productivity and GDP in the agricultural sector. Yi called for an increase in AIDS vaccine research to minimize future economic losses, estimating that the research will cost the country about $125 million. Yi also called for the establishment of a national fund to support the vaccine effort through investments by local governments and businesses, as well as private donations and international cooperation. to the —Xinhuanet, June 7 were living in the Caribbean, about 22,000 of whom were children. According to the report, 51 percent of people living with HIV/AIDS in the region are women, Responding Growing impact of HIV/AIDS on India and there are an estimated 37,000 new cases of HIV in the Caribbean in 2005. Since the first diagnosis of HIV/AIDS in India in 1986, the adult HIV prevalence —Jamaica Gleaner, June 1 Sexual and Reproductive in India has increased to 0.91 percent. “India is where South Africa and Thailand were in the early ’90s,” said Ashok Alexander, director of Avahan, the Bill & HIV Prevalence in Tijuana Rising Rapidly Melinda Gates Foundation’s program to fight HIV/AIDS in India. If HIV/AIDS An estimate of one in every 125 residents in Tijuana, Mexico, between the ages of prevalence continues to rise, he said, the country’s socio-economic consequences 15 and 49 are thought to be infected with HIV/AIDS, said Steffanie Strathdee of will be devastating. HIV/AIDS has not received the kind of attention and urgency it the University of California-San Diego’s Division of International Health. Tijuana’s of deserves because it mostly affects poor people and people living in rural areas. The HIV prevalence is approaching 1 percent, which would be triple the national HIV Rights PLHIV total number of HIV cases in India has just surpassed that of South Africa, making rate. New research indicates that HIV prevalence in Tijuana among injection drug it the country with the largest number of infections. users has tripled since the 1990s and the prevalence among female commercial sex —Business Today, June 4 workers has increased nearly tenfold. UCSD has donated a customized van that serves as a mobile HIV prevention clinic that provides HIV testing and prevention 2 BY PAUL PERCHAL, DIRECTOR, HIV/STI PROGRAM, ENGENDERHEALTH, more than 100 governments include the right of all couples and individuals to decide Women’s HIV/AIDS Support Group in Vietnam materials. In addition, public hospitals and clinics in Tijuana now test all pregnant BETTY FARRELL, MEDICAL ASSOCIATE FOR INTEGRATION OF FAMILY PLANNING IN freely and responsibly about all matters relating to their sexual and reproductive With more than 250,000 HIV-positive women living in Vietnam, it is estimated women for the virus. Romedios Lozada, coordinator of sexually-transmitted infection

3 RH, ACQUIRE PROJECT, AND KEVIN OSBORNE, SENIOR HIV/AIDS ADVISOR, health, including the number, spacing and timing of their children, and to have the that only 10 percent are receiving treatment, according to UNAIDS. Women programs for Tijuana, said the government is trying to improve the situation with INTERNATIONAL PLANNED PARENTHOOD FEDERATION information and means to do so. Still, the rhetoric has not become a reality in most in Haiphong, however, are battling the stigma surrounding the virus by forming limited resources. parts of the world. a support group that has chosen to look directly into the face of the suffering —Goldberg, KPBS, May 31

