INVITATION  AIDS ASIA e FORUM.

Hi,

If you are already a member of this FOURM please forward this message to your
colleagues who may find this FORUM useful.

[AIDS ASIA eFORUM] is an e- forum committed to the development of an Asian
perspective on AIDS prevention and care issues. HIV/AIDS does not recognize
national boundaries. As Asia- pacific countries are increasingly interconnected
through migration and trade, it is imperative to generate a regional perspective
on HIV/AIDS related issues.

A forum for critical analysis of issues, events and programs, which has
implications on, our ability to address HIV/AIDS prevention and care issues
across the region. More than 7,600 subscribers are using this FORUM.

Strategic HIV information and communication support to promote the capacity of
Asian leaders, activists and people living with HIV/AIDS, to facilitate their
engagement and networking, to highlight their experiences and the solutions they
are offering to address HIV/AIDS issues in this region.

A cross cultural discourse on issues and concerns of Asia- Pacific countries
(regions): Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China,
East Timor, Fiji, India, Indonesia, Japan, Kiribati, Laos, Malaysia, Marshall
Islands, Micronesia, Mongolia, Myanmar, Nepal, New Zealand, North Korea,
Pakistan, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon
Islands, South Korea, Sri Lanka, Taiwan, Thailand, Tonga, Tuvalu, Vanuatu and
Viet Nam will be presented and promoted on this forum.

Please review the archived messages on the following url

http://health.groups.yahoo.com/group/AIDS_ASIA/

Dr. Joe Thomas
Editor
AIDS ASIA e FORUM
http://health.groups.yahoo.com/group/AIDS_ASIA/

Dear FORUM,

This is message is a stark reminder of  the linkages o the impacts of
HIV and extreme climatic conditions.  Hope Ms. Pisani is aware of
this development and will contribute some of the proceeds of her book
to the HIV response in Myanmar.

Ms. Pisani, in the web page promoting  her book with a deliberately
insulting name -The Wisdom of Whores- to the multitude of sex workers
in Asia- ridiculed the comments on the impact of  extreme climatic
conditions on HIV vulnerably.

http://www.wisdomofwhores.com/2008/04/30/global-warming-causes-hiv/

Ignorance are ignorance, who ever may be the author of such ignorance
or whichever side of the tourist (researcher?) spectrum they come
from,. Programmes advocated on the basis of ignorance falls under the
crime of criminal negligence.

Hope, Asian Leaders are wise enough to understand the difference
between a UK journalist's travelogue and a book claiming to be
analysing policy implications of HIV response.

Anonymous

Singapore: Blood donor jailed for being HIV Positive.

Myanmar man jailed for lying about sex prior to blood donation
Posted May 15th, 2008 by Raman Iyer

Singapore - A Myanmar national was sentenced to eight months in jail
for lying about his sexual activities before donating blood
subsequently found to be HIV-positive, news reports said Thursday.

While 47-year-old Thu Ra did not know that he had been exposed to the
virus that causes AIDS, he told Singapore's Centre for Transfusion
Medicine that he had not given money or gifts to a prostitute or
anyone else for sex in the previous 12 months.

He also said on October 6 that that he had not had sex with anyone he
had known for less than six months in the preceding year, The Straits
Times said.

Deputy Public Prosecutor David Low Quan Ming told the district court
Wednesday that Thu Ra had in fact had sex with a prostitute four
months before donating the blood.

Thu Ra's lawyer Lee Terk Yang said that his client had taken leave to
donate blood with his brother, sister-in-law and four friends on his
father's 82nd birthday.

Pleading for leniency, Lee said that the potentially lethal nature of
HIV was sufficient punishment.

Judge Thian Yee Sze said said it was fortunate that the tainted blood
donation did not cause another person to be infected with HIV. (dpa)

http://www.topnews.in/law/myanmar-man-jailed-lying-about-sex-prior-
blood-donation

Anand Grover for Special Rappourter on Health for the UN Human Rights
Council.

AAeF. 28th May 2008. Prominent Indian Lawer, Anand Grover Short
listed as the Special Rappourter on Health for the UN Human Rights
Council.

Mr. Anand Grover, has been nominated and short-listed by the
Consultative Group of the UN Human Rights Council as the Special
Rappourter on Health for the UN Human Rights Council

Anand Grover,  a practicing lawyer in the Bombay High Court and the
Supreme Court of India. He has been nominated and short-listed by the
Consultative Group of the UN Human Rights Council as the Special
Rappourter on Health for the UN Human Rights Council

He is also the Director of the Lawyers Collective HIV/AIDS Unit in
India, having offices in Mumbai, Delhi and Bangalore.

He graduated from the University of Surrey with Honours in
Biochemistry in the 1973 and Graduate Certificate in Science
Education from Chelsea College, University of London in 1974. He
completed his law degree from Bombay University in 1981 and was
enrolled at the Bar in that year.

While at Surrey, he was elected as the Deputy President of the
Students Union. In that capacity he contributed to the activities of
Students Union. After he shifted to India in 1975 he worked in the
trade union movement in Mumbai as an activist and advisor. While
studying law he worked as a teacher in the Green Lawns School in
Mumbai and then as researcher in the Centre for Monitoring Indian
Economy.

In 1981 he founded the Lawyers Collective along with Ms. Indira
Jaising. In 1986 he along with Ms. Indira Jaising starting the first
law magazine in India, from the Lawyers Collective, which has
completed 23 years of publication. He is on the editorial board of
the magazine.

In 1998 he set up the Lawyers Collective HIV/AIDS unit in Mumbai and
it its Director.

In his regular practice he has taken up several cases in diverse
areas of law including constitutional, administrative, commercial,
criminal, tort, labour and industrial, family, matrimonial,
succession, trade- marks, copyrights and patent and arbitration.

He has appeared in practically all the High Courts in India and also
appears regularly in the Supreme Court of India. He has also worked
as assisting counsel in a case in the Australian High Court.

Apart from his regular practice as a lawyer he has either assisted or
argued several well known cases as lead counsel in the field of
public interest and human rights law including the Bombay Pavement
Dwellers case, several environmental cases including the Bhopal Gas
Disaster case, the Goa Zuari Agrochemicals case, sex discrimination
and sexual harassment cases including the Air India Air Hostess
cases, animal rights cases including rights of the Camel case, take
over of Management by workers cases including the Kamani Tubes Ltd
and KMA cases, the Garware Nylons case.

In the field of HIV his work has been pioneering and has many firsts
to his credit. He has argued several cases and along with the LCHAU
handled several hundred HIV advice and score of litigations all over
India.

He argued the first HIV case in India relating to the HIV activist,
Dominic D'Souza, the Lucy D'Souza case, which involved the challenge
to the isolationist Goa Public Health Amendment Act. He successfully
argued the first HIV case in India relating to employment law in the
Bombay High Court, MX v ZY. He argued the first case on blood
transfusion in the Calcutta High Court, P v UoI. Some of the other
important cases that he has argued include the Right to Marry case,
Mr X v Hospital Z, several cases relating to the rights of sex
workers, in Mumbai, Surat, Hyderabad and Goa, and the Mumbai Bar
Dancers case.

He successfully argued the first patent case before the Chennai
Patent Controller's against the patenting of the cancer drug,
Gleevec, by Novartis. He also successfully argued the landmark case
of Novartiis against the first Constitutional challenge to Section 3
(d) of the Patent Act in the Madras High Court on behalf of the
Cancer Patient Aid Association.

Currently he is arguing the challenge to the anti-sodomy law in Inida
in the Delhi High Court.

He, along with his group, the Lawyers Collective HIV/AIDS Unit,
drafted the HIV Bill at the request of the Government of India. The
Bill is under consideration with the Government of India and is
likely to be introduced in Parliament this year.

He along with the Lawyers Collective HIV/AIDS Unit have
organized "Realising the Right to Health: A Global South Dialogue on
HIV/AIDS & Access to Treatment" to bring together civil society
actors from the Global South to collaborate on issues relating to
access to treatment.

He was the member of the drafting group of the International
Guidelines on Human Rights & HIV/AIDS. Currently he is a member of
the Reference Group on Human Rights to Peter Piot, Executive
Director, UNAIDS, National Advisory Board Member of International
AIDS Vaccine Initiative, the member of the Board of the International
Council of AIDS Service Organizations (ICASO), Member, National
Board, AVAHAN, the India AIDS Initiative, Gates Foundation, a member
of the Core Group of NGOs representatives in the National Human
Rights Commission of India and the member of the National Advisory
Board on HIV and AIDS set up the Prime Minister of India.

He delivered the Dr Jonathan Mann Memorial Lecture at the
International AIDS Conference held in Toronto in August 2006. He also
delivered the Plenary lecture in the International AIDS Conference on
Narcotics and Harm Reduction in Colombo in August 2007.

Remembering HIV in cyclone response

UN Integrated Regional Information Network - May 27, 2008

JOHANNESBURG, 27 May 2008 (PlusNews) - While most of the local and
international aid workers in Myanmar are scrambling to meet the
immediate needs of 2.4 million people left stranded by Cyclone
Nargis, several organisations are working to ensure that survivors
living with HIV are included in the response.

According to the latest estimate by UNAIDS, around 242,000 people -
about 0.7 percent of Myanmar's population - are living with HIV, but
only about 1,500 of them are receiving life-prolonging antiretroviral
(ARV) treatment via a government programme. Another 10,500 people are
receiving ARV drugs from non-governmental organisations (NGOs),
mainly the international medical charity, Médecins Sans Frontieres
(MSF) Holland.

Speaking on the phone from Yangon, the country's largest city and
former capital, MSF country director Frank Smithuis said most of the
people in their treatment programme were based in urban areas that
had escaped the worst of the storm.

"We have a large programme in Rangoon [Yangon], where there are more
displaced people than dead people," he said. "There were patients who
lost their ARV treatment, or they came in with a plastic bag full of
wet  powder [from dissolved tablets], but it was easy to resupply
them with medicine. Our clinics [in Yangon] were open again by the
next day after the cyclone."

With 10,000 HIV-positive patients in Yangon alone, MSF decided to
provide all of those who made it to one of their clinics with a one-
off cash  grant of about US$10 to buy food. Anti-AIDS treatment must
be  accompanied by an adequate diet.

"It would have been too difficult to make a private assessment for
everyone, so we thought: 'let's keep it simple'," said
Smithuis. "There's plenty of rice here [in Yangon], so there's not
really a food shortage, but prices did go  up."

With assistance from the handful of international AIDS organisations
working in Myanmar - such as the International HIV/AIDS Alliance and
the  Association Francois-Xavier Bagnoud (FXB), a Switzerland-based
NGO that fights poverty and AIDS - local networks of people living
with HIV have tracked down their members and organised relief
supplies for them.

"They're very aware and experienced in community solidarity in the
face  of adversity," said Brian Williams, the UNAIDS coordinator in
Myanmar.

"They were immediately out there, spreading the word about the cash
grant and where to get more drugs." He noted that aid agencies were
careful not to add to already high levels of stigma against people
living with HIV by giving them more assistance than other cyclone
survivors.

"We're not interested in creating stand alone, vertical programmes,"
he  said. "But we do want to watch out for the reverse, that you're
not getting help because you're HIV positive and you're being
discriminated against."

Myanmar's health department reported that its methadone [a synthetic
substitute for heroin] programme for injecting drug users in Yangon
had not been interrupted by the cyclone. As many as 50 percent of
injecting drug users in Myanmar are HIV-positive, according to UNAIDS
figures  from 2003. The goal of the methadone programme is to reduce
the spread of HIV through needle sharing.

Williams said it was only a pilot programme and needed to be
significantly scaled up. "The government doesn't spend nearly enough
on health care in general," he commented. "It should be providing
more resources, but so should the international community."

In the Irrawaddy Delta, the area worst affected by the cyclone, aid
organisations who have been allowed into the country are trying to
respond to survivors' most basic needs for food, water and shelter,
but most international NGOs are still navigating government
restrictions that prevent foreign aid workers entering the country.

MSF, which already had about 1,000 employees in Myanmar, was well
placed to respond rapidly to the disaster. "We didn't have staff in
that part of the country, but we moved them there," said Smithuis.
The medical charity has delivered 1,000 metric tonnes of food, 60,000
shelters and several water treatment machines.

Despite Myanmar's relative isolation, levels of knowledge about HIV
and  AIDS are about average for the region, and the availability of
condoms had improved dramatically in recent years. "There is a
national plan here - the government considers AIDS to be a problem
and lots of NGOs are working on it," Williams said.

