艾滋病: June 2011的归档

  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



(KPL) Over 20 journalists of broadcast media and newspapers attended a workshop on anti-HIV/AIDS efforts by the media and the HIV/AIDS and Sexually Transmitted Diseases Prevention Centre over the last one year.

  The meeting held at the Lao Women's Union, in Vientiane Capital drew the attendance of Deputy Head of HIV/AIDS and Sexually Transmitted Disease Prevention Centre, Dr. Chanthone Khamsibounheuang.

  Dr. Chanthone said that the workshop was very important to review the implementation of the HIV/AIDS and sexually transmitted disease prevention over the last one year and set new plan for the year to come.

  Over the last one year, we advertised condom use and danger of HIV/AIDS for target groups mainly homosexuals, prostitutes and sex buyers through newspapers, TVs, radios and brochures.

  In addition, we held training-of-trainers course on same sex relations among men and condom use.

  The participants of the two-day workshop learned the role of the Lao media in publicizing anti-HIV/AIDS campaign.

Weblink: http://laovoices.com/2011/05/09/anti-hivaids-campaign-reviewed/


| 评论(0)
 KPL Lao News Agency


该培训在位于老挝首都万象的老挝妇女联合会举行,艾滋与性传播疾病预防中心副主席Chanthone Khamsibounheuang博士也参加了会议。


Asia Report 翻译

原文链接: http://laovoices.com/2011/05/09/anti-hivaids-campaign-reviewed/


Asia Report 翻译

原文链接: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx

  Hanoi authorities on Tuesday allocated VND5 billion (US$243,000) for a program to crack down on prostitution.

  Half of the funding will support a rehab center to treat sex workers, including those addicted to drugs, and HIV-infected children.

  Money will also be spent on propaganda such as leaflets, newspapers and documents aiming to raise awareness of sex workers.

  Hanoi police department will also be supported to strengthen crackdown on secret brothels and prostitutes in public places.

  On May 12, the government unveiled on its website a five-year plan to reduce prostitution by an initial 40 percent by 2015.

  With a budget of VND629 billion ($30.5 million), the program looks to free communes and towns from prostitution and minimize harms on society.

  Rehab and healthcare centers, job training for former sex workers and public awareness are among the measures the government said will be taken to battle prostitution.

Weblink: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx

  In 2010, the Population Services International (PSI) program, Sun Quality Health (SQH), and its sister network of village health workers, Sun Primary Health, performed more than 2.1 million client consultations in Myanmar. John Hetherington, who has managed the network since 2007, talked to CHMI (Center for Health Market Innovations) about how--in the second-poorest country in the Asia-Pacific region--SQH has assembled one of the broadest service packages of any social franchise network operating today in an attempt to provide high quality, well regulated priority health services to local people.

CHMI: You offer a wide range of services under the Sun Quality Health brand. How do you select the services the brand will include?
John Hetherington: With a backbone of 1200 doctors in more than 200 townships, we can be entrepreneurial. We first ask, is there a need not being met? And is there an opportunity for a network of providers to offer that service? In Myanmar, the largest health concerns - malaria, family planning, pneumonia, diarrheal disease, TB - are either too expensive to treat, or doctors don't provide the right quality service. As in many places, we started with reproductive health and family planning, where there is a natural fit for social franchising.

Why is it that so many social franchising programs start by offering family planning?

JH: I think family planning is unlike other services because everyone from 15-49 is potentially a client - meaning, they are theoretically all fertile -- and this makes it different than addressing diseases which require many more inputs to be efficient, targeting, testing, etc., particularly in Asia, where many of the big diseases tend to be concentrated epidemics. With FP, you have the potential to offer (almost) anyone you interact with something that can be of service to them. You have the potential for large scale impact without the precise geographical targeting that you would need to treat an epidemic.

Without using the media to market to clients, how does your franchise attract clients?

JH: Advertising for medical services is illegal. Here, as in many countries, there are lots of people who go to their local doctors when they are ill or think they are ill. Many of these doctors have practiced for 20-30 years without continuing medical education. These are the doctors we retrain, so [with their clients] we have a captive audience, in a way.
How do you set prices?

JH: We set prices in a way that they are not a barrier to the poorest person we want to reach in the given target. We make services available at a price people are expecting--50 cents to a dollar for a malaria treatment, versus the five to six dollars it would cost otherwise. If we were not subsidizing these services, doctors would not provide them, or they might give patients the wrong drugs--give an injection, for example.