4 A 20-year old South African woman learned about her HIV status in 1995 when she that lies ahead – nursing, cleaning and feeding the went for a tuberculosis check-up. She was pregnant at the time, and after much soul SRH of PLHIV: A Low Priority for Governments and Providers sick, collecting the bodies of people who die alone in NORTH AMERICA searching, told her partner and family. Her family was supportive, while her partner Competing for resources with other needs, including antiretroviral therapy (ART), hospitals or on the streets, and attending the funerals 5 was shocked and angry, finding it hard to believe. At eight months, the baby she the provision of comprehensive SRH care for PLHIV, is a low priority for most of those whose families have turned their backs. Pham Lack of Funding Threatens Global Fund was carrying died in-utero. Her partner blamed her for bringing HIV to his life and countries with high HIV rates. Consequently, these services are often characterized Thi Hue, a 26-year-old who contracted HIV from her A funding shortfall of $2.1 billion has become the greatest began to physically abuse her. (ICW/IPPF, Dreams and Desires, 2004). by a narrow range of services, poor integration with other HIV services, low quality husband, in 2003 founded Haiphong Red Flamboyant. challenge to the progress of the Global Fund to fight AIDS, of client-provider interaction, high levels of stigma and discrimination, and limited Many women have participated in the group since its TB and malaria, according to fund official, Brian Brink. The ASubjected to endless beatings and unprotected sex, the woman left her husband, access, particularly by vulnerable groups such as IDUs, sex workers and MSM (men founding, and its success has spurred similar groups Global Fund is dependant on getting enough money to meet despite the cultural disgrace and shame. Three months later, hospitalized for the who have sex with men). in the country. Hue, who receives small grants from its obligations, and that money until now has come mainly 10 removal of a cervical cyst, she learned that she was pregnant again. Not wanting international aid groups, works for the local Communist from governments in developed countries, he said. Brink is to have a child at this stage, the young woman requested the pregnancy to be Efforts to operationalize SRH programs for PLHIV are fundamentally inhibited Party’s women’s union to expand support groups across hoping for increased fund raising from private sectors, such as

20 terminated. The doctors agreed on the condition that she consent to being sterilized. by distinct funding and administrative mechanisms that reinforce separateness the city. Bono’s Product Red Campaign, as well as funding from governments in the Middle She had no other option, and for three days, endured the judgmental attitude of the through discrete reporting requirements for monitoring, evaluation and funding — New York Times, May 28 East, Russia and China. The Fund is now considering Round 6 of grant proposals health-care staff, while she waited for the procedure to be performed. accountability. Even within departments such as maternity services, staff of and has until November to raise the necessary donations, with only $200 million 30 antenatal, labor, delivery and postnatal wards often do not communicate across CENTRAL AND EASTERN EUROPE pledged to date, leaving a $900 million shortfall. In this article, we examine the experiences of PLHIV accessing SRH services and units and rarely beyond related out-patient units such as family planning, antenatal, the wide range of quality, resulting from weak or absent political will, to protect the postnatal and child health. In addition, lack of orientation among staff to seeing Russian Health Officials Concerned Over HIV Spread —U.N. Integrated Regional Information Network, June 29 40 rights of PLHIV. Innovative examples of what is possible are also featured showing the value of and learning how to collaborate with related units further impedes Russia’s chief physician, Gennady Onishchenko, expressed concern about the spread that a rights-based approach to quality sexual and reproductive health (SRH) integration, another major problem where communication between HIV and family of HIV among women and mother-to-child transmission of the virus. He said that FDA Approves Bayer’s Automated HIV/AIDS Test

50 services can be a reality where there is strong commitment and collaboration. planning providers rarely occurs. more attention needs to be paid to methods of transmission, and that the issue is Bayer announced the receipt of FDA approval for its automated HIV test, which expected to be discussed at the G8 summit taking place in July in St. Petersburg. detects all known types of the virus. Called EHIV, the test detects antibodies to ARV Accessibility Increases the Need for Sexual and Reproductive Health In Brazil, Ethiopia and Ukraine such services are often restricted to a single focus on He also urged civil society to participate more in efforts to combat HIV/AIDS. HIV 1, HIV 2 and a subtype of HIV 1 in human serum and plasma. The EHIV test

60 With care and treatment becoming more accessible in many countries, women, men pregnancy prevention, omitting the concept of dual protection or counseling on safe Russia estimates that the official number of people living with HIV/AIDS in the is the first fully automated HIV test. It eliminates manual labor and produces more and young people are regaining their health, living longer, and planning for their parenthood or STI/RTI prevention and cancer screening. Providers often recommend country is 334,000, but UNAIDS says it is about 900,000, and other experts say accurate results. futures, which includes decisions about their sexuality and the possibility of starting condoms only, without thinking about broader contraceptive needs. Providers are the number likely is more than 1 million with injecting drug users accounting for a —AP/Houston Chronicle, June 21 70 or expanding a family. They are struggling with a substantial number of SRH issues, also largely unaware of important implications of potential drug interaction between large proportion of infections. such as repeated requests to disclose their HIV status, HIV discordancy, safe sex ARVs and hormonal contraceptives which can influence contraceptive decision- —RIA Novosti, June 8 California Could Lose Millions in CARE Act Reauthorization

