WAPN+ facilitated a treatment literacy and advocacy training forum in Bangkok, Thailand, at the end of September 2010. The training was attended by 22 participants from 13 countries in the Asia Pacific region.

  Treatment literacy can be defined as understanding HIV/AIDS and all aspects of antiretroviral therapy (ART), including types of ARV drugs, how they work, ARV side effects, treatment adherence, HIV drug resistance and other issues. Treatment literacy is essential to ensuring that people living with HIV are well informed and in a position to participate more actively in treatment, including communicating treatment needs to health care providers.  It is also important to have the knowledge and capacity to hold governments accountable and to ensure they improve the quality and accessibility of health services and the quality of ARV treatment.

The attached report provides a full account of the 3 day forum.

Organization: APN+

Weblink: http://www.apnplus.org/main/Index.php?module=news&news=64



详细信息请参考为期三天的培训报告:Report WAPN TL Training 30 Sep-2 Oct 2010_New.pdf

机构: APN+ - 亚太艾滋病感染者网络



On June 5, 1981, an article concerning five previously healthy, young gay men in Los Angeles diagnosed with Pneumocystis carinii pneumonia, an infection that usually appears only in individuals with substantial immune system damage, appeared in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.
Soon more cases like these appeared, at first mainly in gay men, but then also in injection drug users, hemophiliacs and other recipients of blood and blood products, heterosexual men and women, and babies who acquired the infection from their mothers during birth or breastfeeding. We and our colleagues quickly began to confront the reality of a deadly new disease that would change the world. The disease ultimately would be referred to as AIDS.

Thirty years later, we are gratified by the progress that has been made in understanding, treating and preventing HIV/AIDS. We could not have imagined these advances during the early days of AIDS, when all we could do was provide palliative care to waves of dying patients. Whereas survival was once measured in weeks or months from the time of diagnosis, today, the critical discovery of antiretroviral drugs and their use in combination regimens has resulted in greatly improved life expectancy -- decades, rather than months -- for many HIV-infected people who have access to these medicines and adhere to treatment.

We take pride in the contributions of NIH-supported scientists who have been central to the investigation of the HIV disease process, the development of new therapies for HIV/AIDS and the design and validation of methods of HIV prevention. NIH scientists played a key role in demonstrating that HIV causes AIDS and in developing a diagnostic test for the virus. The ability to test the blood supply for HIV has nearly eliminated the risk of HIV transmission through blood transfusion.

NIH has supported basic and clinical research that provided pivotal data for many of the more than 30 drugs that have been approved by the Food and Drug Administration to treat HIV infection, as well as for strategies to address its associated opportunistic infections, malignancies and clinical complications. Clinical trials funded by NIH also have helped determine the most effective combinations of these drugs to slow or halt the progression of HIV disease. Additionally, NIH-supported studies were instrumental in designing effective strategies to virtually eliminate mother-to-child HIV transmission in developed nations and to dramatically reduce HIV transmission from an infected mother to her newborn or nursing child in the developing world. Many of these clinical trials were designed with the involvement and advice of HIV-affected communities, establishing a model for the conduct of clinical trials for other diseases.

NIH-supported, large-scale clinical trials have resulted in other notable achievements in HIV prevention. These studies sought answers to questions of critical importance to the global public health community. They proved that medically supervised adult male circumcision <http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx> more than halves the risk of female-to-male sexual HIV transmission; that needle and syringe exchange programs can reduce HIV transmission without increasing injection drug use; that a vaccine <http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx> can achieve modest protection against HIV infection; and that taking an antiretroviral drug daily <http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx> can reduce the risk of HIV acquisition in men who have sex with men.

Most recently, an NIH-funded clinical trial <http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx> demonstrated that an HIV-infected individual can dramatically reduce the risk of transmitting the virus to an uninfected heterosexual partner by starting treatment when his or her immune system is relatively healthy. NIH also helped train the scientists and establish the infrastructure for an important clinical trial funded by the U.S. Agency for International Development showing that a vaginal gel containing an anti-HIV drug can help protect women from HIV infection. These multiple achievements are important because it is clear that controlling -- and ultimately ending -- the HIV/AIDS pandemic will require a combination of scientifically proven HIV prevention tools.