However, the cyclone could set back Myanmar's HIV prevention efforts.
"We're quite worried about women's protection issues," Williams told
IRIN/PlusNews. "There are a large number of homeless people living in
informal settlements, where access is quite limited and we don't know
if measures are being taken to ensure that there are secure areas for
women."

Mobile clinics equipped with reproductive health supplies, including
post-exposure prophylaxis (PEP) kits, which can prevent HIV infection
after a rape, have made it out to a few villages, but Williams said
more reproductive health services were needed.

"Like in many emergency settings, we are also worried about women who
might find themselves lacking alternatives and resorting to sex work."

http://www.irinnews.org/Report.aspx?ReportId=78433

http://www.aegis.org/news/irin/2008/IR080531.html

Call for Action: Myanmar Cyclone Nargis Emergency Response and the needs of the
People Living with HIV (PLHIV) Community


Contact: Shiba Phurailatpam, Regional Coordinator, APN+ Secretariat Office,
Bangkok. shiba@... , phone:+66 2 2591908-9

In the aftermath of the recent Cyclone Nargis that brought devastating damages
in Myanmar, the Asia Pacific Network of PLHIV (APN+) is extremely concerned
about its impact on people living with HIV and HIV prevention, care and support
efforts in the country.

An informal study recently conducted by people living with HIV in Myanmar found
that many HIV positive people are severely affected by the disaster, left
without food, shelter, clean water and medicine. Many positive people have been
placed in a situation where access to HIV medicines and treatment is extremely
difficult, thereby putting their lives in danger.

The current situation could greatly exacerbate the existing challenges in
Myanmar where basic HIV prevention, treatment and care services are not readily
available and accessible. It is important to remember that Myanmar is one of the
countries in Asia where more than 1% of adult population is living with HIV.
Disruptions in the supply and provision of HIV prevention commodities and clean
needles could put many people at risk of HIV infection.

Under the circumstances, APN+ calls the government of Myanmar, all the relevant
authorities, UN and donor agencies to ensure the following:

Adequate supply of food, water and shelter are provided to those people living
with HIV affected by Cyclone Nargis;

That health care and HIV treatments are not interrupted;
Involvement of the HIV positive community and local organisations in the
responses, in particular in the longer term planning and implementation
processes;

That the local HIV positive community is supported to be an active participant
in all community based responses focused on PLHIV;

Prevention services such as condoms and clean needles are available and easily
accessible;

Remove all restirctions of foriegn aid workers so that more humanitarian aid can
be delivered where needed.

The Asian Tsunami Study conducted by (APN+) and International Federation of Red
Cross and Red Crescent Societies (IFRC) found that HIV positive people faced
increased challenges such as illness, poverty, unemployment, psychological
trauma and discrimination as a result of the 2004 Asian Tsunami. Therefore,
disaster situation emergency responses must include comprehensive HIV treatment,
care and support and prevention services, with particular attention to the needs
and involvement of HIV positive people.

APN+ requests all stakeholders to support people living with HIV and those
working in the response to the Cyclone Nargis disaster  to ensure the
availability of HIV prevention, treatment, and care and support services in
Myanmar.

Shiba Phurailatpam
e-mail: <shiba@...>

Dear friends, partners and colleagues,

Registration for self supporting delegates for LIVING 2008: The
Positive Leadership Summit closes MAY 31. Only a few places are
remaining, so take this opportunity and APPLY NOW!

The Summit will take place at the Fiesta Americana Reforma Hotel,
Mexico City, on 31 July to 1 August, immediately before the XVI
International AIDS Conference.

LIVING 2008 builds on the advocacy agenda articulated at the
HIV+Monaco Conference (January 2008; www.hivmonaco.org), as well as
the Global Consultation on Sexual and Reproductive Health and Rights
(December 2007).

The application form and further details on the LIVING2008 Summit can
be found at WWW.LIVING2008.ORG

Deadline of submission is 31 MAY 2008, and successful applicants will
be notified at the latest by 7 JUNE 2008.

Please note that this application for participation does not include
any financial support. Applicants are expected to cover all expenses
of their participation. You do not need to submit an application if
you were awarded a scholarship through IAS to attend the Summit; this
application process is only for the self-supporting participation.

A selection committee will review all applications to ensure
geographical and linguistic distribution, gender balance,
representation of all key populations and a diversity of experiences
and backgrounds. During the Summit there will be simultaneous
interpretation from and into English, French and Spanish; whisper
interpretation will be available for Russian and Chinese.

With kind regards,


On behalf of the LIVING 2008 Partnership,

Global Network of People living with HIV/AIDS (GNP+)
P.O. Box 11726
1001 GS Amsterdam
The Netherlands
T: +31-20-423 4114
E: info@...
W: www.gnpplus.net / www.living2008.org

The exceptional argument

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/1231

In a recent article in the British Medical Journal, Roger England suggests that
UNAIDS should be shut down. Over the years, there has been much ink spilled over
the issue behind England’s argument. Are HIV and AIDS exceptional? Or instead,
is HIV and AIDS something that ought to be addressed in balance with other
health issues and within efforts to improve health care overall?

I favour the exceptional argument, largely because I view HIV and AIDS - yes, it
is a very real health issue - but on top of as well as intertwined with its
biomedical realities, HIV and AIDS is an issue of ideology. About ten years ago
an extremely astute and very cool Botswanan woman questioned my interest in
HIV/AIDS in Africa, she said: Why do Westerners care so much about HIV/AIDS when
Africans have been dying of malaria for much longer? Good point. Why such
interest?

It started with Ronald Reagan ignoring the virus because it was (predominately)
infecting gay men. Now it’s George W. Bush and PEPFAR’s over-reliance on
promoting abstinence. For these persons of power and others, part of the
motivation behind interest in HIV/AIDS is to use the virus and the disease as a
forum to spread a particular set of beliefs which in turn attempt to dictate a
conservative stance on what constitutes appropriate sexual behaviour.

It is an interest with shades of both religious fundamentalism and imperialism.
But of course, the two have a history of co-mingling, particularly when you
consider the convergence of missionaries and colonisers in Africa.

For many (myself included), in addition to addressing a health issue, interest
in HIV/AIDS in Africa (as exceptional) is to combat the ideology of Reagan,
Bush, and anyone else who narrow-mindedly thinks we actually live in (and/or
ought to live in) a world that defines mutually consensual sex as occurring only
between men and women, in one way/position, and only for the purposes of
reproducing.

There are near endless cases where this dilemma ¬ exception or folded into
something larger ¬ comes into play in our thinking. For example: Why the
exception of Africa Day? As far as I know, we don’t have days to celebrate the
six other continents.

HIV and AIDS as an issue of ideology lends insight into the importance of Africa
Day. Over the last few years the availability of HIV and AIDS medications on the
African continent has increased. But this came only after 2001 when, then
director of the US Agency for International Development (UASID), Andrew Natsios
was hesitant to implement ARV programmes on the continent. He explained his
reason to the Boston Globe and before the US Congress: Africans cannot tell
time; thus, not able to adhere to the regimen for taking the medications.

There was more to Natsios’ hesitancies (i.e., the need to improve health care
systems overall), yet his comments revealed all too common views held by some in
the United States: Africa as a homogenous continent full of folks who have not
kept up with the modern world.

Continuing to dismantle such lines of thinking is one of the many reasons there
is need to embrace the argument of exception and both critically engage HIV/AIDS
in Africa and celebrate Africa Day.

Susan Pietrzyk <spietrz1@...>

http://kubatanablogs.net/kubatana/?p=604

Dear Editor, AIDS ASIA e FORUM,

We "Ashodaya Samithi" and our project Addressing Sigma and Discrimination
Towards HIV+ Sex Workers and Sex Workers in General through Entrepreneurship is
one of the winners of the South Asian Regional Development MarketPlace 2008.

Your posting of the list of the winners of the South Asian Regional Development
Marketplace 2008 were incomplete

Since your first posting was incomplete (missing out names of nine winners) we
request you to re-post the news.

Please note that AIDS ASIA e_group has wide circulation and a complete posting
is important.

We are pasting the link once again for your ready ref.

  
http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/EXTSAREGTOPHEANU\
T/EXTSAREGTOPHIVAIDS/0,,contentMDK:21771640~pagePK:34004173~piPK:34003707~theSit\
ePK:496967,00.html

Thanks and regards
Bagyalakshmi

e-mail: <ashodayasamithi@...>

HIV-AIDS loses out in the Budget

Joe Thomas
On Line Opinion: Australia's e-journal of social and political debate.

Australia's Labor Government unveiled its first budget on May 13,
2008. The indications are clear: HIV-AIDS may not be a priority,
either domestically and internationally. This abrupt and drastic
policy shift is not based on an informed understanding of the human
security implications of emerging and re-emerging diseases such as
HIV-AIDS in the Asia-Pacific region.

The implications of Rudd Government's disengagement on HIV-AIDS
related issues in the Asia-Pacific region will have a long term
impact on the human security of this region. A carefully cultivated
Australian leadership position in HIV response in this region is at
stake. This policy shift will disempower a large section of the
Australian civil society's capacity to engage with their counterparts
in this region.

For instance, "harm reduction" policies and programs are almost
uniquely an Australian civil society contribution to the global
public health. Australian Asia-Pacific regional HIV response has
contributed immensely to the development and the refinement of harm
reduction approaches. This policy shift and its implications will be
carefully monitored by the policy analysts in this region

During the previous government, particularly during the 2005-06 Aid
Budget, Australia committed record levels of resources to overseas
aid. Australia committed to provide an estimated $2.491 billion in
official development assistance (ODA) in 2005-06.

During the previous government Australia also played a leading role
in fighting the spread of HIV-AIDS in the Asia-Pacific. In 2004, the
Australian government launched the $600 million international HIV-
AIDS strategy. In support of this strategy, funding for HIV-AIDS
activities was estimated to be about $70 million in 2005-06.

This includes a contribution of $20 million for the "Global Fund to
Fight AIDS, Tuberculosis and Malaria", as part of a $50 million,
three-year commitment to the fund. There was also a $5 million HIV-
AIDS partnership initiative to strengthen the capacity of regional
HIV-AIDS organisations through partnerships with Australian
organisations.

Australia appointed a Special Representative - an ambassador on HIV-
AIDS - to promote and co-ordinate the Australian HIV-AIDS response in
the Asia-Pacific region.

As a welcome change the 2008-09 Budget indicates the newly elected
government's ODA policy would increase to 0.5 per cent of GNI (gross
national income) by 2015-16. The new Australian government is
expected to provide an estimated $3.7 billion in ODA in 2008-09,
increasing Australia's ratio of ODA to GNI from 0.30 per cent in 2007-
08 to 0.32 per cent in 2008-09.

However, in a significant shift from the previous government's ODA
policy, HIV-AIDS does not appear in the list of the measures
contained in the new budget. Even though, HIV-AIDS still remains a
significant human security threat to several nations in the Asia
Pacific region.

The emphasis of the Rudd Government is on:

1. climate change adaptation needs;
2. establishing Australian leadership on disability;
3. eliminating avoidable blindness; and
4. improving access to clean water and sanitation.

These programs are to be promoted though addressing the Millennium
Development Goals (MDGs). Accordingly, in 2008-09 Australia will
scale up expenditure in major sectors influencing MDG outcomes,
including education (up 5 per cent), health (up 8 per cent), rural
development (up 7 per cent), environment (up 7 per cent) and
infrastructure (up 17 per cent). Assistance to help the most
vulnerable, particularly those who suffer from a disability or who
are refugees or victims of humanitarian crises, will also increase.

It appears that the ODA is also closely linked to the foreign policy
objectives. Accordingly, priority will be given to helping the
Pacific region and Papua New Guinea achieve the MDGs through expanded
assistance in 2008-09.

There is no new significant resource allocation for HIV response,
neither in the budget nor does it gives any indication abut the
possible direction of the future HIV response of Australia in Asia
Pacific region.

There is also no indication about the role of the Australian-
appointed HIV-AIDS Special Representative - an ambassador for the
future Australian HIV-AIDS response in the Asia-Pacific region.

The metal of a government's core value system could be assessed by
its response to the weakest of the weak in the society. In my recent
analysis of the Rudd Government's health policy towards Indigenous
Australians, (Public health implications of the "National emergency
intervention to protect the Indigenous children in the Northern
Territory of Australia"
http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=951 I have noticed that
they are like "old wine in new bottle".

