ICEM HIV/AIDS e-bulletin - No. 57, June 2010

In this issue of the HIV/AIDS newsletter, we report on ICEM’s Southern African Women’s Workshop, which took place at the Midrand Conference Centre near Johnnesburg, South Africa, and we inform about the Global Fund’s call for proposals, and we deal with funding gaps, which may soon lead to loss of lives.

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ICEM Southern African HIV/AIDS Women’s Workshop

Participants at the Women’s Workshop were proudly wearing their scarves with the slogan, “Safe Sex Demands Equal Rights.” This was the theme of the workshop, which was held in Johannesburg from 18-20 May with 26 participants from Botswana, Mauritius, Namibia, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

The decision to hold a women-only workshop was based on the need to identify specific challenges facing women, especially the empowerment of their sexual relations through the use of female condoms (femidoms). An HIV-positive woman from the Treatment Action Campaign (TAC) of South Africa stressed the importance of female condoms and demonstrated their use. Her example also stood out as she gave birth to an HIV-negative baby following the necessary treatment.

The workshop also discussed increasing access for women to prevention, treatment, and care and how to address violence arising from HIV and AIDS status. According to a facilitator from the Twaranang Legal Advocacy Centre, only 5% of perpetrators are brought to book. Women are discouraged by untrained police officers handling violence cases and by lengthy legal procedures.

Intensive role play and group work completed the workshop programme. Participants called for a campaign to promote female condoms. They recommended that unions take a stand against violence; that the quality of counselling and testing be improved; and that police be trained to deal adequately with cases of violence.

Another first of the workshop was that it was an almost paperless meeting. Participants were encouraged to save all workshop documents and presentations on memory sticks given to them as part of the workshop materials.

Global Fund Launches New Funding Round

The Global Fund to Fight AIDS, Tuberculosis and Malaria launched its tenth call for proposals on 20 May. The deadline for submissions of proposals was fixed as 20 August. Thus, applicants will have three months to prepare their proposals, one month less than in recent rounds.

There is considerable uncertainty whether sufficient funds will be available to pay for all of the Round 10 proposals that are recommended for funding by the Technical Review Panel (TRP). The Global Fund says that, currently, based on confirmed pledges, no money is available for Round 10. However, the Global Fund is in the middle of "replenishment," with donors due to specify in October how much they expect to give to the Fund over the next three years. Thus, the amount of money available for Round 10 will certainly increase by the time the Global Fund Board approves Round 10 proposals at its meeting in December 2010.

All proposals submitted by the closing date will be reviewed by the Global Fund Secretariat to ensure that they meet the Fund's eligibility criteria. Eligible proposals will then be forwarded to the TRP for consideration. The TRP will make recommendations to the Global Fund Board, which will make its decisions at its meeting scheduled for 13-15 December 2010. (In the past, all proposals recommended by the TRP for approval have indeed been approved by the Board, though sometimes they have been waitlisted pending funding availability.)

The Round 10 proposal form and various support documents are available in six languages at www.theglobalfund.org/en/applynow.

(Source: Global Fund press release; and Source: Global Fund Observer, Issue 124 of 21 May. GFO is a free service of Aidspan (www.aidspan.org); to receive GFO send an email to [email protected].

The Global Fund Observer has also published a Guide to Round 10 applications which is available in English, French, Spanish, and Russian on the above website.

Malawi Moves to Adopt WHO Guidelines

Developing countries like Malawi are calculating the cost of adhering to new World Health Organization (WHO) guidelines that recommend starting HIV-positive people on antiretroviral drugs (ARVs) sooner.

Malawi is one of three African countries that have conducted WHO-supported feasibility studies to assess what adopting the new guidelines would mean, and has announced plans to roll out the new WHO guidelines by mid-2011. According to the feasibility study, the number of people on treatment would rise by about 50%, which could double the cost of the National ARV Programme in terms of additional drugs, personnel, and equipment, and would probably also mean waiting lists at many clinics. Malawi has a HIV prevalence rate of about 12%.

Implementing the WHO guidelines would mean major changes to national treatment protocols: HIV-positive people would start taking ARVs at a much higher CD4 count of 350 (a measure of the viral load to ascertain when HIV-positive people should begin treatment). Like other countries in the region, it has begun treating HIV-positive pregnant women at the WHO-recommended CD4 count of 350, but the standard CD4 count threshold for initiating ARV treatment remains 250.

Finance is among the major hurdles to adopting the guidelines, as well as infrastructure, supply-chain management, and health worker shortages.

(Sources: IRIN PlusNews, Johannesburg, 27 May)

Eliminate Bottlenecks to End Mother-to-Child-Transmission

Making services for the prevention of mother-to-child HIV transmission (PMTCT) available without addressing the factors that keep mothers from accessing these services was an exercise in futility, experts told a press briefing in the Kenyan capital, Nairobi.

"There are barriers that stop mothers from accessing prevention of mother-to-child transmission and treatment services, some of which include inadequate involvement of men and communities, and lack of information," said Chewe Luo, senior advisor on HIV/AIDS to the UN Children's Fund, UNICEF.

Women might not be able to afford medical care or transport to a clinic; cultural taboos might discourage them from giving birth in medical facilities. "We have to expand the scope of what we do to ensure that the burden of prevention does not fall on women's shoulders alone," Luo said.

