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Time is running out to reach the 2020 HIV targets – UNAIDS

New HIV infections are rising in around 50 countries, AIDS-related deaths are not falling fast enough and flat resources are threatening success. Half of all new HIV infections are among key populations and their partners, who are still not getting the services they need.

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UNAIDS is issuing countries with a stark wake-up call. In a new report, UNAIDS warns that the global response to HIV is at a precarious point. At the halfway point to the 2020 targets, the report, Miles to go—closing gaps, breaking barriers, righting injustices, warns that the pace of progress is not matching global ambition. It calls for immediate action to put the world on course to reach critical 2020 targets.

Photo used for illustration purpose only. Photo by Vittore Buzzi from Unsplash.com.

“We are sounding the alarm,” said Michel Sidibé, executive director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”

HIV prevention crisis

Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. Although this is nearly half the number of new infections compared to the peak in 1996 (3.4 million), the decline is not quick enough to reach the target of fewer than 500 000 by 2020.
The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010. However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.

Treatment scale-up should not be taken for granted

Due to the impact of antiretroviral therapy roll-out, the number of AIDS-related deaths is the lowest this century (940 000), having dropped below 1 million for the first time in 2016. Yet, the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 AIDS-related deaths.
In just one year, an additional 2.3 million people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7 million. Almost 60% of the 36.9 million people living with HIV were on treatment in 2017, an important achievement, but to reach the 30 million target there needs to be an annual increase of 2.8 million people, and there are indications that the rate of scale-up is slowing down.

READ:  ‘HULAGWAY DOS' calls on everyone to fight stigma on HIV

West and central Africa lagging behind

Just 26% of children and 41% of adults living with HIV had access to treatment in western and central Africa in 2017, compared to 59% of children and 66% of adults in eastern and southern Africa. Since 2010, AIDS-related deaths have fallen by 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half (51%) of the HIV burden in the region and there has been little progress in reducing new HIV infections in recent years. New HIV infections declined by only 5% (9000) in seven years (from 179 000 to 170 000) and only one in three people living with HIV is on treatment (33%), although HIV treatment coverage has increased from just 24% two years ago.

Progress for children has slowed

The report shows that the gains made for children are not being sustained. New HIV infections among children have declined by only 8% in the past two years, only half (52%) of all children living with HIV are getting treatment and 110 000 children died of AIDS-related illnesses in 2017. Although 80% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2017, an unacceptable 180 000 children acquired HIV during birth or breastfeeding—far away from the target of fewer than 40 000 by the end of 2018.

“One child becoming infected with HIV or one child dying of AIDS is one too many,” said Mr Sidibé. “Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”

Key populations account for almost half of all new HIV infections worldwide

The report also shows that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

“The right to health for all is non-negotiable,” said Sidibé. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programs. More investments are needed in reaching these key populations.”

READ:  Phl to continue receiving Global Fund support after 2012

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.

“Communities are echoing UNAIDS’ call,” said Vincent Pelletier, positive leader and executive director of Coalition PLUS. “We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”

Stigma and discrimination persists

Discrimination by health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing young people, people living with HIV and key populations from accessing HIV prevention, treatment and other sexual and reproductive health services.

Across 19 countries, one in five people living with HIV responding to surveys reported being denied health care and one in five people living with HIV avoided visiting a health facility for fear of stigma or discrimination related to their HIV status. In five of 13 countries with available data, more than 40% of people said they think that children living with HIV should not be able to attend school with children who are HIV-negative.

New agenda needed to stop violence against women

In 2017, around 58% of all new HIV infections among adults more than 15 years old were among women and 6600 young women between the ages of 15 and 24 years became infected with HIV every week. Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners.

“Inequality, a lack of empowerment and violence against women are human rights violations and are continuing to fuel new HIV infections,” said Sidibé. “We must not let up in our efforts to address and root out harassment, abuse and violence, whether at home, in the community or in the workplace.”

90–90–90 can and must be achieved

There has been progress towards the 90–90–90 targets. Three quarters (75%) of all people living with HIV now know their HIV status; of the people who know their status, 79% were accessing treatment in 2017, and of the people accessing treatment, 81% had suppressed viral loads.

Six countries, Botswana, Cambodia, Denmark, Eswatini, Namibia and the Netherlands, have already reached the 90–90–90 targets and seven more countries are on track. The largest gap is in the first 90; in western and central Africa, for example, only 48% of people living with HIV know their status.