As gratified as we are by these accomplishments, we are sobered by some grim realities and remaining challenges. Despite the global public health community's best efforts to prevent new infections, 2.6 million people around the world became newly infected with HIV in 2009 alone. In developing nations, only about one-third of the 15 million people who need anti-HIV drugs have access to them. In addition, a growing proportion of patients receiving long-term antiretroviral therapy are experiencing treatment failure, drug toxicities, side effects and drug resistance. In this regard, recent studies have noted an increased incidence of malignancies, cardiovascular and metabolic complications and premature aging associated with long-term HIV disease or antiretroviral therapy.

NIH research will continue to address these issues as well as the causes of HIV-related health disparities, their role in disease transmission and acquisition, and their impact on treatment access and effectiveness. These include disparities among racial and ethnic populations in the United States; disparities between developed and resource-constrained nations, and disparities based on gender, age, or sexual identity. NIH research also will continue to play a critical role in providing the scientific foundation to achieve the goals of the President's National HIV/AIDS Strategy. Among the important scientific challenges that remain are the development of a safe and effective vaccine that can take its place among the combination of prevention tools as well as the possibility of curing at least a proportion of HIV-infected individuals.

The HIV/AIDS pandemic will remain one of the most serious public health crises of our time until better, more effective and affordable prevention and treatment regimens are developed and universally available. As the single largest public funder of HIV/AIDS research in the world, NIH is committed to advancing a comprehensive program of basic, clinical, translational and behavioral and social science research toward controlling and ultimately ending this modern plague. In memory of the patients, friends, loved ones and colleagues we have lost over these three decades, we wholeheartedly embrace this responsibility and opportunity knowing that history will judge us as much for what we accomplish during the coming years as for what we have achieved thus far.

Dr. Anthony S. Fauci is the director of the National Institute of Allergy and Infectious diseases. Dr. Jack Whitescarver is the NIH associate director for AIDS research and the director of the NIH Office of AIDS Research.

NIAID conducts and supports research -- at NIH, throughout the United States, and worldwide -- to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at <http://www.niaid.nih.gov/ >.

The Office of AIDS Research, a part of the Office of the NIH Director, coordinates the scientific, budgetary, legislative, and policy elements of the NIH AIDS research program.   OAR sets scientific priorities, enhances collaboration, and ensures that research dollars are invested in the highest priority areas of scientific opportunity that will lead to new tools in the global fight against AIDS.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
美国国家卫生研究院(NIH)医学博士Anthony S. Fauci、博士Jack Whitescarver为艾滋三十周年发表讲话。



    NIH支持的艾滋病预防大型临床实验取得了显著的成果。这些研究解答了很多全球卫生系统共同面临的问题,证明了在严格的医学监控下,对成年男性进行包皮环切手术能够降低一半以上由女性传染的艾滋病毒的风险(http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx );针头和注射器交换项目可以在不增加注射吸毒的基础上降低艾滋病毒的传播; 注射疫苗能在一定程度上防治艾滋感染(http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx );每日服用抗逆转录药物能够降低男男性行为者感染艾滋的风(http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx )。

    最近,NIH支持的临床研究(http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx )表明,艾滋病毒感染者如果在自身免疫系统相对较健康的情况下开始治疗,其感染健康的异性性伴侣的可能性将大大降低。另外,NIH也协助美国国际开发署对其资助的临床研究人员进行培训,并提供研究所需的基础设施,该研究结果表明含有抗艾滋药物的阴道凝胶能够防治妇女感染艾滋。



    Anthony S. Fauci博士是NIH过敏症与传染病学部主管。Jack Whitescarver博士NIH艾滋研究部副主任以及NIH艾滋研究办主任。





主持人:Sen Lam




LAM: 那么你能不能简单地给我们介绍一下太平洋地区的情况?

WILSON: 太平洋地区的数据又有所不同。从2001年至2009年,艾滋病毒携带者的数量从2万8千人升至5万7千人。和亚洲相比较,这些数值并不高,但是对于本地区来说,这确实是一个不小的数字。对于某些社会来说,影响是巨大的。这个地区非常多样化。如果你从整体来看,巴布新几内亚是本地区艾滋流行度最高的国家,感染率达0.9%,但该数值目前日趋平稳,这是共同努力的成果。该区域艾滋感染主要通过性行为传播,特别是在巴布新几内亚。但同时我们也看到注射吸毒也是主要感染途径之一,尽管数值相对较小,但在某些社区和国家却造成很大的影响。


