[Online consultation] Topic 1: Diverse Voices, United Action

The Citizen News Service (CNS) and SEA-AIDS eForum Resource Team have launched the topic 1 online consultation in lead up to the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP). The Topic 1 is open for comments during 21-31 July 2011. The GUIDING QUESTION is: Who are the different partners/ stakeholders that should join hands in your local setting to improve HIV responses? Also share examples of best practices of local partnerships that are working. HAVE YOUR SAY!!! (send comment to bobby@citizen-news.org)

Background: (Source: 10th ICAAP website) The theme of the 10th ICAAP is "Diverse Voices, United Action." HIV/AIDS epidemic is not only deemed as a health issue but a political as well as social and economic one. The pertinent partakers therefore are from diverse backgrounds in society today and we should be able to accommodate the different and changing needs by accepting and working with voices from everyone and anyone.

Have your say! (send comment to bobby@citizen-news.org)

Kind regards

Citizen News Service (CNS) and
SEA-AIDS eForum Resource Team


  1. Partnerships for AIDS at local level are far from satisfactory - TB programme, HIV programme, reproductive, maternal and child healthcare, public health advocates (diabetes, cancer prevention, and other issue focussed), political stakeholders, etc... they clearly are not joining forces.

    HIV is NOT on political agenda - and - since ICAAP is raising issues about united action on AIDS bringing together political, social and other stakeholders - let us break the silos we work within and reach out to these allies at the local level.

    The AIDS movement has done a commendable job in mobilizing resources and response however in communities I live in India, the risk perception for HIV is still very limited. That is why it is not on political agenda.

    Also for instance people working on cancer prevention, seldom see that people living with HIV also deal with cancer - and - incorporating HIV sensitive messages will help further the cause.

    Jitendra Dwivedi
    Abhinav Bharat Foundation (ABF) India
    Email: jitendraabf@gmail.com

  2. Had read on SEA-AIDS some months back: "When bacteria (TB) and virus (HIV) can work so well together, why cannot we? - Michel Sidibe, Executive Director, UNAIDS."

    Time to recollect these golden words and make us review if we are doing enough to work in partnerships.

    Nasir Zaidi, Pakistan



    Indeed responding to the ill effects of HIV and AIDS, preventing further infection and providing the necessary treatment care and support for all people living with HIV and AIDS is not a sole responsibility of the Health Department. There are other governmental agencies and huge numbers of CSOs that should be part of the stakeholders and should be contributing their counterpart along the preventive part of the program, while people living with the disease should be at the center of the program because they are the most directly affected.. They are part to the solution and should not be regarded as the problem.

    Having said that people living with HIV and AIDS should be at the center of any country HIV/AIDS program, they should be properly represented in any forum or decision making body, They should be heard, their decisions should be considered, it is because they have a big stake, to access health services, ART treatment, doable preventive approaches to halt new infections and prevent cross infection.

    When we talk of inclusive, participatory, consultative approaches and processes, these are easier said and can be done but those whoever utilizes these approaches may free willingly abuse the concepts. At country levels, all of these are being utilized but is at most detrimental to PLHA communities. It can be said that PLHAs had been consulted but the results of such consultation are not shared with the positive community. Good to note that the results are utilized to better programs but in its actual course of implementation, the PLHAs are only told what they can do, how they can do such and how much, where they can do these things that they are being told to do.

    HIV program have deteriorated over the past 20 years. Gone are the glory days of a doable partnership for AIDS in the Philippines where prevention program have maintained a low number of case. There are several layers, systems and mechanism to improve the program, engage more stakeholders, MEANINGFUL engagement of PLHAs. These layers have its considerable technical working groups, but sad to say the program have deteriorated, strategies, tasks and activities are fragmented, targeting is not realistic and certain groups are side tracked. Bulk of the actions are still at the national level when most of the MARPs are in their localities and communities, and these communities are not part of the national actions. New infections have doubled per month giving a dramatic increase in the country’s local recorded cases particularly among the MSM. The story is clear, diverse voices maybe engaged, the country’s program is swayed, driven by priorities that is not ours, fragmented actions, where did we fail?

  4. Although I cannot attend the ICAAP because my application for scholarship has been turned down, I am pleased to provide you some inputs regarding the subject:

    This is actual experiences/ setting in the Province of Albay, Philippines.

    The Provincial Government through the Albay AIDS Council has established a strong partnership with Non Government Organization working on Reproductive Health, HIV, MSM community and Vulnerable sectors (Persons with Disabilities, Women, Elderly and Children), Government Agencies, Local Government Units (Cities/ Municipalities), National NGOs and Developmental partners such as UNDP, UNFPA and Local Government Academy.

    Every partner has identified its role in our local response to prevent the spread of STI and HIV in the province.

    The Gay organization here is working on regular community learning group session as well as condom distribution and referrals of possible patients to proper clinics.

    Department of Health is providing us technical support in terms of capacity building among health personnel.

    The Regional AIDS Assistance Team is working on networking with other National Agencies.