The Indigenous health policy of the Rudd Government (initiated by the
previous government and implemented with bi-partisan support) smacks
of racism and is driven by the kind of social welfare which views
social problems as a product of pathology or dysfunction among the
members of society, rather than a product of structural
circumstances, which are part of a wider historical and social
context.

One may argue that the public health policy responses to the
Indigenous Australians are driven by the domestic politics of
appeasing the middle Australians, who grew up in the white only
Australian era with the staple cultural diet of xenophobia.

I sincerely hope, the lack of acknowledgement to the challenges of
HIV and AIDS in Asia-Pacific region in the current budget is not
driven by the values the government exhibits in its response to
Indigenous Australians.

About the Author:
Dr Joe Thomas is one of the leading social commentators on HIV and
AIDS in Asia Pacific region. He has contributed towards HIV-AIDS
related program and policy developments in Australia, India,
Indonesia, East Timor, Philippines, Thailand, Vietnam, China, Hong
Kong, Mongolia and Rwanda. He is the founding Director of the
International Centre for Health Equity Inc. based in Melbourne.
Australia.

http://www.onlineopinion.com.au/view.asp?article=7407&page=0

Chinese AIDS Activist Wan Yanhai is under Police Surveillance. What
you can do?

Wan Yanhai, Director of the Aizhixing Institute, a Beijing based
Civil Society Organisation is under police surveillance apparently as
an act of intimidation. The following is an e-mail he send out
yesterday. What you can do?

Try the following url for some lead.

http://www.hrichina.org/public/contents/article?revision%5fid=51025&item%5fid=16\
13


008/5/25 Aizhixing <aizhiaction@ hotmail.com>:

Dear friends,

Without a clear reason, police officers from Beijing Public Security
Bureau Haidian District Branch informed me in the morning of May 24
of 2008 that a police car will park outside my house and will follow
me to anywhere I will go for a couple of days. I asked why, they said
that they didn't know the reason and they were implementing the task.
They suggested that I take the police car to office or other places.
After the oral notice, I was followed by the police car to
supermarket, restaurant and office. I don't know when the police car
will leave. Please pay attention to the situation.

Regards,

Wan Yanhai, Director
Beijing Aizhixing Institute

AIZHI
http://www.aizhi.org
Box 63, Yayuncun Post Office
Beijing 100101, P.R.China

Street Address:
ZhongYu Business Garden, 12B- 2nd Floor
Room A-171, 42 Fucheng Road
Beijing 100036. China

Tel: 86-10-88114652
Fax: 86-10-88114683
Email: wanyanhai@..., hiwan@...


For background information:

http://www.hrichina.org/public/contents/press?revision%fid=49034&item%5fid=48939

Sex, drugs, and HIV/AIDS in China

Jonathan Watts. The Lancet 2008; 371:103-104
DOI:10.1016/S0140-6736(08)60087-2rt

China has made impressive strides in the past couple of years to
control the spread of HIV/AIDS but if it is to quell the new wave of
infections in the general population, it will have to confront the
country's changing patterns of sexual behaviour. Jonathan Watts
reports from Beijing.

In most of the tens of thousands of gaudy neon-lit karaoke parlours
that have sprung up around China over the past decade, customers are
usually offered three menus. The first for songs, the second for
drinks, and the third—always unwritten, and only explained to men—for
sexual services.

It is a similar story in the countless pink-lit barber shops and
massage businesses that can be seen in every town and city. In many
hotels too, single male guests can expect to be propositioned in the
lobby or by a call from the receptionist touting a special "room
service".
The rise of industrial-scale prostitution has been one of the most
visible signs of China's move from a closed, ideologically focused
state to an open, market-driven economy. Coming alongside an increase
in personal freedoms, rising affluence, the spread of the internet,
and growing curiosity about overseas norms of behaviour, it has
contributed to a far more permissive and promiscuous society than was
the case in the past. The trend is apparent not just in brothels, but
also in high schools and universities.

Until a few years ago, that might have been primarily of interest
only to moralists and sociologists, but new statistics showing that
heterosexual sex has overtaken intravenous drug use as the main route
of transmission for HIV/AIDS has suddenly made sexual behaviour a
central concern for public-health policymakers.

There was good news and bad news when the ministry of health, UNAIDS,
and WHO released their latest annual estimate for the disease last
November. Encouragingly, they believe the rate of increase slowed to
50 000 new infections in 2007, down from 70 000 new infections in
2005. Overall, they estimate China will have 700 000 people living
with HIV by the end of 2007, including 85 000 AIDS patients.

In a  giant population of 1•3 billion, these statistics suggest prevalence is
relatively low at less than one in 1000—far better than the worst predictions of
UNAIDS and others at the start of the decade.

This improvement is in part attributed to the measures taken by the
government in 2003–04 to be more open about the problem, to improve
public awareness, and to offer free testing and drugs.

The first bit of bad news is that the estimates are contentious. By
the end of October, 2006, there were only 223 501 registered cases of
HIV. The government extrapolates from this number to try to include
those who are unaware they have the disease and those who cover it up
because of the stigma attached to HIV. According to several non-
governmental organisations (NGOs), local officials in some areas
continue to massively underestimate the problem, especially with
regard to infections caused by blood-selling operations.

A more disturbing trend, according to the health minister Chen Zhu,
is that sex is now the main route of transmission. Of the new
infections this year, 44•7% were passed on through heterosexual sex,
42% from intravenous drug use, 12•2% from men having sex with men,
and 1•1 % from mother-to-infant transmission.

These figures confirm trends noticed earlier in several regions.

According to the Shanghai media, 70% of HIV positive men and 80% of
HIV positive women in the commercial capital were infected by their
marriage partners. A contributing factor, according to UN officials
and HIV activists, is that a relatively high proportion of homosexual
men in China are married and bisexual.

Hao Yang, deputy chief of the disease prevention and control bureau
under the ministry of health, told the China Daily that men who have
sex with men are proportionately most likely to become infected by
the disease. He said most had more than one sexual partner, less than
one in five used condoms, and many were married so they spread HIV to
their wives or children.

The Shanghai Public Health Clinical Center said 70% of the 77 new HIV
patients it has seen this year were young and well educated. The head
of the centre, Sun Hongqing blamed a lack of knowledge about sexually
transmitted diseases.

Yunnan Province, which is close to southeast Asia's notorious Golden
Triangle of drugs and prostitution, is thought to have been the entry
point for the disease in the late 1980s. Studies there on different
strains of HIV by researchers from the Rockefeller University and the
Aaron Diamond AIDS Research Center suggest that the virus may be
spreading through sex more quickly than previously believed. Yunnan's
provincial government has been among the most proactive in countering
the disease through public education, cooperation with foreign NGOs,
and the provision of free condoms in all hotel rooms.

In April, 2007, Beijing city government declared a "new phase" in the
spread of HIV/AIDS, and pointed to sex as a rising cause of
transmission among the 12 000 people in the capital with the disease.

Another important factor was the huge migration of rural workers into
the city. The municipality said four of every five cases occurred
among migrants. Anticipating further increase, the government said it
will set up a monitoring network, as well as AIDS prevention clinics
in each of the city's 18 districts before the end of 2008.

In Sichuan, the provincial Center for Disease Control and Prevention
told the local media in November last year that HIV was spreading
from high-risk groups to the general population. In the past, it said
the sharpest rises in cases were among drug users and sex workers,
but recently it was finding more infections through physical
examinations of pregnant women, government officials, and young army
recruits. Officials blamed the increase in early and casual sex,
noting that young and promiscuous people are the least likely to use
condoms.

It was a similar story in the central province of Hunan, which
announced plans this summer for compulsory HIV tests for all workers
in recreation venues, such as karaoke parlours. According to the
local media, drug users account for most HIV cases, but the sharpest
increase has been through sexual activity. Officials said the
percentage of HIV infections caused by unprotected sex was less than
15% before 2006, but it rose to 38•7% in the first 6 months of 2007.

Few figures are available for China's burgeoning sex industry. But
according to a study of two cities released last year by the National
Centre for AIDS, between 3•4% and 3•6% of all adult females were sex
workers. If this is the case nationwide, it would mean China has
several million prostitutes.

The rapid changes in society have been evident in several recent
surveys. The gap between the onset of sexual activity and marriage is
growing. Last year, a study of high school students revealed that
most found nothing wrong with a one-night stand. An earlier survey by
the Family Planning Agency found that almost 70% of Chinese were not
virgins when they married, compared with 16% at the end of the 1980s.

But sex education is far behind the trends. The government says it
will step up its education campaigns, especially among high risk
groups. It committed 944 million yuan (US$126 million) to HIV/AIDS
work last year, up about 10% from 2006. As a sign of progress, the
health ministry says condom use by prostitutes has almost tripled
from 14•7% in 2001 to 41•4% last year.

Wan Yanhai, of the Beijing-based Aizhi advocacy group on AIDS issues,
said the government has done a lot to educate people but he wondered
sometimes whether it was sending out the right message. A couple of
weeks ago, he said, the authorities introduced a new policy requiring
all people who stay abroad for more than 1 year to have an HIV test,
which he fears will lead people to wrongly assume that HIV/AIDS is a
foreign disease.

The role of NGOs to identify such problems and offer solutions is
crucial, according to the UN. But Chinese authorities continue to
crack down on many groups that dare to criticise its handling of the
epidemic. Political sensitivities were most apparent ahead of World
AIDS Day, 2007, when a dozen HIV/AIDS patients in Henan were placed
under house arrest during a visit by Prime Minister Wen Jiabao. The
premier's trip to the area—one of the worst affected by the blood-
selling scandal—was seen as a well intentioned attempt to raise
awareness about the spread of the virus, but AIDS activists said the
visit was stage managed by local officials so that he would never get
to hear any complaints. Residents said about 1600 police had entered
the village to ensure there were no embarrassing scenes.

China has made impressive strides in recent years to control the
spread of HIV/AIDS, but if it is cope with the new wave of infections
in the general population, it will have to confront unpalatable
truths, whether in blood-selling villages or gaudy karaoke parlours.

Dear colleagues,

Today Prime Minister Yasuo Fukuda of Japan made a speech in the
symposium named "From Okinawa to Toya-ko" organized by Friends of the
Global Fund Japan, the Global Fund and Japanese Ministry of Foreign
Affairs in Tokyo and pledged 560 million US dollars in the coming a
few years after 2009 to the Global Fund.

Civil society made 2 press releases, one is from Japanese civil
society and the other is global civil society, which both show our
disappointment.

The following is the statement from Japanese civil society.

sincerely yours,

Masaki Inaba
Africa Japan Forum/Japan AIDS and Society Association

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

CIVIL SOCIETY 'DISAPPOINTED' BY JAPAN'S GLOBAL FUND CONTRIBUTION
Civil Society Response to the Japanese Contribution to the Global Fund

Project RING, Japan AIDS and Society Association
Africa Japan Forum

May 23 2008 Tokyo, Japan - Prime Minister Yasuo Fukuda announced that
today Japan would contribute a total of USD 560 Million to the Global
Fund to Fight AIDS, Tuberculosis and Malaria in the `coming few
years`. If the pledge were made for the two years of 2009 to 2010, the
Japanese contribution have increased from USD 186 Million in 2008 to
USD 280 Million in 2009 and 2010.

Yet the ambiguous time period of "the coming few years" leaves open the
possibility that the USD 560 million will be paid over 2008-2011, meaning that
the Japanese contribution to the Global Fund would not increase.

The language makes it impossible to comment on the significance of the pledge at
the time when demand has grown enormously and the contributions from other major
donors have increased significantly.

An estimated USD 15-18 billion for 2008-2010 to the Global Fund will
be needed in order to help meet internationally agreed-upon targets
such as the 2015 Millennium Development Goals and the goal of
achieving universal access to HIV/AIDS services by 2010, this
contribution is far short of the USD 1-2 billion that is Japan's 'fair
share' contribution to the Global Fund.

Donors such as the USA have consistently contributed about one-third
of the Global Fund's funding needs, and the USA represents about
one-third of GNI. On this basis, Japan, which has the second largest
economy in the world, should represent about 12% of Global Fund needs,
which is approximately USD 2.2 Billion FY 2008-2010.

Masaki Inaba from Japan AIDS and Society Association said, "This
contribution is far below what Japan should be paying. As Japan has
the 2nd largest economy in the world, Japan needs to take the
responsibility of being the 2nd largest donor.

" The Global Fund Board, with the support of Japan, recently decided, in
principle, to launch an additional funding Round in 2009, which will increase
the funding demand from countries urgently scaling up programs to fight AIDS,
tuberculosis and malaria. The Japanese government's decision not to pay its fair
share is particularly disappointing, given the increased need being expressed by
developing countries.