Virtual elimination of mother-to-child transmission in Africa - where 20 countries share over 85% of the global burden of mother-to-child HIV transmission - would be possible but only if HIV counselling and testing services were expanded so that all mothers had access to effective antiretroviral (ARV) prophylaxis and treatment.

In 2008, globally, 430,000 children became infected with HIV, 90% of whom lived in sub-Saharan Africa. In the absence of access to ARV treatment, most of them would die within one year of birth, according to UNAIDS. Fareed Abdullah, unit director for Africa at the Global Fund to Fight AIDS, Tuberculosis and Malaria, promised that "The Global Fund will refocus funding to ensure that priority is given to PMTCT programmes in the recipient countries, and more so in the 20 countries that share the 85% of the global burden of mother to child transmission of HIV."

(Sources: IRIN PlusNews, Nairobi, 28 May)

Lost Funding Means Lost Lives

As donors retreat from funding HIV and AIDS programmes, years of progress in HIV treatment are under threat and the lives of HIV-positive people are increasingly on the line, according to a new report by the international medical charity, Médecins Sans Frontières (MSF). Improved access to antiretroviral (ARV) treatment has saved lives, reduced the incidence of tuberculosis (TB) and new HIV infections, and strengthened health systems in many countries hard hit by HIV. But as funding diminishes, these gains are now in jeopardy, says the report, “No Time to Quit: HIV/AIDS Treatment Gap Widening in Africa.”

Funding shortages in eight African countries have already led to drug stock-outs, treatment rationing, and the inability of most of the countries to adopt improved ARV regimens advocated by the World Health Organization (WHO), the report noted. "About 75% of HIV funding in developing countries is international – you can't replace that in the short term," said Mit Philips, a health policy analyst at MSF and one of the report's authors.

The recent decision by the US President's Emergency Plan for AIDS Relief (PEPFAR) to flat-line it’s funding at 2009 levels and decrease annual budget allocations in coming years, has already led PEPFAR-supported clinics in South Africa to begin turning away patients.

UNITAID, the international drug purchasing facility, is to phase out drug funding, leaving Zimbabwe, Mozambique, the Democratic Republic of Congo (DRC), and Malawi without funding for costly second-line ARV drugs by 2012.

Dr Eric Goemaere, MSF Medical Coordinator in South Africa, called donor backtracking a "moral betrayal. Years ago, countries in the southern Africa region were unsure that they could afford treatment, but they were told by the international community 'Set ambitious targets, we will follow with the money',” he said. "If this funding trend is confirmed, I would call it a moral betrayal for patients, who were told to be courageous and face testing because we would provide treatment; for the health staff, who managed to enroll more than four million people on treatment, and who are suddenly told not to enroll patients."

The report predicted that if the downward trend in funding continued, ARVs would become increasingly inaccessible, which would lead to increased rates of mortality and hospitalisation among those living with HIV, and place a strain on already weak health systems. The report also warned that ARV patients may adopt risky strategies for coping with drug supply shortages, such as sharing pills, thereby increasing the likelihood of widespread drug resistance.

(Source: IRIN PlusNews, Johannesburg, 27 May)

HIV/AIDS Project in India Scores Again

The ICEM HIV/AIDS project in India, sponsored by the German pharmaceutical company Boehringer Ingelheim, has continued well into 2010 although funding ceased at the end of 2009.

In the first five months of 2010, 24 courses and awareness meetings were held, under the auspices of the Indian National Mineworkers’ Federation (INMF) and coordinated by its General Secretary, BK Das. These activities did not only reach mineworkers but also school teachers and students in company schools, as well as paramedical staff in company clinics.

The extension of the project was possible because companies had increasingly taken over some of the costs resulting in budgetary savings which could be deployed for organising additional activities.

Headaches for HIV-positive Travellers

China recently became the latest country to lift travel restrictions on people living with HIV, following the footsteps of the US (see e-bulletin No. 50 of November 2009, and No. 52 of January 2010).

“Every individual should have equal access to freedom of movement regardless of his or her HIV status,” UNAIDS Executive Director Michel Sidibé commented on China’s decision.

According to UNAIDS, 51 countries and territories still impose restrictions on the entry, stay and residence of HIV-positive people. Among those countries requiring an HIV test, usually for a stay longer than 30 days, are: the United Arab Emirates, Russia, Singapore, Egypt, and Iraq.

The Inter-Parliamentary Union, at its 122nd Assembly, called for an elimination of all restrictions. It called on parliamentarians to play a leading role in removing them and also encouraged parliamentarians to support legislation and law enforcement to protect people living with HIV from discrimination.

(Source: IRIN PlusNews, Nairobi, 6 May)

News from Global Unions

The ICEM project in India is included in a documentation of good practices which was published by the ILO India Project, which is supported by the US Department of Labor. The publication is available on the website www.ilo.org/hivaidsindia.

The International Transport Workers’ Federation (ITF – www.itfglobal.org) reports in its latest HIV/AIDS update No. 86 of 15 May on counselling and testing camps organised at Ethiopian international and domestic airports. The ITF also recently published the 4th issue of Agenda, an annual publication on HIV/AIDS and transport workers.

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