WILSON: 这真是个非常好的问题,因为当我们谈论覆盖率这个问题时, 尽管整个区域治疗率达31%,东南亚地区更是达到43%,但是更为重要的是如何维持现有的治疗率,如何保持我们目前所取得的成果。总体来说,性工作者、注射吸毒者、男男性行为者以及跨性别者是最容易感染艾滋病毒的群体,我们必须保证艾滋预防和治疗项目的持续性。例如,目前很多国家正在商讨自由贸易协议,这将严重威胁到病患获得药品的途径,这些协议将对整个区域产生可怕的影响。



LAM: 我知道在这些国家很多项目经费都来自外国援助,而非该国自己的财政。这将也是未来发展的趋势吗?


Asia Report 翻译

原文链接: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm

It's thirty years since HIV AIDS was identified and recognised as a global health threat.

Thirty million people have died since the first AIDS case was reported on 5th June 1981. World leaders gather in New York on Monday, to look at the way forward, even though the latest United Nations report says the response to the global HIV-AIDS epidemic has resulted in a significant fall in new infections.

Asia and the Pacific registered some of the best results in stopping new HIV infections, but the region remains extremely vulnerable.

Presenter: Sen Lam
Speaker: Jane Wilson, acting director, UN AIDS, Asia and the Pacific

WILSON: The number of people living with HIV remains stable and new infections are actually twenty percent lower than they were in 2001. So I think that's a very important message to get across. They've turned their epidemics around, and they're providing quality services to their most at risk populations, so really making a very big difference. Cambodia's one of only eight countries worldwide, to have reached eighty percent universal access to anti-retroviral therapies, so that's a real success story.

Thailand also has a coverage of eighty percent for prevention of parent to child transmission services. India's really making quite significant strides, particularly South India. Compared to 2001 to 2009, overall, the average is that rates of infection have fallen by twenty-five percent globally, but India's rate of new infections has fallen by over fifty percent. And when you consider the population scale in India, that's a very, very significant finding. And I think what we say is, alot of this has been achieved by scaling up. You perhaps have heard of some of the very large programmes that are operating there. Many more points of service delivery, very strong partnership with the community and the government. This is the way these things have been achieved.

LAM: And Jane, can you give us a quick snapshot of what's happening in the Pacific?

WILSON: The Pacific, we're talking about very different numbers, as you'd know. I mean, we have between 2001 and 2009, from 28-thousand people living HIV, to 57-thousand. So if you compare with Asia, these are not large numbers, but for the Pacific, these are very significant numbers. And it can have a very major impact on their specific societies. It's a very diverse region. if you look over all, Papua New Guinea has the region's largest epidemic, with the prevalence rate of point-nine per cent but that is gradually starting to level off, so there is some progress being made in the Pacific. It is largely being driven by sexual transmission, particularly in Papua New Guinea and over all, but we are seeing injecting drug use, which is described as a small but significant factor, as becoming apparent in some communities, in some countries in the region.

LAM: And Jane, given the socio-economic factors and the uneven levels of development in Asia, may we assume then, that if gains have indeed been made, that the region is still extremely fragile?

WILSON: That's a really, really good question, because while we can talk about coverage rates, for example of treatment of thirty-one percent overall, and in Southeast Asia of forty-three percent, maintaining these treatment rates, maintaining the progress that we've reached is extremely important. Over all, the communities that are the most vulnerable to HIV, that is sex workers, people who inject drugs, men who have sex with men and transgender people, we really need to make sure that programmes aimed at prevention and treatment are maintained, and that challenges for treatment are dealt with. For example, some of the current free trade agreements being negotiated at present, really have tangible threats to accessible drugs, which would have an appalling effect on the region.

LAM: You touched a little on social and cultural factors, that many Asian countries have strict anti-drug and anti-gay laws, and also a tough stance against sex work. do these factors pose a huge challenge to HIV sufferers?

WILSON: They're absolutely massive. And I think governments are gradually becoming much more aware of these factors, and you've got significant changes of policy in countries like China, like Vietnam, like Indonesia, where methadone programmes, and needle exchange programmes are being rolled out. I think public health officials are overall, aware that sex work is a profession that's been around as long as man has been on the earth. But there're still in many cases, outdated laws. In many cases, handed down from colonial pasts, in some cases not, but these kinds of laws and policies really need to be overtaken so that people can move around the region freely, those people living with HIV and also access treatment, care and support and prevention, without experiencing discrimination.