    Local Government Units responsibility focus on sustainability of HIV programs including the assured provision of budget for the operation of their Social Hygiene Clinics, while in the part of the Provincial AIDS Council, which I am the head, we augment STI/HIV drugs and medicines.

    The Albay AIDS Council also assist local government units in the creation of local policies pertaining to the operation of STI/HIV services including the creation of Local AIDS Council providing funds thereof.

    The Media is responsible in information drive.

    UNDP/UNFPA provide technical, financial support as well as STI commodities to Albay AIDS Council.

    The Department of Social Welfare and Development and Provincial Social Development Office provides financial assistance to PHLIVs to cover expenses for CD4 test and the Provincial government shoulders the payment of their health insurance in coordination with the Philippines Health Insurance.

    Today, we are looking for possible partner to support our proposed establishment of Humanitarian and Health Emergency Center.

    Bicol Regional Training and Teaching Hospital (BRTTH is the hospital based facility partner of the Albay AIDS Council) is responsible in providing laboratory to PHLIV.

    Miguel dela Rama, Philippines
    Email: mgdelarama@yahoo.com

  5. Dear Associates,

    The HIV epidemics in Asia vary between countries in the region, but are fuelled by unprotected paid sex, the sharing of contaminated injecting equipment by injecting drug users, and unprotected sex among men who have sex with men. Men who buy sex constitute the largest infected population group - and most of them are either married or will get married. This puts a significant number of women, often perceived as ‘low-risk' because they only have sex with their husbands or long-term partners, at risk of HIV infection.

    It is estimated that more than 90% of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships. By 2008, women constituted 35% of all adult HIV infections in Asia, up from 17% in 1990.

    In India, Cambodia and Thailand, the largest number of new HIV infections occur among married women. In Indonesia, where HIV was initially concentrated among drug users, the virus is now spreading quickly into sex work networks, including long-term partners and sex workers. Research from several Asian countries indicates that between 15% and 65% of women experience physical and/or sexual violence in intimate partner relationships, placing them at increased risk of HIV infection. According to different studies in India, Bangladesh and Nepal, women exposed to intimate partner violence from husbands infected with HIV through unprotected sex with multiple partners were seven times more likely to acquire HIV compared to women not exposed to violence and whose husband did not have sex with multiple partners. The strong patriarchal culture in Asian countries severely limits a woman's ability to negotiate sex in intimate partner relationships, according to the report. While there is a societal toleration of extramarital sex and multiple partners for men, women are generally expected to refrain sex until marriage and remain monogamous thereafter.

    My experience while working with migrants indicates that the female partners of migrant workers have been shown to be at increased risk of HIV infection when the latter return from working in countries with high HIV prevalence. A study in Vietnam showed that married migrant workers reported having commercial sex partners and low condom use.

    To prevent HIV transmission among intimate partner relationships, the report outlines four key recommendations:
    1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female / male sex workers and should emphasize the importance of protecting their regular female partners.
    2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programmes to include services for male as well as female sexual health.
    3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.
    4. We must start projects for HIV/AIDS effacted Senior Citizens, Women and Children
    5. Operational and Action research must be conducted to obtain a better understanding of the dynamics of HIV transmission among intimate partners.

    Best Wishes,

    Avnish Jolly,
    Chandigarh 160020, India.
    Cell: +91-9814213809

  6. Time has come to think from both the point positive and negative because as a Secretary of ATHB it is my responsibility to inform you all the things which is happening around us with our community. In West Bengal our [transgender and Hijra] community is being neglected by the MSM programmes and this is the reason that today ATHB has formed with own strength.

    1) Bini from transgender community is ailing in hospital. The National AIDS Control Organization (NACO) has not come forward to help Bini. What is the guarantee that they will help our community in future?

    2) Do not you all think that there should be a Target Intervention (TI) for the Transgender/ Hijra in West Bengal? Why there is no TI still in the West Bengal? In future if any Transgender/ Hijra TI comes then what is the guarantee that NACO will give you the money for the crisis management?

    3) Since last eight months the NACO is saying that they are going to give two transgender/ Hijra project in West Bengal but still nothing has been done by them why?

    4) Have heard that the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) is investing resources in programmes for transgender and Hijra community, but no help has come from the Global Fund recipients so far. Then how we will trust them?

    5) NACP IV consulation is going on and on and on 19th July, 2011 there was a consulation in Delhi also and people from West Bengal are going to give input for designing the NACP IV who belong to MSM community but transgender and Hijira community representatives from ATHB and ATHB partners are not invited - why?

    Ranjit Sinha
    Association of Transgender/Hijra in Bengal (ATHB)
    Email: bandhankolkata@rediffmail.com

  7. TB and HIV programmes work independently mostly at local level - is seldom cross referral enough?

    Jitendra Dwivedi, Abhinav Bharat Foundation, India
    Email: Jitendraabf@gmail.com

  8. Programmes addressing reproductive and sexual health, maternal and child health and HIV need to be more effectively integrated at local level.