80 strategies to prevent STIs/RTIs, re-infection, or infecting partners, family planning, making of PLHIV. For example, in one study nevirapine was found to reduce the The Senate Committee on Health, Education, Labor and Pensions in May voted pregnancy and gender-based violence. blood level of a progestin by 18 percent, although most providers do not convey this World Bank, Ukraine Working Group on TB, HIV/AIDS Project 19-1 to approve a bill to alter the Ryan White CARE Act by allocating more federal information to clients. Ukraine’s Ministry of Health and the World Bank have announced the establishment HIV/AIDS funding to southern and rural states. If the measure becomes law, San

90 While societal constraints limit the sexual and reproductive health and rights of the of a working group to address the resumption of a project aimed at combating HIV/ Francisco could lose one-fourth of the $28 million in CARE Act funding it receives population at large, the rights of PLHIV are often overtly and flagrantly violated by PLHIV have reported numerous problems associated with provider attitudes and AIDS and tuberculosis in the country. The World Bank in April announced it was annually; the Sacramento region could lose all of its $3 million in federal funding, archaic laws, policies and harmful cultural practices. These include criminalizing beliefs. Some test women without prior informed consent and share the results with suspending the project because of the government’s failure to launch the program and according to local officials. Federal funding for HIV/AIDS programs in Orange

100 sexual behavior on the basis of HIV status, penalizing HIV-positive individuals who family members rather than the clients themselves. Other providers pressure women distribute funds. The program was aimed at providing funds for medicines, training County could decrease from $4.8 million to $1 million within five years. “We will wish to marry and start a family, and requiring injecting drug users (IDUs) and to undergo abortion and sterilization and direct counseling toward limiting choices for health-care workers, and other prevention measures. It was targeted at high-risk not even be able to cover our basic medical care needs,” Fleming said. “That’s how commercial sex workers (CSWs) to provide personal information or register with about contraceptive use and infant feeding. They have been known to deny care groups such as injection drug users, commercial sex workers, and prison inmates. devastating it is.” the government before receiving services. altogether to HIV-positive patients because of stigma-based fears of occupational Last month, the health ministry agreed to meet all of the bank’s requirements for —Los Angeles Times, May 31 exposure during invasive procedures, such as delivery. An assessment of staff restructuring the project so that the suspended funds will be restored. In addition, stigmatizing and discriminatory attitudes and behaviors of health attitudes in a Ghana family planning-ART integration pilot, by EngenderHealth —Ukranian News, June 5 Black Church Leaders Promote Preaching About HIV/AIDS Testing providers, employers, family members and friends often results in misinformation and Family Health International (FHI), found consistent attitudes that PLHIV At the Clergy Leadership Summit on HIV/ AIDS in Washington, D.C., preachers and in violations of the rights of PLHIV. For example, in Ukraine, health providers should (a) no longer have sex, (b) not have any children, and (c) use condoms LATIN AMERICA AND THE CARIBBEAN were encouraged to discuss HIV testing as well as ways to reduce stigma. Washington, may refuse services to individuals known to be, or are suspected of being, HIV- only. PLHIV desiring children are considered by some providers as being selfish, not D.C., has the highest rate of new AIDS cases in the country, and the majority is positive. In many countries where health insurance is tied to employment, the taking into consideration the burden on the orphaned child and those to assume the AIDS-Related Illnesses Leading Cause of Caribbean Deaths among blacks. Of the district’s more than 500,000 residents, an estimated one in 50 refusal to hire and/or the dismissal of HIV-positive individuals violates their rights, role of parent. Such health-system discrimination – which also violates health-care The 2006 UNAIDS Report on the Global Epidemic revealed that AIDS-related is living with AIDS and one in 20 is HIV-positive. The Rev. Christine Wiley of the compromises their financial independence and negatively impacts their ability to principles of clients’ rights to confidentiality and privacy, access to information, and illnesses are the leading cause of death for people ages 15 to 44 in the Caribbean, Covenant Baptist Church said her church offers weekly HIV testing and distributes access basic SRH services. respect – has discouraged some people living with HIV from accessing services. accounting for 27,000 deaths in 2005. According to the report, the Bahamas, condoms, adding, “The black church is more willing than it’s ever been to deal Barbados, the Dominican Republic and Haiti “dented the progress of HIV;” with this.” Also at the meeting, Marsha Martin, director of the district’s HIV/AIDS Inscribed in numerous international treaties and conference platforms – such as Appropriate counseling skills often fail to surface, either through lack of training, however, Guyana has a “serious epidemic underway.” The Caribbean remains Administration, announced the city’s plans for a campaign to get residents aged 14 those of ICPD (International Conference on Population and Development) and provider biases, and/or unsupportive service delivery systems, e.g., no privacy for the region most affected by HIV/AIDS after sub-Saharan Africa, according to the to 84 to be tested for HIV by the end of 2006. Beijing (the Fourth World Women’s Conference) – reproductive rights agreed to by in-depth counseling. Provider training in counseling skills rarely includes basic report. UNAIDS estimates that at the end of 2005, 330,000 HIV-positive people —Washington Post, May 30

