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XVIII INTERNATIONAL AIDS CONFERENCE VIENNA JULY 2010

M A G A Z I N E

KISS STIGMA GOODBYE! A FRESH LOOK AT HIV/AIDS AND DRUG POLICY


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MAGAZINE CONTENTS 4 | THE END OF THE BEGINNING As the

fight against HIV/AIDS steps up, so do the calls for drastic policy change. Orange looks at the latest updates in this year‘s International AIDS Conference.

14 | O  NE NEEDLE SHARED BY 300 PRISONERS

6 | “BROKEN PROMISES KILL” The opening

Are people sentenced to prison sentenced to illness?

gave the floor to people who devoted their life to the fight against AIDS.

9 | THE YOUNG ONES Every minute, five

persons under the age of 24 get infected with HIV. New strategies were debated at the Pre-Youth Conference.

10 | BREAKING THE MYTHS Years ago, world

leaders proclaimed a war on drugs. But repressive drug regimes fuel the epidemic and increase stigma and discrimination.

11 | SUCCESS FORMULA? Some countries

have an HIV infection rate of 60 percent among injecting drug users, while others have constantly decreasing rates.

12 | BEYOND THEORY The Vienna Declaration is a major step in obtaining basic human rights for HIV/AIDS patients and drug users, but will governments cooperate with it?

12 | MY NEEDLE IS NOT YOUR NEEDLE! Providing clean needles is the fundamental step to minimise the risk of HIV transmissions.

16 | THE CLOCK IS TICKING Five years left

until 2015, the deadline to achieve the Millennium Development Goals.

16 | “NO RETREAT!” The fear of a donor retreat from the Global Fund to fight HIV, Malaria and Tuberculosis is concerning HIV activists.

17 | ACROSS THE WORLD An Orange

overview of the HIV/AIDS fight and national drug policies.

22 | TOURIST TRAP Asia’s thriving sex tourism

scene makes it a hotspot for HIV/AIDScomplications and other human rights violations.

22 | TODAY’S SILK ROAD Bulgaria and

Romania have always been countries on a crossroad for the traffic from east to west.

EDITORIAL

“HOPE OVER DESPAIR” ORANGE REPORTS ON THE FIGHT AGAINST HIV/AIDS AND INTERNATIONAL DRUG POLICIES. OUR AIM: END STIGMA AND BRING MARGINALISED SECTORS OUT OF THE SHADOWS.

by Maximilian Kall, Editor-in-chief

Long-time AIDS activist Annie Lennox quoted Nelson Mandela’s words on his 92nd birthday: “Hope over despair.” It was one of the emotionally charged moments in the opening of the XVIII International AIDS Conference, when the entire audience of more than 10,000 AIDS activists, scientists and decision-makers was deeply touched. A similar reaction struck the audience when Rachel Arinii Judhistari, a 21-year-old young woman from Indonesia, urged young leaders to come forward and fight the disease that hits the young generation terribly. Every minute, a young woman or a young man under the age of 24 is infected with HIV/AIDS. Why are billions of dollars from donors urgently needed to save millions of lives, and why should there be no retreat? How can

universal access to treatment be achieved? How can people make it happen? These were questions brought up at the conference in Vienna, where scientists, AIDS activists and people living with HIV took the initiative for others and demonstrated exemplary leadership. It was a conference for the 34 million people living with HIV/AIDS around the world. It sent messages of hope back home to the 10 million HIV-positive people urgently waiting for anti-retroviral treatment, and for the others suffering from the disease. Basic human rights were the core issue of AIDS 2010. In many parts of the world, human rights are still challenged by poverty and violence. The epidemic of stigma, discrimination and denial is as critical as the disease itself. This is how Jonathan Mann, a


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EUROPEAN YOUTH PRESS

25 | FIGHTING AGAINST THE FIGHT Around the world are people on the frontline fighting against HIV/AIDS. But their actions have often led to harassment, vilification and sometimes even imprisonment.

26 | NOW MORE THAN EVER! Orange photo reportage: a look at the human rights march.

28 | E  VERY NIGHT A COLD-BLOODED NIGHTMARE Lakshmi was threatened to marry, forced to sex, and is today an HIV positive mother of an HIV positive child.

30 | W  OULD YOU EAT FROM THE SAME DISH AS AN HIVPOSITIVE PERSON? Marginalisation, stigma and discrimination are still major obstacles towards the prevention and treatment of HIV/AIDS.

32 | SEX, DRUGS AND ROCK ‘N ROLL HIV/AIDS shook the world when they first entered public consciousness in the early ‘80s. A timeline of some of their more colourful moments.

European Youth Press is an umbrella association of young journalists in Europe. It involves more than 50,000 journalists working for university magazines, Internet projects, radio and video productions, or are interns in editor-rooms, freelance journalists, journalism students or trainees. With print magazines or Blogs, PodCasts and V-Casts, the association wants to give young media makers from all over Europe the opportunity to cooperate directly with each other. Above all, the aim of all member associations and the umbrella structure is to inspire young people to deal with media and take an active part in society by fostering objective and independent journalism. ORANGE MAGAZINE Fresh. Vibrant. Creative. Orange is a youth-driven magazine dedicated to tackling urgent international issues. Writers and photographers from different countries with diverse backgrounds make this magazine unique. They create multi-faced magazines with new and interesting contents. Creating it means having an exciting time in a quite unusual environment. Reading it means getting facts and opinions directly from young and innovative journalists.

33 | THE GLAMOROUS DISEASE? Pick a piece of pop culture and it‘s likely you’ll find something with an AIDS related theme. What is it about AIDS that makes it so appealing?

POWERED BY

34 | D  UDE... DO YOU HAVE SOME RUBBERS? MTV‘s Staying Alive campaign has made AIDS awareness in Africa easier.

WITH SUPPORT OF

IMPRINT

pioneer in the fight against HIV/AIDS, once described it. Stigma against HIV/AIDSafflicted people leads to the marginalisation of millions in their respective societies, leading to fears and stereotypes that must be shattered right away. The stigma of HIV/AIDS and drugs leads to punitive laws, backed by repressive regimes that reinforce human rights abuses. Millions of drug users around the world experience this when their addiction is often not addressed with proper treatment, but by punishment. They are not treated in clinics, but in prisons. In Russia, up to 80 percent of new HIV transmissions are among injecting drug users; in other parts of the world, the rate rests at 30 percent. These people – who are denied access to clean needles and HIV treatment – do not only have to fear for

their lives, but the policeman around the corner as well. Young leadership on HIV/AIDS demands young information sources. This Orange issue aims to bring up the crucial topic of fighting the AIDS epidemic by evidence-based international drug policies, as stated in the Vienna Declaration. It aims to bring this marginalised topic out of the shadows. It aims to ask questions, and provide answers Orange editors were able to research and report on. It aims to take up various perspectives composed of an editorial team from as far as Australia and India, the Philippines, Romania and Holland. Thousands raised their voices in Vienna to carry the message of hope prevailing over despair. Now, make it happen. Enjoy reading!

Publishers line: Orange Magazine European Youth Press, Rue de la Tourelle 23, BE-1040, Brussels, Belgium Editor-in-chief: Maximilian Kall, Germany Local coordination: Matthias Rohrer, Austria Editorial staff: Georgeta Bocşe, Romania Shuk-Wah Chung, Australia Bianca Consunji, Philippines Tejeswi Pratima Dodda, India Elisa Gärtner, Germany Dumitru Iovu, Moldova Marjolein Nieuwdorp, Netherlands Guilherme Correia da Silva, Portugal Dobriyana Tropankeva, Bulgaria Photos by: Ryan Fernandez, Philippines Tatsiana Zenkovich, Belarus Layout: Dumitru Iovu, Moldova Read more about our team at: www.orangelog.eu All articles do not necessarily represent the opinions of the magazine.


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Thousands poured out on the street to show their support for HIV/AIDS patients and to demand increased funding for them.

THE END V

AS THE FIGHT AGAINST HIV/AIDS STEPS UP, SO DO THE CALLS FOR DRASTIC POLICY CHANGE. ORANGE LOOKS AT THE LATEST UPDATES IN THIS YEAR’S INTERNATIONAL AIDS CONFERENCE. by Bianca Consunji, The Philippines, and Marjolein Nieuwdorp, The Netherlands

25,000 PEOPLE FROM 185 COUNTRIES. WHAT CAN THEY POSSIBLY HOPE TO ACHIEVE IN THIS YEAR’S INTERNATIONAL AIDS CONFERENCE IN VIENNA? Conferences are notorious for consuming vast amounts of time, effort and money. People who fly from all over the world present papers, and meetings are held for days. In some cases – as with the case of the UN Climate Change Summit held in Copenhagen – the conferences are unsuccessful in general, with results that turn out to be less than satisfactory. However, this does not appear to be the case in the XVIII International AIDS Conference, dubbed “Rights Here, Right Now.” The centerpiece of the conference, The Vienna Declaration, contains solid steps to

ensure that human rights are protected through the decriminalisation of drug use and possession, as well as a comprehensive drug policy reform programme through a science-based approach. It also points out drugrelated issues, such as increased criminal activity and wasted taxpayers’ money. The Vienna Declaration was largely lauded by the scientific community and supported by high-profile government officials, Nobel Laureates and private companies, but the largely agreeable face of the conference – where most of the attendees have already agreed on the agenda – hides problems that will not go away unless drastic action is taken, and soon. The call for drastic action and increased funding is what brings AIDS activists together with researchers, policymakers and grassroots


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Methadone Man, a comic book on drug replacement therapy, is presented in a form readily understandable to the youth.

Enthusiastic advocates rally for the enforcement of human rights in the fight against HIV/AIDS.

The Free Hugs campaign came to Vienna to support people with HIV/AIDS.

O  F THE BEGINNING workers for a structured dialogue regarding the major issues on the global response to HIV/AIDS. With a global economic crisis threatening to undermine public investments, the conference aims to keep HIV/ AIDS on the front burner. The selection of Vienna as the host city is a reflection of the central role Vienna has played in bridging Eastern and Western Europe, but is also due to its proximity to Eastern Europe and Central Asia, both regions with a growing HIV/AIDS epidemic fueled primarily by injecting drug use.

THE CHANGING FACES OF AIDS The International AIDS Conference is the 18th since the Acquired Immune Deficiency Syndrome (AIDS) first came to light in 1981. Ever since, it

has killed more than 25 million people. It’s a severe epidemic without borders. HIV/AIDS is everywhere, but the intensity of the spread of the virus varies due to divergent causes. In the Russian federation, there is insufficient access to information on HIV, while efforts to reach men who have sex with men with prevention service are hampered by homophobia. In Malawi, you might have to travel 100 kilometers to obtain access to treatment. In parts of the Middle East, blood transfusions are still not completely safe. In Ghana, more than 40 percent of infections occur through sex work, men having sex with men and the use of injected drugs, but only 0.24 percent of the national budget on prevention spending is given to these groups. In his keynote speech at the AIDS conference Bill Gates spoke on the

HIV/AIDS BY NUMBERS Number of people living with HIV

33 million

Number of new HIV infections per year

2.7 million

Number of HIV-related deaths per year

2 million

Number of people in treatment

5 million

Number of HIV/AIDS-related deaths since 1981

25 million

Number of African AIDS orphans

14 million

Sources: The UNAIDS report 2008

over

over


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Access to cheaper and readily available medicine was one of the main concerns discussed by speakers and AIDS activists.

historic opportunity to “Change the face of AIDS” by outlining a roadmap to dramatically reduce new HIV infections. He outlined opportunities for global AIDS investment to save more lives and called for a new focus on efficiency in HIV prevention and treatment. UNAIDS agrees

Around the conference, brightly colored condoms served as decorations as a reminder to practice safe sex.

with his call, saying it must magnify its focus on HIV prevention while addressing the specific needs of each key population including youth, women and girls, sex workers and their clients, people who use injected drugs, men who have sex with men, prisoners, refugees and migrants.

