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TABLE OF CONTENT 1) Introductory Message 2) World AIDS Day 2015 Theme: Zero HIV related Stigma and Discrimination in Health Care. a. Why? b. HIV related Stigma c. HIV related Discrimination d. Interrelation of stigma and discrimination 3) Youth Collaboration in the HIV Response a. We need to become health leaders! b. Young people are crucial for the HIV response. c. Together we will go further 4) International Activities Guide a. Testimonials Booklet b. Advocacy Video c. Change your profile picture 5) Suggested National and Local activities a. Capacity building b. Raising Awareness c. Creating and Sharing Advocacy videos 6) Basic Information on HIV related Subjects 7) Interesting sources 8) Useful SCORA and World AIDS Day acronyms 9) Contributors
Dear SCORAngels and IFMSA members, It’s with a big deal of happiness that I present to you the International SCORA World AIDS Day Manual, a document which aims to guide you through the worldwide campaign we have prepared for WAD as well as providing you with some information on the subject we want to cover through it. World AIDS Day, conceived and adopted unanimously by 140 countries during the World Summit of Ministers of Health on AIDS (London, January 1988) is probably the most emblematic SCORA related event and also provides a true possibility to focus our efforts on raising awareness on any HIV and AIDS related subject. It’s a day recognized by governments, organizations, national AIDS programs and any individual around the world since it offers the importance to take a stance together and fight against AIDS. The day chosen for this collaborative effort is none other than the 1ST of December. The IFMSA, as representatives of medical students from all around the globe envisions a world free of HIV and AIDS and has always been a proactive collaborator of the World AIDS Campaign, engaging its members in numerous activities and interventions throughout the years. This is why WAD has become one of the major focuses of our beloved Standing Committee on Sexual and Reproductive Health including HIV and AIDS (SCORA), fighting against the spread of HIV/AID, advocating for the rights of people living with HIV and aiming at a health attention free of stigma and discrimination are all goals that we need to pursue. We, as medical students are meant to take the lead and stand strong against the AIDS epidemic, we need to be resilient and push for a change since only by standing together we can make our impact considerable and worth accounting for in the future health agendas. From the SCORA International Team, we are proposing a set of many activities that we believe can be done in a local and national level, as well as three main activities mostly focused on online action. For these three international core interventions The PACT, with leadership of IFMSA and the Global Network of Young People Living with HIV, has decided to unite forces once more, to create a joint campaign. We hope that you enjoy this document and participate actively in every intervention proposed. Should you have any questions, please, use and abuse! On behalf of the SCORA International Team Carles Pericas SCORA Director 2015-16
2) WORLD AIDS DAY 2015 THEME: ENDING STIGMA AND DISCRIMINATION For this campaign we felt that we needed to have a theme we could really work on, as proven many times before, focusing on one subject can have many benefits, including:
Helping our World AIDS Day get more media coverage. Providing organizations who have limited resources to meaningful campaign materials. Working through a united effort with the objective of enhancing a global response. Uniting national and international actions to spread the WAD campaign messages.
On 26th October 2015, the PCB adopted the 2016-2021 UNAIDS strategy, critical for ending the AIDS epidemic. This ambitious global agenda shall only be possible if young people from different backgrounds and fields will more than ever, work collaboratively to push through the End AIDS by 2030 agenda Keeping that in mind, we decided that this year our main global interventions would focus on “Galvanizing Youth efforts to end AIDS epidemic by 2030” giving special importance to Ending Stigma and Discrimination. Of course, in your local and national committee you can use WAD to shape the message that suits the needs of your country or region the best. a) Why HIV related stigma and discrimination? Enjoyment of the highest attainable standard of health is a fundamental human right. The provision of health care services is not simply a matter of needs but of human rights, yet it is something that not anyone has access to, even when they have access to health facilities. Evidence shows that heath care settings are one of the most frequent places in which people living with HIV suffer the consequences of stigma and discrimination. These are normally driven by fear of HIV and insufficient awareness of what stigma against people living with HIV looks like and what its consequences are. Consequences that can have a direct effect on the community in the form of either reduced uptake of HIV testing, potential rejection of available treatment or rejection of preventive measures for those at risk of infection among others. In the IFMSA, as medical students, we advocate for the implementation of health-related policies that defend human rights for all including people living with HIV and aim to provide in a near future healthcare services free of discrimination and judgment, adapted to everyone’s needs.