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LOW ODD GHC PAGE 4 BLACK CYAN MAGENTA YELLOW PAGE 25 LOW ODD GHC PAGE 24 BLACK CYAN MAGENTA YELLOW PAGE 5

A mother with her baby, receiving sexual and reproductive health services.

AFRICA the number of people receiving antiretroviral drugs and focus more on the quality and sustainability of the service. “These numbers mean nothing when Uganda Officials Charged with Pocketing the majority of the patients are skipping or selling drugs,” he said. “The fight Global Fund Dollars against HIV/AIDS must be coupled with the fight against poverty.” Ten of millions of dollars in grants from — Inter Press Service, June 2 the Global Fund to Fight AIDS, TB and malaria allegedly have been siphoned off by HIV Prevalence of Ethiopian Women above General Population top officials, their relatives and colleagues HIV prevalence among women is higher than that of the general population information on sexuality, exploration of their own sexuality, and in Uganda. The money has reportedly gone in Ethiopia, Health Minister Kebede Worku said. According to the national practice of how to help clients enjoy safe and satisfying sexual into charities that exist only on paper and surveillance report, 5 percent of women in the country are living with expression. Counseling skills training rarely helps providers move into personal bank accounts of government HIV, compared with 4.4 percent of the general population. Biological from providing information to tailoring it to fit clients’ desires or employees. Jim Muhwezi, the former health vulnerability and low socio-economic status account for this. Of the 35,000 needs. 2 minister, along with two other senior health HIV-positive people receiving antiretroviral drugs from the government officials are at the center of the controversy since January 2005, 46 percent are women. Government statistics Many PLHIV report that health providers offer insufficient or

3 for reportedly creating a new organization estimate that about 1.6 million people in Ethiopia are living with HIV/ incorrect information to make informed SRH decisions. They within the health ministry, known as the Project Management Unit (PMU), which AIDS, but some local and international NGOs put the figure at about 3 million. are often urged by providers to avoid sex because it will worsen funneled $47 million from the fund to about 400 private NGOs. A 10-month — SAPA/ Mail and Guardian, June 1 their condition and PLHIV report feelings of guilt over having

4 investigation was carried out and a final copy of the report in being prepared for sexual desire as well as frustration due to resistance from their public release. Kenya Improving Access to PMTCT partners to cooperate in abstaining or limiting forms of sexual — The Washington Times, June 16 Kenya has increased access to prevention of mother-to-child HIV transmission interactions as they were so advised. Consequently, PLHIVs’ 5 services (PMTCT) over the last five years, to between 40 and 50 percent. Robert Avisi inability to adhere to providers’ instructions creates additional Africans More Open about HIV/AIDS of Kenya’s National AIDS and Sexually Transmitted Infections Control Program barriers to continuity of care as users seek to avoid shaming and Following a recent trip to Africa, UNAIDS Executive Director Peter Piot reported said the government has trained thousands of health workers and traditional birth disrespect by providers’ negative attitudes and inappropriate that people there are becoming more open about HIV/AIDS, greatly helping to attendants, (TBAs) on prevention techniques. The government is also encouraging interactions. PHOTO BY BETH WEINSTEIN / ENGENDERHEALTH reduce the stigma surrounding the virus. “I have met people opening up and living TBAs to help reduce the stigma surrounding the virus so that women will understand