Disappointment was also heard from civil society in Africa. Cheikh
Tidanne Tall, Executive Director of AfriCASO said, "This unexpected
pledge from the Government of Japan creates a deep disappointment for
African CSO's; Africans being the continent which carries the largest
burden of the three diseases through the millions of men, women and
children suffering because of the lack of treatment."

Under the economic climate of decreasing ODA, civil society as well as
some members within the Ministry of Foreign Affairs has worked hard to
ensure that Japan makes a pledge today, yet as society, as government
as a whole, no one has taken the responsibility to fulfill
international promises.

In 2000, at the Kyushu-Okinawa Summit, the Japanese Government, led by
Prime Minister Mori launched the Okinawa Infectious Disease
Initiative, committed itself to the global response to the spread of
the infectious diseases.

Japan had prided itself as helping to pave the way for the establishment of the
Global Fund, as proudly announced
by Foreign Minister Koumura at a political speech in November 2007,
and reiterated by Prime Minister Fukuda's speech in the 2008 World
Economic Forum. This announcement left civil society wondering where
this commitment has gone.

(Project RING: CONTACT)
Contact: Masaki Inaba/Aki Ogawa
E-mail Address: project.ring@...
Phone: +81-90-1264-8110 (Mobile of Masaki Inaba)

Inahama Saki
e-mail: <saki.inahama@...>

Twenty-six civil society organizations from across South Asia won grants today from a US$1 million award pool funded by the South Asia Region Development Marketplace (DM) partnership. The winners received US$40,000 each to implement innovative ideas aimed at reducing stigma and discrimination associated with HIV and AIDS.

"Recognition of these kinds of grass roots organizations is very important," said Ms. Shabana Azmi, actress and social activist presenting the awards. "We have to make sure they are empowered, strengthened, and financed so they can carry out their work. This initiative is a small but very important step in the fight against stigma and discrimination."

Educating journalists about HIV and AIDS in Bangladesh, using traditional folk art to bring about behavior change in Tamil Nadu, India, and establishing youth forums on HIV at universities in Pakistan were among the winning ideas. Using DM funds, they will have up to 18 months to carry out their projects to bring about change in the attitudes and practices that undermine effective HIV and AIDS programs.

"We need to address stigma and discrimination in a big way," said Sai Paranjpye, an Indian filmmaker whose proposal won a grant to produce four short films on the different social manifestations of stigma. "As a filmmaker this grant will help me reach out to the masses to challenge many of the myths associated with the disease."

India was the most represented country among winners, with 12 of 26 winning proposals. Afghanistan, Bangladesh, Nepal, and Pakistan followed with three winning projects each. Two winning proposals came from Sri Lanka

Is poverty a driver for risky sexual behaviour? evidence from
national surveys of adolescents in four African countries

Author: N. Nadise; E. Zulu; J. Ciera

Publisher: African journal of Reproductive Health, 2007

This article, published in the African Journal of Reproductive Health
provides evidence on the link between poverty and risky sexual
behaviour. It examines the effect of wealth status on age at first
sex, condom use, and multiple partners using data from more than
19,000 adolescents from Burkina Faso, Ghana, Malawi and Uganda.

The results show that the wealthiest girls in Burkina Faso, Ghana and
Malawi have later sexual debut compared with poorer adolescents, but
this association was not significant in Uganda. Wealth status is
weaker among males and significant only in Malawi, where those in the
middle income group had earlier sexual debut. Wealthier adolescents
were most likely to use condoms, but wealth status was not associated
with the number of sexual partners.

The paper concludes that understanding patterns and motivations of
early sexual debut, non-use of condoms, and multiple partnerships is
an important contribution to HIV prevention strategies.

From this study poverty appears to influence early sexual debut,
especially among females, and the poor are less likely to be using
condoms.

Therefore, poverty, by influencing sexual behaviour and access to
services, can influence the transmission of HIV infection.

Available online at:

http://www.eldis.org/go/topics/resource-guides/hiv-and-
aids&id=37172&type=Document

Dear Members,

SALT visits in Northern Thailand (September 2008)

S is for Support...Stimulate
A is for Appreciate...Analyse...Action
L is for Listen...Learn...Link
T is for Transfer...Team

The Constellation for AIDS Competence is organizing, once again, a week of SALT
visits in Northern Thailand from 19 to 26 of September 2008. Relevant links:

1. The invitation to the SALT visits
(Online at:
http://www.aidscompetence.org/content/documents/invitation%20SALT%20visits%20200\
8.pdf )

2. A draft programme
(Online at:
http://www.aidscompetence.org/content/documents/Draft%20Programme%20for%20SALT%2\
0Visit%20-%20Northern%20Thailand%202008.pdf)

3. The report of SALT visits in 2006: One week to change our mindset
(Online at:
http://www.aidscompetence.org/content/documents/SALT%20Visits%20in%20Northern%20\
Thailand.pdf )

4. To know more about the progress of communities in Northern Thailand
(Online at: http://www.aidscompetence.org/content/0.1_phayao.htm )

Please confirm your interest at your earliest convenience with Lawan
(lawan@...) or Laurence (laurencegilliot@...). Tel: + 66 53
894 228.

Participants will have to cover their own costs. We hope that you will be able
to attend this week of inspiring visits so that we can learn from your
experience.

I am looking forward to your response.

Laurence Gilliot
Constellation for AIDS Competence
Chiang Mai, Thailand
Website: www.aidscompetence.org
Email: laurencegilliot@...



Rituu B. Nanda,
AIDS Community, Solution Exchange,
New Delhi
e-mail:  <rituubnanda@...>

Dear colleagues,

For those who have interest in media work on the coming
G8 in Japan, I send the information about NGO accreditation process of
International Megia Center for  G8 Hokkaido Toya-Ko Summit.

The application process for NGO access to the International Media
Centre at the G8 Hokkaido Toyako Summit is finally open. Please take a
look at the instruction below/attached carefully, and if you would
like access to the IMC, please act today, as the deadline is FRIDAY THE 23RD MAY
in JAPAN TIME.

Just to remind you all, the total number of NGO accreditations to be
issued by the Government of Japan is quite limited, so you may not be
able to obtain one. The process for media accreditation (issued for
journalists) is also underway at the moment (through the official
Toyako website:

http://www.g8summit.go.jp/eng/press/index.html). If you are in a
position to get a pass for journalist, then you should pursue this as well.

Should you have any enquiries, please do not hesitate to contact
Masaki Inaba (masaki.inaba@...)

Masaki Inaba
E-mail address: masaki.inaba@...
Phone: +81-3-3834-6902
Fax: +81-3-3834-6903
2nd Fl, Maruko-Bldg, 1-20-6 Higashi-Ueno, Taito-Ku, Tokyo 110-0015 JAPAN

====

Notice: regarding application for NGO accreditations for the
International Media Center, G8 Hokkaido Toyako Summit

We, the 2008 G8 Summit NGO Forum of Japan (the NGO Forum) would like
to inform our international civil society colleagues about their access to the
International Media Center (IMC) at this year's G8 Summit.

As many of you will be aware, an international media center (IMC) is
set up at every G8 Summit. This is where the media interested in the
substance of the summit will be stationed to report on the discussions among the
G8 heads of state.

For this year's summit at Toyako, Hokkaido, it will be placed at the
Rusutsu Resort, in the Village of Rusutsu.

The NGO Forum is negotiating with the Ministry of Foreign Affairs to issue NGO
accreditations to the IMC.

Since the G8 Summit is organized under heavy security, and based on
the understanding that the IMC is set up first and foremost to help
effective work by media organizations, no access to the IMC was
granted to NGOs at the last G8 summit held in Japan (Okinawa in 2000). We are
certain that will not be the case this
time round, but the number of NGO accreditations will still be limited.

The NGO Forum would like to collect applications from those of you who
wish to access the IMC, so that we can obtain information as to how many
organizations/individuals would like to get accreditations and request to the
Ministry of Foreign Affairs for their accreditations.

To help us organize this information, please observe the following criteria for
application.:

1. The objective of going to the IMC is to do advocacy and lobby work
through the media.
2. Those who have done this type of work at international conferences
in the past.
3. Those who could be at the IMC for the whole three days.
4. Those who agree to respect the rules concerning the administration
and management of the IMC, to be established by the Ministry of Foreign Affairs.

Additionally, we would like to ask those of you considering applying for an
accreditation that they consider the following information.

- Rusutsu is located two hours ride away from Sapporo and the Chitose Airport.
- It is difficult to find cheap hotel accommodations around the IMC and its 
neighbourhood.
- Transport by non-public means (e.g., rental cars) may be severely
restricted as part  of the transport restriction around the Toyako area, which
includes the Rusutsu  Report.

A shuttle bus service will be provided between the Chitose Airport and
the Rusutsu Resort by the government, but not to Sapporo, where the alternative
summit will take place between the 6th and the 8th of July. However, public bus
service will be operating between the Rusutsu Resort and Sapporo (JPY2,000 =
approx. US20).

Please also be aware that even if you do apply for an application, you
may not be issued one due to the limit to the number of NGO
accreditations to be issued.

It is our understanding that the Ministry of Foreign Affairs will
directly contact those of you who they decide to issue an
accreditation for, if and when they have indeed decided to do so, to instruct
you on the next steps (i.e., request for submission of an application form,
letter of recommendation by your affiliation, electric photo, etc.).

Application for passes to the IMC

Deadline for application: 17:00 JST, Friday the 23rd of May
Send to : imc.toya.ngo@...
2 persons per organization maximum.

Please include in your email the following information on the applicants

Name (as spelled in the passport):
Title:
Organization:
Postal Address of the organization:
Phone & Fax numbers:
Email address:
Mobile phone number:
-----------------------------------

Blood Services in Central Asian Health Systems: A Clear and Present
Danger of Spreading HIV/AIDS and Other Infectious Diseases

Patricio V. Marquez, Lead Health Specialist Europe and Central Asia
Region Human Development Unit and Central Asia Country Management Unit
The World Bank in collaboration with U.S. CDC/CAR, USAID and WHO-EURO
Global HIV/AIDS Program, World Bank â€" May 2008

Available online as PDF file [67p.] at:

http://siteresources.worldbank.org/INTECAREGTOPHEANUT/Resources/cabloo
dbankstudy\.pdf

Understanding how communicable diseases spread is key to controlling
them. Blood transfusions are a small contributor to communicable disease
transmission compared to other well-reported modes, but ensuring the safety of
the blood supply in a health system is largely within the purview of national
governments

The report discusses inter-related parts of blood transfusions
systems, and presents an overview of the parts that need to be strengthened in
Central Asia.

Numerous parts are in serious need of organizational restructuring,
new investment and increased budgetary support for operation and
maintenance.

This report sets them out such that each can be addressed in turn "
and some simultaneously. The report also discusses the health threat posed by
alarmingly low levels of blood supplies, fostered by a culture that places
little value on donating blood, public fear of being infected by giving blood,
and the near absence of donor promotion campaigns.

Evaluating communicable diseases rates in blood donors is essential
for monitoring the safety of the blood supply and donor screening
effectiveness.

This assessment found that the current screening for blood borne
pathogens of donated blood in Central Asia may be providing a false sense of
security -- the risk of receiving an infected blood unit and acquiring a
transfusion transmitted infection in the countries of the region is real.

More ominous is the fact that some health facilities in Central Asia
do not test blood donations at all. This means that the transmission risks
indicated in this study may be conservative estimates, as they are based on a
sample that excludes the blood that never reaches the existing screening systems

Content:

EXECUTIVE SUMMARY
PREFACE
CHAPTER I: THE BURDEN OF COMMUNICABLE DISEASES

CHAPTER II: WHY ARE BLOOD TRANSFUSION SERVICES IMPORTANT IN A HEALTH
SYSTEM?
A. Clinical use of blood and its products
B. Availability of blood supplies
C. Testing for blood borne infections
D. HIV infection through blood transfusions
E. Recommended strategy for strengthening blood transfusion services
F. The challenge in Central Asia

CHAPTER III: STATE OF BLOOD TRANSFUSION SERVICES AND SAFETY OF THE
BLOOD SUPPLY IN CENTRAL ASIA
A. Methodology
B. Main Findings of the Overall Assessment
1. Status of blood transfusion services in Central Asia
2. How safe is the blood supply in Central Asia ?
3. Level of infection among blood donors
4. How have governments responded to the findings of this assessment?
5. Ongoing support from international agencies

CHAPTER IV: RECOMMENDATIONS TO IMPROVE BLOOD SERVICES IN CENTRAL
ASIAN HEALTH SYSTEMS
A. Develop national blood program and improve its stewardship
B. Address chronic under-financing of blood transfusion services
C. Improve the quality of transfusion services and related medical
practice
D. Strengthen preventive public health and primary health care
programs to reduce the supply-demand gap for blood transfusion.
E. Foster regional communication and collaboration arrangements among
the Central Asian countries
F. Are these interventions cost-effective?