Hundreds of couples share a kiss by the Belvedere, where Gustav Klimt‘s iconic painting, „The Kiss,“ is stationed.

Despite efforts to keep HIV/AIDS at bay, more and more people acquire the dreaded virus, with 2.7 million new infections yearly. Worldwide, there are now more than 33 million people living with HIV/AIDS. The demographic of HIV/AIDS patients has changed as well;

“BROKEN PROMISES KILL.” THE OPENING OF THE XIII INTERNATIONAL AIDS CONFERENCE IN VIENNA 2010 GAVE THE FLOOR TO THE WORLD LEADERS, SCIENTISTS, NGO ACTIVISTS, CELEBRITIES, YOUNGSTERS AND MOST IMPORTANTLY – TO PEOPLE WHO DEVOTED THEIR LIFE TO THE FIGHT AGAINST AIDS. THEIR VOICES UNITED UNDER THE CONFERENCE MOTTO “RIGHTS HERE, RIGHT NOW!” EMPHASISED UNIVERSAL ACCESS FOR TREATMENT AND UPHOLDING HUMAN RIGHTS. by Dobriyana Tropankeva, Bulgaria

The official opening of the ceremony was delayed by peaceful protests. The stage was occupied from activists bearing red umbrellas, a symbol of sex workers, and the huge banner “No retreat – fund AIDS.” They were shouting: “Now make it happen” and “We want treatment now.” Massive applause of the more than 10,000 in the room supported the claims. Julio Montaner, President of the International AIDS Society (Canada) and Chair of AIDS

2010, responded to the protests, by saying “There should be no retreat. Fund AIDS.“ He added, “The more we treat, the more we prevent. Treatment is prevention.” Local co-chair of AIDS 2010, Brigitte Schmied, said: “In many countries, people are dying because of shortages in medicine supplies. Doctors and nurses have to decide who is allowed of treatment – who will live and who will die. We need to treat people, not prosecute them.”


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The subject of international controversy, the needle exchange programme aims to reduce drug-acquired HIV contamination through tainted needles.

what used to be called the “gay disease” is no longer limited to men who have sex with men or injected drug users, for that matter. Women and children are now part of the global epidemic that has claimed the lives of over 25 million to date, despite efforts to disseminate information that

Young people discuss sexuality and HIV/AIDS at the Global Village.

mother-to-child HIV can be prevented or contained.

RIGHTS HERE, RIGHT NOW The theme of AIDS 2010, ‘Rights Here, Right Now’ was chosen to emphasize the

critical connection between human rights and HIV/AIDS. Emphasis on the protection of human rights for those most vulnerable to HIV/AIDS is seen as a crucial step in slowing down and eventually ending the pandemic. While not as widespread as it was in the ‘80s and ‘90s, ignorance plays a

“I believe in Treatment 2.0. I am so confident in this method that I put my authority behind it.” – Michel Sidibé from Mali, Executive Director of UNAIDS and Under Secretary-General of the United Nations

“I AM TOO YOUNG TO DIE FROM HIV”

Keynote speaker Sharon Lewin (Australia), Director of the Infectious Diseases Unit at The Alfred Hospital, outlined the multiple barriers to curing HIV, and examined potential avenues for achieving either a functional cure (long-term control of HIV in the absence of combination antiretroviral therapy) or a sterilising cure (elimination of all HIV-infected cells). Studies of patients who can naturally control HIV have demonstrated that a functional cure may be possible with the most consistent finding among these.

Rachel Arinii Judhistari (Indonesia), Founder of the Independent Youth Alliance in Bali: “I carry the voice of young people on this conference. I come from Indonesia, the biggest Muslim country in the world. When I was 15, they told us at school that condom use was propaganda so people lose their faith in God. That was my sexual education. When I went for

“HOPE OVER DESPAIR!” The singer Annie Lennox, longtime AIDS activist from the United Kingdom and UNAIDS International Goodwill Ambassador, showed the audience a picture of Avalili, a girl was born HIV-positive. Her mother died from HIV. When Annie Lennox met her first, Avalili

HIV testing they refused me. They said I wasn’t married and I was too young for HIV. But I am too young to DIE from HIV. It is time to make decisions. It is time to translate from paper to people. We are not only the leaders of tomorrow. We are the leaders of today – Rights here. Right now.”

was sorely struggling with pneumonia. Five months later, Lennox returned to see that Avalili had received treatment. The girl looked like her entire life had changed. Avalili’s fate is not unique; every day, there are more examples of triumph over HIV/AIDS, leading Lenox to repeat Nelson Mandela‘s chant, “Hope over despair!“

“Health is an option, which today depends on the price tag. Governments decide who is more entitled to the right of health and who is less. Human Rights must stand over profit rights,” argued Paula Akugizibwe (Rwanda), Advocacy Coordinator of the AIDS and Rights Alliance for Southern Africa.


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QUOTES

“Five million people are alive because of treatment. We have seen unprecedented activism and the full engagement of people living with HIV. But I am scared by what I see today. Prevention models are coming up short. Some governments are cracking down on vulnerable groups. Treatment is not sustainable and costs are rising.” Michel Sidibé, Executive Director, UNAIDS Protesters interrupt the opening session of the conference, demanding equal rights for sex workers.

“AIDS is a movement and we would not be as far along today if people had not decided to get involved… You can save a life without a very large donation.” Bill Gates, Founder, Bill and Melinda Gates Foundation “We have improved our reaction to the epidemic. This is certainly positive. But this gives a false feeling of security. The threat remains for everyone and will last. Millions infected are not mere statistics. Behind every number is a human being who needs our support because she or he is fighting a disease that is still threatening all of us.” Jean-Marc Delizee, Deputy Minister for Social Affairs and Public Health representing the EU Council “We have to remember that prevention is everyone‘s responsibility. People with HIV don‘t have, only because they live with HIV have that responsibility. So it‘s everyone‘s responsibility to prevent new infections. Therefore, we must share that responsibility.” Vuyiseka Dubula, General Secretary, Treatment Action Campaign

large part in denying the basic human rights to HIV/AIDS patients. Today, stigma and persecution are the greatest enemies of HIV/AIDS patients. Although scientific evidence has proved that the criminalisation of HIV/AIDS-related issues such as homosexuality and drug use are ineffectual, the war against drugs goes on. Discrimination against homosexuals goes on. These pose huge barriers to HIV testing, care and support and dramatically increase risk of transmission. Instead of taking scientifically valid, humanitarian steps to stem the spread of the virus, many nations around the world go on as they did before, in ways that violate basic human rights. HIV/AIDS patients find themselves victimised not only by the virus, but the society that allowed the virus to infect them in the first place. The conference is a chance to demonstrate the importance of continued HIV investments to broader health and development goals.

LEADING THE WAY Despite the odds, the progress in the fight against HIV/AIDS is remarkable: five million people currently

Pained expressions: artists put up installations around the conference venue to express their feelings through the medium.

receive anti-retroviral treatment for HIV, a twelvefold increase in just six years. This triumph has proven wrong many critics, who, 10 years ago, believed that HIV medication could not be made affordable. While new HIV infections have already declined by 17 percent, the speed of the decline is not fast enough to have a significant impact on the course of the epidemic. Today, for every two persons who receive treatment, another five people become newly infected. Moreover, anti-retroviral drugs are expensive, and the majority of the world‘s infected individuals do not have access to medications and treatments for HIV/AIDS when they cannot even spend on basic necessities, such as food and shelter. “This is not the beginning of the end, it is just the end of the beginning,” said former U.S. President Bill Clinton at the first plenary session of the conference. What he said struck a chord in the hearts of HIV/AIDS sufferers and activists around the world. After all, with every advance made in the name of research and development, another one in the name of human rights has to be made if any progress is to be made.


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THE YOUNG ONES by Marjolein Nieuwdorp, The Netherlands

YOUNG PEOPLE AT AIDS 2010 Globally, 5.4 million adolescents are living with HIV. Youngsters are the age group most vulnerable to HIV infection due to many factors like lack of information, societal influences and their inability to obtain access health care services. Building youth leadership is crucial to an effective AIDS response among and by young people. Therefore, mobilising youth networks worldwide and making young people visible at the AIDS 2010 conference as delegates, organisers, speakers and peers is indispensable.

YOUTH-CONFERENCE ACTIVITIES The Youth Programme included a variety of activities like the youth reception, a leadership development workshop, an advocacy campaign and numerous discussion forums, skillsbuilding workshops, art and video. Youth-led initiatives and peer-based education were on-going, like a clinic offered by Dance4Life about how to raise awareness amongst young people about HIV/AIDS and raise money at the same time by organizing danceevents. As DJ Tiësto, Dance4Life ambassador, says: “Dance4Life engages young people around the world to do something about the HIV/AIDS problem in an attractive way. The combination of serious content and entertainment assures that dance4life gets young people on the move.” During the seminar ‘Another brick

PEOPLE GROWING UP TODAY HAVE NEVER KNOWN A WORLD WITHOUT AIDS. YOUNG PEOPLE ARE DISPROPORTIONATELY AFFECTED IN THE HIV EPIDEMIC: 45% OF THE NEW INFECTIONS WORLDWIDE ARE AMONG YOUTH AGED 15 TO 24. THIS MEANS EVERY MINUTE 5 PERSONS UNDER THE AGE OF 24 GET INFECTED WITH HIV.

in the wall’, students from all over the world discussed how different the problems concerning HIV/ AIDS are per continent and even per country, depending on knowledge, health care, politics and so on. Global consequences and causes of HIV/ AIDS are very often interwoven and therefore difficult to understand. To get more knowledge about this and realise that exchange and joint projects between countries in the ‘West, East and South’ are significant and made this workshop very useful. Knowledge is power; education and talking about sex is important. The next step is to empower young

VOXS POPS

people, to advocate for current and critical issues affecting young people worldwide, and further pinpoint current strategies for effective change. Empowering young people to prevent sexual and other transmission of HIV infection among their peers is about implementing policy changes; to provide rights-based sexual and reproductive health education and services. This can be achieved by ensuring access to HIV testing and prevention efforts with and for young people in the context of sexuality education and by ensuring enabling legal environments to reduce vulnerability to HIV.

Joelle Reid (18), England, Youth volunteer Centre for All Families Positive Health (CAFPH). CAFPH aims to enhance the skills of people living with HIV/AIDS so that they are supported to live a fuller life and to be involved in all levels of civil society. “I feel that knowledge is the key to get young people like me involved with the HIV/ AIDS issues because youngsters are the most vulnerable group and it’s very important that they all know how to be preventive.”

Jessica Whitbread (30) from the United States, Northern American representative for the International Community for Women living with AIDS, present at the Youth Reception. “I truly believe that it’s important to involve young people, not only because they are the future leaders and policymakers but also because they influence peers, they have fresh ideas and can push things forward.”

Clelia Molina (20) and Miriam Fischer (19), Austria, visiting the “Get ready for AIDS 2010”reception and festivity. “The band Dunkelbunt playing at this party made us come here, we didn’t know about the conference in Vienna. I think it’s good to have a conference about HIV/ AIDS but I don’t really understand why it’s held in Vienna”.

“I think that the problems concerning HIV/AIDS are very different all over the world and the consequences vary very much, but it exists as well in Europe as in African countries.”


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BREAKING THE YEARS AGO, WORLD LEADERS PROCLAIMED A WAR ON DRUGS. BILLIONS WERE SPENT, BUT DRUGS STILL CONTINUE TO CIRCULATE AROUND THE GLOBE. ACCORDING TO HIV EXPERTS AND DRUG POLICY ADVOCATES GATHERED IN VIENNA, REPRESSIVE DRUG REGIMES FUEL THE EPIDEMIC AND INCREASE STIGMA AND DISCRIMINATION.

by Dobriyana Tropankeva, Bulgaria

Debate in Drug Policy Networking Zone.

