1. ICAAP 2009: Harm Reduction: injecting drug users are patients, not criminals

2. ICAAP 2009: Criminalization of drug use: Is it a solution to end the war on drugs?

3. ICAAP 2009: Looking back - 8th ICAAP: Asian drug users claim the right to speak for themselves

4. ICAAP9 Session Towards the Next UNGASS

5. Community Forum Statement, 9th ICAAP, 9th August 2009

6. ICAAP 2009: Key recommendations at the closing of ICAAP Community Forum

7. ICAAP 2009: Translating political commitment to AIDS into action in Asia-Pacific

8. ICAAP 2009: Migrants, HIV/AIDS, vulnerabilities: links, challenges and path ahead

9. News: Protesters seek cheaper drugs at HIV/AIDS meeting

10. ICAAP 2009: Universal Access – Challenges in the Asia Pacific Region

11. ICAAP 2009: Break the silence on HIV - hepatitis C coinfection

1. ICAAP 2009: Harm Reduction: injecting drug users are patients, not criminals

[on HealthDev.net]: "I stayed in prison for 45 days waiting for a decision (from the Sub-Committee). Some (others) were released. There was no medical treatment. It was very difficult to stay there... (it was) very crowded, not enough water. This place could accommodate 150 people but when I was there, there were 300. They did not know where to put the people. People had to sleep on their sides. If I moved [during the night] I would lose my space", shared a woman from Bangkok, Thailand.

This is the story of a typical state of prisoners in Indonesia, and it also happens in Jakarta. Instead of getting human rights based rehabilitation treatment, injecting drug users (IDU's) are treated like criminals and punished by being locked up in prisons. Many of them experience a worse fate than the woman above.

Most, when released, return to injecting drugs and find themselves back in prison. Harassment causes Injecting drugs users to refrain from using required health and support services. The knowledge of police about harm reduction (HR) can reduce harassment. This is what happened in Bangladesh, in an example of a comprehensive harm reduction program conducted an assessment of the information needs of police personnel in relation to harm reduction programming. Consultative and advocacy workshops were conducted with the police, with a curricula developed and training provided in 5 police training institutes. In total, 12,500 police personnel were trained, including high ranking police offers.

Another example presented from India was that of a pro- harm reduction strategy in the management of service delivery directly impacting the outcome of oral substitution therapy roll-out did from 2007 to 2009. This programmed funded by the Department for International Development (DFID) and the National AIDS Control Organization, was run through 19 centers in 9 states where oral substitution therapy was provided. In India, there were around 25,000 Injecting Drug Users on different drug treatment services at the beginning of 2007 and services available for them included needle syringe exchange programmed (NSEP), detoxification, rehabilitation, income generation, referral for DOTS, HIV, and general medicine. More than 1,725 IDU's were on oral substitution treatment therapy.

Sites with pro-harm reduction strategies employed in their day to day functioning witnessed better results. Following a client suited time schedule of services, adherence protocols applicable to clients, dosage compliance adapted to the client's needs all made a positive impact to the outcome of the programmed.

The engagement of users in the program along with the support groups helped the programs at these sites in a big way. Clients came for their dosage, stayed and helped others to be part of the program. Peer Counseling played an important role. Inclusion of peers who had recently started oral substitution therapy helped the program acknowledge the latest trends and movement of drug users around the supply of the drugs. Clients in the program were also given an opportunity to be part of the program management team. Additional services were provided by these sites as per their needs, such as nutrition and self help groups. The families of clients were also involved, this way increasing the awareness of drug use, its consequences, OST/ Buprenorphine-adherence as a prime focus. The efficacy of the oral substitution treatment lies in how best these three key criteria are combined: accessibility, availability and most importantly acceptability – all need to be translated in harm reduction services. Finally, it is highly important to conduct training to increase understanding of OST at all levels, with health services, policy makers, clients and their families.

Online at: http://healthdev.net/site/post.php?s=5736

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2. ICAAP 2009: Criminalization of drug use: Is it a solution to end the war on drugs?

(on HealthDev.net): Drug use is not a new phenomenon. It has been traditionally accepted and used for?over a hundred years in most countries across the globe. Since the introduction and distribution of new drugs in the market place, people started abusing it and many countries had to devise laws to tackle this menace.