Speaking of which, how do you ensure quality?
JH: Social franchising is more complex to manage than other channels of social marketing--you need higher levels of training, monitoring and supervision.

On our staff, we have close to 80 doctors that, on average, visit each of the 1200 clinics every six weeks. They observe service delivery and answer the franchisee doctors' questions. We also send mystery clients to assure that the level of service quality remains intact. We use vignettes in training.

These techniques ensure that [franchisees] are not gauging people with prices or giving the wrong treatment. However, we don't own these clinics. We hope the training around good hygiene, infection prevention, client relationships, and counseling improves overall practices, since we don't monitor health areas outside the SQH basket of services.

Is it difficult to get providers to participate?

JH: No - their business increases. Their reputation is better, they have more services to offer, and their customers can get an IUD for 50 cents instead of 50 dollars.
In Myanmar, the public sector is not able to serve the needs of most people; 80-90% of people go to the private sector for health care. This is not unique. The private sector, while used by everyone, is atrocious in most places. With proper management, however, it can be made to do less harm--and even do very good work.
I have had surrealistic conversations with some country officials or [global health policy makers] where someone asks [a policy maker], what is your national protocol for first-line treatment for malaria? Yet, if you look at the data, 99% of people go to a pharmacy and buy drugs off the shelf. Some have to have a philosophical shift to understand this.

Describe your relationship with the Myanmar government.

JH: There is always a give and take between an NGO and the government. We have a longstanding relationship with the government in Myanmar and some of our staff are former civil servants. [Officials] appreciate that we are improving the quality of services by providing continuing medical education where there is none, and reporting on treatments not captured by the national health management information system.
The health minister has also seen the impact of Sun Quality Health. It's not minor--it's providing something like 25% of all family planning services, and we are detecting and treating more than 12% of all TB cases nationally.
We heard you are now offering screening for cervical cancer, which is very unusual even though 80% of cases occur in the developing world.

JH: Our franchising director at the time, Dr. Nyo Nyo Mihn learned a couple of years ago at a medical quality conference funded by one of our donors that you can screen [for abnormal cells] with acetic acid and treat abnormal cells with cryotherapy using Co2 in low resource environment, all without electricity. PSI's innovations fund allows us to be entrepreneurial without massive amounts of money, so we are now beginning training.

Some people in the health ministry are concerned that private sector doctors should be doing something they consider to be a hospital service. But almost no one is doing cervical screenings anywhere, so again, there is a choice of doing nothing, or doing something in partnership with the health facilities that are actually being accessed by people.

We are also piloting a basic package of anti-retroviral therapy with 100 clients, which hasn't yet been done in social marketing.

You also provide TB screening and treatment.

JH: Starting this intervention in 2004 was our biggest gamble. A recent study showed that the TB prevalence in Myanmar is five to six times higher than what was previously estimated. Now, our franchise does more than 12% of all case detection and treatment in the country.

Recently, in a village meeting, a woman spontaneously came up to us in tears. She told us she had been dying from TB and the treatment she got from a government clinic wasn't working for her. A PSI health worker told her to go to a [Sun Quality Health] doctor. She said, 'I'm healthy now and you saved my life'. I was thinking, that's one person, and there are 17,000 people every year getting that service that would otherwise die, and give TB to eight other people.

Yet, you still have people outside the country saying you can't work ethically inside the country, and the regime here can also be xenophobic. We can negotiate between those two things--the government doesn't see [the program] as impinging on their sovereignty and the opposition doesn't see it as giving succor to the regime. This model would be interesting to use in other difficult political situations, perhaps in Zimbabwe.

Organization: the Population Services International (PSI)

Learn more about Social Franchising

Weblink: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care


    国际人口服务组织(the Population Services International),Sun Quality Health (SQH)组织与其姐妹组织--Sun Primary Health乡村健康工作者网络于2010年在缅甸全国提供超过210万次健康咨询服务。于2007年接管该项目的John Hetherington接受健康市场创新组织(Center for Health Market Innovations-CHIMI)的采访,介绍SQH如何在缅甸--这个亚太地区最贫穷的国度之一,基于目前可利用的社会特许经营网络,集合最广泛的服务为当地人群提供高质、管理完善的医疗服务。

CHMI:贵机构以Sun Quality Health为商标提供各种各样的服务,你们是如何选择将要提供的服务类别的?








