The INFO Project Blog

So… first I promised to post some pictures from yesterday.  Here are some:

Panel from Monday presentation “Linking Sexual and Reproductive Health”  (L to R) Feliclity Daly, Interact Worldwide, Suni Nanda, International AIDS Alliance, India, Malcolm McNeil, DFID, Fiona Petit, International Community of Women Living with AIDS

Part of Panel from “Meeting the Sexual and Reproductive Health Needs of People Living with HIV”, Sunday August 4

Rose Wilcher, Family Health International, “Contraception - the best kept secret in HIV prevention”,  panel discussion “Meeting the Sexual and Reproductive Health Needs of People Living with HIV”, Sunday August 4, 2008

I first attended a fabulous lecture entitled “Responding to the  HIV Epidemic among Men Who Have Sex with Men”.  During this session, our friends at PSI discussed an excellent program they are currently supporting in Togo designed to create community among MSM, provide HIV prevention education and appropriate referral of services.

Following, I was fortunate to hear former President Bill Clinton speak about his foundation.  Bill Clinton compared AIDS to a dragon stating that “AIDS is a very big dragon… we cannot end until the dragon is slain.” The title of President Clinton’s talk was “HIV and Health Systems Reform: Achieving Universal Access.”  He gave examples of his work and emphasized that successful HIV interventions will naturally positively influence health systems of countries.  In Malawi, there is limited lab capability so the Clinton Foundation recruited lab workers and focused on increasing lab capacity, which in turn strengthened the health system.  In Zambia, with the advent of ART, there has been an increased demand for health services, but workers were in short supply.  So, the foundation has worked with the government to increase the supply and train workers, which again strengthened the health system while providing access to treatment.

In accordance with all other speakers, Clinton acknowledged that stigma and discrimination remain barriers to access for marginal populations such as sex workers and MSM.  Mr. Clinton applauded his colleagues Ban Ki Moon and Felipe Calderon for acknowledging the dangers of homophobia to the fight against HIV/AIDS. Mr. Clinton emphasized that treatment and prevention go hand in hand; treatment with ARVs helps to lower viral loads in individuals which makes it more difficult to transmit the virus.  The availability of ARVs increases the rates of voluntary testing and counseling.

According to Clinton, there is no “silver bullet” for HIV prevention.  Prevention programs must address sexual behaviors, provide condoms, make VCT available and ensure that IDUs have clean needles or substitutes for injections.  Research must be conducted until a vaccine and microbicide are produced.  Mr Clinton also spoke about service integration- health systems can be designed to achieve maximum efficiency through providing HIV services along with TB treatment and care and malaria services.

President Clinton also stated that there is the need for more rigorous evaluation of HIV prevention, treatment and care programs and for the more rapid application of new research and technologies.  More objective expert research should also be conducted and national and international policies should be improved to ensure that HIV is prevented among mothers and infants.  Universal access can not be achieved, according to Clinton, until gender equity is achieved, women have full rights and violence against women is eradicated.

Finally, Mr. Clinton urged that leaders take action to address the United States’ domestic AIDS crisis.  Mr. Clinton provided statistics showing that the HIV epidemic is increasing among African American populations, and stated his foundation will begin to focus on domestic HIV/AIDS issues.

Following Mr. Clinton’s speech I attended a session entitled “Reaching Millions - Youth AIDS and the Digital Age.”  The panel discussed how the internet and cell phone technology can be used to reach youth with HIV and sexual and reproductive health messages.  Here are the highlights and the sites that were presented:

