the shit out of this system, so that this never happens again.…..Vito Russo, Why We Fight

********************

I told a few friends the other day that I was worried that I was turning into a shrieking harpy. There is no doubt that I have been horribly angry for the past 15 years. I have watched the AIDS epidemic flourish, mow down friends, family and colleagues and despite the vast sums of money and hives of activity devoted to combating the disease, new infections erupt in the millions and millions more die horrible, painful deaths each year.

I do blame my government, other governments, drug companies, conservative religious institutions, and a rogue gallery of other villains, but, lately, I can’t help but think of my own role, our community’s role in perpetuating the epidemic.

I’ve written about this phenomenon twice now, once in a piece for the International AIDS Conference in Bangkok, called ‘How to Lose the War on AIDS’ and then again for a meeting convened by the Lawyers Collective in Mumbai last year, in a paper called ‘It Ain’t What You Do, but the Way That You Do It: Ten Points on International AIDS Treatment Activism.

’I am still stuck thinking about this, largely because despite my attempts to provoke a conversation about how we do this work, nothing seems to change very much in our modus operandi. The AIDS epidemic has everything, in Margaret Atwood’s words, to do with power: who’s got it, who wants it, how it operates; in a word, whose allowed to do what to whom, who gets what from whom, who gets away with it and how.

We knew this once, the rallying cry of ACT UP was that AIDS is a political crisis; we know this is still true particularly in places where the fight is conceived as an essentially political one: by South Africa’s Treatment Action Campaign, by Russia’s Front AIDS, by Thailand’s Thai Drug User Network, by Costa Rica’s Agua Buena Human Rights Association.

Don’t get me wrong, I do believe that AIDS is recognized as a political crisis by many, many people. Think of the dozens of sign-on letters we write and circulate, the meetings we attend to pound on the table, the reports, the press releases we put out demanding this, demanding that.

However, I have the sickening feeling that there has been a tremendous domestication of our political resistance--we trade on the legacy of our activist past or the reputation of our fiercest living champions, but as a movement, we have become a paper tiger.

Let’s take the upcoming United Nations General Assembly Special Session on HIV/AIDS in New York in May 2006 where governments will come to boldly lie about their records in fighting AIDS and make hundreds of new, empty promises. UNAIDS has staged a series of consultations leading up to this gathering to develop a framework to achieve universal access to HIV prevention, care and treatment by 2010.

Activists were hand-picked by UNAIDS to attend most of these consultations, where UN and government officials listened to the needs of people living with HIV/AIDS, of sex workers, drug users, women, men-who-have-sex with men and other vulnerable populations, wrote them up in reports and issued the findings in glossy newsletters put together just for the occasion.

The UNGASS meeting will culminate in yet another political declaration on HIV/AIDS, based in part on these consultations and more centrally on negotiations with the governments that compose the UN’s membership on what they can agree to support. Tremendous amounts of energy, money and time have been invested in these processes over the past six months.

I was part of the Global Steering Committee on Universal Access and attended three meetings and helped to develop pages and pages of input for UNAIDS, hundreds of my colleagues are now busy finalizing shadow reports, deciding who will go to New York City in May, who will be selected to speak at the UN, organizing satellite events to highlight important issues.

Will anyone listen to us? Does anyone care what we have to say? Has anyone asked why the hell we’re devoting millions of dollars and hours to this process, when the previous UNGASS in 2001 resulted in a Declaration of Commitment, which was honored neither in word nor deed? What are the opportunity costs for activists that are now hip deep in this bullshit? What work hasn’t been done or could have been done with this time, this money?

The UN system is a system made for and by governments. Why are we engaging with a system in which we are not represented and is beholden not to us but to its member states? Yes, the international community must do more about HIV. But the international community doesn’t exist as an institution, there are countries and countries have leaders.

Imagine if all these resources expended by the community alone for this May meeting in New York City had been devoted to national campaigns demanding that governments honor what they promised 5 years ago? Or towards building real infrastructures for national, regional and international advocacy on HIV/AIDS? Or training each other on how to push for political change?