CHMI: 说到这里,你们如何保证医疗质量?



CHMI: 让医护人员加入这个项目是否困难?




缅甸卫生部部长也看到了Sun Quality Health项目的影响力。我们的计划生育服务占该服务全国总量的25%,我们也对全国12%的肺结核病例开展追踪治疗,这并不是个小数目。

Asia Report 翻译

组织: the Population Services International (PSI)-- 国际人口服务组织

了解社会特许经营(Social Franchising

原文链接: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care











| 评论(0)


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.


PDF Download>>

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









Asia Report 翻译

原文链接: http://www.msmgf.org/index.cfm/id/262

    在5月17日国际不再恐惧同志日这天,专家们在越南河内举行的研讨会上呼吁公众一同行动抵制针对性取向的歧视。"由于对同性恋缺乏认识以及社会偏见,很多同性恋者遭受家庭暴力。"越南志愿者小组ICS的联络与服务官员Huynh Minh Thao表示,她服务的志愿者小组致力于在越南社会为同性恋者塑造一个积极健康的形象。"如果大家都对同性恋有所了解,那么在父母发现自己的还是是同性恋者时,就能避免一些不必要的愤怒和困惑。"她补充道:"改变固有观念是一个任重道远的工作,但是如果我们从家庭和社区层面一步步展开倡导和宣传,最终的结果还是可以很乐观的。"

    2008年越南社会、经济与环境研究所(the Institute for Studies of Society, Economy and Environment- ISEE)对越南3000名女同性恋者和变性者进行调查。结果显示20%受访者表示他/她们曾遭其他家庭成员殴打。

    该研究所高级研究员Nguyen Thi Thu Nam表示,产生自行政管理的偏见阻碍了国际机构为越南同性恋群体提供帮助。"主要障碍来自于医护工作者,不仅是医生,就连管理和行政人员也充满偏见。"

    Nam告诉本报国际家庭健康组织(Family Health International--FHI)对胡志明市和河内市的25名医护人员开展培训,教育他/她们如何发现针对同性恋的歧视。然而,受训者反馈表示在其工作的医院和诊所歧视的案例还是屡屡发生。

    美国国际开发署,越南社会、经济与环境研究所和国际家庭健康组织联合开展的调查报告显示,医护工作者中对男男性行为者(MSM)所持的歧视最高。该报告两位作者--联合国艾滋规划署的Chris Fontaine和国际家庭健康组织的Caroline Francis在本次研讨会上陈述了这份名为《污名化和歧视如何加速HIV感染--区域和全球证据回顾》的报告。







Asia Report 翻译

组织:Family Health International (FHI)--国际家庭健康


Abuse traumatizes gay community

| 评论(0)
On Tuesday (May 17), experts called for renewed action against sexual discrimination at a forum in Hanoi. The event coincided with the International Day Against Homophobia and Trans-phobia.

 "A significant proportion of homosexuals suffer violence in their family because of limited awareness and social prejudices," said Huynh Minh Thao, communication and service manager of ICS - a volunteer group working to foster a positive image of homosexuality in Vietnam. "If everyone was better informed, we could help avoid some of the anger and confusion that occurs when parents discover their child is homosexual."

"Changing such perceptions is a big job but it is possible if it's done step-by-step at the familial and community levels," she added.

In 2008, the Institute for Studies of Society, Economy and Environment (ISEE) surveyed 3,000 gay, lesbian and transgender Vietnamese.

Twenty percent of the respondents said they had been beaten by their family members.

Nguyen Thi Thu Nam, a senior researcher at ISEE, said that administrative prejudices have hindered international organizations from providing assistance to Vietnamese homosexuals.
"There have been major barriers from medical workers--not just doctors but administrators and other officials working at medical facilities," she said.

Nam said 25 medical workers in Ho Chi Minh City and Hanoi were trained by Family Health International (FHI) about how to detect and diffuse discrimination against homosexuals.
However, the trainees have reported that the practice continues to exist in their hospitals and clinics.

According to a joint report by the United States Agency for International Development (USAID), ISEE and FHI, discrimination against men who have sex with men (MSM) persists among medical workers.