• Voxiva- A US based technology company which has partnered with Mexico cell phone company Telcel to offer medication reminders and adherence alerts to people living with HIV/AIDS in Mexico.  The service is free and will be rolled out shortly.  Participants can add family and friends as “treatment buddies”.  Buddies receive an alert if meds are missed so they can remind their lived ones, and can be involved with helping their loved ones cope with HIV.
• Taking it Global - Forges connections between youth in all parts of the world.  Has discussion forums, issue pages and live chats focused on HIV/AIDS.
• Global Youth Coalition on HIV/AIDS - Connects 45,000 youth in 150 countries working on HIV/AIDS issues.  Offers free monthly eCourses on issues related to HIV advocacy and prevention. Will launch iAIDS in World AIDS day, which is a wiki type site, and allows youth to create and edit their own content related to HIV/AIDS and sexual and reproductive health.
• Punto J (this site appears to be down now  - www.puntoj.com.pe) - A Spanish language site designed by youth for youth which has messages, videos and interactive content about HIV/AIDS and sexual and reproductive health.  Trainers receive training on how to show other youth the benefits of the site and how to contribute.
• Thembi’s Diary- An online audio diary of
• MyMysta - A completely mobile non-Internet Web-based social networking site where youth can create profiles, comment on others’ posts about sexual and reproductive health and HIV/AIDS and look at job listings.

Finally, I promoted the integration site at the afternoon session entitled “Pursuing Desire: Sexual and Reproductive Health and HIV Prevention Integration”.  When Kate Kennedy, a PhD student from Johns Hopkins presented her finding with IPPF and UNFPA colleagues on an analysis of integration literature, I seized the opportunity to ask her if she found any of the 50+ articles she used in the integration database.  I asked this is front of hundreds of people and of course provided a plug for the integration site.  Of Course she did use the database, and I was very happy that it aided her research study, and that I got to tell the whole audience about the wonderful resource.  I was pleased beyond belief when one presenter stated that integration of HIV/SRH has only solely focused on women and reproductive health/family planning for women in the past.  Men do not generally present themselves to RH clinics and integration programs need to address men’s sexual health.  This comment received much applause from the audience.

 Lessons from this session included:

• PLWHA face a tough decision when choosing whether or not to parent and need much support
• Interventions addressing the SRH of PLWHA must address provider attitudes (many providers believe that people living with HIV/AIDS Should not be sexual beings or have children)
• Lack of finances, time, lack of provider training are all obstacles to integrating HIV/AIDS
• Diagnosis of STIs is an essential component of integration programs
• Systematic literature reviews of integration research identified gaps: There is little research in comparisons of linked/unlinked services.

Highlights of presenters included:

• Exploring the sexual and reproductive choices of HIV men and women: A qualitative perspective:  Qualitative surveys showed health workers were ill equipped to answer HIV client’s questions about fertility.  PLWHA face stigma and discrimination and are often rejected sexually and are forced to undergo repeated disclosures to each new sexual partner.
• High HIV Incidence among men with genital ulcers in South Africa:  Genital ulcer disease represents an opportunity to identify acute HIV infection and initiate interventions that may reduce the transmission of HIV.  People with genital ulcers are an important entry point for HIV prevention programs
• What do sexual and reproductive health services offer in Europe?-Eurosupport: Supporting the sexual and reproductive health of people living in Europe: Factors which hindered the provision of integrated services in regions of Europe include shortage of staff, lack of specialized staff, lack of integrated approach guidelines. Migrants are the most difficult population to reach with integrated services
• Effectiveness of linking SRH services with HIV services: Strengths of Evidence and Research gaps: The majority of studies analyzed in this systematic literature review show improvements in all outcome studies, and linking HIV and SRH is feasible, especially in FP clinics. Gaps were noted in linked services targeting men, boys, addressing gender-based violence. There is a lack of research comparing integrated services to similar non-integrated services.
• Repeat pregnancy among HIV-positive women participating in a prevention of mother to child transmission study - the Kisumu breastfeeding study, Kisumu, Kenya: 14.2 percent of positive women enrolled in the study had a repeat pregnancy, and most were unplanned.  67 percent of the women followed never used contraception, either because they didn’t think about it, their husband refused or they desired more children.  Women need to be empowered with RH decision-making skills.

I also visited the Global Village, an expo space where NGOs and CBOs from around the world display items such as posters and literature.  Cultural events such as HIV related theater and dance also take place in the village. The village also has a fabulous art exhibit, seen below, chronicling the lives if HIV+ individuals from around the world.