LAM: And Jane, I understand that many of these countries don't spend their own money; that much of the funds for treatment and other programmes come in the form of foreign aid. Is that likely to be an issue in the future?

WILSON: It's extremely worrying, particularly in some countries - we take Vietnam, which is becoming a middle income country and they're very reliant on international donors and then, can't access donor funding in the same way. People when they go on anti retroviral therapy need to maintain it for the whole of life, and if they stopped taking drugs, of course their health suffers, they become resistant, and if they have to start taking drugs, they have to go to more expensive second-line drugs, so it's extremely important that drug regimes, anti retroviral regimes are maintained and that people can continue treatment, because that's also a very good way of preventing HIV infection.

Weblink: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm

NAIROBI, 7 June 2011 (PlusNews) - Epidemiologist Elizabeth Pisani raised eyebrows in 2008 with her book, The Wisdom of Whores, a frank account of her experiences working in the field of HIV/AIDS, from the politics of raising money to conversations in the backstreet brothels of Bangkok. She spoke to IRIN/PlusNews:

Question: Why have HIV prevention efforts failed to curb the spread of the pandemic?

Answer: Prevention has failed for many reasons. One is that we didn't actually start prevention until we had reached such a critical mass of HIV infection that prevention was always going to be difficult. The higher the prevalence in the population, the more effective prevention needs to be just to keep levels constant, let alone lower prevalence.

Globally, we missed some really easy wins when it comes to HIV prevention. One was needle exchange programmes for injecting drug users. Countries which have adopted these policies and adjusted their laws to accommodate them have virtually wiped out HIV among these populations. Unfortunately, a lot of countries have chosen not to do that, including the US and Russia.

Another easy win is providing commercial sex workers with condoms, lubricant and sexually transmitted infections screening; this isn't promoted nearly enough, particularly in sub-Saharan Africa, even though the evidence shows that it is fairly easy to achieve very high levels of condom use in commercial sex.

We've been very selective about our use of different HIV prevention methods. Prevention tools must work in four major ways in order for them to succeed - they must work behaviourally, technically, politically and financially - if any one of these things is missing, prevention won't work. Abstinence, for instance, works technically - you are definitely not going to get HIV through sex if you abstain - but behaviourally, studies tell us that abstinence doesn't actually work very well, so telling people to cross their legs for the rest of their lives isn't really going to prevent HIV.

Q: What is the truth within the HIV response that we're ignoring and why?

A: One of the great distortions is the gender thing; we've spent a lot of time acting like it's all about innocent women versus wicked men, when in fact it is impossible for heterosexual transmission to occur in the millions without both sexes being involved. The fact is, women like to get laid too. In sub-Saharan Africa, young women entering marriage are more likely to be the infected partner; more men will infect HIV-negative wives while married, but still, about one-third of new infections in marriage are a result of women infecting their husbands.

This fantasy of the innocent woman has led to some misdirected programming such as women's empowerment programmes and microfinance - both of which are useful, just not in the case of HIV. What should have been done is extremely aggressive promotion of condoms and sexual health services, especially in the context of sex work, much earlier on. We're still not focusing enough on commercial sex.

We've dichotomized HIV epidemics as generalized and concentrated, but even in generalized epidemics, commercial sex work contributes a much higher proportion of new HIV infections [than the general population].

Q: Treatment as prevention - is it the answer to ending the AIDS pandemic?

A: I think treatment is the answer to ending AIDS, but I don't think it is the answer to ending HIV, which is an important distinction. I don't think that it is financially feasible to scale up treatment to the levels it needs to reach in the population in order to end HIV transmission.

For those of us who worship at the altar of the randomized control trial, the recent HPTN 052 study gave us very good evidence that HIV treatment reduces infectiousness, something we've known for a while. But it has only proven this at an individual level; it doesn't tell us about the population level, whether the low viral load can be maintained in the entire population on treatment for the entire lifespan of this population while still ensuring newly infected people - who are highly infectious - are not infecting other people.

In addition, the study excluded people who were not able to adhere to treatment - that meant drunks, people who travelled for work and so on, did not participate in the study. People in the study were in a well-supported trial situation, and we don't know if we can feasibly recreate such a situation in the real world.
This is not to suggest that we shouldn't treat more people, and treat them earlier than we do at the moment. It is bound to reduce the infectiousness of people infected with HIV so it will certainly have an impact, but because treatment allows people to stay alive and sexually active for much longer it won't, in itself, be enough to wipe out new infections.