Drugs as we know them were not always the prohibited narcotics they are today. Back in 1870, in the United States, liquid opium was taken as medicine just as much as Aspirin is used today. However, when Chinese sailed to America and smoked opium in dens, the act was seen as defiant and shocking. The fear of the unknown provoked the first law against drugs in USA in Nevada, which prohibited smoking of opium. In Europe, heroin was initially sold as medicine against morphine addiction from the German pharmaceutical company Bayer. Nowadays, it is an illicit drug. However, it may be used in some countries such as Switzerland, Germany, Denmark as long as it is controlled by medical supervision. Ethan Nadelmann, Executive Director

of the Drug Policy Alliance from New York, is full of examples. He is a long-time advocate of human rights-based drug policies in the US and around the world. The last he would do is to promote drug use. However, he has clear evidence that criminalisation of possession presents drug users with even higher risks: a person who fears a harsh justice system and faces incarceration for years does not use harm reduction services. To illustrate this, he discussed an experiment in Canada, where a group of people addicted to heroin were part of a test group. Half of them were given heroin, while the

other half was provided with Dilaudid, a legal medicine with similar effects. The result? Not even the long-term heroin users could tell the difference. “Heroin is like a demon,” Ethan Nadelmann says. “But clean, pharmaceutical heroin does not differ from other pain medication.” DRUGS WON’T DISAPPEAR FROM THE WORLD’S SURFACE

People have always found a way to drug themselves for various reasons, whether for recreational purposes or as medication. The criminalisation and penalisation has never (and will not) lead to less drug use, experts like Nadelmann say. “If the drug business is controlled by the

“KNOW YOUR DRUG WAR”

HUMAN RIGHTS, HARM REDUCTION AND DRUG POLICY NETWORKING ZONE The Drug Policy Networking Zone at AIDS 2010 was a space for sharing ideas, experiences and expertise on drug policy reform. Together with the Harm Reduction and Human Rights Networking Zones it produced a ‘mega’ zone with

a full schedule of talks, discussions, debates and multimedia running throughout the week. One of the major sessions was: “Beyond a declaration”, how to move towards drug policy reform?” dedicated to the Vienna Declaration with one

of its key authors: Evan Wood, from the International Centre for Science in Drug Policy. On 21st July there was a short commemoration with speeches and a minute of silence dedicated to the International Remembrance Day in memo-

riam of those who have died as a direct, or indirect result of substance misuse. The slogan “Know your drug war” was meant to emphasize the tremendous costs and missing successes of the international “war on drugs”.


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MYTHS mafia and black market it will be always out of control,” Nadelmann explains. He cites the Prohibition in the United States as an example to support the idea of legal drug control. Back in the 1920s, alcohol was banned in the U.S. to curb the effects of abusive drinking. However, the law backfired: people resorted to bootlegged liquor or made their own. Instead of drinking beer, hard liquor such as whiskey became the drink of choice, because it was easier to make a profit out of drinks with higher alcohol content. Crime and corruption increased as the mafia (led by Al Capone and other figures) took over the country “The analogy is very much the same today,” says Ethan Nadelmann. Surveys among school pupils in the U.S. state that they find it easier to buy marijuana than alcohol. Legalising marijuana appears to have broad support, with some 56 percent of Californians in favour of the motion (as surveyed in an April 2009 Field Poll). A California voter initiative that would legalise possession and sale of marijuana has qualified for a November 2010 ballot. Some countries like Switzerland, Portugal and the Netherlands have relatively tolerant drug policies, while many Asian countries are extremely repressive. Kasia MalinowskaSempruch, the Open Society Institute‘s Director of the Global Drug Policy Programme, shared her sentiments about a visit to China: “I visited the Uyghur community in a village in Xinjiang. The place was covered with needles. It was dangerous to walk on it,” she says. “I met there a worker who was limping. He hurt his leg when he jumped of the second floor of a building running away from the police. He was not afraid to be arrested. He was afraid of being sent to a rehabilitation centre. In China, you are sent to it without a trial. However, there is very little treatment there. You don’t know your release date. Every day you spend there, your family pays for you. If they don’t, you stay hungry. He was afraid that if he is caught, his daughter wouldn’t be able to afford to go to college.”

SUCCESS FORMULA? THERE ARE COUNTRIES AROUND THE GLOBE THAT HAVE A RATE OF INFECTION WITH HIV UP TO 60 % AMONG INJECTING DRUG USERS, WHILE OTHERS HAVE CONSTANTLY DECREASING INFECTION RATES. IS THERE A RECIPE FOR SUCCESS? PORTUGAL AND IRAN ARE TWO EXAMPLES FOR SUCCESSFUL HARM REDUCTION POLICIES. by Georgeta Bocşe, Romania

In 2001, Portugal became the first European country to officially abolish all criminal penalties for personal possession of drugs, including marijuana, cocaine, heroin and methamphetamine. Critics feared at the time that a “drug tourism” movement would star t. The result was contrary. A research commissioned by the Cato Institute found that in the five years after the start of decriminalisation, illegal drug use by teenagers had declined, the rate of HIV infections among drug users had dropped, deaths related to heroin and similar drugs had been cut by more than half, and the number of people seeking treatment for drug addiction had doubled. National Co-ordination for HIV/AIDS infection is an initiative in Portugal that offers several programmes on harm reduction. Most successful is their the needle and syringe exchange programme.

HARM REDUCTION

The International AIDS conference in Vienna 2010 is unified around the idea that everyone deserves HIV treatment because everyone’s life is worth the same. Not so long ago, a common perception of HIV/AIDS was that if you got infected, you basically did it to yourself and deserved it. Nowadays, the general perception is that it is the person plus the environment that come together to create the HIV risk. According to Sempruch, the AIDS community agrees that harm reduction services should be offered to people who are in prisons. “Everybody will agree that anti-retroviral treatment should be offered to people who are in prison. Here, I think the AIDS conference’s position is clear. I think where we are less clear is saying why people dependent on drugs are in prison in the first place,” she says.

Maria Jose Santos, a nurse working for the programme, says that in 1993 the prevalence of new HIV infections among IDUs was up to 80 %, but now it decreased to 42,5%. National Coordination also has substitution programmes and personnel that instructs drug users how to inject. In the future,

Maria explains, National Coordination will also focus on giving out kits for sniffing cocaine and smocking crack. “We have to adapt to the changes on the drug market. We have the law but the community does not agree” she says. As a result there are no injection rooms in Portugal and also needle and syringe exchange is quite impossible in prisons. A COUNTRY YOU WOULD LEAST EXPECT TO BE PROGRESSIVE: IRAN According to the International Harm Reduction Association (IHRA), harm reduction programmes are carried out in 93 countries. Yet they are often underdeveloped, need 25 times more money and the national coverage is too low.

Gerry Stimson, executive director of the IHRA, says that the best examples come from countries that you would least expect. “Introducing harm reduction has always been a struggle, but it has often succeeded in the most unlikely places”, Stimons says. “Iran is the leading country in the Middle East and Northern Africa regarding harm reduction – thanks to its highly educated medical elite and also because they worked with religious leaders so that harm reduction is consistent with Islam.”


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BEYOND THEORY THE VIENNA DECLARATION IS A MAJOR STEP IN OBTAINING BASIC HUMAN RIGHTS FOR HIV/AIDS PATIENTS AND DRUG USERS, BUT WILL GOVERNMENTS COOPERATE WITH IT? by Tejeswi Pratima Dodda, India

It’s hard to resist the optimism of a prospective new approach to the HIV/AIDS epidemic, especially if you’re one of the 15.9 million people who inject drugs worldwide. Many users do so illegally and in an unsafe way, primarily because of the criminalisation of illicit drug users. The Vienna Declaration states that there is a need for the United Nations and other bodies to acknowledge the limits of drug prohibition. It argues that scientific research and international surveillance systems provide evidence that law enforcement does not reduce the prevalence of drug use among communities where drug demand is high. It calls for a transparent review of the current policies and implementing a science-based public health approach to address the individual and community dangers of illicit drug use. The biggest reform that the declaration demands is to put an end to the prohibitionist legal framework and introduce regulations that countries could adapt according to their national policies. The debate around the Vienna Declaration seems to be part of a larger question

involving the criminal justice system and the public health system. The basic difference is the preventive approach of the public health system and the reactive approach of the criminal justice system. As many public health systems have a track record of successful community engagement programs, this is not an unfamiliar challenge for some countries. The question remains on whether the declaration demands a public health system that complements the criminal justice system, or a public health system that replaces the criminal justice system. Perhaps the integration of both the systems will work best for the innumerable local epidemics within HIV/AIDS. The UN has endorsed the declaration, the extent of the possible reform is not clear yet. In spite of the scientific community’s endorsement, the Canadian government has officially disagreed with the content of the declaration and stated that it would create inconsistencies within their national law. Canada’s reaction raises questions on the possible responses from governments of other countries.

THE VIENNA DECLARATION AT A GLANCE MORE THAN A DOCUMENT, IT TAKES A LANDMARK STANCE ON ASSERTING HUMAN RIGHTS. BUT WHAT DOES IT ENTAIL? by Bianca Consunji, Philippines

What is it about? 1. It calls for the decriminalisation of drugs, citing evidence that the multitrillion-dollar global war on drugs failed. 2. It supports policy changes on drug use, pushing for harm reduction founded on science-based principles (ex. needle exchange programmes and opiate substitution therapy) 3. It advocates scrapping current drug treatment and punishment, such as compulsory treatment centers and harsh prison sentences, due to the human rights violations committed under such conditions.

Who support it? Notable names in science, religion, law and civil society have signed the declaration, although it has yet to gain popular support from governments around the world. Signatories include Nobel Prize Laureates such as James Orbinski, MD, Prof. Vernon L. Smith, PhD, Prof. Jack SzostaK, Prof. Françoise Barré-Sinoussi, PhD, and Professor Sir Harold Kroto, FRS. Former heads of state include César Gaviria (Colombia), Fernando Henrique Cardoso (Brazil) and Ernesto Zedillo (Mexico). Popular figures such as writers Paolo Coehlo and Mario Vargas Llosa round out the list.

ACCORDING TO RECENT UNAIDS REPORTS, THE HIV PREVALENCE AMONG INJECTING DRUG USERS (IDUS) IS AS HIGH AS 70 PERCENT. CHANGE IS POSSIBLE: PROVIDING CLEAN NEEDLES IS THE FUNDAMENTAL STEP TO MINIMISE THE RISK OF HIV TRANSMISSIONS. BUT WHERE ILLICIT DRUG USE IS A SEVERE CRIMIE, PEOPLE AFFECTED SHRINK BACK FROM UTILISING LIFE-SAVING HARM REDUCTION SERVICES. by Georgeta Bocşe, Romania, and Elisa Gärtner, Germany

To minimise the danger of HIV transmission due to infected needles and syringes, many AIDS scientists and activists support providing addicted persons with new needles in exchange for their used ones.


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MY NEEDLE IS NOT YOUR NEEDLE! This reduces the risk of HIV and removes used needles from circulation in the community. The needle exchange programme (NEP) started in Amsterdam, The Netherlands in 1984 and was soon followed by other European countries. Opponents to offering sterile needles for free mainly argue that this approach also supports drug use and therefore is an ethical and moral issue. Additionally, they regard the exchange programme as a health risk for the public at large, since drug users could discard their needles in unsafe places like playing areas for children. However, various studies support the introduction of needle and syringe exchange in pharmacies or injection rooms. About 80 countries established the programme so far. Recently, also the United States announced the support of needle exchange programmes.

