HIV/AIDS Prevention
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Posted August 7th, 2008 by New Tactics
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August's featured online dialogue focused on HIV/AIDS Prevention. The New Tactics project decided to keep the momentum going from the International HIV/AIDS Conference held in Mexico City this month, by hosting this important dialogue on HIV/AIDS Prevention tactics. It's not too late to join our dialogue practitioners working in this field and share your experiences, challenges, successes and questions as well as gain ideas and tools to apply to your efforts.  

Our featured resoure practitioners include:

  • Sarah Kalloch of the Physicians for Human Rights (PHR) (USA)
  • Dr. Syed Asif Altaf of the International Transport Workers Federation
  • Nathalie Applewhite of the Pulitzer Center on Crisis Reporting (Jamaica and Haiti)
  • Pablo Frisch of Intercambios Asociación Civil (Argentina)
  • Lorraine Teel and others of the Minnesota AIDS Project (USA)
  • Lucrecia Jose Wamba of the Southern Africa AIDS Trust (SAT) (Mozambique)

Click here for biographical information on this month's featured resource practitioners.

Summary of dialogue

Introduction: HIV Prevention and Human Rights

In a context of huge social inequality, income disparity and poverty, drug users are extremely vulnerable in terms of human rights, experiencing social marginalization, discrimination, stigmatization, and deprivation of rights. Intercambios, works to reduce the adverse consequences of drug use, mainly the risk of HIV infections, and to ensure users have access to information and protection against abuse by police officers and health care providers.

More broadly, the Physicians for Human Rights believes that human rights are absolutely central to HIV prevention and every facet of the epidemic. In particular, women rights are crucial, notably the right to education, employment, inheritance, health care and reproductive health services. Prevention is about the right to information. However, physicians and activists who work on HIV prevention remain at risk of persecution – a case in point is that of two Iranian doctors who worked on harm reduction and who were detained in Iran in 2008.

Community Capacity-Building, Outreach and Education

Communities have the potential to tackle HIV and AIDS. Through mutual support and solidarity amongst community members they can come up with strategies to respond to the challenges brought by HIV/AIDS, just as they in the past with other challenges. At the same time, it is important to reach at-risk communities where they are and to reach and test those individuals who would otherwise not have access to testing.

Community capacity building is a key tool of harm reduction programs. Each community has its potential to develop effective networks and these kinds of programs can have strong political consequences in terms of local empowerment and creating bigger networks of social inclusion which go beyond the strictly sanitary field. That is where their potential resides. As it is crucial to adapt to the local context and needs of a certain community, each program is inevitably different.

Raising Awareness

Video can be a most effective tactic in raising awareness of an issue. The Pulitzer Center in the Caribbean created two videos focusing on the stigma and discrimination associated with the HIV epidemic and having a positive outlook on life with HIV. Putting a human face on these issues, is by far the most critical "value added" that video offers, helping others relate to those who are HIV positive, challenge stereotypes and create a window into larger more complex issues. Using video for their HIV projects was part of Pulitzer’s overall approach to raising awareness of under-reported issues by engaging the audience through every platform possible. In another project, Heroes and Hope, Pulitzer targeted different groups for “heroes” and for “hope”. While it is challenging to measure impact with media and education they did have some success stories - grants, people stepping forward to help/speak about HIV, increased reporting by journalists on the issue and discussions in schools.  Many things need to be kept in mind, however, when deciding to create a video of this nature, as discussed in the online dialogue on Video Advocacy.

Pictures too may be a helpful tool in raising awareness of HIV/AIDS, stimulating and facilitating discussions on issues surrounding the epidemic. One organization, Humilza, collaborated with a local artist in Tanzania to produce paintings in a traditional style using animals instead of pictures. It is hoped that this tactic will reduce stigma in the country.  Another tactic that has been used involves real people being photographed and then asking the question: “Am I [HIV+]? Are you?... You can’t tell by just looking”.