READ:  GLAAD releases new HIV and AIDS style guide for journalists

A big year for the response to tuberculosis

There have been gains in treating and diagnosing HIV among people with tuberculosis (TB)—around nine out of 10 people with TB who are diagnosed with HIV are on treatment. However, TB is still the biggest killer of people living with HIV and three out of five people starting HIV treatment are not screened, tested or treated for TB. The United Nations High-Level Meeting on Tuberculosis in September 2018 is an opportunity to bolster momentum around reaching the TB/HIV targets.

The cost of inaction

Around US$ 20.6 billion was available for the AIDS response in 2017—a rise of 8% since 2016 and 80% of the 2020 target set by the United Nations General Assembly. However, there were no significant new commitments and as a result the one-year rise in resources is unlikely to continue. Achieving the 2020 targets will only be possible if investments from both donor and domestic sources increase.

Ways forward

From townships in southern Africa to remote villages in the Amazon to mega-cities in Asia, the dozens of innovations contained within the pages of the report show that collaboration between health systems and individual communities can successfully reduce stigma and discrimination and deliver services to the vast majority of the people who need them the most.

These approaches continue to drive the solutions needed to achieve the 2020 targets. When combination HIV prevention—including condoms and voluntary medical male circumcision—is pursued at scale, population-level declines in new HIV infections are achieved. Oral pre-exposure prophylaxis (PrEP) is having an impact, particularly among key populations. Offering HIV testing and counseling to family members and the sexual partners of people diagnosed with HIV has significantly improved testing access.

Eastern and southern Africa has seen significant domestic and international investments coupled with strong political commitment and community engagement and is showing significant progress in achieving the 2020 targets.

“For every challenge there is a solution,” said Sidibé. “It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”

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POZ

Alternative PrEP forms needed for better uptake

Low uptake of daily oral PrEP since US Food and Drug Administration approval and low medication adherence among users have stimulated the investigation of other modalities for delivery, such as injectable PrEP and on-demand PrEP.

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Pre-exposure prophylaxis (PrEP) is widely accepted as an effective strategy to prevent HIV. However, low uptake of daily oral PrEP since US Food and Drug Administration approval and low medication adherence among users have stimulated the investigation of other modalities for delivery, such as injectable PrEP and on-demand PrEP.

A study – titled “Acceptability of Injectable and On-Demand Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in California”, written by Matthew R. Beymer, Jennifer L. Gildner, Ian W. Holloway and Raphael J. Landovitz – attempted to determine the demographic and behavioral predictors of willingness to try alternative PrEP delivery mechanisms among young men who have sex with men (YMSM) who stated that they were unwilling to try daily oral PrEP.

The study particularly recruited 265 YMSM in California through geosocial networking applications; and then analyzed a subsample who stated that they were either ambivalent about trying or unwilling to try daily oral PrEP. The researchers used chi-square and Fisher’s exact tests to determine characteristics associated with willingness to try injectable PrEP, willingness to try on-demand PrEP, and willingness to try either alternative form.

The study found that for individuals who stated that they would not be willing to try daily oral PrEP, ∼85% were willing to try on-demand and/or injectable PrEP. Individuals who reported some college or more reported greater willingness to try injectable PrEP (adjusted odds ratio [aOR]: 2.92; 95% confidence interval [CI]: 1.32–6.46), on-demand PrEP (aOR: 2.28; 95% CI: 1.06–4.90), or either method (aOR: 5.54; 95% CI: 1.78–17.22).

Confusion about PrEP still common, according to study

According to the researchers, “future research should determine how to enhance uptake of emerging forms of PrEP among the individuals most at risk for HIV.”

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It is worth noting that – while other countries are already discussing alternative PrEP forms – countries like the Philippines continue to have limited access to PrEP. With this, it remains a (sadly) very elitist approach to deal with HIV, with only those who have contacts to pilot project implementers able to access the same.

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From the Editor

3 Terms you need to know in HIV advocacy in the Philippines

HIV advocacy in the Philippines has evolved – and in many ways, devolved – to highlight erroneous practices. Here are at least three terms in use locally that highlight how BROKEN HIV advocacy is in the Philippines.

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Photo by Samantha Sophia from Unsplash.com

I was in Northern Mindanao when I first heard of a term used to refer to a service “provider” who – in a word (and there really is no going around this) – ALLEGEDLY “molested” masseurs who had to be tested for HIV as required by their line of work.