DECRIMINALISATION AND HARM REDUCTION Organisations that fund harm reduction often advocate for the decriminalisation and depenalisation of drug use, to also reduce HIV-rates. European examples of Netherlands and recently, Portugal show that the legalisation of

“Clear scientific evidence shows the more we offer substitution therapies and provide clean needles, the more drug use goes down, not up.“ – Former US President Bill Clinton at the 2010 International AIDS Conference

drug use or abandoning punishment for the possession of drugs contributed to reduce consumption. In Western countries, funding is organised nationally or by the municipalities. In developing countries, financing of harm reduction programmes like needle exchanges is basically provided by the Global Fund and non-governmental organisations such as the Global Drug Policy Programme of the Open Society Institute (OSI) and international harm reduction NGOs. In more repressive countries, where no sufficient drug policy applies, social workers are being supported: “People fear going to exchange institutions because the police could identify and incarcerate them,” explains Kasia Malinowska, director of the OSI Global Drug Policy Programme.

BY DRUG USERS, FOR DRUG USERS The Vancouver Area Network of Drug Users (VANDU) works to improve the lives of people who use illicit drugs. The organisation runs North America‘s first supervised injection site in Vancouver. Board member Diane Tobin has been in VANDU for eight years. She promotes positive experiences on harm reduction programmes in Vienna. Orange: How many IDUs utilise the ser-

vices at the centre daily? Diane Tobin: About 100 persons a day and there is no restriction regarding the number of needles that they can take away. Of course we encourage them to bring back the used needles, but this is not a condition. The return rate is up to 85 %. We also have patrols that go to the streets and pick up any used needles or syringes. Are people taking advantage of the injection rooms that you have? We are at full capacity. Around 20 people use our services at a time. We only have 20 booths and we are working towards increasing them. It is only closed for a few hours during night for cleaning. Do IDUs trust these places, aren’t they afraid to approach you because of the police? The police are pretty good. We have an agreement with them which protects the people who come here. What are the other programmes on harm reduction that the centre takes up? We have the methadone programme. We also have a lot of educational workshops on drugs, HIV/AIDS and associated diseases. We started a caravan where we are mainly trying to reach out to drug users. Most of our organisation’s success is because it is totally run by drug users. We don’t have non-users voting on our problems. It is our voice that is heard.


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Let’s say you were imprisoned for buying heroin, which you started taking for depression. Now, you’re addicted to the drug just as others are to cigarettes or alcohol. But unlike them, your addiction gets you arrested for a criminal offence. And if you acquire HIV through a dirty needle, chances are, you’ll have to overcome the problem on your own – in a cell, among other prisoners. Prisons around the world are besieged with HIV infections acquired from injected drugs. The link between drug use and HIV infection is astounding, but since drug use is often regarded as a criminal offence and not as a health problem, affected persons rarely get medical treatment after incarceration. Thus, illegal drug dealing became a common practise in prisons. The need for medical treatment is often not met suitably, and thus leads to illegal consumption and side effects such as shared syringes and underground drug dealing. The Drug Policy Guide 2010 of the International Drug Policy Consortium reports that sharing rates often range between 60 to 90 percent in prisons. Kasia Malinowska, Director of the Global Drug Policy Programme of the Open Society Institute, shares horrifying tales of drug hygiene problems. “In one instance, there was a needle used by 300

ONE NEEDLE  SHARED BY

300 PRISONERS HIV INCIDENTS AMONG DRUG USERS ARE EXTRAORDINARILY HIGH IN PRISONS ACROSS THE WORLD. ARE PEOPLE SENTENCED TO PRISON SENTENCED TO ILLNESS? Honduras‘s San Pedro Sula prison is the perfect breeding ground for HIV infections. For example, this inmate reuses needles when giving tattoos to fellow prisoners. Photo by Pep Bonet. AIDS Alliance „Positive Lives Project“.

by Elisa Gärtner, Germany, and Guilherme Correia da Silva, Portugal


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“30 million people go through the worldwide prison system every year. These are reservoirs of disease and epidemiological pumps.” Paula Akugizibwe (Rwanda), Advocacy Coordinator at the AIDS and Rights Alliance for Southern Africa

Stefan Franke / www.jugendfotos.de

people, and it doesn’t really resemble a needle anymore”. Shared syringes are only one of the several factors that increase the risk of a widespread infection within prisons. The close proximity of large numbers of people in often unsanitary environments creates the conditions for blood-borne viruses such as HIV. Infections do not only come from drug use, but are also spread through sexual abuse or illegal tattooing, for example. Prisons are seen as incubators for HIV. According to the 2010 Drug Policy Guide from the International Drug Policy Consortium, the disease’s rates in prisons are up to 100 times higher than in a regular community. HEALTH PROBLEM

For many years, organisations and scientists have appealed for the acknowledgement of drug-addicted persons as patients. Activists like Anya Sarang from Russia urge policy makers to rethink the criminalisation of drugs. “There is not only a justice approach, but a health approach,” she says. This leads to the search for alternatives to the status quo, and an appropriate

adaption of the issue to the public health system. Needle and syringe exchange and counselling programmes are required to break the circle of spreading HIV among syringe-sharing persons. The programme has also proven to reduce the amount of persons using drugs instead of encouraging drug use. So far, only a few countries have implemented exchange facilities in prisons. According to the International Harm Reduction Alliance, since the beginning of the 1990s, about 60 prisons have established exchange programmes in 10 European and Central Asian countries. Anya Sarang says more than half of HIV infections in Russian prisons could have been avoided with needle exchange programmes. The HIV prevalence among drug injecting persons in Russia is 37 percent; in prisons, it is believed to be at a significantly higher level. Organisations like the Open Society Institute and the Drug Policy Alliance in New York go even further and demand the disengagement of prisons for criminal offenders and detention centres for drug users, regardless if they are following an illegal practice by possessing drugs. “You can send a drug user to prison for $30,000

a year, or spend $5,000 to 10,000 on a drug treatment programme,” explains Ethan Nadelmann, Director of the Alliance. THE VIENNA DECLARATION

The Open Society Institute is one of the most relevant funders of harm reduction programmes. In terms of drug policies in prisons, Kasia Malinowska, director of the Global Drug Policy Programme, expects important developments through the Vienna Declaration. “Prisons are no places for drug users. A prison is a university of crime.” Prisons would not be burdened with the care of HIV patients, and the risk for HIV spread would reduce immediately. Malinowska lobbies for general drug treatment facilities where persons receive counselling, treatment and a therapy if they want to end their addiction. The approach of Portugal’s decriminalisation of drug use may prove as a good example that European countries could follow. In 2001, the Portuguese government decriminalised drug possession. This resulted in a reduction of drug use and drug-related deaths—a fact that other governments should look into.


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MAGAZINE

THE CLOCK IS TICKING FIVE YEARS LEFT UNTIL 2015, THE DEADLINE TO ACHIEVE THE MILLENNIUM DEVELOPMENT GOALS (MDG). TOGETHER WITH THE SUCCESSES THERE IS AN ARRAY OF GOALS AND TARGETS THAT ARE LIKELY TO BE MISSED. by Guilherme Correia da Silva, Portugal

In 2000, world leaders set eight timebound goals called the Millennium Development Goals to tackle extreme poverty. These include reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other diseases. “We are at crossroads, 2010 has been an important milestone in working towards the MDGs. We’re seeing some progress, but we are also seeing some major gaps,” says Gottfried Hirnschall today, Director of the HIV Department at the World Health Organisation (WHO). Though some parts of the world have

made progresses regarding MDGs, SubSaharan Africa remains a problematic area, where major gaps have been seen in maternal health and HIV prevention, and child mortality is still high (in 2002, 174 of every 1,000 children dyed in the region before they were five, according to UNICEF). “We have various interventions that need to be bundled and need to be focused on those that are at greatest risk and most vulnerable,” Hirnschall stated. Barriers between health and education system have to be removed and legal framework needs to be reworked. It is necessary to

“pool resources to train people in a more integrated fashion, to review policies to be more comprehensive.” The United Nations General Assembly has decided to convene an MDG summit next September, which is expected to carry out a review of successes, obstacles, challenges and opportunities regarding MDGs. Hirnschall believes that there should not be any reason for a delay of the 2015 deadline: “We must not lose the momentum. The economic climate is not very favourable for that right now, but we cannot use that as an excuse.”

Protests have found wide support of the audience – claiming for “no retreat“ on AIDS funding. Protesters called for a “Robin-HoodTax“ on financial transactions for the poorest and most affected by the disease.

“NO RETREAT!“ THE FEAR OF A DONOR RETREAT FROM THE GLOBAL FUND TO FIGHT HIV, MALARIA AND TUBERCULOSIS IS CONCERNING HIV ACTIVISTS. NGO EXPERTS SEE DONORS DISENGAGING FROM THE FIGHT, LEAVING BEHIND PEOPLE WHO ARE STILL IN NEED OF LIFE-SAVING TREATMENT.

According to Oliver Moldenhauer, head of the access to medical treatment campaign of the German chapter of Médecins Sans Frontières (MSF), there is a decrease in large donors to the Global Fund. “The international community seems to be cutting off the funding stream. In Uganda, the Anti Retroviral drugs were out of stock due to lack of funding. And in AIDS treatment, nothing is worse than to stop. We feel that this will be a more common experience and that the rationing of treat-

ment will be more and more common”. Michel Kazatchkine, Executive Director of the Global Fund, told the journalists at AIDS 2010 Conference that without a successful Global Fund replenishment, the world will not meet the Millennium Development Goals. Kazatchkine believes that “the replenishment will only be a success if we are able to raise enough funds, not only to allow us to continuing existing projects but also to fund large scale new programmes.“

As 2015 approaches, many people believe that widening the mandate of the Global Fund would be a good answer to fulfil the Millennium Goals. “We’re struggling at this moment to fill the demand that we receive, just on the interventions that we are already funding. So this becomes relevant if there is more funding available and if the world thinks that the Global Fund represents an effective structure and system,“ says Jon Lidén, communications director of the Global Fund.


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ACROSS THE WORLD Orange editors report from their home countries: How severe is the current situation? What are the policies to combat the epidemic? Which stories have touched the societies? And what is the correlation between injecting drug use and new HIV transmissions? The statistics are based on recent UNAIDS country reports available at: www.unaids.org/en/CountryResponses/Countries/.

CHINA’S CONTRADICTORY HIV/AIDS FIGHT POLICIES AND PROGRAMMES by Shuk-Wah Chung, Australia

According to an UNAIDS estimate there are about 700,000 people living with HIV (PLWH) and 85,000 with AIDS in China. Intravenous drug use (IDU) has been the major factor, however infection though sexual transmission is on the rise – it accounts for about 50 percent of HIV/AIDS cases passed on through sex workers, affected partners and homosexual sex. Overall, the HIV infection rate among China’s population is very low at only 0.05 percent, but despite this a report released last year stated that HIV/AIDS was China‘s leading cause of death among infectious diseases.

DRUG USE Heroin is one of the most commonly used drugs and sharing equipment is very common. Yunnan, a province in South China, is home to about 25 percent of the country‘s HIV cases as it borders the opium-rich “Golden Triangle” of Vietnam, Laos and Myanmar. According to the provincial government, the virus has been found in 128 of its 129 counties. An initial zero tolerance attitude to drug use meant that the government was slow to implement HIV prevention and harm reduction programs for drug users. But now, China boasts more drug replacement clinics and needle social marketing programmes than any other country in Asia. Although, severe penalties for drug users still remain. Hard-core criminalisation or death means that users are reluctant to step forward risking arrest or social stigma. As a result, the disease spreads.

International public health experts, including UNAIDS and the WHO, have commended the Chinese government for its implemented HIV prevention and treatment programmes. Some of these include: • China CARES (China Comprehensive AIDS Response), a community-based HIV treatment, care and prevention programme, in which patients are provided with free, domestically produced antiretroviral drugs. • “Four Frees, One Care,” a policy which provides free HIV treatment to poor people in urban areas and to everyone in rural areas; free education for AIDS orphans; and free services for the prevention of mother-to-child HIV transmission. The WHO estimated that in 2007 China was supplying 19 percent of those in need of treatment with antiretroviral therapy. But although the treatment itself is free, patients often have to pay for associated clinical tests.