We believe that our cooperation in this with the Global Network of Young People Living with HIV and all other networks of young key populations, including young people who sell sex, use drugs etc. is essential and can help us achieve the goals of this intervention. A mentality shift towards a more accepting and non-discriminatory perspective is still much needed in future and current health care providers, but step by step we can change that. b) HIV related stigma* It refers to the negative beliefs, feelings and attitudes towards people living with HIV; groups associated with people living with HIV (e.g. the families of people living with HIV); and other key populations at higher risk of HIV infection. a) HIV related discrimination* It refers to the unfair and unjust treatment (act or omission) of an individual based on his or her real or perceived HIV status. It encompasses the unfair treatment of marginalized groups, such as sex workers, people who inject drugs, men who have sex with men, women, transgender people, people in prisons and other closed settings, youth, migrants, refugees and internally displaced people. HIV-related discrimination is usually based on stigmatizing attitudes and beliefs about populations, behaviors, practices, sex, illness and death. *Information taken from the UNAIDS publication: “Guidance Note. Reduction of HIV related stigma and discrimination”. 2014
b) Interrelation of stigma and discrimination Eliminating stigma is a platform to eradicate discrimination in healthcare, regardless of this and despite the fact that both issues are intrinsically related, the way to address them is fairly different. While stigma elimination requires primarily a change in an individual’s mindset, getting discrimination to zero is an obligation by law, recognized in any international or national human rights treaty, it requires immediate action.
This “Zero Discrimination” tag belongs to the UNAIDS strategy “Getting to Zero” which expires this year and was focused on Zero new HIV infections, Zero Discrimination and Zero AIDS-related deaths.
3) YOUTH COLLABORATION IN THE HIV RESPONSE a) We need to become health leaders! Since the beginning of the epidemic, it has been acknowledged that strong leadership is crucial in mounting an effective response at the local, national, and international levels. IFMSA and SCORA realized that long ago, that’s why their members eventually decided to join and lead the fight against AIDS. “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm” Quoted from the Hippocratic Oath it’s something that all IFMSA members have been embracing after their medical studies for more than 60 years now! Our unique contribution to the world of public health, as a youth organization through our collective intellectual and executive capacity has qualified us to share in this major undertaking. Medical students are considered youth equipped with a great deal of knowledge of health which makes our voices heard and considered in all agendas. We need to keep working and keep being enthusiastic, energetic and spiritual change makers.
b) Young people are crucial for the HIV response Every day, around 3000 young people become infected with HIV and many of the 5 million young people living with HIV are without access to treatment. These numbers show us that young people are disproportionately affected in the HIV pandemic and that they remain at the center of the HIV/AIDS epidemic in terms of rates of infection, vulnerability, impact, and potential for change. They face the economic and social impact of HIV/AIDS on families, communities, and nations. Where young people are well informed of HIV risks and prevention strategies, they are changing their behavior in ways that reduces their vulnerability. For example, in several countries, targeted education has led to delayed sexual debut and increased use of condoms resulting in a decrease in HIV prevalence in young people. Yet efforts to increase HIV knowledge among young people remain inadequate leading to 3000 young people newly infected with HIV daily! Everything leads to the fact that young people need to be put in the center of the efforts and the initiatives to effectively face HIV pandemic. c) Together we will go further! It’s a well-known fact that the quote on the right of this page is nothing else but the truth. In the IFMSA we value and treasure our partnerships since they always add up a lot and we get a lot further if we join forces. In this case, aligning goals and objectives through the pact with Y+ is definitely a blessing and a chance to take things to the next level.