I can hear Zackie Achmat’s voice in my head calling me an ultra-leftist for refusing to deal with institutions to affect change. Well, Zackie and TAC engage with their government on a daily basis and have created a national infrastructure to press for political change. I am not suggesting that there is no use in the UNGASS meeting in May, particularly when it is part of a comprehensive political response to the AIDS crisis.

However, for many people, the UNGASS meeting in May has a role that is isolated from any other kind of political activity and has taken on a significance that it doesn’t deserve. For me, the frenzy around the UNGASS meeting represents an anti-political moment. The UNGASS’s role, its real contribution, to paraphrase Arundhati Roy, is to defuse political anger and blunt the edges of political resistance.

How did we get here? Well, not to over-simplify, but I think that we’ve seen an NGO-ization of HIV/AIDS that has weakened or destroyed our ability to build asocial movement to fight for our right to health, to be free of discrimination and violence, to the other services we need to stay alive and free from HIV infection.

We’ve also seen people living with HIV/AIDS, sex workers, women, men-who-have-sex-with-men, ethnic minorities, young people, drug users who are also working in the field become essential monsters: that is they think and act as if the greater involvement of people with AIDS (GIPA) or their vulnerable group has a value in and of itself, as if they have some special purchase on knowledge or rights simply because of who they are instead of linking those rights to a responsibility to engage politically in a feminist, anti-racist, anti-homophobic, pro-sex, pro-harm reduction, and pro-poor struggle that links us in solidarity, in commonality with each other, with millions of other people for whom other struggles perhaps matter more than our own.

What would I love to see? Well, it would be great if we could have the chat that Vito Russo asked for in 1988. I’d like us to ask if the institutions and organizations we’ve built up are really working towards achieving political change or are actually stymieing it.

How accountable are our NGOs to people living with HIV/AIDS and communities affected by the epidemic at the district level, the province, the country, the region, the planet? Are we creating institutions that seek to justify their own existence, their own organizational survival and expansion at the expense of challenging the powers-that-be: governments, UN agencies, drug companies, etc? Who is setting the agendas for our work? Are these agendas in the service of achieving specific, local political accountability or are they making calls for a more diffuse, generalized, international responsibility?

Are we becoming carpet baggers, itinerant technocrats, damn missionaries, toting our expertise around the globe trying to help people in other countries to solve their own problems or are we trying to promote local solutions to local problems by local people? Are we just talking about change, rather than mobilizing for it, trying to make it happen?

Are we just managing change, trying to turn resistance into a well-mannered, reasonable, salaried, 9-to-5 job, channeling the struggle into a three-day media event in New York City in May, a weeklong international AIDS conference in Toronto in August, and endless series of meetings, reports, conference calls and email exchanges?

I also want to stop talking about GIPA-the greater involvement of people living with HIV/AIDS. I am sick of GIPA and will not promote it any longer. Roy Cohn, the vicious, nasty, conservative asshole had AIDS and he was gay to boot. Roy Cohn sent Julius and Ethel Rosenberg to the electric chair and sat at the right hand of Senator Joseph McCarthy in the 1950s when he persecuted hundreds of decent Americans for communist sympathies, whether or not they had then or ever been members of the Communist Party. He was not part of my community.

Do women want to claim Margaret Thatcher as one of their own? Do gay men want to claim Ernst Rohm, commander of the Nazi storm troopers as a fellow fag? Do Africans want to claim Idi Amin or Hendrik Verwoerd among their kin? If your own sense of your history or politics is based on biology, serostatus, country of origin, gender, sexuality, well, get ready to get in bed with all of the folks mentioned above.

This kind of identity politics excuses everything and accepts no political responsibility. It’s time we start asking each other: what are you doing to promote the reproductive and sexual rights of women; to fight rape and violence against women; to promote access to HIV/AIDS prevention, care and treatment, to education, to safe and affordable housing and other basic services regardless of gender, sexuality, ethnic origin, regardless of ability to pay?

What are you doing to legalize methadone, buprenorphine, syringe exchange and reform drug and narcotics regulation, protect sex workers from harassment, ensure they have working conditions that don’t endanger their health or well-being? What are you doing to ensure that young people get comprehensive information about sexuality, STIs and HIV/AIDS?