HUMAN RIGHTS Despite China’s low HIV infection rate and successful policies and programmes, major contradictions still remain in the fight against the disease. HIV/AIDS human rights activists and NGOs are often harassed and face repression from the Chinese authorities. Human Rights Watch (HRW) have reported numerous examples of harassment and surveillance of AIDS activists and support groups, including the detainment of prominent AIDS and human rights campaigner, Hu Jia. In May 2010, Wan Yan Hai, Director of Beijing’s first and most prominent AIDS group, Aizhixing, fled China due to continual

harassment from authorities. He now lives in the States along with his family. Censorship also remains about the issue, especially when it affects poorly on the government. When Aizhixing decided to broadcast a documentary in July 2010, security forces immediately cancelled the screening. The documentary centred around 23-yearold university graduate Tian Xi who is living with HIV/AIDs. He was infected at the age of nine through a blood transfusion, but has managed to continue living positively with the disease. Tian Xi has been active in calls for compensation for HIV/AIDS patients infected when receiving healthcare, and for hospitals to address medical malpractice.

CHINA’S FUTURE IN THE FIGHT AGAINST AIDS Public ignorance and a society that still views sexual issues as quite taboo means that education about HIV/AIDS still remain low. However, the government is working on increasing anti-drug education for the general population and in schools as well as working with neighbouring countries to prevent drug smuggling. Stigma is very much associated with the disease, meaning that many are reluctant to be tested or come forward about the disease. But despite the contradictions that surround China’s fight against AIDS, the country’s low rate means it has a capability to support other countries. According to Bill Bowtell, Executive Director of the Pacific Friends of the Global Fund, China has the ability to help fill in the global funding gap due to their performance over the financial crisis. “Until just a few years ago China was a recipient of international money for HIVAIDS programs – today it could easily make up the shortfall from Europe at the blink of an eye,” he said. THE MAP


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ROMANIA

NETHERLANDS 16 622 000

Population

18 000

Number of people living with HIV

4%

Percentage of new transmissions due to drug use

22 215 421

Population

16 299

Number of people living with HIV

1.44%

Percentage of new transmissions due to drug use

BULGARIA PORTUGAL 10 637 000

Population (2009)

34 888

Number of people living with HIV (estimate 2008)

42.5%

Percentage of new transmissions due to drug use

7 563 710

Population

3 900

Number of people living with HIV (according to the UNAIDS estimate)

43%

Percentage of new transmissions due to drug use (2009)

Source: Ricardo Jorge National Health Institute, 2008

SOUTH AFRICA

ACROSS THE WORLD

THE MAP

49 320 000

Population

5 700 000

Number of people living with HIV (2008)

20%*

Percentage of new transmissions due to drug use

* Studies for South Africa provide unclear estimates.


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BELARUS 9 724 700

Population

13 000

Number of people living with HIV (officially registered)

49.3%

Percentage of new transmissions due to drug use

CHINA

INDIA 1 183 458 000

Population

2 400 000

Number of people living with HIV

1.6%

Percentage of new transmissions due to drug use

1 300 000 000

Population

700 000

Number of people living with HIV

42%

Percentage of new transmissions due to drug use


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INDIA: CRIMINALISATION OF DRUG USERS by Tejeswi Pratima Dodda, India

If you were in India and possessed needles and syringes, you can be arrested for possessing drug paraphernalia. The Narcotic and Psychotropic Substance Abuse Act of India does not effectively differentiate between a drug user and a trafficker. In some jurisdictions medical prescriptions are essential to buy a syringe. With drug laws that make it difficult to access clean equipment, the Injecting Drug User (IDU) is a primary driver of India’s HIV/AIDS epidemic. There is a sharp contrast between the legal framework

which operates on a policy of criminalisation and a public health system which is introducing harm reduction interventions. IDUs in India face dual stigma and discrimination for being an IDU and HIV positive. Loon Gangte, the president of Delhi Network for Positive People, was stamped a blood seal for being IDU and HIV-positive. He did not disclose his status to his own family members for many years in the fear of being ostracised. But he slowly came to terms with it and decided that his positive status could not deprive him of his basic rights and how people perceive him. He now runs interventions for people who are victims of both the disease and the stigma.

ROMANIA: MASSIVE BUDGET CUTS ON HIV/AIDS CARE by Georgeta Bocşe, Romania

Until recently, the HIV/AIDS situation in Romania was stable. The level of epidemic was low and there was no sign of concentration among vulnerable groups despite high-risk behaviour identified among them. What changed this stable situation were the national pharmaceutical policies that suffered great changes this year. The new law was enforced on 1st of July. The law changes radically the prices that patients suffering from chronic disease will have to pay for their treatment. The treatment for an HIV patient costs between 500 and 1500 euros a month, while the average income in Romania is around 330 euros a month. All this comes shortly after treatment for HIV/ AIDS patients was completely unavailable. Thousands of patients were in the position of stopping their antiretroviral treatment for weeks or even months. The EU HIV/AIDS Civil Society Forum wrote an open letter to the Romanian Government, calling on the government to

ensure access to antiretroviral treatment. The topic soon made it to the international media, prompting the EU Observer to write ”Romania risks HIV epidemic.” Back in August 2009, hundreds of HIV/AIDS patients protested in Bucharest because of the lack of medication. In 2009 the budget for HIV treatment was reduced by 10 million euros. The government explains the cutback was necessary because of the economic recession. Because of this, the needle exchange programs were also reduced and are in danger of being suspended. In the last six years, heterosexual transmission was the main probable route reported by newly registered HIV cases. Contrary to public belief, from the total of 342 new cases of infections discovered last year, only eight were aquired through homosexual intercourse. According to data presented by the Matei Bals Institute for Infectious Diseases, one of the most vulnerable categories are the truck drivers with the rate of infection of 7.69 percent in 2009, in comparison to prisoners percent and 1.44 percent for intravenous drug users.

BULGARIA: NATIONAL POLICIES TO COMBAT HIV/AIDS

by Dobriyana Tropankeva, Bulgaria

Bulgaria is still a country with low HIV prevalence in the general population. However, the country faces a great challenge related to the possibility of rapid development of concentrated epidemics in separate group identified as most-at-risk: injecting drug users, men who have sex with men, sex workers and young Roma people with risk behaviour and prisoners. Since 1986, when the first HIV case registration came in the country, to May 2010, a total of 1109 HIV cases had been registered in Bulgaria. The annual number of newly registered HIV cases increased from 50 in 2004 to 171 in 2009. From the total number of registered cases from 1986-2009 with a known route of transmission, 66 percent are heterosexual, 21 percent are injecting drug users, and 10 percent are MSM. 17 cases (two percent of all cases) were infected through transfusion of blood and blood precuts as such last were registered in 1996. Bulgaria ensures free of charge anti-retroviral treatment and monitoring of the treatment for all people living with HIV. The effectiveness of the provided ARV treatment and medical care is evidenced by the percentage of the people, who are still on treatment 12 months after its initiation - 89.58 percent for the 2008 cohort of beginning patients. In 2008, the Bulgarian Government adopted the new National Programme for Prevention and Control of HIV and Sexually Transmitted Infections (STIs) for the period 2008-2015.The main goals are to reduce the number of new HIV infections and improve the quality of life for people living with the disease.


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SOUTH AFRICA: ONE OF THE MOST DRAMATIC SITUATIONS IN THE WORLD by Elisa Gärtner, Germany

South Africa is one of the most HIV/AIDSaffected countries in the world. Statistically, worldwide the most people die from HIV/

AIDS here. Despite the fact that South Africa is said to be a terminal for the circulation of drugs like heroin, intravenous drug use is widely uncommon. In general, the entire field of drug use is very stigmatised in South Africa and is therefore under-researched. According to UNAIDS, among those people who con-

PORTUGAL: INJECTING DRUG USE MOST FREQUENT REASON FOR HIV INFECTIONS by Guilherme Correia da Silva, Portugal

Portugal is one of the countries in Europe with the biggest rate of newly diagnosed cases of HIV per million people. According to the report “HIV/AIDS surveillance in Europe - 2007,“ elaborated by the European Centre for Disease Prevention and Control and the World Health Organization’s Regional Office for Europe, in 2007, Portugal reported a rate of 217 newly diagnosed cases of HIV infection per million population. Just Estonia

(472 per million) and Ukraine (285 per million) were ahead. Despite those figures, the number of newly diagnosed cases in the country decreased. In Portugal, by the 31st of December 2008 there were 34.888 HIV cases notified (the country has circa 11 million inhabitants), as stated in a report of the Portuguese Ricardo Jorge National Health Institute. However, it is estimated that the number of HIV cases is higher than the official numbers. The biggest number of notified cases is associated with injecting drug users followed by the infection through heterosexual intercourse.

BELARUS: WHY ARE THE PREVENTIVE PROGRAMMES NOT EFFECTIVE? by Tatsiana Zenkovich, Belarus

The registered number of HIV-positive people in Belarus was 10,690 in January 2010. In accordance with the official data, the index of HIV prevalence among the population in Belarus was 0.1 percent of the overall population. AIDS was diagnosed on 1,821 Belarussian people, from which 937 died. Preventive programmes among the most vulnerable population groups, especially among injecting drug consumers and among female sex workers, are often ineffective due to strict legal conditions. There

is no statement in the criminal code that regulates the minimal dose of drugs which leads to criminal prosecution. There is no alternative to imprisonment regarding delinquencies that relate to illegal drug circulation. Moreover, the state does not provide funding for harm reduction programmes. The system of rehabilitation of people who where formerly addicted to drugs is not developed. There is especially a deficit of social integration. The lack of awareness of different aspects of HIV, about rights and needs of people who live with HIV leads to the maintenance of stigma and is a risk factor in providing general access to treatment, care and support.

sume drugs intravenous to share the needle it is a common practice. Thus, HIV prevalence among injecting drug users is estimated at 20 percent. This is dramatically high. The government offers heroin detoxification programs for drug addicts. Support like a state-organised needle exchange programme does not exist.

NETHERLANDS: A CRIME THAT SHOCKED THE COUNTRY

by Marjolein Nieuwdorp, The Netherlands

In 2009, one story captured the public interest for weeks: At certain sex-orgies, several men were injected with HIV infected blood by three men from Groningen, Netherlands. This way, at least 12 people were purposely infected with the AIDS virus. The three men, all HIV-positive, allegedly advertised gay sex parties online, lured participants to their location, then drugged them with a combination of ecstasy, alcohol and the date rape drug GHB, raped them and injected them with HIV-positive blood. This is an extraordinary example of the way drug abuse can lead to the cause of the spread of HIV. The Netherlands has a concentrated HIV epidemic (i.e. a low prevalence of HIV infection), in the general population, but a higher prevalence in specific sub-populations. The Dutch government seeks to place HIV/AIDS policy in a larger framework of sexual health with special policies for those risk groups. Estimation of the HIV prevalence yielded the following preliminary results for the Netherlands in 2008: Men who have sex with men 55 percent, drug users 4 percent, migrants from Sub-Saharan Africa 3.1 percent, migrants from the Caribbean 0.4 percent, female sex workers 1.8 percent, and for the remaining population 0.02 percent.


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MAGAZINE HUMAN TRAFFICKING

TOURIST TRAP DRUG TRAFFICKING

TODAY’S SILK ROAD BULGARIA AND ROMANIA HAVE ALWAYS BEEN COUNTRIES ON A CROSSROAD FOR THE TRAFFIC FROM EAST TO WEST, BECAUSE OF THEIR GEOGRAPHICAL SITUATION RIGHT IN THE MIDDLE OF THE BALKANS. THE OLD SILK ROAD NOW HAS BECOME THE MAIN WAY FOR DRUGS AND HUMAN TRAFFICKING. by Georgeta Bocşe, Romania, and Dobriyana Tropankeva, Bulgaria

Bulgaria and Romania joined the EU in 2007, making Turkey the external border of the Union and an important gateway for drug trafficking into and through Bulgaria. The elimination of most border controls and internal borders in the EU makes it an even more attractive market for illegal drugs. Romania and Bulgaria are likely to join the Schengen area in April 2011, which will leave the Bulgarian external border the last custom control on the “Old Silk Road,” making it more vulnerable to cross-border trafficking. Heroin, cocaine and other synthetic drugs are the primary drugs that are trafficked from this region.