4) INTERNATIONAL ACTIVITIES GUIDE As mentioned previously, we are focusing our international campaign into three main actions, all of them conducted through social media and online cooperation. The three activities are complementary to each other and follow the Ending Stigma and Discrimination theme that we talked about right at the beginning. They are all done as part of The PACT led by the IFMSA and the Global Network of Young People Living with HIV.
Pay attention to the next few paragraphs, there you will find the explanation
of how you can participate in each activity as well as the call and access to the necessary resources and materials. a) Testimonials Booklet This activity takes shape into a booklet that aims to collect different HIV-related experiences in a healthcare setting (either bad or good) from future healthcare providers, people living with HIV or anyone willing to participate. By presenting this booklet to our members and spreading it to health professionals, we aim to initiate an impulse that will destigmatize HIV. It’s important to note that we are doing this with Y+, since to understand the needs of the community and be aware of what we should do to improve the future healthcare, we should directly work with them and get an insight of their struggles. What are the different steps to participate? 1. Spread this manual to make sure it reaches the maximum amount of people possible. 2. Write down your own story and encourage anyone willing to participate to write their own. 3. The story should be no longer than 300 words and include your first name, age and profession 4. Send the story plus a picture of yourself (not mandatory). Everything needs to be sent to scorad@ifmsa.org before the 27th of November. On the 1st of December, the booklet will be displayed through the different IFMSA and SCORA communication channels. b) Advocacy Video In SCORA we are well known for promoting our work and advocating through videos created by our members, so this time we will keep this trend alive. We ask you to send us a short video (either individually or with a group) in which you give us your insight on how Stigma and Discrimination in healthcare settings can be tackled.
What are the different steps to participate? 1. Spread this manual to make sure it reaches the maximum amount of people possible. 2. Film a video of you or your group starting with the sentence: We can only end stigma/discrimination by‌..*insert your statement* 3. Try to make the video in horizontal, it can either be filmed with your phone, tablet or camera. 4. Send the video to scorad@ifmsa.org before the 27th of November. On the 1st of December, the booklet will be displayed through the different IFMSA and SCORA communication channels. Summary: 1. Record a video with your statement to fight stigma, discrimination or 2. Impress us with your HIV-related story in a healthcare settings (see conditions in the call above) 3. Send everything to scorad@ifmsa.org before 27/11
23:59 GMT
c) Change your profile picture Five different models of new profile pictures have been created following the theme of this year’s campaign; In order to spread the campaign as much as possible you can do the following: 1. Open the link below that leads to a folder with the pictures and the manual. 2. Change your profile picture right when you receive them. 3. Update the profile picture description with the folder link so people can access the manual and the other pics. LINK: https://drive.google.com/folderview?id=0B7Px49e9sZ27dXhid0NkNW5tcVE&usp=sh aring
As mentioned previously, these three activities are a joint effort of Y+ and IFMSA SCORA within the framework of The PACT
5) SUGGESTED NATIONAL AND LOCAL ACTIVITIES Of course, the success of our campaign and efforts doesn’t rely only on global interventions but working locally and nationally provides us with a lot of room to advocate and push through our message. Below you will find a brief list of some activities that we believe could work well in your Local Committees or NMOs. Feel free to use any of them if they can help you shape your WAD Campaign.