10 positively with HIV, not only in Malawi, but in T anzania [and] Mozambique,” Piot and follow the best choices in infant feeding. Despite these efforts, Kenya has failed A Provider Perspective said. “This was not the case two years ago.” Piot said Malawi is an example of how to meet the 2001 UNGASS goals of ensuring access to PMTCT services for 80 Providers acknowledge their discomfort with, and a lack of a developing country can implement effective HIV transmission prevention and percent of pregnant women worldwide. Officials cite a lack of participation among proper knowledge about, sexuality issues that are so crucial to

20 treatment programs. The country’s HIV prevalence has decreased from 16 percent men in the health of women and infants as barriers to PMTCT efforts. good SRH care and support. A situation analysis of voluntary in 2004 to 14 percent in 2006, while the number of people receiving antiretroviral — Irin News, May 24 counseling and testing (VCT) and family planning services in drugs has increased from fewer than 4,000 in 2004 to almost 50,000 South Africa revealed that the vast majority of providers in 30 in 2006, and about 500,000 people in the country have been tested ASIA KwaZulu Natal provided only general counseling on methods for HIV. and largely neglected “sensitive issues” at all, especially those — Reuters, June 15 India Pushing to Increase HIV/AIDS Awareness related to HIV. They might promote condom use but would not 40 Some 100,000 Indians with HIV will be provided go into more nuanced discussions related to sexual scenarios or MTCT Second Leading Cause of HIV in Uganda free antiretroviral drugs by early 2007, Indian condom negotiation.

50 Mother-to-child transmission is the second most common means of officials said. Under a program which began in 2004 HIV transmission in Uganda after sexual intercourse, researchers and has already treated 35,000 people, the drug will While abundant literature documents violations of the rights of said. At least 20,000 HIV-positive infants are born annually, be made available to another 50,000 affected people clients, the needs of providers and the barriers that hinder them 60 indicating an HIV-positive pregnant woman’s risk of transmitting the and a further 15,000 by the beginning of 2007. The from doing their jobs are frequently ignored, including weak virus to her infant increases if she is living with malaria or syphilis. head of India’s National Aids Control Organization health systems, poor training and a supportive supervision structure. Providers New resources “That is why pregnant mothers with HIV should test for malaria (Naco), Sujata Rao, said India’s records showed that living with HIV are also often denied employment, health insurance, housing, and/ CHANGE’s HIV and Stigma Curriculum: Understanding and Challenging HIV 70 and syphilis and get treatment to reduce the risk of infection of the 5.2 million people in the country were infected with or other social benefits because of their serostatus. Stigma: A Toolkit for Action was designed to deepen the understanding of stigma, child,” researchers said. HIV, not the 5.7 million estimated by UNAIDS. UN address how gender affects stigma and discrimination, and facilitate processes

80 — New Vision, June 12 estimates were based on “different methodology,” Effective Practices Using a Rights-Based Approach to SRH for PLHIV to address these issues. EngenderHealth’s Client Oriented Provider Efficient she said, because the UN surveys had included the Despite formidable barriers to SRH care for PLHIV, many countries can cite promising (COPE) quality improvement approach, includes a training curriculum on reducing entire population for the first time. “We will study their assumptions,” she said, interventions that address the SRH needs and respect the rights of PLHIV stigma and discrimination in health facilities. EngenderHealth, ICW and UNFPA

90 African Nations Develop Generic Drug Factories adding that India’s AIDS control program was focusing on increasing awareness of collaborated to develop a comprehensive training and programming manual, SRH Ugandan drug importer, Quality Chemicals, in a joint venture with Indian the disease among students and through the media, and how to prevent it. “Once Special studies in collaboration with positive women for HIV Positive Women and Adolescents Girls, which is guided by a rights-based pharmaceutical company Cipla, plans to manufacture ARVs in the capital, Kampala, people know that AIDS is treatable, although not curable, it will reduce the stigma The International Community of Women Living with HIV/AIDS (ICW) undertook approach to client-centred care.

