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





Asia Report 翻译

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


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)







  Globally, women constitute approximately fifty percent of all HIV infections. Women may eventually comprise the majority of people living with HIV/AIDS in the world; this is already true in Sub-Saharan Africa where women constitute sixty percent of the individuals living with HIV. The recognition that women's inequality may be a driver of women's vulner- ability to contracting HIV has led to a series of feminist legal responses in an effort to address HIV.


  This Article assesses feminists' conflicting legal, policy, and regulatory proposals to address sex workers' vulnerability to contracting HIV. This Article employs a Governance Feminism ("GF") analysis that allows us to assess feminists as powerful actors in the institutions that govern HIV. This Article focuses on two cases in which particular legal and policy proposals can be traced directly to feminist engagement and disagreement: the drafting of the United Nations Joint Programme on HIV/AIDS Guidance Note on Sex Work and the creation and implementation of the Anti-Prostitution Loyalty Oath.

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