Finally, sport, especially soccer, has been used to raise awareness and prevent HIV/AIDS. Soccer players are worldwide role models and can have a significant influence on youth.

Treatment, Care and Support

In Zambia, a book was produced by HIV+ parents with the aim of of supporting parents to disclose their status to the children and hopeful increase levels of community treatment literacy and to improve adherence to ARV drugs.

In Minnesota, the Minnesota AIDS Project AIDSLine is this state’s information and referral service for both HIV prevention and services. It accomplishes this through a variety of programs and interventions, one of which is the “Quick Connect Program” which offers short-term, face-to-face assistance for people living with HIV.

Advocacy

In the 1990s there were no clear laws in Minnesota on the sale and possession of syringes, leaving pharmacists to use their discretion on who to sell to. This often lead to discrimination against younger people and those of color. Syringe exchange programs sprung up and the MN Department of Health attempted to clarify the law and allow for the legal sale. Despite much opposition, a law was passed allowing the sale of up to 10 syringes, with criminal charges for those individuals caught in the possession of a used syringe with residue of a hard drug.

The Physicians for Human Rights launched the Health Action AIDS Campaign (HAA) in 2002 to bring together infectious disease experts, medical and public health students, researchers and AIDS activists to advocate for science and human rights based response to the epidemic. Since then, PHR has used three advocacy tactics to get HIV prevention to the forefront of community and policy maker minds:

  1. an annual summit in Washington DC on a particular topic - including women and AIDS (2007) and IDU and harm reduction (2006)
  2. town hall meetings 2-3 times a year with colleague organizations like the Minnesota AIDS Project, students, health professionals, people livings with HIV/AIDS, community organization, media and the general public
  3. annual AIDS Week of Action to raise awareness and take action on critical AIDS prevention, treatment and care issues.

Using both a top-down and bottom-up approach broadly educates not only the policy-makers, but also their constituents on the ground in order to hold them accountable and responsible for their decisions regarding HIV/AIDS policy

Intercambios thinks criminalization is one of the biggest obstacles that drug users face. Since 2003 they have organized and promoted the National Conference on Drug Policies in Argentina. Advocacy has brought them good results - in 2008, the Argentine national government publicly announced deep compromise with the modification of the current legislation in the direction Intercambios had been pointing for more than 13 years.

Measuring Impact

The Minnesota AIDS Project has worked to prevent new HIV infections among men who have sex with men since the epidemic came to Minnesota in 1983.  The PrideAlive program is designed to create a community of gay and bisexual men who maintain and advocate for health-promoting choices for themselves, peers and community affected by HIV, by confronting social issues including homophobia, HIV/STD prevention and health disparities. Between 2003 and 2008, PrideAlive reached almost 90,000 people through programming and community outreach, held almost 1000 educational trainings, social events, and safer sex workshops for MSM and distributed more than 100,000 condoms, lube and dental dams. In addition, 950 people have used PrideAlive’s HIV counseling, testing and referral services.

The global transmission of the HIV/AIDS for the past two decades has coincided with the current period of economic globalisation, making HIV a workplace issue and a trade union issue. As it reaches epidemic proportions in heavily affected regions, it devastates the economy and market, as is being witnessed in sub Saharan Africa. While the transport sector plays an important role in the economic and social development of a country, it also plays a role in HIV/AIDS transmission. Since the late 1980s, International Transport Workers Fedetation (TF) has been actively involved in HIV prevention programmes for different sectors of transport workers, by bringing HIV/AIDS into the mainstream of transport unions; project activities that support and coordinate transport unions’ interventions in awareness raising, negotiate collective bargaining agreements and workplace policies on HIV/AIDS, lobbying national governments and international institutions, and providing treatment and care for already infected workers; and ensuring that the lessons learnt are captured, shared and used by affiliates to defend and improve the rights and conditions of transport workers.