100 starting in June 2007. “It’s a huge thing, the business of local production and it’s and discrimination associated with the disease,” she said. a participatory research and advocacy project designed by and for HIV-positive becoming really hot on the African agenda,” said Dr. Mohga Kamal Smith, health —BBC, July 3 women, to document and assess their reproductive health experiences and needs, A rights-based approach can provide a framework for empowering individuals in policy adviser at Oxfam, which campaigns for affordable access to medicines. The and to foster advocacy efforts based on the research results. HIV positive women communities, improving practices in service delivery, and goes a long way toward boost in local production in more countries is driven by the increasing unreliability of Chinese Phase I Clinical Trial of HIV Vaccine Concluded are actively involved in the Ukraine’s studies focused on existing operational policies holding governments accountable. EngenderHealth, ICW, IPPF,GNP+, WHO, affordable and effective medicines. Since the supply of cheap, generic Indian drugs Researchers in China feel confident that their AIDS vaccine is safe after concluding pertaining to family planning and HIV/AIDS that will inform the country’s new UNAIDS, UNFPA and Young Positives are currently developing a rights-based has dwindled in the last year since India tightened up its patent laws to comply the first of three clinical trials. The trial participants, ages 18 to 50, were given National Reproductive Health Program. SRH package for PLHIV, including policy, health systems and advocacy guidance, with the World Trade Organization, African nations are seeking ways to produce either a single experimental HIV vaccine or a combined vaccine between March to support national governments, donors, NGOs, CBOs/FBOs, PLHIV networks, the drugs for themselves. Countries such as Ethiopia, Tanzania and Ghana are also and October 2005. “Currently, data based on clinical observations have shown Government-civil society collaboration to link HIV/AIDS and SRH/family planning and women groups in addressing the SRH needs of PLHIV. considering developing their own generic drug plans in an effort to quell the HIV/ everything is normal,” said Chen Jie, deputy director of the country’s Center for In Brazil, Ethiopia and Ukraine, EngenderHealth and UNFPA, in collaboration with AIDS epidemic by providing greater access to cheaper ARVs. Disease Control. The Ministry of Science and Technology and the State Food and the local ministries of health and PLHIV networks, are integrating a basic package A rights-based approach calls on the international community, national governments — BBC News, June 8 Drug Administration will decide whether to go forward with a Phase II trial based of SRH services for HIV-positive women in HIV/AIDS programs. In Ethiopia, and localities to not only empower PLHIV against AIDS-related stigma and on an assessment of the Phase I trial including immunization procedures, appropriate Pathfinder has focused on integrating HIV/AIDS with SRH through community- discrimination, but also to establish and expand the range, access and quality of Kenyan PLHIV Selling Their ARV Drugs dose level, and safety of the vaccine, and whether the trials are meeting China’s based reproductive change agents, who within their SRH role also identify PLHIV, SRH information and services. Working toward a rights-based approach for SRH HIV-positive people in Kenya are selling their antiretroviral drugs to buy food, with clinical research safety standards. orphans and vulnerable children (OVC), distribute HBC Home bases care kits, of PLHIV will save lives, help to end stigma and discrimination, and benefit both some people registering at more than one treatment site to obtain extra drugs for —Xinhua/People’s Daily, June 11 provide referrals for HIV/AIDS services, and reinforce behavior change messages. PLHIV and the general population through the provision of quality SRH care. sale, said Patricia Asero of the Kenya Treatment Access Movement. These trends have raised concerns about drug-resistant strains developing in Kenya. The number HIV/AIDS Will Cost China $40B over Next Five Years Linking ART and SRH For further information, contact: Paul Perchal at pperchal@engenderhealth.org of people receiving the drugs has increased from 24,000 in 2004 to 39,000 in Over the next five years, China’s economy is projected to lose $40 billion due to ART programs are ideal sites for linking HIV and SRH services, such as gynecological 2005, and an expected 95,000 people in 2006. Omu Anzala of the University of lost labor as people become sick or die from HIV-related illnesses. According to care and screening for gender-based violence. In Ghana, EngenderHealth and FHI Nairobi’s School of Medicine said the government should be less concerned with Zeng Yi, an official from the Ministry of Health, HIV/AIDS will cost $2 billion in are integrating family planning interventions in ARV treatment and care programs. 24 | Global AIDSLink Global AIDSLink | 5