Drug users are being criminalized in most countries. "They have to face severe penalty or imprisonment of 25 years" said Annie Madden, Director of the Australian Injecting and Illicit Dug Users' League (AIVL) during the penal discussion in the 9th ICAAP pre-Congress Drug User Community Forum. She further stressed that 85% of prisoners in Australia are imprisoned due to drug related offences and if a person is caught possessing drugs for personal consumption then he/she will be sent to community service but it will again depend on the number of offence this person has committed.

The existing criminal justice systems in most countries are not relevant to drug users and it is doing more harm than good. They are widely misunderstood and discriminated against, and for various reasons could be considered less a priority issue for governments to address. "We are not bank robbers, rapists, or killers (who typically get much less time). We are not rip-off artists or fraud merchants. We are those who made or sold or used a product that millions of people want" commented a drug user attending the 9th ICAAP conference.

Drug users' needs are complex and simple solutions would not resolve their multiple problems. However the problems faced by the drug users can be somehow minimized by looking at the world through a human rights lens and from a more holistic perspective. Evidence has shown that criminalization of drug use doesn't bring back the drug user into the mainstream rather they are compelled to go underground and this makes the service provider difficult to reach them. This could be one reason for why the drug user community has less access to the health care system.

"The existing international drug policy does not deter the drug users from using drugs, instead it is doing more harm than good" said Gabor L. Somogyi, a consultant from the International Drug policy consortium (IDPC). The IDPC is a global network of NGOs and professional networks that come together to promote objective and open debate on drug policy issues at the national and international level. Gabor further added that harm reduction programmes need to be included keeping in mind the harms associated with injection of drugs but at the same time other prevention and intervention programmes need to be in place so that we can stop young people at the very early stage from indulging into drug use habit. The drug policy that has been put in place for over fifty years need to be reviewed and the governments should consider the scientific evidence regarding the effective and positive responses in tackling widespread drug use.

HIV/Hepatitis C (HCV) co-infection among injecting drug users is another emerging issue that needs immediate global attention. "It has been always neglected at national and international forums" said Giten Khwairakpam, programme coordinator for Seven Sisters, the coalition of Asia Pacific Regional Networks on HIV/AIDS, a broad based Alliance bringing together seven regional networks, during the panel discussion at the Drug User Community Forum. He further added that people can't afford the expensive Peginterferon HCV treatment because most of the drug users are below the poverty line. The issue of HIV/HCV co-infection needs a serious and immediate attention because thousands of lives have already been claimed. People are dying of HCV even though they are on ARV treatment. Governments are not doing anything to address this emerging and serious issue.

The 1948 Universal declaration of Human Rights also mentioned health as part of the right to an adequate standard of living (article 25). The right to health was again recognized as a human right in the 1966 International Covenant on Economic, social and Cultural Rights.

Since then, other international human rights treaties have recognized or referred to the right to health or to elements of it, such as the right to medical care. The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognizing the right to health. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences. So the right to health and access to treatment including HCV treatment also applies to drug users. Denying their rights is a violation of international human rights treaty signed by the member states. Governments, stakeholders, civil society organization representatives and political leaders who are attending the congress need to open up their eyes and look into the negative impact on people's lives especially people living with both HIV and HCV.

There is a pyramid being built, upside down, with fewer and fewer supporting workers at the bottom. Eventually, this unnatural pyramid must fall, unless you — the drug user community, wake up and realize that the laws of nature, including human nature, cannot be legislated out of existence. Just remember the following precepts:

- Drug use is not drug abuse.

- Drug use does not cause crime. Drug prohibition causes crime.

- Drug abuse is a medical and psychological problem, not a criminal problem.

- Security cannot be gained by giving up your liberties.

- Free minds, free bodies and free markets lead to liberty, security and prosperity.

Morality cannot be legislated, nor can the laws of natural economics. Governments always tend to over control and to be corrupt, and they need to be watched very closely.