THE WAY FORWARD

Annex 1: Status of Health-related MDGs in Central Asia
Annex 2: Methodology for Assessing Accuracy of Blood Screening in
Central Asia
Annex 3: Questionnaire: Blood Donor Information
References


Surekha Garimella
e-mail: <garimellasurekha@...>

The 2008 International AIDS Society (IAS) Governing Council Election. The
deadline for voting is 21 May 2008

Dear AIDS ASIA e FORUM Members,

This is to remind the members of the International AIDS Society(IAS)
from the Asia Pacific region about the dead line for the 2008 IAS
Governing Council Election. The Deadline for voting is 21 May 2008.

If you have you been an IAS member for at least one year, then you
could participate in the 2008 IAS Governing Council Election.  This
time there are 3 vacant seats in Asia Pacific region. The details and
the list of the Candidates are listed at the IAS web page. The voting
can be done only through the IAS web page.

You may long on to the IAS web page and sign on the members tab at
the right hand top corner of the IAS web page.

https://www.iasociety.org/membership/gc_election/VotingSearch.aspx?member_id=115\
38

Or

http://www.iasociety.org/


2008 IAS Governing Council Election: Details of the Voting

There are 3 vacant seats in Asia Pacific region.

Kindly read the rules and instructions carefully before proceeding
with the voting.

Rules

- You can vote for a maximum of 3 candidates.

- You may vote for yourself if you are one of the candidates.
- You cannot vote for the same candidate more than once.
- You can only vote for the candidates who are listed on the IAS web.
- You can only cast your votes through the IAS website. Votes sent by
email, post, fax etc. will not be considered.

Instructions

Step 1: Click on the name of the candidate you would like to vote for.

Step 2: Click on the "Vote" button to cast your vote. You will be
asked to confirm your choice. Please note that votes cannot be
revoked.

Repeat the same process to vote for more candidates.


Thank you.

Joe Thomas

Editor
AIDS ASIA e FORUM

Myths behind AIDS might lead to billions in misspending

By James Chin, Special to The China Post

Sunday, May 18, 2008

GENEVA -- As health ministers gather for the World Health Assembly
here this week, there is one organization that can justifiably feel
smug. UNAIDS -- the U.N.'s specialist AIDS advocacy body -- has
raised some US$110 billion for the next five years: thanks to its
efforts, AIDS will shortly become the biggest single item in foreign
aid.

Raising money is the easy part. Spending it effectively is harder.
Good managers know that good policy cannot exist without accurate
data but UNAIDS has systematically exaggerated the size and trend of
the pandemic, in addition to hyping the potential for HIV epidemics
in "general" populations. While this distortion of HIV epidemiology
has been useful for raising money, it has resulted in billions of
dollars of unnecessary and misdirected spending.

Part of UNAIDS's fundraising success has been its ability to convince
donors that the pandemic is getting worse and is also a potential
threat to all people everywhere. But UNAIDS's claims are not
supported by the epidemiologic data.

This data tells us that those at greatest risk of HIV infection are:
heterosexuals and gay men who have unprotected sex with concurrent
and multiple partners, within open or overlapping sex networks;
regular sex partners of HIV infected persons; and people exposed to
HIV infected blood, such as injecting drug users.

In framing the global response to AIDS, UNAIDS has ignored this and
promoted a range of myths that have more to do with political
correctness than science.

For instance, UNAIDS claims that poverty and discrimination are major
determinants of high HIV prevalence. In 1987, John Mann, the first
head of AIDS at the World Health Organization, claimed that
being "excluded from the mainstream of society or being discriminated
on grounds of race, religion or sexual preference, led to an increase
of HIV infection," a litany uncritically accepted by UNAIDS.

All available data suggests the opposite. In Africa, AIDS is a
disease associated with wealth. The richest people in Kenya, Tanzania
and Ethiopia have HIV rates several times higher than the poorest,
probably because wealthy men and women in these countries have more
sex partners.

Poverty and discrimination present barriers to gaining access to
prevention and treatment but are not primary determinants of sexual
behavior -- the real determinant of sexual HIV transmission. The U.S.
response to global AIDS -- US$50 billion over the next five years
(held up in the Senate but likely to pass) -- is based on the poverty
principle. This mistake could lead to all kinds of mis-spending down
the line.

In a similar vein, UNAIDS has consistently claimed that the world is
on the brink of generalized heterosexual HIV epidemics. In 1997,
UNAIDS chief Peter Piot gloomily foretold that "AIDS will cut through
Asian populations like a hot knife through cold butter." Aside from a
few explosive heterosexual epidemics within large commercial sex
networks in Thailand, Myanmar, Cambodia and several states in India
in the late 1980s to early 1990s, Dr. Piot's dire and colorful
prediction never occurred.

A recent report by an independent commission on AIDS in Asia has
acknowledged that epidemic sexual HIV transmission has not spread in
Asia beyond the highest HIV-risk groups, such as gay men, injecting
drug users, and sex workers, into any general population. However,
UNAIDS's perpetuation of the myth that everyone is at risk of AIDS
has led to billions wasted on HIV prevention programs directed at
general populations and especially youth, who, outside of sub-Saharan
Africa, are at minimal risk of any exposure to HIV.

UNAIDS's proposed budget for 2008 includes US$1.9 billion for
prevention programs aimed at young people and the workplace. While
some of this will be usefully spent in sub-Saharan Africa, the rest
is effectively wasted.

At least US$5 billion has been wasted in this way in the last five
years. Meanwhile, to the shame of the global health bureaucracy, a
handful of diseases that are relatively inexpensive to prevent or
treat -- several vaccine-preventable diseases, diarrheal diseases,
malaria and some acute respiratory infections -- continue to account
for about four million annual child deaths globally.

UNAIDS is apparently concerned that support for AIDS programs might
be reduced if most regional HIV rates are stable or decreasing and
HIV remains concentrated in the highest-risk populations.

These are realistic concerns but global and regional HIV rates have
remained stable or have been decreasing during the past decade; HIV
continues to be concentrated in populations with the highest levels
of HIV risk behaviors; and HIV is incapable of epidemic spread in the
vast majority of heterosexual populations.

Continued denial of these realities will further erode whatever
credibility UNAIDS and other mainstream AIDS agencies and experts may
still have, and will seriously damage the future fight against this
disease: let's face the data and put the money where the real
problems really are.

James Chin, a former chief of the surveillance, forecasting, and
impact assessment unit of the Global Program on AIDS of the World
Health Organization, is clinical professor of epidemiology at the
School of Public Health, University of California at Berkeley. His
monograph The Myth Of A "General" AIDS Pandemic is published by the
Campaign for Fighting Diseases this month. He is in Geneva to meet
policymakers at the WHA.

http://www.chinapost.com.tw/commentary/the%20china%20post/special%
20to%20the%20china%20post/2008/05/18/156965/p2/Myths-behind.htm

The 9th International Congress on AIDS in Asia and the Pacific in
Bali in August 2009

Welcome to the 9th ICAAP

The organizing committee and sponsors warmly invite you to attend the
9th ICAAP. The congress will be held at the Bali International
Convention Center (BICC) in Nusa Dua, Bali – Indonesia from 9 – 13
August 2009. Bali International Convention Centre is the largest and
most technologically advanced resource in Bali for meetings and
events. It is ideally located in Nusa Dua, home to the island's most
luxurious hotel and resort accommodation and conference facilities,
just 10 kilometers from Bali's international airport and 25 minutes
from the chic and vivacious Kuta, Legian and Seminyak districts.

Why should you consider attending?

Leading scientists in the world in this area will be invited to
present plenary lectures focusing on developments in different areas
over the past two years and to discuss possible future developments
and fruitful areas for research.

Discuss social, economical and programmatic aspects of HIV/AIDS
including stigma and discriminations

Strengthen collaboration and networking of nations, leaders,
activists, community in general in Asia and the Pacific to fight
HIV/AIDS and related issues

Leaderships and political commitments

Many different aspects of the AIDS response will be discussed with
delegates from Asia and the Pacific. We expect in the order of 5,000
delegates.

There will be special exhibitions running alongside the conference.
These will include stands of international organizations, displays of
various AIDS programs from PLHIV groups and organizations offering
technical and financial help to the AIDS response.

Place for sharing experiences, learning, speaking up, updating
information, networking

Bali is also known as the "Island of the Gods", where temples and
ceremonies can be found almost everywhere and everyday.

In Bali the passage of life is measured through elaborate rituals
performed by artistic and hospitable local people. The Balinese
maintain a precious heritage of unique arts and a dynamic culture
amidst breathtaking panoramas of cultivated rice terrace, awesome
volcanoes, pristine beaches and thousands of temples, augmented by an
unrivalled range of modern leisure activities.

There will be exciting pre and post congress activities as well as
attractive day-trips designed to immerse you in the Bali experience.

ICAAP9 Program

The theme of the 9th ICAAP is "Empowering People, Strengthening
Networks"

For more than 20 years countries around the world have faced the AIDS
epidemic more or less alone. Best practices have been documented to
help countries deal with their specific epidemics, but as the world
becomes more globalized and country borders become more fluid,
interventions that address mobility, migration and global and
regional responses become more important.

The empowerment of people – both HIV-positive and HIV-negative
vulnerable to HIV – and the strengthening of networks - PLHIV groups,
faith-based organizations, communities, governments, regions,
sectors, as well as individuals - are important components to
addressing this change.

With increased mobility in-country and across borders, nations can no
longer expect to work alone in its response to HIV and AIDS.
Regional and international cooperation is needed to address HIV
transmission among migrant populations. Strong networks are of utmost
importance when countries need effective interventions to halt the
epidemic in its tracks.

The 9th International Congress on AIDS in Asia and the Pacific in
Bali in August 2009 aims to address, among others, issues of
mobility, migration, as well as gender and people with disabilities
in order to empower the people and strengthen networks to effectively
respond to AIDS.

Congress Tracks

Track A - Empowerment for Prevention & Epidemiology
Track B - Strengthening Treatment & Care
Track C - Enabling and empowering environment: tackling social,
economic, cultural & religious barriers
Track D - Leadership & Broadening the Response
Track E - Universal Access, Networking & Partnerships

http://icaap9.aidsindonesia.or.id/

The 1st Year Delegate Working Report from Liang Yanyan: Member for Developing
Countries NGO Delegation, Representing Asia Pacific

Early 2007, Liang Yanyan nominated herself to compete the position of member for
the Developing Countries NGO Delegation Asia Pacific Representative. Liang
Yanyan received strong support from Beijing AIZHIXING Institute and Beijing
YIRENPING Center.

The two NGOs jointly send the delegation a letter of supporting to show their
support to me and they will support the expenses of communications regarding the
position if I was selected. Furthermore, Liang Yanyan also received support from
35 Chinese grassroots NGOs and China National AIDS Joint Meeting of CSOs, which
had more than 80 members at that time. APCASO also sent a letter of reference
for Liang Yanyan.

In April 2007, Liang Yanyan was informed that she was finally selected as the
delegation member representing Asia Pacific Region. The term of the membership
is two year, until April 2009.

The mission of the delegation is represent the NGOs working in the developing
countries working on AIDS, Tuberculosis and Malaria on the Global Fund Board.
The Board is the supreme governance body of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, whose decision points will strongly influence the
implementation and management of the Global Fund. The Board meeting will be held
twice per year. The Board has 20 voting seats and 4 non-voting seats, and the
Developing Countries NGO seat is one of the voting seats.

After Liang Yanyan was selected, she has accomplished a plenty of work to
fulfill her duty as a delegation member. The detailed working report is the
following part of this document. Liang Yanyan welcomes the suggestions of all
the people to help her improve her future work. Let me then introduce in brief
the reason why I resigned from the two supportive NGOs.

The First Year Working Report

April 2007, Liang Yanyan attended the 15th Board Meeting. The newly-selected
delegation members met each other and discussed together the future development
of the delegation for the first time.