The findings, entitled "How stigma and discrimination drive HIV: A review of the regional and global evidence" were presented at the forum by authors Chris Fontaine of the UN's AIDS-fighting agency UNAIDS and Caroline Francis of FHI.

Francis explained that such stigmas go beyond medical facilities.

"It doesn't matter where you go, this stigma exists in different forms," she told the forum.
The qualitative research was collected with help from eight participants in HCMC and nine in Hanoi.

Their findings indicate that homosexual discrimination has pushed some gays to drug use, pickpocketing, unsafe sex, fighting, suicide, stress, depression and dropping out of school.
The report also presented ample evidence that homophobic attitudes continue to exist in Vietnam's healthcare system.

"Sex between a man and a woman is normal but sex between two men or two women is not normal... I think it's something sick. Many people in society think it's not healthy; I do too," a 22-year-old officer at Hanoi Community Health Care told the researchers.

The report quotes one homosexual as saying: "My friend sought treatment for a sore anus and the doctor yelled at him: 'the anus is for bowel movements, not for having sex.'"

Vietnam is the second country in the world and the first in Asia to ratify the Convention on Child Rights, but the recent study found that 13 out of 17 participants in the research reported suffering violence from family, teachers and friends during their formative years.

Vietnam's HIV epidemic is concentrated among people who inject drugs, sex workers and the MSM. The Vietnamese Health Ministry estimates there will be around 280,000 people living with HIV by 2012, including 5,670 children.

The researchers urged Vietnamese leaders to develop and implement comprehensive communications programs that target police, education practitioners and the intimates of homosexuals to help them better understand the consequences of violence and discrimination.

They also called for the creation of psychological, health, employment, education and legal counseling services for MSM.

"Action should be taken to create a positive image of homosexuals," Buu, a gay man in HCMC, told researchers. "Society shouldn't think of a gay couple as being any different from a straight one. We wish society would recognize that true love exists between homosexuals."

Organization:Family Health International (FHI)--国际家庭健康

Weblink: http://www.thanhniennews.com/2010/Pages/20110525141452.aspx



  • 了解儿童在面临感染威胁或已感染艾滋病毒的儿童在治疗和关爱服务中的主要关注点:其中包括预防艾滋母婴传播(PMTCT)的关键作用;婴儿早期治疗所面临的挑战;帮助艾滋儿童获得最佳治疗方案以确保其长期存活;
  • 明确在为艾滋儿童做相关倡导工作中艾滋病毒感染者国家网络、区域性社区和相关组织的作用;

  • 针对小儿科艾滋治疗和关爱服务优先考虑社区倡导活动,并制定相关战略计划,其中包括为促进最佳艾滋儿童治疗和关爱方案提供资源。

 *区域治疗工作小组(Regional Treatment Working Group)是TREAT Asia、亚太艾滋病感染者网络(APN+)、国际治疗准备联合会(ITPC)和无国界医生组织(MSF)的合作平台。

Asia Report 翻译

组织: TREAT Asia

原文链接: http://www.apnplus.org/main/Index.php?module=news&news=63

Regional Community Forum on HIV Treatment in Children, Bangkok, Thailand.

Forum organizer:  Regional Treatment Working Group*
Forum dates:  22 and 23 April 2011
Location:  Bangkok, Thailand
The Forum

A two-day Regional Community Forum on HIV Treatment in Children bringing together key stakeholders from the region (35 participants, 9 countries) providing an opportunity for discussions between community partners, medical providers, non-governmental organizations and UN agencies to identify knowledge gaps and propose advocacy strategies for next steps.
·    Understanding key issues in the care and treatment of children exposed to and infected with HIV, including the critical role of PMTCT, challenges of early infant diagnosis and access to optimal treatment options for ensuring the long-term survival of children living with HIV;
·    Identifying the role of national networks of people living with HIV and of regional community and supporting organizations in advocating for the needs of children living with HIV; and
·    Prioritizing and strategizing community advocacy activities around pediatric HIV treatment and care, including resource needs for promoting optimal treatment and care for children living with HIV.