With that in mind, the drug users' community needs to show solidarity demanding the right to health and fight against the criminalization laws. The war on drugs is a war against drug users. It doesn't deter the drug users to stop using drugs but rather make them more vulnerable.

Online at: http://healthdev.net/site/post.php?s=5717

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3. ICAAP 2009: Looking back - 8th ICAAP: Asian drug users claim the right to speak for themselves


[Mods note: This Key Correspondent (KC) piece from ICAAP 2009 is in response to a recent posting, "Looking back - 8th ICAAP: Asian drug users claim the right to speak for themselves" ( online at: http://www.healthdev.org/viewmsg.aspx?msgid=6567b292-4080-4f23-b52c-536e2d800163 ), which reported on the Colombo ICAAP 2007 announcement of the formation of the Asian chapter of the International Network of People Who Use Drugs.
Renamed Asian Network of People Who Use Drugs (ANPUD) in early 2009, the network has in the past two years remained active in drawing attention to the rights and needs of drug users regionally, participating in various international and regional meetings, and steadily working towards formalizing its status as a representative network with elected membership. SEA-AIDS members are invited to share thoughts and experiences. Thanks.]

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Two years after the initial launch during the ICAAP in Colombo, the Asian Network of People who Use Drugs (ANPUD), the only regional network of drug users in Asia, is forging ahead and being formalized as an active organization driven by its membership.

Indeed, in the past two years, several key members of the network have invested significant time and energy in building structures within the network to ensure the organization's responsiveness to the needs of people who use drugs in Asia. Specifically, ANPUD's constitution is currently being finalized and members are discussing official registration in Asia.  Membership criteria are included in the constitution and further information will be circulated shortly to inform potential constituents how to join the network.

Although the process of formalizing governance and registration has been spread over the last two years, the network and its members have been active in several areas.  Members of ANPUD have been invited onto various committees and platforms such as the UNAIDS Program Coordinating Board (PCB), the Commission on Narcotic Drugs (CND), the UN Regional Task Force on Injecting Drug Use and HIV/AIDS in Asia and the Pacific and the Executive of the Asian Consortium on Drugs, HIV, AIDS and Poverty being some of the recent ones.

ANPUD and the Asian Consortium on Drugs, HIV, AIDS and Poverty (also known as Response Beyond Borders or RBB) have organized several meetings, beginning with the First Asian Consultation on Drugs, HIV, AIDS and Poverty in Goa, India, in early 2008 – where the Goa Declaration was released. Follow-up workshops were organized in Phnom Penh, Cambodia in October 2008, Kathmandu, Nepal in February 2009 and during a WHO-UNODC supported workshop during the 20th International Conference on the Reduction of Drug related Harm in Bangkok in April 2009. These meetings have been critical to unite members around a common platform, understanding of the different needs of drug using communities spread across Asia and determining the next steps.

In addition, ANPUD is represented on the Board of INPUD (the International Network of People who Use Drugs) to facilitate cooperation and collaboration at the international level. However, it should be clear that ANPUD is an independent organization with its own mission and vision and not a subsidiary organization of INPUD. A key member of ANPUD recently stated that “without INPUD there is no ANPUD and vice-versa.” The co-dependency between the networks is fundamentally grounded in the core issues of human rights abuses and universal access that both networks are addressing.

Among these issues, and central to ANPUD is the ‘MIPUD principle' coined during the Bangkok meeting – 'Meaningful Involvement of People who Use Drugs' in all aspects of policy and programming related to drug use and HIV and Hepatitis C prevention. “Nothing about us, without us' is another principle that is fundamental to ANPUD's philosophy. ANPUD has already made important achievements in actively engaging with the Global Fund, UN agencies notably UNAIDS, WHO and UNODC, Funding Bodies, the Australian Injecting and Illicit Drug Users League (AIVL) and some governments in Asia around the MIPUD principle.

In short, the development of ANPUD has seen a growing consciousness among members of network functions, the challenges involved in representation of large populations with diverse needs, and the opportunities for mobilizing support for the network and its members.