When interviewed, some of these masseurs alleged that a certain medical practitioner who – during testing – would “dulaan ang among itlog ug utin (fondle our testicles and our penises).” And then – as if to show them who’s the boss – “mu-ngisi pa jud siya, unya mu-schedule sa uban sa amo-a ug booking (this person would smirk at us, and would even schedule trysts with some of us).”

That was the first time I heard of a term that is apparently used to refer to people like this person: “advoKATI”, a play on “advocacy” and “makati (literally, itchy; and contextually, a slut)”, because they supposedly use advocacy as a cover for their itch/desire to pick up or sleep around.

Through the years, other terms being used related to HIV advocacy also came to my attention. And here are at least three of them; all of them highlighting how BROKEN HIV advocacy is in the Philippines.

***

1. advoKATI
n. Refers to a person who uses the advocacy as a front to get sexual partners.

The medical practitioner mentioned above is an example; though – by no means – is his case unique. Other examples include: giving (donated) vacc in exchange for sex with a PLHIV; providing after-testing services only to good-looking newly-diagnosed persons with HIV, while the not-so-good-looking are left to fend for themselves; and “counselors” using the confused state of mind of newly-diagnosed PLHIVs to sleep with them.

2. advoCASHy
n. Profiting from HIV advocacy; or people who profit from the same.

Let’s get this straight: Profiting from HIV is not exactly new; nor is this exclusive to the Philippines.

Globally – and perhaps even more apparent – is the profiteering done by pharma companies that produce the life-saving ARVs for PLHIVs. There is also the issue with accessing “good” drugs by developed countries (e.g. PrEP) versus “dumping” of those not already used by the developed countries in the poorer countries (e.g. phase out of Nevirapine and Efavirenz).

READ:  GLAAD releases new HIV and AIDS style guide for journalists

Perhaps Peter Mugyenyi said it best when he tackled in “Genocide by Denial: How Profiteering from HIV/AIDS Killed Millions” the “incredible self-indulgence of the pharmaceutical companies and the cold-heartedness of the rich world that turned a blind eye until it was far too late, and then responded too slowly with too little.”

Now not just the big “bodies”, but even the other players in responding to HIV are mimicking this. And yes, this includes HIV “advocacy” in the Philippines, which is emulating this, too.

Here, we continue hearing that “there is no money in advocacy”, much more for those affected by HIV. This is supposedly why it’s difficult accessing existing treatment, care and support (TCS) – because, as always stressed – “there just isn’t enough money to go around”.

And then you hear about HIV “advocates” who can afford to buy numerous stuff (from a number of cars to a number of properties to luxury items to high-end gadgets to getting cosmetic surgery, and so on) from their “small” salary as NGO workers.

Or “advocates” who have drivers. WITH UNIFORM.

Or “advocates” who can tour the world using only their “meager” earnings from their “small” salary.

This is NOT to begrudge people their salaries.

BUT when you couple these with:

  • Inability of newly-diagnosed PLHIVs to go to treatment hubs because they don’t have money to pay for their fare.
  • Complaints from PLHIVs about inability to access to treatment because they can’t pay PhilHealth.
  • Non-access to other meds for opportunistic infections (or the need to beg the likes of DSWD or PCSO to fund these meds).

I am starting to sound like a “sirang plaka (broken record)”, repeatedly writing about issues I’ve already written about.

READ:  ‘HULAGWAY DOS' calls on everyone to fight stigma on HIV

BUT there’s this disconnect that is too painful to just ignore.

All because there are “advocates” who see HIV as a cash cow.

3. advoKATKAT
v. The use of HIV advocacy for social climbing. “Katkat” is a Bisayan word meaning “to climb”. This is often related to advoCASHy as it emphasizes only the glam in “helping” even sans the actual helping.

There are NGOs paying PR firms to promote HIV “advocacy”. Ask them how many people got tested because of the “campaigns”, and they’d tell you: Our indicator is the number of Facebook likes. “Likes” derived from the money paid to celebs, bars, photographers/videographers, alcohol consumed, et cetera. Partying in the guise of advocating.

There’s an “award” for people who “helped” HIV advocacy in the Philippines – even if grassroots HIV workers question the “winners” (e.g. who these people are, how they were chosen, what they’ve really done for the HIV community). What’s seemingly important is the hype created; particularly since celebs “joined” the “cause”. More photo ops mean more exposure means more (possible) funds.