I was selected as the Regional Focal Point in delegation meeting. In this Board
Meeting, the delegation as a whole nominated the Board Member Elizabeth Mataka
as the Vice-chair of the Board, and finally Ms. Mataka was selected as
vice-chair by the Board. Ms. Mataka is an eminent female NGO leader. Since the
15th Board Member, Ms. Mataka has worked closely with the selected Chair of the
Board, Mr. Rajat Gupta, the Board Member of the Private Sector seat to
ameliorate the working effectiveness of the Global Fund Board, and promoted to
Board to discuss and make decision on the issues of Malaria, Gender and Civil
Society Participation.

August 2008, Liang Yanyan was sponsored by Beijing AIZHIXING Institute to attend
the ICAAP 8. During the meeting, Liang Yanyan attended several sessions
regarding the Global Fund, communicated with the NGO representatives and
introduced the delegation to them.

She also improved her relationship with the Global Fund Secretariat staff.

September 2007, Liang Yanyan communicated with the Global Fund Secretariat to
make efforts to attend the Global Fund EAP Meeting after she knew there would be
a meeting during ICAAP in August.

Finally, Liang Yanyan was sponsored by Ford Foundation Beijing Office to attend
the meeting. During the meeting, Liang Yanyan was introduced by the Global Fund
Secretariat Civil Society Team to the CCM members in the EAP region. She
introduced the delegation and the Board to them. After the meeting, Liang Yanyan
published a over 10 pages report in both English and Chinese.

September 2007, Liang Yanyan opened an e-column on the Chinese HIV/AIDS
Information Network (CHAIN), under the section of Civil Society. From then,
Liang Yanyan regularly reported to her constituency about her work and published
the latest information by the column and NGO email groups. She also translated
much English information into Chinese to make Chinese constituency be informed
about the Global Fund. Furthermore, the column is the first delegate column on
CHAIN’s website.

November 2007, Liang Yanyan attended the 16th Board Meeting held in Kunming
China. During this meeting, Liang Yanyan worked closely with her Developing
Countries NGO Delegation colleagues, and finally many decision points favorable
to civil society participation was made, including Dual Track Financing,
Community Systems Strengthening and Gender Sensitive Approach. All the decision
points have a positive influence on the Round 8 Call for Proposal. Liang Yanyan
also attended the meeting between the NGO Committee and the Communities
Committee to China CCM and there civil society delegations to the Global Fund
Board, the meeting between China civil society and the Chair and Vice-chair of
the Board, and helped with the communication between each other.

During the Board Meeting, Liang Yanyan worked within three civil society
delegations and published a statement to encourage Chinese government to
strengthen the participation of Chinese civil society.

She also discussed and  shared information with the Portfolio Manager of China
Global Fund grants Mr. Oren Ginzburg about the mplementation of China AIDS Round
6.

After the 16th Board Meeting, Liang Yanyan keep communicating with the Portfolio
Manager Oren Ginzburg by emails to inquire the latest progress of the China AIDS
Round 6. So far, the Call for Implementers notice has been published widely by
all the SRs, although something still need to be improved, in my opinion, the
overall implementation goes well.

February 2008, Liang Yanyan attended the joint meeting held in UK between the
three civil society delegations, including the Communities Delegation, the
Developing Countries NGO Delegation and the Developed Countries NGO Delegation.
During the meeting, three delegations discussed fully together on hotspot issues
and developed the joint short-term, midterm and long-term objectives on
different issues. Several working teams was built up on key issues.

After the meeting, Liang Yanyan reported back to the constituency in both
English and Chinese by NGO email groups and her column on the meeting
achievements, and reported that she had attend two working groups, which is
Round 8 and Medicine.

February 2008, Liang Yanyan nominated a list of NGOs working in the developing
countries of Asia Pacific Region (including China) to the Global Fund
Partnership Forum Steering Committee. The Global Fund Third Partnership Forum
will be held in Dakar, Senegal from 8 to 10 December 2008. The main objective of
the meeting is to gathering a broad range of stakeholders to discuss Global Fund
performance and to make recommendations on its strategy and effectiveness. The
final decision on invitation will be made by the Steering Committee and the
Global Fund Secretariat.

March 2008, the Round 8 Call for Proposal was launched. Liang Yanyan publicized
the news and related Global Fund new policies by NGO email groups and her
column. Liang Yanyan also emailed to the Global Fund Secretariat to acknowledge
their work on making the Chinese translation of the key documents available.
Later, Liang Yanyan informed the Global Fund Secretariat with the technical
problem on downloading Chinese documents in time. On March 20, Liang Yanyan
attended the meeting of the AIDS Working Group to the China CCM, and nominated
herself to attend the writing team as NGO representative, which is also her
commitment to fulfill her duty as a member for Round 8 Working Group after the
three delegation joint meeting held in February. Furthermore, Liang Yanyan
translated the newsletter Action Alert published by Civil Society-led technical
support mechanism Civil Society Action Team (CSAT), and published the
translation widely to the Chinese constituency by NGO email
groups and her column to help them understand more on the Round 8 Application.

On April 10, Liang Yanyan attended the China Round 8 Writing Team meeting.
During the meeting, Liang Yanyan was nominated the member for the Core Writing
Team as a NGO representative. Until now, except for the week during Global Fund
17th Board Meeting, Liang Yanyan has attended all the meeting of the Core
Writing Team, and assisted to record every steps of the team’s work. In the team
meeting, based on her knowledge on the target population migtant workers, she
advocated the proposal to include more activities on civil society capacity
building and outreach. She also mentioned the potential conflict of interest
between the potential PR and CCM Chair should be clarified in the Eligibility
part of the proposal.

April 2008, Liang Yanyan attended the 17th Board Meeting. Working closely with
the delegation members, the delegation input to make the decision that an extra
Round 9 will be launched be approached. In her opinion, for the recipient
countries, this is the most important decision points made by the 17th Board
Meeting. Currently, the Global Fund Secretariat has prepared for the
implementation of the decision point.

May 2008, Liang Yanyan will assist Global Fund Secretariat to distribute two
Chinese brochures published by the Global Fund (Global Fund: Who we are, What we
do and An Evolving Partnership: Global Fund and Civil Society in Fight AIDS,
Tuberculosis and Malaria) to 200-300 Chinese grassroots NGOs under the help of
CHAIN, to raise the awareness of Chinese NGOs on the Global Fund. Now, the
Customs declaration is undergoing, after that, the brochures will be distributed
as quickly as possible.

May 2008, as the Asia Pacific Regional Focal Point of the delegation, Liang
Yanyan is going to build up a regional consultative group. This is a voluntary
and not a fulltime work. An email group is going to be built to regular consult
the opinions of the consultative group members, and the latest information from
Global Fund Board will be distributed to the group members.

May 2008, Liang Yanyan will attend the CCM workshop held by the Technical
Support Facility (TSF), a technical support partner of the Global Fund, which is
cosponsored by UNAIDS and IPPF. During the workshop, the TSF consultants and
country partners in this region will discuss about the Global Fund.

During the first year, Liang Yanyan keeps the regular cooperation with the NGO
Committee and the Communities Committee to China CCM, and share the important
information from the Board in time with the two Committees. In the second year
of her delegation term, she has the following goals:

Build up communication with the CCM members representing NGOs in the countries
other than China in Asia Pacific Region.

Improve the effectiveness of consulting constituency before and after the Board
meetings

Review the Round 8 application process, and work together with the technical
support partners of the Global Fund to mobilize NGOs in Asia Pacific to
participate into the Round 9 and Round 10 application.

Cooperate with UNAIDS China Office to prepare the implementation of RCC/GC, and
advocate for the civil society participation into the process.


Yanyan Liang
AIDS NGO worker in China
Developing Countries NGO Delegation member to the Global Fund Board
e-mail: liangyanyan@...
Mobile: +86 13811227702
Fax: +86-10-51917981
Address: 2105A, Zhongsheng Building, No. 2 Beifengwo St. Haidian District,
Beijing 100038 China

Medecins Sans Frontieres makes its research accessible to health workers  in
developing countries

Brussels/London, 15 May 2008. The international medical humanitarian
organisation Medecins Sans Frontieres (MSF) today launched a website on  which
it makes available, for free, published research based on its medical work. This
research has frequently demonstrated pioneering approaches for tackling a broad
range of diseases in many countries and, often, has influenced clinical
practice. Well-known examples are MSF’s pioneering work in treating
populations with HIV using antiretroviral medications and malaria with
artemisinin-containing treatment.

MSF hopes  that health professionals, policy makers and researchers, especially
those in developing countries, will now have easier access to the results of
MSF’s field research.

MSF is archiving all its peer-reviewed research and commentary articles on the
site. At its launch, there are over 350 articles on HIV care, malaria,
tuberculosis, leishmaniasis and other diseases, as well as more general topics
such as  medical care in emergencies, refugee health and health politics. As new
articles are published, they will be archived on the site.

The articles have been published in journals such as BMJ, New England
Journal of Medicine, PloS Medicine, The Lancet, and Transactions of the  Royal
Society of Tropical Medicine and Hygiene. The publishers of these, and many
other peer-reviewed journals, have responded positively to MSF’s request to
make their articles available free of charge; as a rule, articles from many of
these publications are available only for a fee.

We were concerned that health professionals in developing countries would  not
be able to pay for access to our medical research and would miss  information
that could be highly relevant to their work,� says Tony Reid, medical editor
at the office of MSF in Brussels.

The vast majority of our medical activities, and by extension our research
initiatives, take place  in poorer countries. We therefore applaud the
willingness of medical publishers to allow us to archive the articles  free of
charge for the global medical community.

The new website, at www.fieldresearch.msf.org, requires no password or  sign-up
and full-text articles are available for free.

The articles are  easily accessed through the site’s search function, and also
through search engines such as Google or Yahoo. And through an RSS feed users
can choose to be notified of new publications on the site.

Note: For more information, please call Erwin van ‘t Land on +32 475 661  342
or contact Tony Reid, tony.reid@...

________________

Jean-Marc Jacobs
Communications officer
Medecins Sans Frontières (MSF) - Brussels
+32 2 474 7487 (direct)
+32 499 25 85 62 (mobile)
e-mail: <Jean-Marc.JACOBS@...>
______________________________

Dear FORUM,

Dr. Bernard Hirschel and Alexandra Calmy’s aptly named New England Journal of
Medicine editorial “Initial Treatment for HIV Infection — An Embarrassment of
Riches” is a timely reminder to the Asian and Pacific policy makers and opinion
leaders, of the hard and winding road ahead of them. It seems the campaign for
universal access has lost its traction in many of the countries in this region.
This editorial also sharply focuses on the inequity in access to health care
resources and knowledge between developed and developing countries. [Joe Thomas.
Editor AIDS ASIA eFORUM]


Initial Treatment for HIV Infection — An Embarrassment of Riches

Bernard Hirschel, M.D., and Alexandra Calmy, M.D. Editorial: The New
England Journal of Medicine. Volume 358:2170-2172. May 15, 2008.
Number 20

Drugs that are used to treat patients with human immunodeficiency
virus (HIV) infection are classified according to their target. The
first ones to be developed were nucleoside reverse-transcriptase
inhibitors (NRTIs), which lead to premature termination of the
nascent DNA chain, and nonnucleoside reverse-transcriptase inhibitors
(NNRTIs), which bind and inhibit reverse transcriptase. The viral
protease inhibitors were next. NRTIs, NNRTIs, and protease inhibitors
remain the staples of highly active antiretroviral therapy, but other
targets, such as the CCR5 receptor, the fusion peptide, and viral
integrase, have recently yielded promising molecules.

At this time, eradication of HIV is impossible. Rebound inevitably
follows cessation of therapy, and therapy must therefore be lifelong.
With more than 20 drugs to choose from, there is an embarrassment of
riches. Possible combinations are almost endless, as are the
possibilities of side effects, either beneficial or damaging drug
interactions, and the development of viral resistance.

Early in the antiretroviral-therapy era, the combination of indinavir
(a protease inhibitor) and zidovudine and lamivudine (both NRTIs)
predominated as the reference treatment. In 1999, the NNRTI
efavirenz, in combination with zidovudine and lamivudine, proved to
be more effective in diminishing the plasma concentration of HIV type
1 (HIV-1) RNA (the "viral load") than the reference treatment.1
Indinavir has since been largely replaced by atazanavir or lopinavir
combined with a small dose of ritonavir to boost absorption and
plasma levels.