However, the road ahead is still fraught with challenges for the burgeoning leadership within ANPUD.  First and foremost, ANPUD is operating in a culturally and linguistically diverse region where the human rights of drug users are regularly violated and access to harm reduction services is poor. Limited access to modern communication technologies for people who use drugs in Asia remains a huge barrier. Resource mobilization – both in terms of human and financial resources – is also a key issue in developing a sustainable network. Furthermore, the unfavorable legal and policy environments in Asia are sure to create hurdles for ANPUD when linking with nascent or established drug user networks.

Jimmy Dorabjee who is coordinating the development of ANPUD until a Steering Committee is established noted that “Building confidence and capacity within the network is critical to self determination and must be linked to local drug user networks if capacity is to be shared effectively across Asia. ANPUD has gained respect, credibility and support from a range of key stakeholders including UNAIDS, WHO and UNODC. With the current supportive environment, the time has come to firmly embed and integrate the MIPUD principle into UN, civil society and Government policies and initiatives across the Asian Region'.

In the near future, the establishment and growth of ANPUD will translate to increased involvement of people who use drugs in policy and programming dialogues, greater consistency across advocacy messages and platforms, easier access for community representation and an increase in evidence informed interventions for drug users across the Asian region. Even though much remains to be done, for the members of ANPUD the last two years have demonstrated the power of collective action.

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4. ICAAP9 Session Towards the Next UNGASS

On 11 August, a satellite session titled UNGASS & Community: C ivil Society Involvement in UNGASS on HIV was organized by the 7 Sisters, World AIDS Campaign, UNAIDS and GESTOS at the 9 th International Congress on AIDS in Asia and the Pacific (ICAAP9). Presenters Aditya Wardhana (JOTHI/UNGASS Forum Indonesia) and Supecha Baotip (Raks Thai) presented on the process community groups in their respective countries faced in the last UNGASS-related HLM in 2008, highlighting difficulties with country reports and the use of shadow reports. Moi Lee Liow (APCASO) presented the commitment of APCASO to support community involvement in future rounds of UNGASS – in particular, pointing out that the dates for the upcoming UNGASS on HIV had not been settled and that after 2010-2011, some indications were pointing to subsuming UNGASS processes under the banner of the Millennium Development Goals.

Pascal Tanguay (AHRN) was also invited to present the results from the UNGASS on drugs and highlight linkages for community groups to pursue within the UNGASS on HIV. Presented from an IDPC perspective, Pascal covered the UNGASS on drugs processes and mechanisms as well as salient outcomes. This was followed by an overview of implications and suggestions for future action. Amongst the most significant recommendations, Pascal identified petitioning UNAIDS and the PCB for system-wide coherence within the UN family on drug-related issues; invited HIV activists to share their experience of engagement with the UN and particularly UNGASS towards an exchange of skills across the drug and HIV fields; proactively contacting national governments in the region to encourage consistent internal positions on HIV, drugs and human rights; and to further encourage governments to present evidence to support their country monitoring, evaluation and reporting processes.

Participants' reactions to the session indicated great interest from community groups to engage further in UNGASS although there are clear limitations among those groups given limited knowledge and experience around UNGASS, pointing to a need for more advocacy and community support.

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5. Community Forum Statement, 9th ICAAP, 9th August 2009

“The change we want to see…” by Caroline Thomas (Indonesia) & Gurmit Singh (Singapore)

We, the communities of People Living with and affected by HIV, representing Women and Lesbians, Drug users, Youth, Sex workers, Men who have sex with men, faith groups, and Migrants organized and conducted 8 separate community forums on 7th and 8th August, to consolidate our learning and take stock of progress as we prepared for the 9th ICAAP. Read more

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6. ICAAP 2009: Key recommendations at the closing of ICAAP Community Forum

The Pre-Congress Community Forum of ICAAP9 had conducted 8 forums which took place on 7th and 8th of August in various places in Bali. The 8 forums included were PLHIV, Interfaith, Youth, Migrants, People who use drugs, Sex Workers, Women including Lesbians and MSM.

The closing plenary of the forums took place in Bali International Convention Center [BICC] on August 8th. All forums had come up with recommendations to be taken to the congress and all recommendations will be drafted into one joint statement which will be addressed at the Congress Opening Ceremony in Garuda Wisnu Kencana.