* Regional Treatment Working Group is a partnership platform of TREAT Asia, Asia Pacific Network of People Living with HIV (APN+), International Treatment Preparedness Coalition (ITPC) and Medecins Sans Frontieres (MSF) - Access Campaign

Organization: TREAT Asia
                       Asia Pacific Network of People Living with HIV (APN+)

Weblink: http://www.apnplus.org/main/Index.php?module=news&news=63


作者:Alex Delamare


    当Thida Win因在街边从事性交易而感染艾滋病后,她转而向其他性工作者,而非医疗机构寻求帮助。

    几乎完全是由性工作者开展的"顶端"项目为Thida Win提供治疗,使她避免了来自社会对艾滋病和性工作的双重污名化。





    "顶端"项目发起人和主管Habib Rahman表示为大家提供一个不受社会禁忌约束、能够与同仁共同讨论问题的空间是这个项目的主要目标。







    Myint Myint在离婚之后进入一家按摩院工作,之后她立刻感染了艾滋病毒。她表示顾客们(其中大部分是卖豆或卖鱼的小贩)对于使用安全套都表现的非常迟疑。

    联合国艾滋病规划署缅甸事物官员Soe Maing表示:"缅甸艾滋感染呈下降趋势,关键受影响群体的感染率也在下降,但是基数仍然非常高。"



    该项目由国际人口服务(Population Services International)组织于七年前展开,目前雇员来自全国19个市镇,总人数达350人,其中95%为女性性工作者和男男性行为者。


    Thida Win第一次参与性交易的时候还是一名大学在校学生,她表示婚姻和抚养下一代的经济负担使她不得不继续从事性服务。


Asia Report 翻译

原文链接: http://news.yahoo.com/s/afp/20110522/hl_afp/myanmarhivhealthsocial_20110522185905

By Alex Delamare (AFP) 

YANGON -- When Thida Win contracted HIV after selling her body on the Yangon streets, it was her fellow sex workers that she turned to, not Myanmar's crumbling health service.

The Top project, run almost entirely by those in the sex trade, gave her treatment, a place to be herself away from the dual stigma of HIV and prostitution -- and eventually a job.

"I am now a health worker for my community and I can forget I am positive. I am so proud to work for the programmes, I will work for them for my whole life," the 33-year-old told AFP.

Top and similar projects are a vital resource in army-dominated Myanmar, where a chronically underfunded health service, large itinerant populations and poor education fuel one of Asia's worst HIV epidemics.

Nearly one in five of Myanmar's estimated 60,000 sex workers were infected with HIV in 2008.

A United Nations report from August last year said legal constraints and discrimination made it hard to reach those in the trade, which is illegal. Surveys suggested police even used condoms as evidence for arrest.

Top founder and director Habib Rahman said providing a place free from taboos and letting people share their problems with contemporaries was a key aim for the project.

Rahman said many women enter sex work without knowing about the risks.

"In general in Myanmar I do not think there is any sex education in school," he said.

The project recruits former and current sex workers to help educate others about HIV, spreading the message from a position of trust within the community.

"We cannot tell anyone to stop selling sex even though they are positive but what we do is tell them how they can keep healthy and protect the client by using condoms," said Rahman.

He said Top's part-time "peer educators" who chose to continue in the sex trade were encouraged to always use protection, while full-time employees were instructed to stop selling sex altogether.

Myint Myint contracted HIV soon after being recruited to work in a brothel following the break-up of her marriage. She said her clients, mainly local bean and fish traders, had often been reluctant to use protection.

HIV transmission in Myanmar occurs "primarily through high-risk sexual contact between sex workers and their clients", as well as men who have sex with men and their partners, according to the UN report.

It said while injecting drug users have the highest HIV prevalence, at 36 percent, they are also likely to pay for sex and "this interaction may refuel the sex-work-driven epidemic".

Years of neglect by the ruling generals -- Myanmar spent just 0.9 percent of its budget on health in 2007 -- have left foreign donors facilitating most of the country's HIV treatment.

A new government, which came into power after controversial November 2010 elections, has raised hopes of more investment from overseas donors -- but not the state, which is expected to spend around 20 percent of outlay on the army this year.

In 2009 the UN estimated 240,000 people in Myanmar were living with the virus and while there have been improvements, the situation remains worrying with prevalence rates the third highest in Asia after Thailand and Papua New Guinea.

"The HIV epidemic in Myanmar is on a decreasing trend and among the key population groups it is also reducing -- but it is still really quite high," said Soe Naing of UNAIDS in Myanmar.

He said some state provision for HIV treatment does exist in big cities, "but of course the standards and situations are not ideal. People are reluctant to go to them because of privacy issues and quality".