Current guidelines recommend initiating antiretroviral therapy with
two NRTIs in combination with either an NNRTI or a protease
inhibitor.2 So the first question is, Which NRTIs and which protease
inhibitor do we choose? And the second question is, Which is better,
an NNRTI or a protease inhibitor?

Phase 4 studies that compare treatment strategies are desirable, but
they are difficult to do.

In a rapidly moving field such as HIV therapy, what is the "reference
treatment"? Trials have to be large and continue for a long time, and
patients may vote with their feet and refuse to continue with a
therapy that they judge, rightly or wrongly, to be inferior to the
latest miracle drug. And large trials that continue for a long time
are expensive.

Drug companies have little to gain, and much to lose, from comparing
one of their already marketed drugs with another that may be better.

The National Institutes of Health, through the Clinical Trials
Network, have very properly undertaken trials such as the Strategies
for Management of Antiretroviral Therapy (SMART; ClinicalTrials.gov
number, NCT00027352 [ClinicalTrials.gov] ),3 which showed that
intermittent treatment was inferior to continuous treatment for
patients with HIV infection.

In this issue of the Journal, Riddler et al.4 report on the AIDS
Clinical Trials Group Study A5142, which compared three drug
combinations in the initial therapy of 753 patients with HIV
infection: efavirenz plus two NRTIs (efavirenz group), lopinavir–
ritonavir plus two NRTIs (lopinavir–ritonavir group), and lopinavir–
ritonavir plus efavirenz (NRTI-sparing group).

As previously noted, the first two regimens were popular and widely
prescribed. The third is theoretically attractive, since it avoids
the use of NRTIs, which are suspected of contributing to side
effects. An uncontrolled study of 86 patients showed that this
combination would be effective, although it was not well tolerated:

after 48 weeks, 24% of patients either discontinued the study regimen
because of adverse events or were lost to follow-up.5 A study by Boyd
et al. looked at efavirenz with ritonavir-boosted indinavir as an
NRTI-sparing option, with similar conclusions.6

The results of the study by Riddler et al. are difficult to put in a
nutshell. We want regimens that win in all categories: suppression of
HIV-1 RNA, an increase in the CD4 cell count, a lack of emergence of
resistance, low toxicity, and simplicity.

However, the study by Riddler et al. yields a split decision. When
the regimens were ranked according to suppression of HIV-1 RNA, the
efavirenz group had the best results, closely followed by the NRTI-
sparing group and the lopinavir–ritonavir group, although the
difference between the efavirenz group and the NRTI-sparing group was
not significant.

When the regimens were ranked according to the emergence of drug
resistance, the winner was the lopinavir–ritonavir group, followed by
the efavirenz group and the NRTI-sparing group, and again the
difference between the lopinavir–ritonavir group and the efavirenz
group was not significant. Finally, as measured by the proportion of
patients who discontinued or changed their treatment, all three
groups had similar rates of adverse events.

Patients who participate in clinical trials differ from the majority
who do not participate — one reason why clinical practice often
cannot reproduce published results. Efavirenz causes side effects
involving the central nervous system, including sleep disturbances
with vivid dreams, dizziness, and daytime drowsiness.7 Such symptoms
are frequent and troublesome early on; they largely disappear after a
few weeks of therapy.

Nonetheless, in all studies we are aware of, a sizable percentage of
patients discontinued efavirenz because of these effects; the
proportion was particularly high among patients who acquired HIV
through illicit drug use, partly because efavirenz interferes with
methadone. We are struck by the fact that Riddler et al. did not
record much of this type of discontinuation in their study. This
suggests that their patients were greatly motivated to continue their
prescribed regimen, perhaps through their repeated and close contact
with the investigators — a type of Hawthorne effect8 that is
difficult to duplicate in routine practice.

Another problem with the study relates to the NRTIs that were
administered in the efavirenz group and the lopinavir–ritonavir
group. All patients received lamivudine, but the second NRTI was
zidovudine (which was assigned to 42% of patients), extended-release
stavudine (24%), or tenofovir (34%). NRTIs differ in both side
effects9 and efficacy.10 Since the study started, the formulation in
the lopinavir–ritonavir capsule has been replaced by tablets that
produce a more consistent plasma drug level11 and are perhaps
associated with less diarrhea and nausea. Extended-release stavudine
has never been marketed because of pancreatic toxicity.12 Tenofovir
and emtricitabine (a drug that was not used in the study) have become
the reference NRTI combination. In summary, these reservations cast
doubt on the future applicability of the study's findings — doubts
that will not be easily resolved by further studies.

Nonetheless, on the basis of this study, it seems that efavirenz plus
two NRTIs is hard to beat.

In addition to the stated results, one has to consider the low pill
burden, since brand-name formulations contain efavirenz,
emtricitabine, and tenofovir for a one-pill daily regimen, and the
fact that in most countries, efavirenz costs less than lopinavir–
ritonavir.

These data should challenge the 40% of clinicians who start
antiretroviral treatment with a protease inhibitor and should
reassure those who, in resource-limited settings, must use
combinations of NRTIs and NNRTIs because they are cheaper.
Will new drugs dethrone efavirenz? Etravirine (an NNRTI),13
raltegravir (an integrase inhibitor),14 and maraviroc (a CCR5
inhibitor)15 are targeted to patients with drug-resistant virus. But
because of their excellent pharmacokinetics and initially favorable
side-effect profiles, these drugs have a potential for earlier use16
and in a few years may even be successfully combined.

Dr. Hirschel reports receiving consulting and lecture fees from
Merck, serving on advisory boards for Merck and Tibotec, and
receiving travel grants from Bristol-Myers Squibb, GlaxoSmithKline,
and Roche. No other potential conflict of interest relevant to this
article was reported.

Source Information: From the Department of Infectious Diseases,
Geneva University Hospital, Geneva.

References

1. Staszewski S, Morales-Ramirez J, Tashima KT, et al. Efavirenz
plus zidovudine and lamivudine, efavirenz plus indinavir, and
indinavir plus zidovudine and lamivudine in the treatment of HIV-1
infection in adults. N Engl J Med 1999;341:1865-1873. [Free Full
Text]

2. Guidelines for the use of antiretroviral agents in HIV-1–
infected adults and adolescents. (Accessed April 18, 2008, at
http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.)

3. The Strategies for Management of Antiretroviral Therapy
(SMART) Study Group. CD4+ count-guided interruption of antiretroviral
treatment. N Engl J Med 2006;355:2283-2296. [Free Full Text]

4. Riddler SA, Haubrich R, DiRienzo AG, et al. Class-sparing
regimens for initial treatment of HIV-1 infection. N Engl J Med
2008;358:2095-2106. [Free Full Text]

5. Allavena C, Ferré V, Brunet-François C, et al. Efficacy and
tolerability of a nucleoside reverse transcriptase inhibitor-sparing
combination of lopinavir/ritonavir and efavirenz in HIV-1-infected
patients. J Acquir Immune Defic Syndr 2005;39:300-306. [CrossRef][ISI]
[Medline]

6. Boyd MA, Srasuebkul P, Khongphattanayothin M, et al. Boosted
versus unboosted indinavir with zidovudine and lamivudine in
nucleoside pre-treated patients: a randomized, open-label trial with
112 weeks of follow-up (HIV-NAT 005). Antivir Ther 2006;11:223-232.
[ISI][Medline]

7. Fumaz CR, Tuldrà A, Ferrer MJ, et al. Quality of life,
emotional status, and adherence of HIV-1-infected patients treated
with efavirenz versus protease inhibitor-containing regimens. J
Acquir Immune Defic Syndr 2002;29:244-253. [ISI][Medline]

8. Coats AJ. Clinical trials, treatment guidelines and real
life. Int J Cardiol 2000;73:205-207. [CrossRef][ISI][Medline]

9. Gallant JE, Staszewski S, Pozniak AL, et al. Efficacy and
safety of tenofovir DF vs stavudine in combination therapy in
antiretroviral-naive patients: a 3-year randomized trial. JAMA
2004;292:191-201. [Free Full Text]

10. Gallant JE, Dejesus E, Arribas JR, et al. Tenofovir DF,
emtricitabine, and efavirenz vs. zidovudine, lamivudine, and
efavirenz for HIV. N Engl J Med 2006;354:251-260. [Free Full Text]

11. Klein CE, Chiu YL, Awni W, et al. The tablet formulation of
lopinavir/ritonavir provides similar bioavailability to the soft-
gelatin capsule formulation with less pharmacokinetic variability and
diminished food effect. J Acquir Immune Defic Syndr 2007;44:401-410.
[CrossRef][ISI][Medline]

12. Drugs.com. Interactions between videx-ec (didanosine) and
stavudine extended release (stavudine). (Accessed April 25, 2008, at
http://www.drugs.com/drug-interactions/videx-ec_d00078_stavudine-
extended-release_d03773.html.)

13. Lazzarin A, Campbell T, Clotet B, et al. Efficacy and safety
of TMC125 (etravirine) in treatment-experienced HIV-1-infected
patients in DUET-2: 24-week results from a randomised, double-blind,
placebo-controlled trial. Lancet 2007;370:39-48. [CrossRef][ISI]
[Medline]

14. Grinsztejn B, Nguyen BY, Katlama C, et al. Safety and
efficacy of the HIV-1 integrase inhibitor raltegravir (MK-0518) in
treatment-experienced patients with multidrug-resistant virus: a
phase II randomised controlled trial. Lancet 2007;369:1261-1269.
[CrossRef][ISI][Medline]

15. Lalezari J, Goodrich J, DeJesus E, et al. Efficacy and safety
of maraviroc plus optimized background therapy in viremic, ART-
experienced patients infected with CCR5-tropic HIV-1: 24-week results
of phase 2b/3 studies. Presented at the 14th Conference on
Retroviruses and Opportunistic Infections, Los Angeles, February 25–
28, 2007.

16. Markowitz M, Nguyen B-Y, Gotuzzo E, et al. Rapid onset and
durable antiretroviral effect of raltegravir (MK-0518), a novel HIV-1
integrase inhibitor, as part of combination ART in treatment HIV-1
infected patients: 48-week data. Presented at the 4th International
AIDS Society Conference on HIV Pathogenesis, Treatment and
Prevention, Sydney, July 22–25, 2007.

Dear all,

As some of you may know that I have been working with PATH since 2007 November
as Program Manager managing the Microbicides advocacy project in India.

I am writing to inform you all that I am leaving GCM/ PATH to take up a position
with ICW as Asia Pacific Coordinator, based in Bangkok, Thailand.

ICW is an international network of Women Living with HIV/AIDS (www.icw.org ) 
and it is run for and by HIV positive women to promote positive women’s voices
and advocates for changes that improve their lives. The post will be employed by
the Asia Pacific Network of People living with HIV/AIDS (APN+)
(www.apnplus.org), seconded to ICW, and based in the APN+ office in Bangkok,
Thailand.

The Asia Pacific Regional Coordinator is a new, full-time post created by ICW to
lead the development of ICW in the region as a strong advocacy platform for
women living with HIV. I am happy to join ICW to strengthen their initiatives in
this part of the region. I am expected to join the new office in the 1st week of
June.

I have been privileged enough to work with you all in various capacities over
past 8 years in Delhi and I would like to take this opportunity to thank you all
for providing excellent opportunities and support during this period and also
for contributing immensely to my knowledge base.  I am sure our path will cross
and I will have many more opportunities to work with you all in the new role.

And I look forward to your continued support to take up this challenging role.

Please note that my last working day with PATH is 15th May and you can reach out
to me at anandiy@... and I will update you with my new contact details
soon.

With regards
Anandi


Anandi Yuvaraj
Program Manager, HIV SRH
PATH-A catalyst for global health
A-9, Qutab Institutional Area
New Delhi 110 067, India
Tel: +91-11-2653 0080-88 Extn: 205
Fax: +91-11-2653 0089
E-mail: ayuvaraj@...
Web: www.path.org

Dear AIDS ASIA FORUM,

Re: http://health.groups.yahoo.com/group/AIDS_ASIA/message/1231

Some reflections, that  will also be posted to the BMJ website, as below
(http://www.bmj.com/cgi/eletter-submit/336/7652/1072)

HIV is exceptional, in that it is transmitted and prevented with and through
intimate social relationships more than through  public health paradigm, though
cofactors associated with public health are relevant.

It is not curable yet drugs for treatment deceptively imply it is, or could be,
whilst resistance issues and associated  ethics are only partially realised
there is no effective vaccine -human behavior change is still the driving force
for prevention

It is a human experience more than any other disease known except the plague
-and it has not gone away.. It resurges here and there,and continues to expand
worldwide  and any workers or activists associated with the early years of the
epidemic who warned that urgent action was needed ,or acted too late ,are
appropriately and rightly sensitised to the intergenerational nature of HIV,
both now and  for future generations.