a) Capacity Building: o Peer Education workshops for healthcare students focused on HIV. o Organizing interactive lectures or round table discussions with prominent
externals Trainings for future healthcare professionals on how to deliver a positive HIV result o Trainings on how to identify, avoid and fight current stigmatized and discriminatory health care practices o Capacity building interventions for future healthcare providers on Positive Health Dignity and b) Raising awareness: o Young people can visit HIV centers to break the stigma among them. o Concert to fundraise and increase awareness to include non-medical students and youth. o Street campaigns to spread information and destigmatize and break the myths and fake facts around HIV. o Promote screenings of movies that put on the table HIV related issues and give some space to debate. o Wear and distribute red ribbons or create a huge ribbon with people, candles or fabric. o “Stop HIV/AIDS” parties, concerts or sports events. o Indoor stands in pharmacies or drug stores (done in partnership with condom companies) o Using web portals and social media, making a special web site & mass emailing friends and fellow colleagues o Condom, Sperm or Virus mascots (have a volunteer dress up :P ) o
c) Sharing and creating advocacy videos: Topics for the videos may include stigma
for people living with HIV, HIV & MSM, HIV and sex work, ART, PEP and PREP, difference between HIV & AIDS, diagnostic methods, blood donation policies, universal health access to people living with HIV or influence of health workers in the lives of people living with HIV among others.
Some of last year’s WAD National activities :)
6) BASIC INFORMATION ON HIV RELATED SUBJECTS When Was HIV was First Detected? Antibodies to HIV have been detected in blood samples dating back to 1959. In 1981 the US Centers for Disease Control published the first scientific paper on the epidemic in a report of a rare cancer, Kaposi’s sarcoma, detected in a small number of gay men. HIV was first isolated in Paris in 1983 by Dr. Luc Montagnier. How is HIV Detected? HIV is detected by an HIV antibody test. It is incorrect to call it an “AIDS test” because the test cannot detect AIDS, but instead detects the antibodies that are produced as a result of HIV infection or the antigen itself. It can take up to three months for someone’s immune system to produce antibodies to HIV. This is called the “window period”. An HIV antibody test performed during this window period could be negative even through the person may be infected. What Does Being ‘HIV Positive’ Mean? A person who has had an HIV antibody test, and the result is positive, is sometimes referred to, and may refer to themselves, as being “HIV positive”. Treatment is not a cure Sometimes, combination antiretroviral therapies are written about as if they are a cure for HIV. It is important to recognize that, so far, HIV has not been cured or eradicated by any available drug. People who are on these drugs are still living with, and will continue to live with, HIV. People living with HIV and AIDS continue to experience a range of health issues - from minor to life threatening. There are currently no vaccines available for HIV or AIDS and the treatments help with the symptoms of HIV and AIDS but do not cure them. How is HIV Transmitted? The ability of HIV to live outside the body is very limited and therefore, compared to most other diseases, HIV is not particularly easy to transmit. It is a communicable disease, but it is not contagious like air- borne viruses such as influenza. HIV cannot be transmitted by hugging, shaking hands, coughing or sneezing. Nor can it be transmitted by sharing glasses, cups or utensils.
There are three main modes of HIV transmission: Unprotected anal and vaginal sexual intercourse Sharing drug injecting equipment Mother to child during pregnancy, birth or breast feeding.