Let’s base our personal commitment to the fight against HIV/AIDS not on who we are, but what we do for others and not just for those who are like us, but those who are different in whichever way each of us chooses to categorize it. If we hold our organizations accountable, we have to hold ourselves accountable too. So, I am one pissed off sister.

I am angry at the epidemic, but angry about a machine we’ve created that drains the politics out what is happening around us, that, in fact, fosters both an institutional and personal anti-politics that fuels the fires of HIV/AIDS. I don’t know when we’ll all get the chance to talk, but we need to have a conversation about where we’re going and how we’re going to get there.

Otherwise, we’ll see each other at the next UNGASS in another 5 years time and realize we’ve been driving around in circles all this time, never recognizing we’ve seen this all before, our journey hasn’t even started and the car is, sadly, out of gas.


Source: ITPC eForum

Myanmar Shadow Report for the 2006 High Level Meeting on AIDS

Compiles by the Concerned Civil Society Observers (Anon), 1 May 2006

The Union of Myanmar joined all member states of the United Nations in making a Declaration of Commitment on HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS five years ago.

In this 2001 Declaration, member states of the UN promised that they would meet time-bound and measurable goals on HIV prevention and care. Later this month there will be a High Level Meeting on AIDS, also called the UNGASS review, to report on progress over five years. It will be held from 31 May to 2 June at the United Nations in New York.

The UN Joint Programme on HIV/AIDS has stated that it is committed to ensuring the meeting is fully informed and comprehensive. Each member state has been asked by the Secretary General of the UN to prepare a report before the meeting. The UN asked that country reports be developed in collaboration with groups representing civil society.

The Government of the Union of Myanmar did not do this. A draft of the country report indicators was made available to a few UN and nongovernmental stakeholders at a meeting in Yangon in March. It is unknown whether the comments of these organisations were taken into consideration in drafting of the final country report.

The Community Partnership division of the UNAIDS secretariat in Geneva committed itself to publish the submitted national progress reports on its website by the end of April. One hundred and twenty six country reports are posted but Myanmar's report is not one of them.

It is now less than a month before the High Level Meeting. Information to prepare this shadow report had to be obtained from unofficial sources inside the country. Had the official national report been submitted on time and posted, the preparation of this shadow report could have been a transparent, accountable, and effective process.

There are four important issues in the official Myanmar country report that are noted by this shadow report:

1) governmental spending does not demonstrate governmental commitment to an adequate response to the epidemic
2) there is no official strategy for HIV in the armed forces
3) a large proportion of men admit to extramarital sexual relationships
4) exaggerated claims about high quality of care of sexually transmitted infections cast doubt on the reliability of other data

1) inadequate governmental funding
Due to differences in official and unofficial exchange rates, it is difficult to accurately determine official governmental spending for any reason in Myanmar. The government reported 22 million kyat annual spending on HIV/AIDS in an application to the Global Fund against AIDS, Tuberculosis, and Malaria several years ago.

That figure was widely interpreted as representing a real annual expenditure of about 20 thousand dollars. In the Myanmar country report for the High Level Meeting this year the amount reported is 78 million kyat. Using a rough exchange rate of one thousand kyat to the dollar, this represents almost a four fold increase of spending to about 80 thousand dollars.

Few countries have increased spending four fold over the last few years (Russia's spending has gone up twenty fold) so Myanmar deserves congratulations for increasing spending. But the overall amount is too low. Myanmar officially recognises HIV as a priority health issue. Spending one and a half cents per capita on HIV does not demonstrate that it is committed to tackling the problem.

2) lack of a strategy for the armed forces
The Myanmar country report discloses that the country does not have a strategy to address HIV/AIDS issues among its national armed forces. In most countries lack of a strategic plan for the military would not be a big issue. Not so in Myanmar.

The International Crisis Group estimates that there are at least 400,000 armed lower ranks within the armed forces, representing approximately 3 per cent of the adult male population. Armed men in the ethnic forces are estimated to be at least 70,000. Military spending accounts for a large proportion of the central budget.