Q: In your book, Wisdom of Whores, you make the case that in Asia, HIV prevention should focus on high risk groups such as sex workers and IDUs. In East and Southern Africa, where HIV is much more generalized, what is the best way to approach HIV prevention?

A: I genuinely don't know what to do for HIV prevention in sub-Saharan Africa, and if anyone else has got ideas that really work I don't see them being put into practice. I would predict that incidence is unlikely to fall, and there's a fair chance that it will rise.

On the other hand, if it is possible to provide and keep expanding treatment at a higher CD4 count and sustain it without it undermining the progress of other health and development issues, then HIV may not - eventually - be such a big deal. Members of the 'AIDS mafia' - such as myself - won't say that HIV is not a big deal because we come from the generation of AIDS, when people died, which was a very big deal. But today, if HIV treatment is affordable and available and an HIV-positive person is in a well-managed situation, truthfully, HIV is really not that big a deal.

What I mean is it is not a big deal for an infected individual; it is a huge deal for health systems and tax-payers who have to manage the epidemic, and there is a real threat of drug-resistant strains emerging and taking us right back to the age of AIDS.

Q: In Wisdom of Whores, you say in the past the epidemiological data on HIV was presented in ways that aimed to cause alarm and spur increased AIDS funding. Has this changed - is the data we see today more reflective of the truth about the state of HIV?

A: I think it's getting harder to beat up the statistics the way we used to, and perhaps there has also been a realization that it can be counterproductive to the work you are doing - you might get the money but you can't do what you need to with it.

There is a greater realism compared to the earlier years, and I think there is less distortion even than five years ago. Perhaps lessons are being learned, or perhaps I've just been out of the UN system for too long to see what's going on.

Weblink: http://www.plusnews.org/report.aspx?reportID=92915

流行病学专家 Elizabeth Pisani2008年撰写的《妓女的智慧》(The Wisdom of Whores)一书引起了巨大反响,书中披露了其多年来在艾滋领域工作的经验,内容涵盖了从筹款的政治艺术到在曼谷与按摩院性工作者的交流等。IRIN/PLUS NEWS对她进行采访。






Q: 在对抗艾滋的过程中我们忽略了什么?为什么?





从另一个方面来说,在对其它健康和发展问题不造成影响的情况下,如果有可能在CD4细胞值更高的时候提供和扩大治疗,那么艾滋病毒最终将不会是什么大事。"AIDS Mafia"的成员,例如我自己,不会随便说"艾滋病毒并不是什么大问题"这样的话,因为我们是经历过艾滋感染爆发高峰期的一代人,病人的死亡可不是一件小事。但是现在如果每个人都有途径接受治疗并能够承担治疗费用,并且每个感染者的病情都能得到很好的控制,那么艾滋病将不再是一个大问题。

Asia Report 翻译













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A Toolkit for MSM-Led HIV and AIDS Advocacy

Speaking Out is an advocacy toolkit created to address the urgent need for men who have sex with men (MSM) everywhere to engage in advocacy locally, nationally, and globally to end the HIV epidemic and promote their human rights. The toolkit equips individuals and organizations with tools and techniques that enable them to become advocates right now, whoever and wherever they happen to be.

Now, more than ever, it is important for our communities to identify our own strengths, weaknesses, and needs, advocating as individuals and collectives for our rights in ways that work for us. MSM communities live and breathe in diverse and complex ways, and we must raise our voices on our own terms, from our respective contexts. That is what this toolkit is all about: ensuring we have the tools we need to become more involved in advocating for our rights, in our homes and schools as well as in governments and international forums.

This toolkit builds on advances made in past toolkits from around the world, with some key differences: (1) it is specifically MSM-focused with exercises and ideas that serve as conduits for the energy and contributions of MSM communities; (2) it is built on the belief that organizations can start where they are, and assumes that the skill sets of individual advocates and organizational maturity of MSM groups are wide-ranging and take time to develop; and (3) it approaches HIV and AIDS from a broad human rights framework, balancing public health and human rights approaches toward addressing MSM community susceptibility to HIV.

We hope you find this toolkit useful!  Please do not hesitate to write to us with any questions or concerns at speakingout@msmgf.org.


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Weblink: http://www.msmgf.org/index.cfm/id/262


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