There were quite a lot of comments addressed in the plenary that was led by Gurmit Singh from the International AIDS Society and Caroline Thomas from Spiritia Foundation, with similarities in the comments. The highlighted issues addressed by the plenary participants were mostly about community involvement including the rural community, decriminalisation of People Living with HIV (PLHIV), abolishing stigma & discrimination against PLHIV and most important of all is the issues of core funding. The Global Fund was getting quite interesting comments regarding the multi-layers funding disbursement. And it is important to acknowledge the fact that there are many people at the grassroots level who are not aware of the process and mechanisms of Global Fund.

Liping Mian from the World AIDS Campaign mentioned that it is important to address the involvement of the community, but it is also necessary to acknowledge that communities often got isolated because of the capacity issues. So, before getting involved in the decision and policy making processes, all community members should build their own capacity first. Without adequate capacity, it is fearful that the community will not be getting equal place in the decision and policy making processes.

Apart from the interesting recommendations that had came out, some people were disappointed to see that everything seemed to be going in circle. People were still talking about the same things, suggesting similar ideas and conducting the same process in holding the Community Forum. However, the migrants' community felt satisfied enough with the whole processes because they nearly lost their voices in the beginning of this event , considering the decision to include migrants in the community forum came very late after Coordination of Action Research on AIDS and Mobility (CARAM) Asia sent a complaint letter through the Congress Coordinator. The migrants' community had been pushing to have their forum accommodated in the event in order to address their concerns and recommendations.

"Instead of holding the donors and governments accountable, let us hold ourselves accountable too..." , a comment from Anandi Yuvaraj from International Community of Women living with HIV (ICW).

Online at: http://healthdev.net/site/post.php?s=5710

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7. ICAAP 2009: Translating political commitment to AIDS into action in Asia-Pacific

[on HealthDev.net]: HIV and AIDS is everyone's concern and human rights is a priority in all aspects of HIV/AIDS. Unfortunately, not all countries are endorsing the HIV/AIDS epidemic with a human rights based approach. National Human Rights commissions have an obligation to protect people living with HIV/AIDS (PLHIV), by providing them social and legal protection as human beings. However even with human rights laws and legislations, why are they being ignored by society?

Every stakeholder has a critical role to play, in particular parliaments have an especially important role to play in supporting government campaigns in the protection of affected communities. Carol Kidu, Ministry of Development of Papua New Guinea (PNG) explained about the national strategic plan developed in 1987 to respond to HIV and AIDS and the role of the legislative and political branches of government towards structural transformation began in 1997.

Criminalisation of sex workers and men who have sex with men (MSM) were repealed by a plenary in the government, and included in PNG's National Strategy on HIV/AIDS. In 2003, a Parliamentary working group on HIV and AIDS was established to accommodate political acknowledgment from civil society response. There were a lot of challenges during the process, mostly caused by the complexity in culture in translating political commitment into action.

Kidu also explained that partnership included bottom up and top down approaches, and equal active involvement with OPEN principles: Ownership, Partnership, Expert and Networking. This principle did not just involve heart and non-judgment but another principle is also needed, the ART principle: alcohol, drugs use, rape, harassment and talk. In order to do this we should develop an informal economic policy, and not allow the future to judge us for the government's errors.

Ms Shapna Member of Nepal Parliament told how to respond broader with respect to PLHIV and affected communities with an emphasis on accountability as an important part and how parliaments could work together and what political commitments should be made. Policies need to cover various political aspects such as services, human rights, civil society and leadership into tackling the epidemic. She also told about the need to educate every stakeholder on how to translate commitments into action and how to fulfill the rights of key populations. A good level of understanding of Universal Access is needed by the Parliament, in order to make politicians accountable for providing the services and reaching the targets set.

Even though Ban Ki-Moon, the Secretary General of United Nations said "Our principal leadership and commitment is critical" to make HIV/AIDS laws happen, only few countries have followed. We need to change the mindsets of parliamentarians by getting rid of prejudices that divide the marginalized communities and focus on human rights approaches. We also need to encourage multi-sectoral stakeholders to transform political commitment into action.