There’s the funding of a photo campaign because the one disbursing the fund are “models” in the campaign, themselves.

There’s a well-funded beauty pageant even if we have (often denied) ARV shortage (not to mention hubs that still do not offer all tests included in the OHAT package, from CD4 count to viral load count).

As already noted in the past, there’s this focus on the glam/social climbing (e.g. get celebs to promote testing), perhaps forgetting that real advocacy goes beyond that.

Too much focus on the glitzy fibs, less emphasis on the grimy truth

And so here we are now, with 31 new HIV cases reported every month in the Philippines. Ten years ago, we only had one case EVERY DAY.

We are fucked. But we’re not only fucked because of lack of sex education, non-promotion of condom use, antiquated practices (e.g. we have yet to teach U=U in the country, or make PrEP and PEP widely accessible), and so on.

READ:  Eric: Unwavering positive attitude in facing HIV

We’re also in deep shit because the people who should be serving us want us to be there so they can benefit from it.

This is the new(er) world of “advocacy”…

It’s called advoCASHy to promote advoKATI and advoKATKAT.

***

Back in Northern Mindanao, I asked those who alleged to have been victimized if they complained – officially.

I was told: “Na, kinsa ra ba mi (Yeah, right! Who do we think we are)? Kolboy kontra sa medical practitioner, paminawun ba mi (Sex workers versus a medical practitioner, who would listen to us)?”

Despite recognizing power structures and all that, I admit I still initially found the “excuse” inexcusable. Lodging a complaint against an abusive service “provider” seems like a good first step to remedy this situation. Letting things as they are only allows the erroneous system to continue.

And then – much later – the person they alleged did them harm formed a new NGO, and this NGO was funded by a bigger NGO based in Metro Manila. I mentioned the allegations to one of the heads of the Metro Manila-based NGO, hoping – perhaps – for them to closely look at the allegations since, and after all, they were “enabling” the person involved by funding this person.

Let me get this straight: These are all allegations, of course, and they need to be investigated to be validated/invalidated. Everyone involved ought to be heard – from those who accused, and the accused. But that they exist at all should already be cause for concern.

Alas, the allegations were ignored.

So this “provider” continues to be coddled – and enabled – so long as this person’s NGO churns out reports that the bigger NGO can use to get even more big bucks.

All too apparent, people choose to turn the blind eye so long as money keeps flowing in…

No wonder HIV advocacy is in the Philippines remains broken…

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NEWSMAKERS

Address causes that put young people at risk of HIV – Pia Wurtzbach

Pia Alonzo Wurtzbach urged decision makers to address the causes that put young people at risk of HIV.

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UNAIDS Goodwill Ambassador for Asia and the Pacific Pia Alonzo Wurtzbach urged decision makers to address the causes that put young people at risk of HIV, speaking at the International Youth Day Conference organized by the United Nations Youth Association of the Philippines in collaboration with the United Nations Association of the Philippines.

“We live in a world where adolescents and young people, especially from key populations, are still left behind. We cannot fail to address their needs. I challenge the indifference and I call for action now,” said Wurtzbach.

Every day, approximately 230 young people are newly infected with HIV in Asia and the Pacific. In 2017, almost half a million young people between the ages of 15 to 24 years were living with HIV in the region.  In the Philippines, young people account for 69% of new HIV infections and data indicates that there is a growing HIV epidemic among young men having sex with men. Young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, sex workers and people who use drugs) are at a high risk of HIV acquisition due to rights violations, discrimination, exclusion, criminalization and violence.

This year’s theme for International Youth Day was Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out and participate in decision making processes. This includes in healthcare settings, which should be places of safety, free from stigma, discrimination and violence. This is not always the case in Asia and the Pacific, where policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. In the region, available data indicates that more than half of the countries requires parental consent for HIV testing for adolescents younger than 16 years old.

READ:  Aiza bats for access to HIV testing by minors

‘‘We need a critical change to respond to the dynamic shift of the HIV epidemic among young key populations, not only in the Philippines, but in Asia and the Pacific,” stressed Eamonn Murphy, UNAIDS Regional Director for Asia and the Pacific. “We need the innovation and creativity of young people in designing HIV interventions that work for them and, at the same time, support their leadership in challenging structural barriers in accessing health services, including parental consent requirements for adolescents and the lack of comprehensive sexuality education,” he added.