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ASIA’S THRIVING SEX TOURISM SCENE MAKES IT A HOTSPOT FOR HIV/ AIDS-COMPLICATIONS AND OTHER HUMAN RIGHTS VIOLATIONS. by Bianca Consunji, Philippines, and Tejeswi Pratima Dodda, India

Transgender sex workers, commonly known as „ladyboys“ in Thailand, dance in an outdoor bar in Phuket. Thailand‘s reputation for rampant human trafficking has alarmed human rights watchdogs, but little has been done to rectify the situation.

Heroin comes from Central Asia (primarily Afghanistan) and traditionally took the “Balkan route” from Turkey through Bulgaria to consumers in Western Europe. The UN World Drug Report 2010 shows that approximately 85 tonnes of heroin traverse through the Balkan route (Afghanistan – Iran – Turkey – southern and central Europe), which is 80 percent of the Western Europe supply. Chemicals used for the production of heroin pass through Bulgaria from the former Yugoslavia to Turkey and beyond. Synthetic drugs produced in Bulgaria are also transported through Turkey to markets in West Asia. The cocaine

Blame it on Paul Gaugin, Rudyard Kipling or South Pacific, if you will. For centuries, artists portrayed Asia as a mysterious land where golden-skinned natives smilingly welcomed foreigners to pristine beaches dotted with palm trees and a honey-dipped sunset. The countries were bestowed with equally exotic titles: Thailand the “Land of Smiles,” the Philippines was the “Pearl of the Orient,” Indonesia was the “Emerald of the Equator, and Cambodia was the “Land of the Golden Pagodas.” When Westerners, particularly members of the U.S. Army, made their way to the East during World War II, it was paradise itself. The locals were friendly, the weather warm and balmy. Although initially met with resistance, visiting soldiers were showered with hospitality, and Asia was eventually dotted with U.S. bases in the 20th century. Subsequent conflicts such as the Vietnam War brought more attention to Southeast Asia, and consequently, its women. The fetish for Asian women – often

portrayed as fragile, delicate and eager to please – was a commonly used theme in western media. Readily available information on mail order brides sprouted in the late ‘80s and early ‘90s, prompting a number of Asian countries to take legal action against the growing trend. The Philippine Congress passed the Anti-Mail-Order Bride Law in 1990, but a quick search on Google will still reveal a number of sites matching up Filipinas with potential husbands. The last decade made it easier for travelers, as food, accommodations and later on, sex could be bought for cheap. Pattaya, Thailand, is known for its gorgeous beachfront just as well as it is known for its flawless, doe-eyed ladyboys who nimbly clamber up poles and gyrate onstage. Cambodia, a backpacker favourite, is also a paedophile haven, where young children are sold for a fistful of dollars and a sack of rice. Apparently, the relationship between tourism and human trafficking is directly proportional in some of the poorer regions in Asia, and has become an accepted fact.

in Europe comes mainly from Latin America, and it also uses the “Balkan route” to Western Europe. According to the American International Narcotics Control Strategy Report, this route is “extremely difficult to control.”

Report, June 2009. Human trafficking in this region involves commercial exploitation of trafficked people for sex and forced labour. The most frequent destinations are Spain, Italy and Germany. A recent report by the European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers shows that individuals from Romania (12 percent) and Bulgaria (seven percent) currently make up a fifth of all prostitutes in the EU. The report also points out the striking differences in the EU’s sex industry across the east and west divide. In most western European countries the majority of prostitutes are migrants, while in former Communist countries most of the sex workers are locals.

HUMAN TRAFFICKING ON THE BALKANS Romania and Bulgaria are strategically located on the route of human trafficking. While they facilitate as transit countries for drug trafficking, they are the origin and main suppliers in the case of human trafficking according to the U.S. State Department Trafficking in Persons


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MAGAZINE

FALSE PROMISES Pim, a Thai woman who escaped her captors after years of working in the sex industry, was lured to Bangkok with promises of a waitressing job. “I grew up in the countryside in Phetchabun, northern Thailand,” she recounted to BBC News in a 2007 report. “My parents were farmers and I helped them in the fields. We were poor but we always had enough to get by. I wanted to study to become a nurse, but when my parents split up I had to leave school and find work as a day labourer, harvesting crops for local farmers. I didn‘t like it much, and it only paid 100 baht a day.” She took a job as a dancer at a local bar, and upon force from management, eventually started having sex with the clients in a room above the bar. Her story is similar to Kiki’s, who sold sugar cane juice on the streets of Phnom Penh for a living. It was not a life she wanted, but the only way she could eat a meal. Girls of her age were taking up overseas jobs with high salaries, and the prospect of a better life tempted her to follow their footsteps. Kiki was smuggled out of the Thai border and taken to a brothel in Malaysia for bonded sex work. She was constantly raped, and occasionally abused for refusing to have sex with strangers. Many years later, she broke into tears in front of the Southeast Asia (SEA) Court of Women on HIV and Human Trafficking: from Vulnerability to Free, Just and Safe Movement. She is back in Phnom Penh, where she tested positive for HIV. “I have not talked to anyone about the disease except my doctor and now this court. Whenever I think or talk about it, the only thing I can do is cry,” says Kiki. The Mekong region of Asia is one of the dangerous routes for trafficking within Asia. Consisting of Cambodia, China, Laos, Thailand, Vietnam and Myanmar, it has diverse patterns if trafficking – internal, cross border in form of both formal and informal recruitment mechanisms involving men, women, boys, girls and sometimes an entire family. The Mekong region serves as a base to girls who are trafficked to other parts of Asia like

Illegal sex activities are openly advertised without fear of prosecution in some regions of Asia. According to the U.S. State Department Reports on Human Trafficking, 2.5 million people work under forced labor due to human trafficking worldwide. Most are used for commercial sexual exploitation.

India, Philippines, Malaysia and Indonesia. All these countries also have their thriving domestic market of sex tourism. According to a conservative estimate by UNDP, up to 400,000 people are trafficked every year in Asia alone. It is shocking that the link between HIV and trafficking has been established recently and as a result there is absolutely no integrated policy or programming in any of the Asian countries. In spite of the large numbers of people trafficked within Asia and high prevalence of HIV in Asia, there has been negligible research on this issue by governments, UN and civil society organizations. South East Asia (SEA) Court

of Women on HIV and Human Trafficking: from Vulnerability to Free, Just and Safe Movement is a useful step in that direction but it has not lead to any action on the ground so far. Information on sex work in brothels is available but nothing about sex work practiced in other settings. The underground nature of the trade and the lack of proper estimates of people involved in the trade are factors that make it an extremely complicated problem. However, not taking into account the numbers involved is this dual vulnerability could have disastrous consequences for reversing the epidemic. The names of the characters mentioned above have been changed to protect their privacy.


AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

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FIGHTING AGAINST THE FIGHT THE PLIGHT OF AIDS ACTIVISTS AROUND THE WORLD THERE ARE PEOPLE ON THE FRONTLINE FIGHTING AGAINST HIV/AIDS. BUT THEIR ACTIONS HAVE OFTEN LED TO HARASSMENT, VILIFICATION AND SOMETIMES EVEN IMPRISONMENT.

by Shuk-Wah Chung, Australia

On the morning of 16 February 2006, Chinese HIV/AIDS activist Hu Jia was reported missing. He was a founder of Loving Source, an advocacy group for individuals with AIDS, and was outspoken in denouncing the government over their treatment of AIDS patients in Henan province, central-east China, in which hundreds of thousands of people were infected with HIV after a staterun blood collection programme in the 90s. After six weeks Hu suddenly reappeared, looking “weak and possibly suffering from kidney damage” as a result of not getting regular medicine to treat his hepatitis B. It was eventually discovered that Hu was in fact detained by police with no charges against him. The following year he was arrested at his home in Beijing for “inciting subversion of state authority,” and in April 2008 was sentenced to three years and six months in prison. Hu, a recipient of the Human Rights prize awarded by the European Parliament, is currently suffering from liver cancer and despite pleas by his wife for medical parole he still remains in prison with little medical treatment. This example, along with many others does not just happen in China. According to Joseph Amon, Director of Health and Human Rights at Human Rights Watch, the harassment and detainment of AIDS activists is a “global phenomenon.” “These are basic fundamental barriers to getting to where we need, which is an end to this epidemic,” says Amon. In Uganda LGBT and gay rights activists have been intimidated and arrested simply for speaking out and asking to be a part of national HIV/AIDS strategies; in Uzbeki-

stan Maxim Popov was convicted for seven years in prison last September for writing a brochure advocating the use of condoms and sterilised needles in the mainly Muslim country; and in Zimbabwe activists were arrested for marching on World AIDS Day, even though they had asked for permission beforehand. Amon says that governments see these activists and NGO groups as a threat, forcing them to be accountable for where they’ve gone wrong. “When that accountability function comes from NGOs or the press there’s a push to counter that and to cover up and intimidate these groups that are raising concerns,” says Amon. “And that ultimately will lead to the continuation of the HIV epidemic.” TO BE TOO VOCAL OR NOT VOCAL ENOUGH

Robert Carr, Policy Director of the International Council of AIDS Service Organization in Canada has experienced first hand how dangerous his role as an AIDS activist can be. When he gave a presentation at the Mexican AIDS conference in 2008, a recount of his story was published the next day in his native country of Jamaica with the headline, “Jamaica Receives Gay Bashing At International Aids Conference.” His details were published and he was seen as providing a platform for homosexuals, which is a taboo subject in Jamaica. Fortunately Carr had plans in place for his family in case of any threats. “Luckily I had organised my life at home so that I wasn’t vulnerable to threats,” says Carr. “But it really brought home to me the level of venom that lives underneath the

Still suffering in prison: Hu Jia, Human Rights and AIDS activist in China

surface that people will bring if they think you’re pushing the system too much.” And this is where the contradiction lies – either be too vocal or not be vocal enough. Zhen Li from Tong Zhi – the major advocacy group for men-having-sex-with-men (MSM) in China – says that they’ve learnt to keep within the boundaries. “If your voice is too loud the government will punish you,” says Zhen. “AIDS is a political issue so it’s hard to make a clear line with what’s political and what’s HIV/AIDS.” However Zhen Li also points out that whilst the work of activists like Hu Jia have had their work abused by the government, there’s at least hundreds of other NGOs which still exist that will continue to fight and strengthen support. “Inside these frameworks we try to fight more and create more benefit for NGOs,” says Zhen. “Not so many people understand this disease so if we can develop a mechanism to bring governments and NGOs together we can empower these people and let the whole society understand this.” Hopefully, this understanding will also reach governments.


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MAGAZINE

A little girl holds up a board to lend her support to the cause.

NOW MORE THAN EVER! “Condomise don’t compromise.” A woman promotes condom use, still one of the most effective tools against HIV and STDs, including a female condom plastered in the centre.

IT WAS THE SOUND OF DRUMS, WHISTLES AND THE FOOTSTEPS OF THOUSANDS OF PEOPLE MARCHING THAT DROVE THE MESSAGE ALL AROUND THE WORLD. HUMAN RIGHTS AND HIV: NOW MORE THAN EVER. by Shuk-Wah Chung, Australia Photos by Ryan Fernandez, Philippines, and Tatsiana Zenkovich, Belarus

Attended by an estimated 20,000 people, activists, supporters and people living with HIV all gathered in Vienna‘s famous Heldenplatz, or Heroes Square to urge governments around the world to increase funding for HIV/ AIDS. Amongst issues like decri-

“Rights here, right now” was the theme of the conference with attention given to why the global AIDS struggle starts with achieving human rights.

minalisation, increased education, and providing access and effective treatment, people from diverse ethnicities and age groups all bonded together over solving this crucial issue. There are still many obstacles, but there was a palpable feeling of hope on that day.