Top clinics provide everything from testing and counselling to routine medical care.

Last year it gave treatment and consultation to 11,770 female sex workers and 10,727 men. It also accounted for 40 percent and 82 percent of all HIV tests for those groups respectively in the country.

The programme, which was formed by Population Services International (PSI) seven years ago, now employs 350 people -- 95 percent of whom are from the sex worker community and men who have sex with men -- in 19 towns and cities.

In Myanmar, where the US estimates around a third of people were below the poverty line in 2007, money worries are likely to continue to drive people into sex work.

Thida Win, who was still a university student when she first sold sex, said the financial burden of marriage and children only pushed her further into the trade.

"I got my degree with sex work, I supported my family very well with sex work," said the chemistry graduate, who said her earnings still help support seven family members.

Weblink: http://news.yahoo.com/s/afp/20110522/hl_afp/myanmarhivhealthsocial_20110522185905

Times of India

  KOLKATTA: Seema Folka is excited, nervous and proud that she will be rubbing shoulders with the state's who's who on Friday. The 43-year-old will be attending Trinamool Congress leader Mamata Banerjee's swearing-in ceremony.

  Folka is a sex worker who will be in the invitee's gallery when Banerjee and her ministers take the oath.

  "We are thankful to Didi for showing a humane gesture by including sex workers in her invitee list. This quality in her will keep her connected with people from every section of the society," said Folka.

  Driven to the profession by abject poverty, Folka entered the professiion at a young age. Her father used to work as a daily wage earner to feed five mouths till he became bed ridden due to gastric ulcer. Her mother's meager income as domestic help was too insufficient for the family. Most of the time Seema and his two siblings would go without food for days. And when Seema's marriage was arranged, the groom's family broke the engagement as Seema's father could not meet the dowry demand. That was when Seema left her Murshidabad dwelling for Sonagachi, the biggest red light area in Kolkata to salvage the family out of poverty.

  "I will be wearing a green colour tant saree for the ceremony. I am a little nervous because I have never been a part of such a formal function. But I am sure I will remain composed and witness the historic event like any of those in the guest gallery," said Folka.
Durbar Mahila Samawaya Committee (DMSC), an advocacy organisation of the sex workers is elated about the prospect of their representative being present at such an important event.

  "It is great on part of Mamata Banerjee to have remembered us on such an important day. This infact is the first time a sex worker has been invited to be a part of an event like this.

  We hope her government will continue to support our cause in future," said DMSC secretary Bharati Dey.

OrganizationDurbar Mahila Samawaya CommitteeDMSC

Weblink: http://articles.timesofindia.indiatimes.com/2011-05-19/india/29559770_1_swearing-in-ceremony-mamata-banerjee-dmsc

    Durbar Mahila Samawaya委员会(DMSC)是亚洲第一个性工作者工会,成立于1997年,该联盟立刻接管了当地政府的艾滋项目。DMSC在西孟加拉地区拥有6万 名男、女性会员。委员会主要致力于倡导性工作合法化、平等工人权利,以及促进与改善工作环境与工资。

Times of India


    Seema Folka兴奋、紧张并非常骄傲,因为星期五她将有机会与国家重要领导人肩并肩站在一起。这位43岁的性工作者将参加催那木国会(Trinamool Congress)领导人Seema Folka的就职仪式。



    "在典礼那天我将身着绿色的纱丽服。我有点儿紧张,因为我从来没有出席过这么正规的场合。但我确定我将保持镇定,并和其他人一起见证这个历史性的时刻。" Folka表示。
对于其成员出席如此重要的活动,性工作者倡导组织Durbar Mahila Samawaya委员会(DMSC)感到非常骄傲。DMSC秘书长Bharati Dey 说:"Mamata Banerjee能在这么重要的日子仍记得我们,让我们感到很欣慰。事实上这是性工作者第一次受邀参加这一类的活动。我们希望政府今后能够继续支持我们的工作。"

Asia Report 翻译

组织:Durbar Mahila Samawaya委员会(DMSC)


香港特别行政区政府 卫生署 艾滋病网上办公室





    「曾有不安全性行为的人士应致电卫生署爱滋热线2780 2211,预约免费、不记名、保密的爱滋病病毒抗体测试。」










加入邮件组: yzdc@asiacatalyst.org