Wurtzbach encouraged people to advocate for young people’s participation in the AIDS response as leaders and agents of change and build strategic partnerships to end the AIDS epidemic.

“We have miles to go to end AIDS in the Philippines and we need to equip young people with the right information and enable them to access services that are safe and responsive to their needs,” Wurtzbach concluded.

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POZ

993 new HIV cases in Phl in June; 77 AIDS-related deaths reported

There were 77 reported deaths due to any cause among people with HIV last June in the Philippines, more than double the 30 deaths in May. 19% were 15-24 years old, and 51% were 25-34 years old. Also, 90% of the cases acquired HIV from sex.

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The HIV situation remains bad in the Philippines.

There were 77 reported deaths due to any cause among people with HIV last June in the Philippines. This is according to the HIV/AIDS & ART Registry of the Philippines (HARP), which reported that – among those who passed away – 72 were males and five were females.

This is more than double the May figure, when 30 deaths were reported.

For June’s 77 deaths, 15 (19%) were 15-24 years old, 39 (51%) cases were from 25-34 years old, 16 (21%) cases were from 35-49 years old age group, and seven (9%) case were 50 years and older. Ninety percent of the cases were reported to have acquired the infection through sexual contact (12 through male-female sex, 36 through male-to-male sex, and 21 through sex with both males and females), and 10% (8) of the cases were infected through sharing of needles.

The number of deaths may actually be higher because of under-reporting.

But to date, the HIV situation in the country continues to be bad, with 31 new HIV cases reported every day.

In June 2018, there were 993 new HIV cases reported to HARP. This is higher than the number reported in May, with the newly infected reaching 950. In April, it was “only” 924.

Among the new HIV cases, 18% (174 of the total) had clinical manifestations of advanced HIV infection (WHO clinical stage 3 or 4) at the time of diagnosis. Ninety-four percent (934) of the newly diagnosed were male. The median age was 27 years old (range: 3-73 years old). More than half (52%, 512) were 25-34 years old and 29% (287) were 15-24 years old at the time of testing.

READ:  March 2016 continues upward HIV trend in Phl with 736 new cases

As noted – and worth highlighting – is the age of those getting infected with HIV in the Philippines, with the affected populations getting younger.

In June 2018, 287 (29%) cases were among youth 15-24 years old; 95% were male. Almost all (99%, 285) were infected through sexual contact (23 male-female sex, 187 male-male sex, 75 sex with both males & females). Two cases had no data on mode of transmission.

There were 31 newly diagnosed adolescents 10-19 years old in June 2018. All were infected through sexual contact (5 male-female sex, 20 male-male sex, and six had sex with both males and females). There were two newly diagnosed child less than 10 years old and was infected through vertical/mother-to-child transmission.

One third (33%, 324) of the new HIV cases were from the National Capital Region (NCR). Region 4A (17%, 167 cases), Region 3 (12%, 123), Region 6 (7%, 66), Region 12 (6%, 58) and Region 7 (6%, 55) round off the top six regions with the most number of newly diagnosed cases for June, together accounting for 80% of the total.

Also, sexual contact remains the predominant mode of transmission (98%, 977). Among this, 88% were from males who have sex with males (MSM).

Other modes of transmission were needle sharing among injecting drug users (1%, 7) and vertical (formerly mother-to-child) transmission (<1%, 2).

There were seven cases that had no data on mode of transmission.

Among the newly diagnosed females for June, four were pregnant at the time of diagnosis, three of the cases were from NCR and one case from Region 7.

READ:  Sick from Sucking

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POZ

Let science inform application of law in criminal cases related to HIV, according to experts

Prosecutions of people living with HIV for acts that pose no risk of HIV exposure or transmission prompt scientists to issue a statement urging the criminal justice system to use science when considering prosecution of HIV non-disclosure, exposure or transmission.

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A group of 20 leading HIV scientists from around the world have issued a scientific consensus statement urging governments and people working in the legal and justice systems to pay close attention to the significant advances in HIV science to ensure that science informs the application of criminal law in cases related to HIV.

“Science has greatly advanced in recent years which has been critical in allowing countries to make evidence informed decisions in their HIV programming,” said Michel Sidibé, executive director of UNAIDS. “With all the new scientific advances now available we need to continue to use science as evidence to deliver justice. No one should face criminalization because of a lack of information or understanding by the justice system about the risks of HIV transmission.”