Young people all around the world also called on governments to increase funding and help put an end to the disease. “Now make it happen!” they shout.


AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

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A participant uses his bald head to publicise the ubiquitous AIDS red ribbon.

People prepare placards bearing messages for the march.

Crowds wait in anticipation of speeches including a special performance by UNAIDS’ global Goodwill Ambassador, Annie Lennox.

Michel Sidibé (left), Executive Director of UNAIDS addressed the rally saluting the thousands of marchers as being “a force for change… a force for human rights.”

“Buprenorphine” Babe marches above the crowd. Along with methadone, buprenorphine is the most-effective, most-researched medicines for treating drug addiction.

For many people living with HIV, getting access to simple treatment still remains a barrier.


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EVERY NIGHT, A COLD-BLOODED NIGHTMARE LAKSHMI WAS THREATENED TO MARRY, FORCED TO HAVE SEX, AND IS TODAY AN HIV POSITIVE MOTHER OF AN HIV POSITIVE CHILD. HER LIFE REFLECTS THE STORY OF MANY WOMEN IN THE WORLD WHO FACE MASSIVE VIOLATIONS OF THEIR FUNDAMENTAL SEXUAL AND REPRODUCTIVE RIGHTS. OUT OF THE 31.3 MILLION ADULTS WITH HIV IN THE WORLD, 15.7 MILLION ARE WOMEN. THE FEMINISATION OF THE EPIDEMIC MUST BE ADDRESSED. by Tejeswi Pratima Dodda, India

Mother and child, India. Positive Lives, AIDS Alliance, by Dayanita Singh

“I WISH I HAD THE COURAGE TO TELL MY HUSBAND THAT IT IS MY BODY AND HE HAS NO RIGHT TO FORCE OR ABUSE ME.” LAKSHMI, INDIA As a little girl, Lakshmi often held a cane in her hand and pretended to be a science teacher in her village school. She was in love with life and its endless possibilities for her future. When she reached puberty, things slowly changed. Her future was a constant reason for fights between her parents. Relatives had begun suggesting suitable grooms for her. Her father was convinced that she was prepared for marriage, and that it was time for her to fulfil her responsibilities as a woman in this world. A helpless mother silently watched her daughter’s world fall apart. She was married to a man 10 years older from a neighbouring village. Her husband often forced her to have sex, and every

night was a cold-blooded nightmare for Lakshmi. At 19, she was HIV-positive, widowed and mother of a one year old HIV-positive girl. Every day she prays to God to give young girls the courage that she did not have, to stand up for their rights and dreams. India has a population of 2.27 million people with HIV/AIDS. 39 percent of them are women. An estimated 90 percent of them have been in a monogamous relationship like Lakshmi. Besides being biologically more susceptible to HIV than men, women bear the burden of the disease due to their socio-cultural and economic environments. One of the primary reasons for the disproportionate nature of the epidemic is gender disparity. The only way one can eradicate gender inequalities and empower women like Lakshmi is to equip them with the capacities to be comfortable with their sexuality and the skills to negotiate their choices in sexual and

reproductive health. Contrary to popular misconceptions that women involved in commercial sex work and those that indulge in drugs are likely to be positive, a large number of women get infected with HIV due to their inability to say “no” to their partners. Many women like Lakshmi with a steady, single partner find it very difficult to abstain from sex or insist that their partner use a condom. Wife inheritance, early child marriage and female genital mutilation are some of the cultural practices that increase their risk of HIV infection. “PEOPLE ALL OVER THE WORLD HAVE BECOME SO COMMODITY DRIVEN THAT THEY PERCEIVE HUMAN RIGHTS AS A COMMODITY TOO! WE SHOULD ALL REMIND OURSELVES THAT THE UNIVERSAL DECLARATION OF HUMAN RIGHTS


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AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

BEATEN, IGNORED, RECOVERED NIPAKORN NANTA WAS RULED UNDER THE VIOLENT HAND OF HER HUSBAND AND HAD HER CHILD’S LIFE IN DANGER. TODAY SHE HELPS OTHER WOMEN. documented by Dobriyana Tropankeva Born in Phayao, northern Thailand, Nipakorn moved to the capital Bangkok where she met and married her husband. But soon after the marriage he began using drugs (methamphetamines). He abused her physically. He forced her to have sex with him. When she refused he beat her severely. When she expected her first child, she asked her husband to stop using drugs. He ignored her. After the baby was

born the situation worsened. Her husband accused her of cheating on him and that she was a sex worker. One day he kicked her while the baby was in her hands. For Nipakorn, this was the final straw. Her child’s life was threatened and she left him. She moved back to her parents in the north. Despite her ex-husband‘s apologies, she remained defiant as she and her baby deserved a better life.

Four years later, Nipakorn discovered she contracted HIV from her ex-husband. Fortunately, her child was unaffected. She attended meetings with other victims of sexual violence and becomed an educator for people living with HIV. Nowadays Nipakorn is president of the Thai Positive Women Network which helps women to share their stories and exchange experiences.

SEX IS WORK… … WHEN A MOTHER DOESN’T HAVE ANY OTHER CHOICE TO SUPPORT HER FAMILY AND CHILDREN. WHEN YOU ARE STARVING FOR FOOD AFTER DAYS WITHOUT EATING. WHEN IT’S THE ONLY OPTION THAT SOCIETY LEAVES FOR YOU. Jamian Rodgers, a former sex worker, proves that nobody would voluntarily choose this profession if he or she had another option. Today she promotes HIV prevention for the Jamaican Ministry of Health. “I started as a sex worker at an early age. I left school and got involved in the trade because I had to take care of my three younger brothers. But after a couple of years I was caught by government officials for my work.

They helped me to graduate from school and find another job. Then I realized that it’s important for me to help others. I started working with the Ministry and helping other girls, empowering them in the same way I was. I connect with the girls while they still work on the streets and I try to find out what they really want to do and try to help them. The big problem though in Jamaica is that most of the sex workers are illiterate, so we teach

them how to read and write. We help get them reintegrated into society so they can be normal citizens in our society – like opening a bank account, registering for a house etc. So far this program has proven to be good. We have success stories of women who have started their own businesses after attending the program and we still have girls on the street who do peer-to-peer education and continue the work that we are doing.”

IS NOT A CHOICE BUT AN OBLIGATION FOR EVERY ONE OF US.” MICHEL SIDIBÉ, EXECUTIVE DIRECTOR, UNAIDS

systems need to be reworked to ensure human rights for all girls and women. The lack of basic rights like access to education, income and property limit women’s control over sex and reproduction, and contribute to high rates of violence against women in girls: Education: Universal education for all girls is still a global challenge. Education plays a critical role in increasing awareness, reducing risk but most of all, it equips them with the ability to stand up for themselves and take their rights into their own hands. Income: Due to the lack of access to education, women economically become dependent on their partners which limit their ability to makes decisions in their interest. Legal status of women: Inequal property rights, lack of proper laws to support women in marriage, against sexual exploitation and abuse make women and girls dependent

on their partners and increase their risk of HIV. It is time to ensure that all women are protected, promoted and fulfilled regardless of their HIV status, marital status, gender, identity, age and sexual practices. Lakshmi not only represents the voices of women from India but from all over the world, who live in similar oppressive, gender skewed societies. In countries like Lesotho, Women account for more than half (57 percent) of adults estimated to be living with HIV/AIDS. “It is important to cultivate leadership among women who can lead campaigns and initiatives to educate and empower women to initiate and control their holistic life choices including sexuality and reproduction,” says Michel Sidibé, executive director of UNAIDS. Any effort to guarantee these rights would require recognizing women’s leadership as vital to achieving these commitments.

In 2006, heads of state and governments of several countries signed a declaration promising to “promote gender equality and empowerment of women; to promote and protect the rights of the girl child in order to reduce the vulnerability to HIV/ AIDS.” Four years later, many of these governments have not been able to introduce and implement an effective gender based prevention policy, fundamental women rights became mere documents of research. National AIDS strategies need to see the greater link between gender and HIV and create capacities that will cater sufficient resources to the sexual and reproductive needs of women and girls. The service delivery


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MAGAZINE

WOULD YOU EAT FROM THE SAME DISH AS AN HIV+ PERSON?

by Guilherme Correia da Silva, Portugal

WHAT STIGMATISATION AND DISCRIMINATION DO HIV-POSITIVES EXPERIENCE?

%

Negative attitudes and behaviours because of HIV status

63 47 43 42

Negative attitudes or exclusion from family activities Loss of employment Health professionals are not helpful or willing to provide care

Source: UNAIDS, Stigma and Discrimination: A Hindrance to Effective HIV Responses, June 2010

MARGINALISATION, STIGMA AND DISCRIMINATION ARE STILL MAJOR OBSTACLES TOWARDS THE PREVENTION AND TREATMENT OF HIV/AIDS.

If you knew someone in your community who was HIV-positive, would you: eat from the same plate as them, work together in the same office, or send your child to the same school as them? According to a report that was carried out by a NGO delegation on stigma and discrimination, a majority of people have said no. Even people who are aware of how HIV is contracted are still afraid of having these people in close contact with their community. “Stigma is a matter of attitudes,” says Susan Timberlake, Senior Advisor on Human Rights and Law of UNAIDS. “It only serves to demean other people.” According to Timberlake, many of these negative behaviours and attitudes come from health care situations, including doctors and nurses. But sometimes


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AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

„The epidemic of stigma, discrimination and denial is as crucial as the disease itself.“ – Jonathan Mann, first director of the World Health Organization‘s Special Programme on AIDS from 1986-1990.

Photograph by Jenny Matthews / Panos (JMA-10157145).

the worst discrimination comes from those who are supposed to love you the most – family. “You are ostracised, gossiped about, denied services, criticised, thrown out of the house, thrown out of the marriage, and blamed for bringing disease into the family or into the community,“ says Timberlake. “Basically, you are feared.” Even in some of the most developed countries where there has been thorough education on the disease, People Living With HIV (PLWH) are still afraid of perceptions. Daven Seebarran, Executive Director of the Wood Buffalo Society, an organisation that targets HIV/AIDS issues in central-remote Canada, says that despite

the country’s many advances against discrimination, PLWH are still reluctant to disclose vital information in case it destabilises other aspects of their life: “There’s the fear of losing their jobs or of housing instability.” STIGMA: A FUEL FOR HIV/AIDS

In Turkey, stigma and discrimination can be felt everywhere, says Cenk Soyer, member of the Positive Living Association. “In your work area, you cannot disclosure your status. People do not know a thing about HIV/AIDS. The biggest fear is to be confronted with people’s stereotypes.”

Timberlake says that negative attitudes and stigma towards HIV/AIDS means people are even reluctant to get a simple test. “People don’t want to go get tested because they don’t want to know the results and they’re afraid that the test will come out in public,” says Timberlake. “They’re afraid of going into a clinic where the people in the community will see them”. Even the act of practicing safe sex is related to HIV stigma. “Sometimes, men don’t want to use condoms because they fear that it looks like they’re HIV positive.” As we move into the next century efforts to stop HIV/AIDS begin with ending discrimination.


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SEX, DRUGS AND ROCK ‘N ROLL HIV/AIDS SHOOK THE WORLD WHEN THEY FIRST ENTERED PUBLIC CONSCIOUSNESS IN THE EARLY ‘80S. HERE ARE SOME OF THEIR MORE COLORFUL MOMENTS IN POP CULTURE. by Bianca Consunji

The National Public Radio aired the first AIDS story on July 3, 1981. It came out on the same days as the first widely circulated news article about AIDS in the New York Times. It addressed the mysterious circumstances surrounding the five young homosexual men who were treated for what was yet to be discovered as AIDS.