It is now well recognized that to gain the upper hand against the AIDS epidemic, community and membership organisations such as trade unions need to be involved in an active way. HIV/AIDS interventions that have proved to be successful are successful only because comprehensive local responses were developed and a broad mobilisation of civil society organisations took place. To control the HIV/AIDS epidemic among international drivers and helpers, it is very important that unions and employers work very closely in consultation with other relevant stakeholders.

Resources

Introduction

Community Capacity-Building, Outreach and Education

Raising Awareness

Treatment, Care and Support

Advocacy

  • MN Department of Health Syringe/Needle Access Initiative   
  • Physicians for Human Rights Proven Advocacy Tactics
  • Intercambios articles (Spanish) 
  • The International Transport Workers Federation HIV/AIDS Prevention Programmes
    • Related New Tactics Resources
    Related Tactical Notebooks: 
    Engaging Key Stakeholders: Ensuring the right to HIV/AIDS education and health care services
    Lorraine Teel's picture

    Advocacy to change laws regarding syringes

    Submitted by Lorraine Teel on Wed, 08/20/2008 - 12:26.

    In the United States the sale and possession of syringes was treated differently state to state and often even with states, city to city. In Minnesota, in the 1990's the laws regarding the sale and possession of syringes was a bit unclear. State laws "allowed" for the pharmacist to use discretion in regards to the sale of syringes. In other words, if the pharmacist thought, or knew, that you were diabetic or had another condition requiring injections, they would generally sell syringes to you, no prescription required. For example, if you purchased your insulin at that pharmacy, you could easily purchase syringes. If, on the other hand, the pharmacist "suspected" that perhaps you were purchasing syringes for illicit purposes, e.g. to inject non-prescribed drugs, s/he would more often than not refuse to sell syringes. In practicality this often translated to a refusal to sell syringes to young people and most especially those who were people of color.

    As syringe exchange programs began to spring up across the country working to make syringes available on a one-to-one exchange basis (one used syringe exchanged for a new sterile syringe), in Minnesota we attempted to clarify the law and allow for the legal sale. At that time, one other state, Connecticut, had been successful in a similar effort.

    We first worked to gain the support of a number of stakeholders that we anticpated would oppose these efforts. These included pharmacists (fearful that their retail stores / pharmacies would become havens for illicit drug users seeking to purchase syringes), leaders from communities of color (who were increasingly opposing syringe exchange or legal access to syringes on the basis that drug abuse was devastating their communites) and substance abuse professionals (who viewed those of us working to provide better access to syringes as "enablers" or indivduals who were aiding drug abusers to continue their abuse. We also had to contend of course with talk radio and other media outlets who saw this effort as an idiotic strategy that would increase the number of drug abusers, criminal acts, etc. And we naturally had an entire legislature and governor to convince.

    Ultimately what made the difference in a key way in Minnesota was grass roots organizing of all our supporters to support this initiative. Tthe Minnesota AIDS Project had already grown a statewide network of individuals who were willing to contact their local elected officials regarding HIV concerns. Letters of support for clarifying the law and allowing for the legal purchase and possession of up to 10 sterile syringes was what we were seeking. They key was sterile syringes. If someone was caught with a used syringe that contained, for example, cocaine residue, then that individual might be charged with drug possesion. We only fought for the right to purchase AND for their to be clarity on safe disposal of used syringes options.

    Most important was the story told by one constituent of a legislator uncertain how to vote. This constituent was living with HIV and had been infected through a contaminated needle used to inject drugs. He had been working on an oil rig. He was heterosexual, married and had children. His story was persuasive and we ultimately won the vote in a committee by that one legislator's vote (a 10-9 vote in our favor). The measure moved to the full legislature where we had already been working with members and also the governor.

    I will never forget what a difference that one vote made based on the one story from one person living with HIV. As a result, Minnesota now allows for the legal sale of up to 10 syringes. We also have two needle exchange programs (one mobile, one fixed site) and have never been challenged.

    For more information on the Minnesota Laws, information is available at the Minnesota Department of Health's website here http://www.health.state.mn.us/divs/idepc/dtopics/stds/mnpharmacy.html