The armed forces are spread all over the country but are concentrated in areas of unrest or former rebel activity. Not surprisingly, these areas also have a high prevalence of HIV. Men in the military often serve away from their wives and family. Unprotected sex is common in this situation.

Since there is no HIV strategy for the armed forces, observers of the HIV epidemic in the country are not surprised to hear reports of summary dismissal of soldiers found to have HIV and lack of care for infected soldiers and their families. The governmental forces are not the only ones to suffer from lack of an official HIV strategy: rebel ethnic armies also have no HIV plans. They are not included in the governmental country report to the United Nations.

3) sexual behaviour of men
Official reports from Myanmar governmental sources rarely mention sexual behaviour, so it was with a measure of surprise that the official country report documents were found to have new data on men's sexual behaviour.

No one doubts that most Burman women who are not sex workers have just one sexual partner – their husband. But information about the sexual behaviour of men is rarely reported. The new report says that 28.2% of men admit they had sex with someone who were not their wives in the last twelve months. This data was obtained from official sentinel surveillance activities undertaken by the state National AIDS Programme.

The government of the Union of Myanmar deserves praise for it openness in making public this data on men's sexual behaviour.

This figure certainly means the mystery of Myanmar men's sexual behaviour is over. A significant number of men admit that they bought sex in the last year. It is this large number of men having unprotected sex with a smaller number of women who sell sex that drives the epidemic. The prevention goals are clear – partner reduction and increased condom use.

4) quality of care for sexually transmitted infections
The report states that forty thousand men with venereal diseases last year were observed at health care facilities to be appropriately diagnosed, treated and counselled. This is simply untrue. The government does not have the personnel to monitor the quality of care for all these men reporting to doctors with symptoms of sexually transmitted infections.

The last time that a sample of doctors was observed in a study to see how they provided care to a hundred and fifty men with sexually transmitted infections was almost ten years ago. Only 15% of the care observed at that time was adequate. It is impossible that the quality of care has improved to 100% accuracy in a few years and staggering to think that a governmental agency would report that forty thousand doctor-patient interactions were observed by researchers.

The inaccuracy of this data throws doubt on other data in the report. If the Ministry of Health cannot be trusted to publish reliable data on the care provided by health care staff can we believe the Ministry when it reports that that one in five young people knows how to prevent HIV infection?

Outgoing United Nations Secretary General Kofi Annan has stated: "While certain countries have reached key targets and milestones for 2005 as set out in the Declaration, many countries have failed to fulfil the pledges.

"It is up to all of us in civil society to determine whether Myanmar has fulfilled its pledge made five years ago. And whether the state is fully committed to increasing effective action against the epidemic. We think it is not.

Concerned Civil Society Observers

Advocacy Guide: Meaningful Involvement of Civil Society in the UNGASS Review Meeting

HDN & ICASO

Five years ago, under the heading of ‘Global Crisis- Global Action’, the United Nations General Assembly held an unprecedented special session on HIV/AIDS (UNGASS) – the first time the General Assembly ever addressed a specific health issue.

The resulting UNGASS Declaration of Commitment (DoC) on HIV/AIDS adopted by all UN Member States provided a comprehensive framework to halt and to reverse the HIV/AIDS epidemic by 2010, and included specific and measurable milestones for 2003, 2005 and 2010.

Five years after its adoption, governments are being called to report on progress they have made toward implementing these promises. One of their commitments is to: “..devote sufficient time and at least one full day of the annual session of the General Assembly to review and debate a report of the Secretary-General on progress achieved in realizing the commitments set out in the Declaration.

”Between May 31st and June 2nd, 2006, every member country of the United Nations will be sending a delegation to New York to participate in this review meeting. The International Council of AIDS Service Organizations (ICASO) and Health & Development Networks (HDN) have partnered to prepare this guide to assist you to advocate to be part of your national delegation, to support and to influence them.

It also describes other ways in which you can participate in the UNGASS Review process. This guide will be available in French and Spanish March 31st, 2006.