The expert group of scientists, convened by UNAIDS, the International Association of Providers of Care (IAPAC) and the International AIDS Society, warn that an overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. Around 73 countries have laws that criminalize HIV non-disclosure, exposure or transmission, and 39 countries have applied other criminal law provisions in similar cases.

“Many of these laws do not take into account measures that reduce HIV transmissibility, including condom use, and were enacted well before the preventive benefit of antiretroviral therapy or pre-exposure prophylaxis was fully characterized,” said José M. Zuniga, IAPAC President and Chief Executive Officer. “Most people living with HIV who know their status take steps to prevent transmitting HIV to others. Laws that specifically criminalize HIV non-disclosure, exposure, or transmission thus primarily exacerbate HIV-related stigma and decrease HIV service uptake.”

READ:  How each one is a cure

Most prosecutions have occurred based on perceived risk of HIV transmission through sexual activity. Some have also occurred for biting, spitting or even scratching. Prosecutions, and convictions, have often been influenced by a lack of knowledge or appreciation of scientific evidence regarding the possibility of transmission of the virus. In many instances, they have been influenced by deep-rooted stigma and fear associated with HIV, which still exists despite the huge advances in HIV treatment and prevention.

“We support this globally relevant expert consensus statement, for which we have been long-time advocates,” said HIV Justice Network’s Senior Policy Analyst Sally Cameron, on behalf of the Steering Committee of HIV Justice Worldwide, a global civil society coalition campaigning to end unjust prosecutions. “HIV criminalization is a growing global phenomenon that unfairly targets people living with HIV through criminal prosecutions and harsh penalties. This welcome statement makes the case that our current understanding of HIV science, alongside key human rights and legal principles, does not support this miscarriage of justice.”

The peer-reviewed consensus statement, endorsed by 70 additional scientists from around the world, was released today in the Journal of the International AIDS Society. It describes scientific evidence on the possibility of HIV transmission under various circumstances, the long-term impact of HIV infection and the means of proving HIV transmission so that it is better understood in criminal law contexts.

Based on a detailed analysis of the best available scientific evidence on HIV transmission and treatment effectiveness, the statement notes that there is no possibility of HIV transmission through saliva as a result of biting or spitting, even where saliva contains small quantities of blood. There is no to negligible possibility of HIV transmission where a condom is used correctly during sex, or where a partner living with HIV has an undetectable viral load.

READ:  Aiza bats for access to HIV testing by minors

In addition, effective antiretroviral therapy, low viral load, the use of pre-exposure prophylaxis (antiretroviral drugs taken by an HIV-negative person before a possible exposure), or post-exposure prophylaxis (antiretroviral medicines taken after a possible exposure) all significantly reduce the possibility of HIV transmission.

International guidance on HIV in the context of the criminal law recommends that “proof of causation, in relation to HIV transmission, should always be based on evidence derived from a number of relevant sources, including medical records, rigorous scientific methods and sexual history” (Ending overly broad criminalization of HIV non-disclosure, exposure and transmission: critical scientific, medical and legal considerations).

The experts recommend strongly that more caution be exercised when considering criminal prosecution, including careful appraisal of current scientific evidence on HIV risk and harms. The consensus statement is expected to help policymakers, prosecutors and courts be guided by the best available science and thereby avoid the misuse of the criminal law, as is currently happening in many countries worldwide.

Read the full Expert Consensus Statement on the Science of HIV in the Context of Criminal Law.

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From the Editor

3 Reasons why TasP and U=U won’t happen soon in the Philippines…

Treatment is available for people with HIV. And if a PLHIV gets treatment, he does not need to die from AIDS-related complications, and he’ll reduce his viral load so he can’t transmit HIV to others. But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.

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Fact: Treatment is available for people living with HIV.
And if someone with HIV gets treatment, he/she does not need to die from AIDS-related complications.
And if someone also gets treatment, the antiretroviral treatment (ART) he/she uses reduces the HIV viral load in his/her blood, semen, vaginal fluid and rectal fluid to “undetectable level”. And get this: Evidence shows that individuals on effective antiretroviral treatment (ART) with an undetectable viral load cannot transmit HIV to others.