    N Chaudhary, Bangladesh

  9. I would like to highlight the concerns of Young people perinatally infected by HIV.

    It was never previously anticipated that children born with HIV would have the opportunity to live on to adulthood. However thanks to the roll out of ART programmes in developing countries, children perinatally infected by HIV now face a chronic disease rather than a progressive fatal one. These young children as they grow into teenagers highlight evolving needs of pediatric HIV care, including educational and prevention strategies surrounding sexual health for young people and learning skills for social integration in communities and workplace.

    Currently, most young people living with HIV in developing countries receive their treatment, care and support through pediatric care clinics. Existing counseling and health care support packages need to be redesigned to address the gap between pediatric and adult care. There is an urgent need to develop a counseling and life skills curriculum for youth living with HIV.

    Recent WHO/UNFPA guidelines on care, treatment and support for women living with HIV have underscored the need to address the particular sexual and reproductive health needs of adolescent girls with HIV, ensuring the availability of age-appropriate information and counselling on sexual and reproductive health and safer sexual practices, partner notification, and offering family planning counseling and services that are adolescent-friendly

    Policy makers and service providers need to understand the concerns of young children perinatally infected with HIV and to actively and meaningfully involve them in the development of programmes drawing on their life experiences. They need to address their challenges as they transition to adulthood, including their right to education, vocational guidance, housing and livelihood.

    Addressing the needs of adolescents, especially those of girls, is critical to the achievement of every one of the Millennium Development Goals (MDGs). Education is not only a goal in itself (MDG2) but fundamental to eradicating poverty and hunger (MDG1). Three of the UN endorsed MDGs are directly pertinent to the reproductive health of women and young girls living with HIV. MDG 3 seeks to achieve greater gender equality and empower women; MDG 5 aims to improve maternal health; and MDG 6 focuses on stopping and reversing the spread of HIV infection. And the promotion of gender equality and empowerment of women (MDG3) has to start with the young girls.

    As children with HIV are living longer, governments, donors, UNICEF, UNAIDS, community organizations and other stakeholders working on HIV must put the issue of perinatally infected children with HIV on their agenda. We must assess the needs of these young adolescents and understand what type of unique support services they require to have a bright future and achieve their dreams.

    Ishdeep Kohli
    Public Health/Media Consultant
    Mumbai, India
    Email: IKohli@tuiu.edu

  10. 12. Comment from Garima Patel

    Country-level partnerships should make sure that louder voices don't dominate - and - they are truly driven by the communities even if governments and big NGOs and donors are a part of it.


    The key issues for GFATM to focus on:

    - To strengthen country ownership in proposal development, implementation and lapses;
    - More proactive approaches to grant-making to maximize the impact;
    - Primary focus on strategic approach to strengthen M&E systems;
    - More focus on quality assurance mechanisms and long-term capacity building;
    - Improve certainty of funding to reinforce country planning processes;
    - Differentiated approaches to grant management;
    - To improve communications for better mutual understanding of roles and responsibilities.
    - Apart from that the entire performance-based funding system should be reviewed to streamline it and ensure its integrity. It is an urgent need to clearly articulated roles and responsibilities that are going beyond the MoU model, under the partnership framework and it should focus on key factors limiting scale-up and be implemented through partnership arrangement in order to strengthen the present health system.

    The most important part is to emphasize quality management approaches to build capacity for grant supervision and it is important to strengthen the civil societies role on CCMs. It should also emphasize on the need to increase resources for the provision of Technical Assistance.

    Adding to this, a better focus on cost-effective strategies is needed keeping country ownership as a key standard. There is also a need for improvement in aligning and harmonizing GFATM processes and to strengthen the linkages between programme areas.

    Joy Ganguly
    Consultant/Technical Specialist - Harm Reduction
    New Delhi, India
    Email: gangulyliani@gmail.com

  12. Mohd. Zaman Khan01 August, 2011

    It is indeed interesting and illuminating to read the comments made from people from all over. Yes HIV is still not a political agenda in Malaysia. Why not? Perhaps the reason is still the stigma attached to the manner how you get infections; unprotected heterosexual, sex-workers, men having sex with men activities is not kindly looked upon. Culturally Asians look with frown on these activities.

    It is important that the issue be politicized not only to get more funding from the government and donations from corporate organizations as well as individuals. Political debates on the issue would create more awareness an in time to come eradicate stigma and discrimination.

    We cannot work in isolation; not just NGOs and the health authorities. This is particularly so in Malaysia where there is nearly 2 million immigrant workers wo fuelled the sex industry.

  13. "Diverse Voices, United Action—10th International Congress on AIDS in Asia and the Pacific
    Regional leaders, governments, global organisations, medical researchers, community organisations, activists and many others have gathered in Busan, South Korea to attend the 10th International Congress on AIDS in Asia and the Pacific (ICAAP).

    Between 26 and 30 August, more than 2500 people from 64 countries have convened to discuss regional, national and local approaches to combating what is one of the world's biggest killers.

    This year’s ICAAP theme was 'Diverse Voices, United Action', and the region's largest forum on HIV and AIDS has lived up to its mantra.

    Key leaders began the conference with the AIDS Champions meeting at Nurimaru APEC House on Friday, 26 August. They reaffirmed their call for the international community to ensure the response to the disease remains a joint effort and to maintain the momentum gained over the past few years."