To download copies please visit: www.icaso.org or www.ungasshiv.org Or write to ungass@icaso.org

Action: Consultation on the civil society participation in the HIV/AIDS UNGASS DoC processes ICASO

From ICASO (International Council of AIDS Service Organisations)

OPPORTUNITY FOR INPUT: CONSULTATION ON THE PARTICIPATION OF CIVIL SOCIETY IN THE PROCESSES RELATED TO THE HIV/AIDS UNGASS DECLARATION OF COMMITMENT [DoC] AT COUNTRY LEVEL

Dear friends/colleagues:

The International Council of AIDS Service Organizations (ICASO) is undertaking a project entitled:

'STORIES FROM THE FRONTLINES: LESSONS LEARNT IN THE INVOLVEMENT OF CIVIL SOCIETY IN THE MONITORING AND REPORTING PROCESS ON THE IMPLEMENTATION OF THE UNGASS DECLARATION OF COMMITMENT'.

Almost five years ago, under the heading of 'Global Crisis- Global Action', the United Nations General Assembly held an unprecedented special session on HIV/AIDS (UNGASS) - the first time the General Assembly ever addressed a specific health issue. The resulting UNGASS Declaration of Commitment (DoC) signed by all UN Member States provided a comprehensive framework to halt and to reverse the HIV/AIDS epidemic by 2010, and included specific and measurable milestones for 2003, 2005 and 2010.

Five years after its adoption, governments are being called to report on progress they have made toward implementing these promises. Paragraph 94 of the DoC calls for civil society involvement in the national periodic reviews of the progress achieved in realizing these commitments, to identify problems and obstacles to achieving progress, and to ensure wide dissemination of the results of these reviews. This project aims to compile information on how civil society organizations (CSOs) have participated in the UNGASS DoC-related reporting processes at country level.

The output of this consultation will be a report highlighting lessons learnt on how CSOs have monitored and reported on the implementation of the DoC. The consultation will look at the involvement (or not) of CSOs in the preparation and discussion of the national official (government-led) report, and the participation of CSOs in civil society-led monitoring and reporting initiatives. Your stories will inspire and interest others to mobilize and advocate for more civil society involvement in the response to HIV. The aim is that we all share, learn from and replicate the positive processes and experiences in other countries in the coming years.

The Stories from the Frontlines will highlight best practices, success stories, as well as barriers, challenges and opportunities faced in participating in the UNGASS reporting process. It will include stories from civil society actors and organizations from all regions of the world in order to capture differences in national experiences. Stories will be collected through an electronic consultation in 4 languages (English, French, Spanish and Russian). Civil society organizations worldwide are invited to send us their experiences. These could be success stories or challenges.Please send your responses before April 7, 2006 to ungass@icaso.org

Below are some questions to help guide you in your responses. There are two scenarios for this consultation.

The first one deals with the involvement of civil society in the government-led reporting process.

The second scenario deals with civil society monitoring and reporting 'outside' the government-led process (shadow reports). If you participated in both scenarios, please complete both parts.

There is a third part with overall general questions, which apply to both scenarios. You do not need to answer the questions in order. Although these questions have been designed to guide your response, please feel free to add as much information as you want. Include your contact information (email and phone number) as well as your organization and country. Please also indicate if you authorize ICASO to use/publish your name and your organizational affiliation.

Depending on the number of words submitted, ICASO will edit your contribution, but you will have a chance to review it befor e it gets published. We thank you in advance for your participation.

PART A: SCENARIO 1: Involvement in government-led reporting process.

Were you (individually or your organization) involved in any way with the official (government-led) UNGASS reporting process in 2005? If yes, please provide detailed information about your experience. Please include answers to:
a) Were you contacted/invited by the government authority or did you have to contact them/take the initiative?
b) What was the process used by the government to collect the data and was it inclusive of civil society input?
c) Did the UNAIDS country office (or UN-theme group) play a role? Explain
d) Did the methodology to collect data/seek input included meetings of stakeholders? Who was invited/included? How many meetings were organized?
e) Who was responsible for writing the report?
f) How was the consultation process carried out once the report was drafted? Were there consultations with stakeholders? Was there an opportunity to provide input?
g) Was the input provided by civil society taken into account in the final report submitted to UNAIDS? Did you get a copy of this report?

