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ASIA: Prescription for HIV/AIDS Pandemic – Social Justice

BALI, Aug 13 2009 (IPS) - The prescription that thousands of participants effectively issued at a just- ended AIDS conference here was clear: It is time to fight social and political inequities so that the medical gains in curbing HIV and AIDS can work with maximum efficacy.

The recognition that it is time to look far beyond the medical and scientific dimensions of the region’s battle against HIV and AIDS is the theme that flowed through the more than 200 sessions at the 9th International Conference on AIDS in Asia and the Pacific (ICAAP).

There were many more sessions in the Aug. 9-13 conference addressing issues such as stigma and discrimination, sexuality and gender, resource shortages, community involvement, harm reduction, human rights, men who have sex with men, drug users, and laws that criminalise behaviour by certain groups – rather than medical therapies.

In closing ICAAP at the Bali International Convention Centre, World Health Organisation Regional Director for Southeast Asia Samlee Plianbangchang, dedicated more time to the social aspects of the epidemic rather than the biomedical ones during his remarks.

“Equity and social justice are of paramount importance for responding to the HIV/AIDS epidemic,” Samlee told the some 3,600 participants at the conference. His remarks reflected how HIV is as much as social and development disease as it is a medical one.

“HIV remains one of the most formidable public health challenges of our times. In the Asia-Pacific region, HIV affects mostly vulnerable and difficult- to-reach populations, especially sex workers, men who have sex with men and injecting drug users,” he said.

It is because of this characteristic of the epidemic – there are 5 million people living with HIV and AIDS in the region – that special efforts need to be made to change societal attitudes so that hard-to-reach groups get the same opportunity to know about and be treated for the infection.

“The main message has been that to address AIDS, we need to tackle the socio-political and economic inequities that drive the epidemic and restrict access to information, treatment and care,” Rosalia Sciortino, professor at Thailand’s Mahidol University and the chairwoman of the social track of ICAAP, said in an interview.

Addressing the “structural conditions” of the epidemic would help reduce the gaps between North and South, rich and poor, women and men, among diverse sexual communities, majority and minority populations, among citizens and non-citizens, and among migrants and refugees, she said.

“Social change is needed to control AIDS,” Sciortino pointed out. “Groups are not born vulnerable, but are made vulnerable by societies that marginalise and exploit them.”

Groups like drug users, sex workers and men who have sex men – often stigmatised as not deserving of attention or treatment or as bring social ills – have been falling through the cracks, despite major gains made over the last decade in increasing the numbers of people with HIV who have access to anti-retroviral therapy.

The discussion around HIV and AIDS used to be more along the lines of ‘access for all,’ which was the theme of the International AIDS Conference in Bangkok, Thailand in 2004.

Overall, the Asia-Pacific has seen the number of people getting anti- retrovirals increase more than threefold from 2003 to some 565,000 today, according to Joint United Nations Programme on HIV/AIDS (UNAIDS) figures. Worldwide, the number of people on anti-retroviral therapy stands at 4 million.

Many U.N. officials stressed this week that the region is poised to meet by next year the targets of universal access to treatment – agreed upon by the world’s governments in 2006.

Among the better performers are countries like Thailand, Laos and Cambodia, where more than 80 percent of the people who need anti-retrovirals get them.

In many countries too, Samlee explained, progress in national response to the AIDS epidemic over the last two decades is being reflected in declines or levelling off of HIV prevalence, and longer life spans among those with the virus.

But, alongside the positive overall figures, statistics also show worrisome trends. These include increasing infections especially among men who have sex with men, and also among intravenous drug users.

About a third of men who have sex men report having been harassed in some way, studies say, making it difficult for them to be reached by prevention and treatment campaigns. In Asia, Indonesia has the highest proportion of drug users infected with HIV, at 60 percent, followed by Burma at nearly 50 percent.

Then there are groups like women, especially those in intimate relationships whose partners engage in risky behaviour and infect them.

Women make up 35 percent of all new infections among adults in Asia, up from 17 percent in 1990. UNAIDS also says that more than 90 percent of women living with HIV acquired the virus from their partners in long-term relationships.

Looking ahead, Samlee encouraged HIV researchers to be aware of social gaps in working on responses to the pandemic. “Research addressing equity and benefitting marginalised populations should receive high priority,” he added.

ICAAP also saw discussions around conservative approaches to religion and gender biases that make it even more difficult to reach and address the needs of the weakest, most shunned groups.

However, there were not many representatives from conservative religious groups at the conference, or many representatives from the pharmaceutical sector – which drew a lot of flak here this week. For instance, activists staged lightning protests Wednesday to demand a stop to patents on HIV drugs.

For future conferences, Sciortino proposed a more open and “more daring” discussion of sexuality and touchy issues such as condoms and safe sex.

But participants like Monica Abo from Fiji said that AIDS conferences over the years have already done a lot of talking, referring to past ICAAPs such as the last one in 2006 in Colombo, Sri Lanka, where the theme was ‘Waves of Change, Waves of Hope.’

From the theme of this year’s ICAAP here in Bali, which is ‘Strengthening Movements, Empowering Networks,’ she suggested that perhaps the next ICAAP should have the slogan ‘Less Talk, More Action.”

Held once every two years, the next ICAAP will be held in Busan, South Korea.

*TerraViva at ICAAP 09 (

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