Dr Tien Nguyen, Vice Chair of the Vietnam Parliament Committee of Social Affairs, told about how to open a legal channel to provide human rights based services with social involvement and budget allocation. He also explained about how the Government supported harm reduction programmes by starting three methadone maintenance therapy (MMT) programmes in three big cities in Vietnam. Even though there was contradictory issues about harm reduction in Vietnam he recommended two main points for Parliaments by setting up a key group for advocating human rights based harm reduction approaches in Parliament, and how members of Parliaments could be real advocates for policy change.

Ms Claire More, Senator of Australia said how important is to bring personal commitment into political commitment. She suggested that it is important to develop partnerships in order to translate political commitment by promoting dialogue amongst key constituents. It is important to involve constituents in decision making process, to ensure they trust and are trusted, and most of that they are heard. She sated that the development of forums between the community and the Parliament is essential for decision making. HIV/AIDS was included on the political agenda in Australia since 1989, and this means it's everybody concerns.

Online at: http://healthdev.net/site/post.php?s=5735

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8. ICAAP 2009: Migrants, HIV/AIDS, vulnerabilities: links, challenges and path ahead

[On HealthDev.net]: Migrant population is a key component of workforce in many countries of the world, and in the Asia-Pacific supporting industries, farming, construction, healthcare and domestic work. Migrants, impacted by several factors, are highly vulnerable to HIV/AIDS.

At the 9th International Congress on AIDS in Asia and the Pacific (ICAAP) in Bali, Indonesia, in an important community forum of migrants across the region, these vulnerabilities were addressed and a joint discussion was held to recommend future priorities.

In the opening remarks of the forum, an activist working on the issues of migrants said – "Migrants work for the dreams of their families. They leave their homes and countries and live in difficult situations to support families back home. They are exposed to health risks. However, sadly, most countries lack arrangements and procedures to protect this important work force".

Nearly 175 million people live abroad as migrant workers in the Asia-Pacific. This constitutes about 28% of the total global migrant population. Nearly half of the region's migrants are women. The region also happens to be the largest source of female migrants working in homes abroad for domestic help.

The prevalence of HIV/AIDS in migrants is high. To understand it with an example, let us look at Indonesia where 32% PLHIV are former migrants. Mandatory testing for migrants is a common practice in a number of countries and therefore, most migrants who contract HIV are diagnosed through regular tests. Found positive, most are deported.

The vulnerability of migrants is a complex cycle. There are various factors ranging from social conditions to physical needs linked to it. Low knowledge on sexual health is a major issue. Most migrants have very little knowledge on sexually transmitted diseases and preventive aspects. Systems to explain them about potential risks in their home countries and destination countries are weak, inadequate and in some cases do not exist at all.

Isolation from the families, physical exhaustion and sexual needs promote risky sex practices. Lack of social shackles encourages casual or commercial sex. Poor health seeking behavior also contributes to the complexity of situation. There is also a two way vulnerability – migrants and their spouses back home can both indulge in unsafe sex, and can infect each other

Injected drug use for relaxation and stress relief has also increased among migrants posing another threat in the context of HIV spread. However, the vulnerabilities of migrants have not been given sincere attention. Their voices are not being heard. The impact of HIV/AIDS on migrants and their families is profound causing economic crisis, social isolation and psychological and emotional distress.

"The biggest challenge in fighting HIV/AIDS lies not in the disease itself, but is in the mindsets of people and in changing the attitudes" – comments a former migrant. "We are here to change these mindsets, change the attitudes and fight for our rights."

An activist from the region shares the components of Prevention of HIV/AIDS among Migrant Populations in Thailand (PHAMT) programme. The programme covers 440,000 migrants and focuses on including migrants within the provisions of National AIDS Plan, setting up drop-in centers for counseling, condom distribution, combining outreach and in-reach services and advocating for Migrant Friendly Services.

The participants worked in groups to draft recommendations focusing on migrant populations and HIV. The recommendations suggested removing mandatory testing of migrants in the countries where they work, inclusion of migrants as a vulnerable demographic group in National AIDS Plans of countries, introduction and strengthening of Migrant Friendly Services, comprehensive and integrated health services including ART and counseling, and gender sensitivity.