“Lor”, one of the HIV-positive people Outrage Magazine met in Mindanao, who lamented how he was not informed of “what to now do after I tested HIV-positive”.
Eventually, without being able to access treatment, he passed away from AIDS-related complications.

This is why treatment as prevention (TasP) is important.
So important, in fact, that the World Health Organization (WHO) guidelines call for “test and treat” strategies to “initiate all people diagnosed with HIV on ART as soon as possible after diagnosis as a way to decrease community viral load and reduce the rate of new HIV infections”.

But in the Philippines, among the common reasons why TasP is NOT working is because of the failures of the service providers themselves.
Testing is picking up, yes. But even now, not even half of PLHIVs access ART.
But so many of the after-test services continue to be lacking.

Here are three (of the many) reasons why I think TasP and U=U won’t happen soon in the Philippines:

READ:  Northern Mindanao to observe World AIDS Day 2015 with ‘LIMA: The HIV Monologues’

1. After people get tested, no one really knows what to do next.
In the past three days, I have been speaking with three people whose HIV rapid test results were “reactive”. Soon after the tests, they were basically “dumped” by their “counselors”/service providers. These three were basically left on their own – and, as two of them said, “ni walang flyer na binigay para sana alam ko man lang ano na ang gagawin ko (no flyer was even given so I would at least be guided on what to do next).”
You’d expect more from the center where they got tested, too – both are satellite treatment hubs of one of the country’s major treatment hubs; and one is (in)famous for its extremely well-funded “efforts” to supposedly stop the spread of HIV in the Philippines.
The way I see it: Centers without after-testing support should NOT exist.
Because I said this before, and let me say this again: “You can’t just test people and then – after finding out they’re reactive/positive – ‘dump’ them to become somebody else’s problem. Because if/when you do, your concept of service provision is too limited, and as such, you’re actually part of the problem you claim to be dealing with…”

2. Baseline tests are NOT covered by PhilHealth.
In the Philippines, the treatment, care and support (TCS) received by most people living with HIV (PLHIVs) are covered by the Philippine Health Insurance Corporation’s (PhilHealth) Outpatient HIV/AIDS Treatment (OHAT) Package. Specifically, to those who are enrolled in PhilHealth, P30,000 is allocated per PLHIV per year, or P7,500 every quarter.
The 2010 circular that guided the implementation of the OHAT specifically stated that “covered items under this benefit are drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retroviral drugs (ARV) toxicity and professional fees of providers.”
The revised OHAT Package released last June 2015 stated that “covered items under this benefit are drugs and medications, laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity and professional fees of providers.”
Meaning: baseline tests are NOT covered by the OHAT package.
In 2015, Outrage Magazine interviewed Dr. Rosanna Ditangco, research chief at The Research Institute for Tropical-AIDS Research Group (RITM-ARG), a treatment hub located in Alabang. She lamented that management issues come to play in the delivery of treatment, care and support (TCS) services to PLHIVs.
For instance, “the OHAT Package does NOT cover baseline tests yet”, including such baseline laboratory tests as CBC, chest x-ray, PPD and blood chemistry (i.e. lipid profile, BUN, Creatinine, FBS), and CD4 count.
Let’s call this out already: This policy is – in a word – idiotic.
You need ARVs to treat HIV. You can ONLY get ARVs if you get your baseline tests done. If you have no money to pay for these baseline tests, then say goodbye to ARVs. Sans ARVs, you’re as good as dead.

3. Many medical practitioners in HIV advocacy continue to not know much about… HIV. Or even if they do, they continue to be sources of HIV-related discrimination.
One of the (aforementioned) guys who only recently got tested for HIV told me that – when the attending doctor was informed that his CD4 count is 60 – he was sarcastically told: “Ha, good luck!”.
I saw for myself how one nurse told a PLHIV “not to have sex anymore, ever. Para di na kayo dumami (So your number won’t grow).”
Try bringing up U=U in the country, and among the staunchest deniers are those working in HIV advocacy. I remember one of them tell me before: “Magkakalat pa (You’re giving them excuse to spread HIV)!”.
I also know of doctors who won’t even touch people they suspect to have HIV – due to disgust or fear or whatever, I can only surmise…

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There are other issues, of course (from slow government response to wrong priorities to fund mismanagement to profiteering).

7 B.S. (or at least half-truths) you hear about HIV in the Philippines

And so here’s another fact: Unless these are dealt with, expect for the worst to come.

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