PART B: SCENARIO 2: Involvement in monitoring/reporting "outside" the government-led process.

Were you (individually or your organization) involved in any way in monitoring and reporting on the implementation of the DoC outside the government-led process? If yes, please provide detailed information about your experience. Please include answers to:

a) Was this involvement part of a larger/multi-country project?
b) Did the initiative produce a 'shadow' report? Is the report available? What format have you used to present the information? (cases studies, theme/topic based, etc)
c) How have you used the report?
d) What methodology/process was used to collect and validate the data/information? What data did you collect? Who was involved? Which sectors were included as 'key informants' or participants?
e) What role, if any, did the UNAIDS country office (or UN-theme group) play?
f) What was the reaction of the government (if any) to your initiative? Did any government official participate?
g) Did other NGOs/CBOs/CSOs participate in the process?
h) Was this report (or the information therein) in any way incorporated into the official government-led report?

PART C:

1) What are some of the barriers/challenges that you faced in any or both of the above scenarios? How did you overcome them?
2) What are your recommendations for:a. More involvement of civil society in monitoring/reporting initiatives b. More effective civil society-led monitoring/reporting initiatives
3) What are your major lessons learnt/recommendations for CSOs that would like to get involved in these monitoring/reporting processes in the years to come?

We look forward to hearing your story.

Thank you, in anticipation, for your cooperation.

[Note: Members can find this announcement in French, Spanish, and Russian on the ICASO website at: http://www.icaso.org]


Source: PartnersZimbabwe eForum

Selection of Civil Society Participants to the UNGASS Review Meeting (Update) Civil Society Partnerships

23 February 2006

Declaration of Commitment on HIV/AIDS Review Selection of Civil Society Participants

UpdateIn 2005 the United Nations General Assembly agreed to convene a High-Level Meeting and undertake a Comprehensive Review of the progress achieved in realizing the targets set out in the Declaration of Commitment on HIV/AIDS from May 31 to June 2, 2006 (Resolution A/RES/60/224).

To ensure the Review draws on the expertise of all key sectors engaged in the AIDS response the Resolution called for the Office of the General Assembly President to draw up a list of civil society participants (to join those already accredited through ECOSOC) for consideration by Member States by 15 February 2006.

The Office of the General Assembly President asked UNAIDS Secretariat to receive applications. UNAIDS published information and an application form on its website and received applications for possible participants up until an agreed deadline of 3 February. That process is now closed and late applications are not being accepted.

On 15 February the Office of the General Assembly President forwarded completed applications from this process to Member States for their consideration on a "no-objection basis" as described in the Resolution A/RES/60/224. A small percentage of organizations applying did not provide complete information and so their details could not be forwarded to Member States for their consideration.

Member States are now reviewing the list and have the right to object to suggestions that were put forward for consideration by 3 March 2006.

The General Assembly President will then formally present a list of organizations to the Assembly for decision. As soon as possible thereafter the list of organizations that has been agreed for accreditation will be published.

It is important to note that civil society organizations cleared for accreditation to attend the Review Meeting will not be guaranteed any financial support however UNAIDS will endeavor to secure support for some organizations to attend the Review and will publish details of that process on its website in March.

ECOSOC accredited organizations will be able to participate in the Review through a separate process. These organizations are being asked to confirm their interest in participating in the meeting by 30 March 2006 with the DESA Non-Governmental Organizations Section of the United Nations Secretariat.

In all cases civil society organizations are encouraged to approach their governments to be included in national delegations wherever possible.

Please direct any queries to: csp@unaids.org

Civil Society Information Note from UNAIDS

26 January 2006, BTS EForum

Please find below, the UNAIDS Civil Society Information Note outlining four ways in which civil society can participate in the upcoming comprehensive review of progress towards the UNGASS Declaration of Commitment on HIV/AIDS targets. The meeting will take place in New York from 31 May - 2 June 2006.

Please note that the deadline for civil society nominations/applications to be submitted to the UNAIDS is 3 February 2006. You can access the UNAIDS application form in English, French, Spanish and Russian at http://www.unaids.org/en/GetStarted/CivilSociety.asp on the UNAIDS website.