Blood-borne Transmission Exposure to HIV contaminated blood is another potential route of transmission. Injecting drug users who share needles and syringes are at risk of HIV infection because there is often a small amount of blood left in the syringe after injection. This type of exposure can also occur during skin piercing and tattooing procedures if equipment has not been properly sterilized after having previously being used on someone infected with HIV. Body piercing or tattooing should always be undertaken at licensed studios that use new ink pots for each procedure and disposable needles or an autoclave to sterilize equipment. What is Safer Sex? HIV can be transmitted in semen, pre-ejaculate, vaginal fluid, blood and breast milk. Therefore any unprotected anal or vaginal intercourse (that is, insertive or receptive sex without the use of a condom or barrier contraception) has the potential to transmit HIV. The risk of transmission is also greater when the person also has an untreated sexually transmitted infection. There is a much lower risk of transmission through oral sex, but this risk increases when there are cuts or sores in the mouth through which HIV may enter the bloodstream. Safe sex prevents semen, pre-ejaculate, vaginal fluid or blood from coming into direct contact with the internal membranes of another person. Penetrative sex can be made safer by using a condom and water-based lubricant. Condoms remain the best protection against the sexual transmission of HIV, provided they are used correctly and consistently. A water-based lubricant should always be used with condoms to prevent breakage. Occupational Exposure Being pricked with a contaminated needle (which may sometimes occur in health care settings and is known as a needle stick injury) presents a small risk of transmission. In the everyday practice there have been cases of HIV infection among health care workers following occupational exposure to blood or body fluids, mainly through needle stick injuries, thus it is important to maintain basic hygienic practices as well as provide health care workers with proper self-protection tools (one-use latex gloves, safe containers for used needles, protective goggles where there is a possibility of blood spatters etc.). There is no recorded case of HIV being transmitted through a discarded needle in a community setting. Mother to Child There are two main routes of HIV transmission between mother and child. One is known as perinatal infection, where a pregnant woman with HIV can transmit the virus to the fetus during pregnancy or during the process of the birth. The risk of perinatal transmission can be reduced through careful management of the pregnancy and delivery. This may include the use of antiretroviral drugs, taken by an HIV positive woman during pregnancy and the birth, and given to the newborn child for six weeks.
The other mode of transmission is breastfeeding. Women with HIV should avoid breastfeeding, except in countries where water quality for bottle-feeding cannot be assured and where many mothers cannot afford formula. In developing countries, shorter courses of antiretroviral treatments have decreased the rate of mother to child transmission.
HIV and Sex Work Sex workers, along with other marginalized groups such as men who have sex with men and injecting drug users, are often labeled a ‘high risk group’ in the context of HIV and AIDS. But the debate about sex workers’ wider role in the global AIDS epidemic often polarizes opinion. Some argue that sex workers are being wrongly portrayed as ‘spreaders’ of HIV, while others claim that HIV transmission through paid sex is ‘driving’ the epidemic. In truth, the situation differs vastly between different countries and regions. While HIV prevalence is high amongst sex workers in some areas, in others it is relatively low, and they seem to play a fairly minor role in the spread of HIV. For instance, in most parts of Western Europe and North America, HIV transmission through paid sex is not considered to be a major issue. In other regions, however, notably parts of Asia and Easter Europe, large numbers of sex workers are living with HIV, and this is influencing the overall pattern of the AIDS epidemic. As well as regional differences between sex workers, the picture is further blurred by a general lack of information on this group. Sex workers are a marginalized and often criminalized population, and are therefore very difficult to track and monitor making them really hard to reach with HIV prevention programmes. HIV and STIs Correlation The presence of certain STIs significantly increases the risk of HIV transmission and
acquisition. People infected with an STI, particularly ulcerative STIs, are generally at higher risk of acquiring HIV. Increasing evidence suggests that people dually infected with both HIV and an STI, particularly with the herpes simplex virus type 2 (HSV-2), are at a high risk of transmitting HIV as well as progressing more rapidly to AIDS. Many of these STIs may be asymptomatic or cause only minor symptoms. As a result, people may not be aware that they have an STI and will therefore not seek treatment and continue to be infectious. This is why improved knowledge about STIs and regular testing, especially for people at high risk of STIs, such as gay and other homosexually active men who have multiple partners, is an important means of HIV/AIDS prevention. Harm Reduction Strategies Harm reduction, such as the establishment of needle and syringe programs followed by condom distribution among those who are especially vulnerable is the best way to contain the spread of HIV/AIDS. But for this to happen, we need a supportive environment for such programs. What’s the meaning behind the Red Ribbon? The Red Ribbon is an international symbol of AIDS awareness that is worn by people all year round and particularly around World AIDS Day to demonstrate care and concern about HIV and AIDS, and to remind others of the need for their support and commitment. The red ribbon started as a “grass roots” effort, and as a result there is no official red ribbon, and many people make their own. It’s easily done - just use some ordinary red ribbon and a safety pin! In early 1991 Visual AIDS in New York created the idea for a global symbol in the fight against AIDS. A symbol for solidarity and tolerance with those often discriminated by the public - the people living with HIV and AIDS. The Red Ribbon was born. Red ribbon was for the first time ever worn by Jeremy Irons at the Tony Awards in 1991. The Red Ribbon was later on recognized as a global solidarity symbol, especially after Freddy Mercury concert at Wembley when thousands of people wore ribbons on Easter Monday 1992. The Red Ribbon is:
Red like love, as a symbol of passion and tolerance towards those affected Red like blood, representing the pain caused by the many people that died of AIDS Red like the anger about the helplessness by which we are facing a disease for which there is not a cure yet Red as a sign of warning not to carelessly ignore one of the biggest problems of our time
The main idea behind wearing the Red Ribbon is the universal hope that red ribbons will be no longer needed.