HIV means loss that accumulates for the infected and the affected, despite
limited treatment success

HIV has been, uniquely, the most potent entry point to broader health and
development understanding of the last twenty five years . Health gains in
general have been enormous in terms of infrastructure , and more importantly HIV
and AIDS have shown the ethical foundation of health as a social obligation and
objective -a relational morality for global health has been lived out and
articulated through solidarity , community driven initiatives , an awakening of
human capacity for response in local people , in technical support
professionals, and health systems based in universal human rights, grounded in
turn in compassionate concern for engaging with suffering and living with hope.

Such gains are  currently being injected into the renewal of Primary Health
Care, Neglected Tropical Diseases, the health of women and girls , and youth
related sexual health and life skills , to name just a few disciplines.

Participatory caring with persons leads to change  in others -the key to
destigmatisation. HIV as much as leprosy has been a pathway for learning and
change and to expansion of national responses to health and in a development
context

Money is a problem if it is channelled only into 'stovepipe' interventions.

Most NGO's and governments are guilty, in relation to HIV ,and are also guilty
of the same offense in other  health fields. That can change and it must if the
MDG's are  be achieved.

Immersion in the real experience of personal, family and community loss and hope
is the key to transformation for all -and remains a needed discipline for
critics who feel that funding allocation should shift.

The truth is that HIV funds need to be spent differently, and global health
needs more , but HIV should not have access to less

As far as priority is concerned, more current funding needs to be used to
stimulate response and transfer in the most local of situations -the home and
neighbourhood -and learning from the local response by the most powerful and
rich policy and provider  institutions .

Ian Campbell MRCP(UK) DRCOG
International Health Programme Consultant
London, UK
e-mail: iancampbell11@...

[Is this article, yet another browbeating AIDS denialists presenting a bunch of
pseudo-scientific arguments, deserved to be ignored? Or does this article
deserve a closer look and one need to come out with a cohesive response? I leave
it to the readers to decide.
Editor. AIDS ASIA]

The writing is on the wall for UNAIDS

Views & Reviews. Roger England, chairman, Health Systems Workshop, Grenada
roger.england@...
BMJ  2008;336:1072 (10 May), doi:10.1136/bmj.39569.497708.94

The creation of UNAIDS, the joint United Nations programme on HIV and
AIDS, was justified by the proposition that HIV is exceptional. The
foundations of exceptionalism were laid when the "rights" arguments
of gay men succeeded in making HIV a special case that demanded
confidentiality and informed consent and discouraged routine testing
and tracing of contacts, contrary to proved experience in public
health.1

But exceptionalism grew—to encompass HIV as a disease of
poverty, a developmental catastrophe, and an emergency demanding
special measures, requiring multisectoral interventions beyond the
leadership of the World Health Organization.

The exceptionality argument was used to raise international political
commitment and large sums of money for the fight against HIV from,
among others, the World Bank, through its multi-country AIDS
programme, the Global Fund to Fight AIDS, Tuberculosis and Malaria,
and the US Presidents' Emergency Plan for AIDS Relief.

With its own UN agency, HIV has been treated like an economic sector rather than
a disease.

The proposition of exceptionality is now under stress. The poverty
argument has been exposed as baseless. The country surveys carried
out by Measure DHS (Demographic and Health Surveys) of, for example,
Ethiopia, Kenya, and Tanzania show that prevalence is highest among
the middle classes and more educated people.2

Although HIV can tip households into poverty and constrain national development,
so can all serious diseases and disasters. HIV is a major disease in southern
Africa, but it is not a global catastrophe, and language from a top UNAIDS
official that describes it as "one of the make-or-break forces of this century"
and a "potential threat to the survival and well-being of people worldwide" is
sensationalist.3

Worldwide the number of deaths from HIV each year is about the same as that
among children aged under 5 years in India.

Similarly, multisectoral programmes were misguided and have got
nowhere slowly and expensively. Some small projects of non-
governmental organisations (NGOs) have successfully integrated
sectoral efforts, but government ministries such as agriculture and
education have not succeeded in the HIV roles imposed on them.

Vast sums have been wasted through national commissions and in funding esoteric
disciplines and projects4 instead of beefing up public health capacity that
could have controlled transmission.5 Only 10% of the $9 billion (£4.5 billion; 
5.8 billion) a year dedicated to fighting HIV is needed for the free treatment
programme for the two million people taking those treatments. Much of the rest
funds
ineffective activities outside the health sector.

These fractures in the structure of exceptionalism are now obvious.

Less obvious is the possibility that it is exceptionalism, not rural
Africans, that drives stigma and discrimination.6 Managers of
Médecins Sans Frontières's pioneering treatment project in South
Africa fretted about what to call the centres providing the
treatment, fearing that stigma would deter clients, so they called
them infectious disease clinics. Patients had no such inhibitions,
however, and within days were queuing to get into the "AIDS clinic."7

But relentless promotion of HIV as different can only have reinforced
stigma, the equivalent of a public health "own goal."

It is no longer heresy to point out that far too much is spent on HIV
relative to other needs and that this is damaging health systems.8 9
10 11

Although HIV causes 3.7% of mortality, it receives 25% of
international healthcare aid and a big chunk of domestic expenditure.

HIV aid often exceeds total domestic health budgets themselves,
including their HIV spending. It has created parallel financing,
employment, and organisational structures, weakening national health
systems at a crucial time and sidelining needed structural reform.12
13

Massive off-budget funding dedicated to HIV provides no incentives
for countries to create sustainable systems, entrenches bad planning
and budgeting practices, undermines sensible reforms such as sector-
wide approaches and basket funding (where different donors contribute
funds to a central "basket," from which a separate body distributes
money to various projects), achieves poor value for money, and
increases dependency on aid.

Yet UNAIDS is calling for huge increases: from $9 billion today to $42 billion
by 2010 and $54 billion by 2015. UNAIDS is out of touch with reality, and its
single issue advocacy is harming health systems and diverting resources from
more effective interventions against other diseases.

Steadily, the demand is increasing for better healthcare systems, not
funding for HIV. Mozambique's health minister stated: "The reality in
many countries is that funds are not needed specifically for AIDS,
tuberculosis, or malaria. Funds are firstly and mostly needed to
strengthen national health systems so that a range of diseases and
health conditions can be managed effectively."14

Guyana's national health sector strategy notes the need "to convince our
development partners (who support us with external aid) that some of the money
they provide us with should no longer be earmarked for their favourite diseases,
mainly HIV, but must be spent to improve our general health services so that we
can handle all diseases better and according to our actual disease
priorities."15

HIV exceptionalism is dead—and the writing is on the wall for UNAIDS.

Why a UN agency for HIV and not for pneumonia or diabetes, which both
kill more people? UNAIDS is scurrying to reposition itself in the
face of these realities and will no doubt soon join the Global
Alliance for Vaccines and Immunisation (GAVI) and the Global Fund in
claiming expertise in how to strengthen health systems.

But continuation of a dedicated HIV organisation can only distort
healthcare financing and delivery systems. UNAIDS should be closed
down rapidly, not because it has performed badly given its mandate,
which it has not, but because its mandate is wrong and harmful. Its
technical functions should be refitted into WHO, to be balanced with
those for other diseases.

Putting HIV in its place among other priorities will be resisted
strongly. The global HIV industry is too big and out of control. We
have created a monster with too many vested interests and reputations
at stake, too many single issue NGOs (in Mozambique, 100 NGOs are
devoted to HIV for every one concerned with maternal and child
health),14 too many relatively well paid HIV staff in affected
countries, and too many rock stars with AIDS support as a fashion
accessory. But until we do put HIV in its place, countries will not
get the delivery systems they need, and switching $10 billion from
HIV to support general health budgets would make a big difference—
roughly doubling health workers' salaries in the whole of sub-Saharan
Africa, for example (or trebling them, if you don't include South
Africa).

References

1. De Cock KM, Abori-Ngacha D, Marum E. Shadow on the continent:
public health and HIV/AIDS in Africa in the 21st century. Lancet
2002;360:67-72.[CrossRef][ISI][Medline]

2. Demographic and Health Surveys. www.measuredhs.com/start.cfm.

3. Piot P. "Why AIDS is exceptional" (speech given at the London
School of Economics, London, 8 Feb 2005).
http://data.unaids.org/Media/Speeches02/SP_Piot_LSE_08Feb05_en.pdf.

4. World Bank Operations Evaluation Department. Committing to
results: improving the effectiveness of HIV/AIDS assistance.
www.worldbank.org/oed/aids/?intcmp=5221495.

5. England R. Coordinating HIV control efforts: what to do with
the national AIDS commissions. Lancet 2006;367:1786-9.[CrossRef][ISI]
[Medline]

6. Jewkes R. Beyond stigma: social responses to HIV in South
Africa. Lancet 2006;368:430-1.[CrossRef][ISI][Medline]

7. Kasper T, Coetzee D, Louis F, Boulle A, Hilderbrand K.
Demystifying antiretroviral therapy in resource-poor settings.
Essential Drugs Monitor 2003;32:20-1.

8. Halperin D. Putting a plague in perspective. New York Times
2008 Jan 1. www.nytimes.com.

9. England R. Are we spending too much on HIV? BMJ 2007;334:344.
[Free Full Text]

10. England R. We are spending too much on AIDS. Financial Times,
2006 Aug 14. www.ft.com.

11. Foster M, Gottret P. Scaling up to achieve the health MDGs in
Rwanda: a background study for the high-level forum meeting in Tunis
12-13 June 2006.
www.hlfhealthmdgs.org/Documents/June2006ScalingUptoAchievetheHealthMDG
sinRwanda.pdf

12. England R. The dangers of disease specific programmes for
developing countries. BMJ 2007;335:565.[Free Full Text]

13. Health Systems 20/20. Systemwide effects of the Global Fund:
evidence from three country studies. Bethesda, MD: Health Systems
20/20, 2007.

14. Garrido PI. Women's health and political will. Lancet
2007;370:1288-9.[CrossRef][ISI][Medline]

15. Ministry of Health of Guyana, National health sector strategy
2008-12. Georgetown, Guyana: Ministry of Health, 2008.

http://www.bmj.com/cgi/content/full/336/7652/1072

Regional Conference on TB, HIV/AIDS and Respiratory Diseases

South Asian Association of Regional Cooperation *(SAARC) Second
Conference on TB, HIV/AIDS and Respiratory Diseases *is being
planned  from 15-18 Dec, 2008, Kathmandu, Nepal.

Log in to below address for more details.

http://www.saarctb.com.np


The deadline for abstract submission is 30th June, 2008


SAARC Tuberculosis and HIV/AIDS Centre,
Thimi, Bhaktapur,
GPO Box: 9517, Kathmandu, Nepal
Tel: 00977-1-6631048, 6632601, 6632477,
Fax: 00977-1-6634379

E-mail: saarctb@...
Website: saarctb.com.np

Dear Reader

 

The Global Fund to Fight AIDS, Tuberculosis and Malaria is a global public/private partnership dedicated to raising and disbursing large amounts of additional finance to prevent and treat the three pandemics.  The Global Fund has so far committed more than US$10 billion to over 520 programs in 136 countries.

 

The Global Fund is seeking candidates with backgrounds in Finance, Legal, Strategic Planning, Project/Grant Management, Public/Private Partnerships, Policy Guidance, Monitoring and Evaluation, Publishing, and more. Please share this information across your networks and contacts.

 

 

The Global Fund is currently receiving applications for the positions listed in the table below.

 

APPLICATIONS SHOULD BE SUBMITTED ELECTRONICALLY VIA THE GLOBAL FUND WEBSITE www.theglobalfund.org/en/jobs

Online applications will be acknowledged and a confirmation sent to the e-mail address provided.

 

Candidates whose applications are of interest will be contacted and invited to participate further in the selection process.

 

 

 

TGF/08/FT392	Senior CCM Support Officer (Training)	Geneva, Switzerland	26/May/2008
TGF/08/FT391	Senior CCM Support Officer (Policy)	Geneva, Switzerland	26/May/2008
TGF/08/FT388	Policy Support Officer	Geneva, Switzerland	26/May/2008
TGF/08/FT376	Senior Operational Policy Officer	Geneva, Switzerland	23/May/2008
TGF/08/FT285	Manager, Private Sector Resource Mobilization	Geneva, Switzerland	09/May/2008