“And The Band Played On,” a book by journalist Randy Shilts, chronicled the progress of HIV/AIDS. It included an extensive discussion of the story of Gaëtan Dugas (known as “Patient Zero”), who was believed to have played a key role in spreading AIDS in North America. Its direct-to-television film counterpart was released in 1993. Shilts, an advocate of gay rights and HIV/AIDS prevention, later died of AIDS-related complications in 1994.

Queen frontman Freddie Mercury died of AIDS less than 24 hours after admitting his illness after years of denial to the public. “Let’s Talk About AIDS,” a spinoff of the popular song “Let’s Talk About Sex,” is released by R&B group SaltN-Pepa. The song contained lyrics such as “Now you don’t get AIDS from kisses, touches, mosquito bites or hugging/toilet seats, telephones, stop buggin’/you get

it from sex or a dirty drug needle, anal or oral now, people.” “For Our Children,” a song released by Walt Disney Records, is released for the benefit of the Elizabeth Glaser Pediatric AIDS Foundation, calling attention to children with AIDS. NBA star Magic Johnson was diagnosed with HIV in a routine physical before the playoffs season, but went on to play for the USA Dream Team in the 1992 Olympics.

Philadelphia, the first major Hollywood film to address HIV/AIDS, earned Tom Hanks his first Oscar for his portrayal of Andrew Beckett, a gay lawyer who is fired from his company upon discovering that he has AIDS.

Tom Hanks picked up another Oscar for Forrest Gump, which depicts the untimely death of the title character’s love interest from a mysterious, unnamed disease—in 1984—obtained by a lifestyle heavy on sex and drugs.

The Cure, a film about two boys in search of a cure for AIDS, explores the theme of HIV/AIDS obtained from tainted blood transfusions and the stigma of living with the disease. HIV/AIDS became a common theme in Hollywood films and television shows. “Waterfalls,” a song by popular R&B trio TLC, stayed at number one on the Billboard Hot 100 for seven weeks. It was the second biggest single of 1995. The

song narrated the death of a character who died because of a sexually related disease with “three letters,” widely interpreted as HIV. Boys on the Side, a film starring Whoopi Goldberg, Mary-Louise Parker and Drew Barrymore, tackles HIV/AIDS in heterosexual women. In its early days, it was widely perceived as a “gay disease” and was in fact called the Gay-related Immune Deficiency before the term AIDS was developed.

Trainspotting, a critically acclaimed film that depicts a group of heroin addicts in the late 1980s, exposes the dangers of acquiring HIV through shared injections and unprotected sex. Jonathan Larson’s Rent, one of Broadway’s longest-running productions, debuted on April 29 after spending two years Off-Broadway. The musical, based on Puccini’s La Bohème, tells the story of a group of impoverished young artists struggling with HIV/AIDS.

MTV’s showed “Staying Alive,” a documentary on six HIV/AIDS-affected young people. It expanded to a multimedia campaign in 2002; in 2005, it launched the Staying Alive Foundation.

Angels in America, a Pulitzer Award-winning play by Tony Kushner, portrays HIV struggles interspersed with religion and politics.

Product Red, an initiative co-started by U2’s Bono to raise money for the Global Fund to Fight AIDS, launched its first product tie-up with American Express. Portions of proceeds of items sold under the (Product) Red line are given to the Global Fund. Brands such as The Gap, Apple, Starbucks, Motorola, Nike and Converse have released limited-edition products under the label.


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AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

THE GLAMOROUS DISEASE? PICK A PIECE OF POP CULTURE AND IT’S LIKELY YOU’LL FIND SOMETHING WITH AN AIDS RELATED THEME. BOOKS, FILM, ART, AND MUSIC HAVE FEATURED IT. WHAT IS IT ABOUT AIDS THAT MAKES IT SO APPEALING?

by Shuk-Wah Chung, Australia

In Team America by Trey Parker and Matt Stone – the comedy film that stars marionettes – protagonist Gary Johnston stands on a puppet sized version of New York’s Broadway theatre. Backed by shining lights, a chorus of dancers and a catchy piano riff, he sings, “There‘s a hero inside of all of us. I‘ll make them see everyone has AIDS.”

The song, like the rest of the film, makes fun of the AIDS pandemic and the bandwagon everyone has jumped on to end the disease. But like all parody there’s always an underlying truth. After all, AIDS is the “go-to” disease these days for celebrities these days. HIV/ AIDS characters in films have led to Oscar awards. Musicians like EasyE, Liberace and Fela Kuti have lived posthumously with a number of pop culture material based on them. So is AIDS, once the symbol of death that we once saw in the eighties, now the “chic” disease where supporting the cause embodies a sense of being cool? According to Martin Pfitscher, gallery educator from the Kunsthalle Wien in Vienna, pop culture has used HIV/AIDS as a form of communication. “Ordinary humans have died of the same disease that artists have, and they’re not any different because

of their art,” says Pfitscher. “It’s a way of bringing the message to people through art.” Keith Haring, a gay New York artist who hung around the likes of Andy Warhol and Jean-Michel Basquiat during the late ’70s early ’80s, died from AIDS at 31. The Kunsthalle Wien showcased his work during the International AIDS Conference, including photos of him living it up in the artsy NY scene. Sex, drugs and … AIDS? “AIDS is not a natural thing,” says Pfitscher. “It’s a social and cultural thing.” There’s no doubt that sex, drugs and the environments you’re in leads to the infection of the HIV virus. AIDS wiped out the said artsy golden period of downtown NY. But through all the images of death, dying and disease that we’ve seen, there’s one image that sticks: the image of glamour.

VIENNA LIFE BALL: “TODAY I REPRESENT THE EARTH.” At the Vienna Life Ball, an annual fundraiser where tickets range from 75 to 2,500 euro for VIP seats, stars such as Dita Von Teese, Boris Becker and Patti La Belle all walked the red carpet leading up to the historic City Hall where a huge AIDS red ribbon was erected over the entrance. To add to the atmosphere, people dressed up in crazy costumes for the occasion. One participant, wearing blue body paint and a blown-up globe on his head says that his outfit was styled for publicity. “Today I represent the earth and we all live on the earth, but there are 35 million people affected by AIDS.” Whether for publicity or show, high-class behaviour and creativity always draws a crowd. Along the metal barricades lining the red carpet, an eager audience had lined up to catch

a glimpse of a celebrity. So amongst all this glitz and glamour where exactly was the AIDS message? “The costumes all raise awareness to people who wouldn’t normally listen,” says Susan, an American tourist. “It’s so under-represented and needs to be publicised more. I’ve read the stats and it’s mind boggling.” Celebrity endorsement and events like the Life Ball has given HIV/AIDS a leverage over most other diseases. For those who make the effort to find out more about the disease, pop culture and fundraisers like the Life Ball all hope to make an impact on the viewer. Or as Richard, a doctor with the WHO in Zimbabwe said, “I’m sure that people are thinking that it’s a concert but once they see the red ribbon, they’ll know.”


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MAGAZINE Sex and relationships are fun. MTV gives young people a chance to discuss them with Lupita Nyonga and Nicholas Mutuma.

WE ARE YOUNG, HIP, FUN AND COOL. WE DON’T LIKE LISTENING TO THE HISTORY OF HIV/AIDS AND HOW MANY PEOPLE DIED IN THE PAST 20 YEARS. WE DON’T LIKE FEELING GUILTY ABOUT OUR ACTIONS. WE DON’T LIKE TO SHOW OUR EMOTIONS. IT’S NOT COOL. BUT WHEN DID WE SAY WE DON’T CARE? WE ARE TIRED OF BEING LABELLED AS AN AGE-GROUP THAT JUST DOES NOT GET IT! WE ARE NOT DUMB. WE JUST LIKE TO KEEP IT REAL. TALK TO US IN A LANGUAGE WE UNDERSTAND. DON’T SHOW US THE VIDEO YOU MADE IN 1992 ON HIV/ AIDS. IT DOES NOT MEAN ANYTHING TO US.

by Tejeswi Pratima Dodda, India

DUDE… DO YOU HAVE SOME RUBBERS? “Cutting-edge media is so critical today. I understand that blogging, Facebooking and Tweeting will probably have more results than spreading pamphlets of the G8 declaration in getting down the HIV prevalence among young people and in reducing stigma. And we plan to work towards it.” – Michel Sidibé, Executive Director of UNAIDS


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AIDS 2010 • XVIII INTERNATIONAL AIDS CONFERENCE 18 - 23 JULY 2010 · VIENNA, AUSTIRA

Project Ignite, MTV Staying Alive Campaign

Are young people revolutionising the way we communicate? Sure! How else would you explain 90 percent of a random sample consisting of young people in Kenya saying that a scripted drama on MTV changed their perceptions on HIV testing, concurrent relationships and stigma? The findings are part of a larger study by the School of Public Health at Johns Hopkins University. The show, entitled ‘Shuga’ in Kenya and Zambia, and ‘Tribes’ in Trinidad and Tobago was produced for Project Ignite, a component of the MTV Staying Alive campaign. The media campaign is designed to reflect the lives of young people’s sexual behaviour, to stimulate awareness, lessen stigma, and ultimately reduce the rate of HIV infections among young people. The cast of the series are young people from Kenya and Trinidad and Tobago. “Young people increase capacities for change. We need new energy to tackle the epidemic. We should invest in young people. MTV had the brand advantage but it was young people playing leaders and comunicating in a way that their peers could relate to,” says Bill Roedy, CEO of MTV Networks International. You can‘t miss Lupita Nyonga and Nicholas Mutuma, not even among 25,000 delegates at the XVIII International AIDS Conference. As they walk down the corridor, they look bright, young, stylish and confident. As the lead cast of ‘Shuga,‘ they are the faces of young leadership. “Young people need to know themselves. Different people have different temptations and different pressures. The more they embrace their individuality the better for them. After the show, a lot of young people from Kenya Facebooked me and asked for advice,” Lupita recounts. Both Lupita and Nicholas feel that traditional media

campaigns are often prescriptive, preachy, and pedagogic for young minds. That is where ‘Shuga’ scores, it uses cool lingo like rubbers for condoms. Nicholas adds: “Messages should change. We need to keep it cool! ‘Shuga’ won’t be as relevant five years later. Constant innovation is the key.” One of the complaints that young people seem to have on HIV/AIDS media messaging is the fact that testing is promoted in a large scale but “What next?” is a question that majority of young people have. A lot of young people fall apart after they are tested positive.

4.9 MILLION HIV POSITIVE PEOPLE ARE BETWEEN 15 TO 24 YEARS OLD Stigma, depression and social exclusion are some of the common problems young people face. Mass media has

immense potential to influence young people, and there is an immense need to use this power constructively. HIVPOZ. net is an example of exercising that power, is a dating website for positive people started by a positive person. It provides a platform for heterosexual and homosexual HIV-positive people to find partners and give them a chance to experience a normal life. Initiatives like this automatically address stigma and social exclusion and send positive messages to a large number of people who silently die many deaths every day due to stigma. Jimmy Kolker, Chief of HIV/AIDS at UNICEF says, “We are keen on providing technical expertise to organisations and media houses on creating programming for young people like we did for the staying alive campaign.” Media campaigns like Ignite indicate that public-private partnerships are the way to go to empower young people to recognize risks and make better decisions.

hivpoz.net


LOST IN THE MOMENT: HUNDREDS OF COUPLES GATHER AT A MASS KISSING EVENT AT THE BELVEDERE PALACE LAST JULY 21, 2010. ECHOING ARTIST GUSTAV KLIMT‘S FAMOUS PAINTING, THE EVENT COMBINED ART AND ACTIVISM, SEXUALITY AND SOLIDARITY WITH THE AIDS AWARENESS MOVEMENT.

Orange :: International AIDS Conference 2010  

"Kiss Stigma Goodbye!" - Orange magazine reporting on drug policies. XVIII International AIDS Conference, Vienna July 2010.

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