7) INTERESTING ONLINE SOURCES ORGANIZATION AIDS Education Global Information System (AEGIS) UNICEF - Global AIDS Campaign
WEBSITE www.aegis.com www.unicef.org
AIDS About
aids.about.com
AIDS Prevention and Control Project
www.apacvhs.org
UNFPA
www.unfpa.org
American Foundation for AIDS Research US Agency for International Development (USAID)
www.amfar.org www.usaid.gov
World AIDS Day, United Kingdom
www.worldaidsday.org
HIV In site - Gateway to AIDS Knowledge
hivinsite.ucsf.edu
HIV Positive.com - HIV/AIDS Information USA
www.hivpositive.com
The World AIDS Campaign (WAC)
www.worldaidscampaign.org
International AIDS Economics Network
www.iaen.org
You and AIDS - The HIV/AIDS Portal for South Asia
www.youandaids.org www.ias.se
International AIDS Society The UK National AIDS Trust (NAT)
www.nat.org.uk
Marie Stopes International Australia
www.mariestopes.org.au
Project Inform - HIV / AIDS information, USA
www.projectinform.org
International Community of Women Living with HIV/AIDS The AIDS Memorial Quilt and Names ProjectFoundation
www.icw.org
UNAIDS, United Nations Joined Programme onHIV/AIDS
www.aidsquilt.org
www.unaids.org
8) USEFUL SCORA AND WORLD AIDS DAY ACRONYMS AIDS Acquired Immunodeficiency Syndrome HAART Highly Active Anti-Retroviral Therapy HIV Human Immunodeficiency Virus IFMSA International Federation of Medical Students’ Associations LORA Local Officer on Sexual and Reproductive Health including AIDS NGO Non-governmental Organization NMO National Member Organization NORA National Officer on Sexual and Reproductive Health including AIDS The PACT Coalition of Youth Organizations committed and actively working in the HIV response. PCB Programme Coordinator Board (UNAIDS) SCORA Standing Committee on Sexual and Reproductive Health incl. HIV/AIDS SCORA D Director on Sexual and Reproductive Health including HIV/AIDS SCORA LO Liaison Officer for Sexual and Reproductive Health issues including HIV/AIDS SCORA RA SCORA Regional Assistant STI Sexually Transmitted Infection STD Sexually Transmitted Disease UNAIDS Joint United Nations Programme on HIV/AIDS WAD World AIDS Day WAC World AIDS Campaign Y+ Global Network of Young People living with HIV YFC Youth Friendly Center YFS Youth Friendly Services
9) CONTRIBUTORS
Ahmed Taha HIV and other STIs Program Coordinator
Carlos Andrés Acosta SCORA RA for The Americas
Anna Zahlut SCORA Co-RA for Europe
Carles Pericas Escalé SCORA Director
All the members of the SCORA International Team hope you enjoy as much as possible World AIDS Day and we can’t wait to learn about your activities in the IFMSA SCORA Facebook site (please share them with us :D) Warm Hugs, SCORA IT