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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:
- an annual summit in Washington DC on a particular topic - including women and AIDS (2007) and IDU and harm reduction (2006)
- 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
- 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
- Open Society Institute Publications
- General Human Rights documents published by the UN
- United Nations International Guidelines on HIV/AIDS and Human Rights
- HIV/AIDS and Human Rights in a Nutshell, paper by FXB Center at Harvard School of Public Health
- PHR’s Healthy Women=Health Rights platform
- PHR’s briefings and fact sheets on the intersection of human rights and harm reduction
- www.IranFreetheDocs.org
- WITNESS human right online channel
Community Capacity-Building, Outreach and Education
- Southern African AIDS Trust (SAT)
- Articles about SAT's work published by the Canadian Public Health Journal
Raising Awareness
- Online Dialogue on Video Advocacy
- Pulitzer Center:
- PACT website
- PACT in Botswana: HIV Peer Education Pictures
Connecting to Care
The Minnesota AIDS Project AIDSLine is this state’s information and referral service for both HIV prevention and services. The AIDSLine accomplishes this through a variety of programs and interventions. One of these is the “Quick Connect Program”.
The Quick Connect program offers short-term, face-to-face assistance for people living with HIV. This program serves an average of 200 individuals annually. Clients meet with an AIDSLine staff member to learn more about HIV and local resources (insurance, HIV medical care, financial assistance, food resources, etc.). Before the appointment, clients complete a phone screening. Staff uses the data from the screening to help tailor the information and referrals given to the client during the appointment. The majority of the clients seen in Quick Connect are referred to programs for long-term support such as HIV Case Management.
In the process of the appointment, staff will assess the client’s understanding of HIV and transmission risk and provide the client with more information as appropriate. If the client is sexually active we engage him or her in a non-judgmental discussion about their sexual practices and what they can do to reduce their risk of transmitting HIV to their partners or becoming re-infected with a different strain of the virus. Staff offers clients free condoms and lube to encourage safer sex practices. Our agency stocks a wide variety of condoms, including the female condom, and we work with the client to determine which product would be most appropriate for them.
One challenge we have in this program is that the clients we meet with often have multiple needs, many not related to HIV, and often are in some state of crisis. Clients who are unable to meet their basic needs, e.g. housing and food, or have just learned about their status are often unable or unwilling to discuss sexual practices in detail. When this is the case we still provide the client with material to read about transmission after the appointment if they are willing to take this. We also make sure the client understands that they can contact the AIDSLine through the phone or on-line chat service in the future if they need to learn more about safer sex practices. We have found that simply opening the door to these discussions encourages the client to continue them at a later time when they are ready and able to focus on sexual health issues. When appropriate, we will refer the client to local health education and risk reduction programs for more in-depth education regarding HIV transmission.
Similarly, if we meet with a client who is an injection drug user, we discuss harm reduction options to lessen their risk of transmitting HIV to drug partners. If they are actively using, we inform them of needle exchange programs and other area supports to ensure that they have access to clean needles.
Having frank and open sexual discussions with clients, especially those newly diagnosed, can be difficult. AIDSLine staff receives extensive training on these skills. This training includes cultural pieces to assist our staff in connecting with the diverse clientele we meet with. We have found more challenges in engaging some of the refugee populations we work with in safer sex discussions and continue to brainstorm internally and with partner agencies on best practices in this area. However, as noted above, we have found that simply informing the client that they can have these discussions with staff encourages later follow-up, often with their case manager or medical provider.
Here is a link to the section of our website that has information about the MAP AIDSLine:
http://www.mnaidsproject.org/prevention/aidsline.htm