You can also access the letter of the President of the General Assembly (GA) referred to here in this posting at http://www.healthdev.org/eforums/cms/showMessage.asp?msgid=9705 on the forum archives.]

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Comprehensive Review of progress towards targets set out in the Declaration of Commitment on HIV/AIDS (31 May- 2 June 2006, New York)

Accreditation of Civil Society Participants

Further to the 13 January 2005 letter of the President of the General Assembly (GA) on civil society participation (1), this is to clarify that there are four ways for civil society organizations to be accredited to the 31 May-2 June Review:

1. Civil society organizations that are accredited to the Economic and Social Council of the United Nations (ECOSOC) will be able to register and secure accreditation through the Non-Governmental Organizations Section of the United Nations Secretariat. ECOSOC accredited organizations are encouraged to confirm their interest in participating in the meeting by 30 March 2006 with the Non-Governmental Organizations Section of the United Nations Secretariat at desangosection@un.org providing information on the number of representatives expected to attend the meeting. Registration will permit attendance at the meetings, and facilitate consideration for participation in the round tables of the meeting.

2. Member States and Observers have also been invited to include civil society and private sector representatives in their national delegations to the meeting. Non-ECOSOC accredited civil society representatives are encouraged to negotiate participation as part of a country delegation.

3. NGO members of the UNAIDS Programme Coordinating Board may participate in accordance with operational paragraph 7 of GA Resolution A/RES/60/224.

4. To facilitate further attendance by civil society organizations, the Office of the GA President will draw up a list of additional civil society organizations to be invited. UNAIDS is currently receiving nominations for consideration by the Office of the GA President. The deadline for nominations is 3 February 2006. Only organizations who have sent in a nomination form and who are not in any of the above categories will qualify for consideration. Nomination forms are available form the UNAIDS website www.unaids.org or by emailing UNAIDS at csp@unaids.org.

After the closing date all nomination forms will be reviewed to check that they are from bona fide organizations working on AIDS by a panel that includes NGO representatives to the UNAIDS Programme Coordinating Board. A tentative list of civil society organizations will then be forwarded to the Office of the President of the GA for his consideration. The GA President, after appropriate consultations with Member States, will circulate the list for consideration by the GA on a non-objection basis not later than 15 February 2006.

Further information: csp@unaids.org


Source: Break-the-silence eForum

UNGASS 2006: GA Draft Resolution Approved on Implementation of the Declaration of Commitment on HIV/AIDS

New York, 28 December 2005 -- In 2001, the General Assembly held a special session on HIV/AIDS which led to the adoption of a resolution entitled "Declaration of Commitment on HIV/AIDS.

This resolution outlined a number of commitments in the areas of leadership; prevention; care, support and treatment; human rights;reduction of vulnerability; children orphaned or affected by HIV/AIDS;alleviation of social and economic impacts; research and development; resources; and follow-up.

The World Summit Outcome Document reaffirmed full implementation of this Declaration and following several informal consultations earlier this month led by Ambassador Hackett of Barbados and Ambassador Laohaphan of Thailand the GA adopted a new resolution on 23 December 2005 that "decides to undertake a comprehensive review of the progress achieved" in reaching the Declaration's targets.

This review session will be held from 31 Mayto 1 June of 2006 and will be followed by a high-level meeting on 2 June 2006,which aims to maintain engagement of world leaders in the global response to HIV/AIDS.

The review will take place in the form of plenary sessions, panel discussions, roundtables and a hearing with civil society. Civil society members will also be invited to participate in the roundtable discussions and the resolution encourages member states to include in their delegations representatives of civil society from their respective countries from various sectors, including people living with HIV/AIDS.

The Secretary-General will be responsible for preparing a comprehensive report prior to the review on progress achieved and remaining challenges.Click here to download the adopted resolution submitted by the President of the General Assembly on preparations for and organization of the 2006 follow-up meeting on the outcome of the twenty-sixth special session: implementation of the Declaration of Commitment on HIV/AIDS.

http://www.reformtheun.org/index.php/united_nations/1884

source: Health Gap List