Migrant workforce will keep playing an important role in the region. It is time to understand the needs of migrants and their vulnerabilities.

It is time to introduce and ensure Migrant Friendly Services.

Online at: http://healthdev.net/site/post.php?s=5712

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9. News: Protesters seek cheaper drugs at HIV/AIDS meeting

BALI, Indonesia, Aug 12 (Reuters) - A small band of protesters holding aloft a banner disrupted a large HIV/AIDS conference in Indonesia on Wednesday to demand access to drugs to treat HIV patients dying from Hepatitis C.

The World Health Organisation says 4-5 million people living with HIV/AIDS around the world are also infected with hepatitis C, a disease that can cause liver failure.

"Hepatitis C + silence = death," read the banner carried by protesters accusing pharmaceutical giant Roche AG (ROG.VX) of setting the price of a drug to fight Hepatitis C virus (HCV) too high for dying patients to afford.

Protesters said pegylated interferon, a drug marketed by Roche and intended to flush out the virus, costs $1,500 a month.

"Shame on you Roche, shame on you!" they chanted.

Roche was not immediately available for comment.

Most people infected with both HIV and Hepatitis C are injecting drug users. Both diseases are blood borne and transmission is through the sharing of used needles and other equipment, even cotton swabs.

Although international health agencies and governments have sought to make HIV drugs available to sufferers, high costs limit access to treatment for hepatitis C in most countries.

According to the WHO, injecting drug users are excluded from treatment in many countries due to fears of the interaction between drugs and the likelihood of reinfection.

But Nanao Haobam, who is infected with both viruses, said such an approach was untenable as patients were dying.

"In my community back home, I have seen more than 50 (HIV positive) people die because of HCV. There must be many more than that," he said.

Haobam, 38, is a former injecting drug user and now an HIV/AIDS activist in Bangkok. He told Reuters he learned he was HIV positive in 2000 and was diagnosed with HCV two years later.

"I was on treatment, but that didn't get rid of all the HCV. I recently saw a doctor and he advised me to start treatment for hepatitis as I am now in the initial stage of cirrhosis," he said.

"But I just can't afford it, I have to leave this matter in the mercy of God."

Failure to treat cirrhosis, the hardening of the liver, will lead to a patient requiring a transplant or dying.

The prevalence of chronic HCV infection among patients with HIV in western Europe and the United States is estimated at 25 to 30 percent. In Asia, 80 to 90 percent of injecting drug users who are HIV positive are co-infected with HCV.

Co-infection rates average over 40 percent in eastern Europe and extend to 70 to 95 percent in Estonia, Russia and Ukraine.

"If governments can't make the drug available, the least they can do is to get rid of the patent, so that generic versions can be made," Haobam said.

Online at: http://www.reuters.com/article/africaCrisis/idUSSP532727

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10. ICAAP 2009: Universal Access – Challenges in the Asia Pacific Region

[On HealthDev.net]: JVR Prasada Rao, Director of the UNAIDS Regional Support Team of the Asia and Pacific region, reiterated that "Universal Access is an achievable goal, and not just an aspirational goal", all people should be able to access the services to live with health and dignity. Chairing the session on 'Universal Access: What it takes to deliver in the Asia-Pacific Region', Mr Rao stressed that countries in Asia need to think big and with confidence. Referring to the findings of the report 'Redefining AIDS in Asia -- Crafting an Effective Response ', published by the Commission on AIDS in Asia, he stated that by pragmatically focusing prevention programmes on key populations – commercial sex workers and their clients, intravenous drug users (IDUs) and men having sex with other men (MSM), a considerable impact could be made by governments in halting and reversing the number of new infections across the Asia Pacific region.

At the UN high level meeting on AIDS in June 2006, the world committed itself to Universal Access to HIV prevention, treatment, care and support for all people in need by 2010. Following this, most countries organized consultations with key stakeholders, including civil society organizations, networks of people living with HIV, to agree on national universal access targets and on ways for overcoming the obstacles in achieving them. Since then, the commitment to universal access has galvanized AIDS responses around the world and reinforced the engagement to stand by those infected and affected by HIV. Specifically in the Asia-Pacific region, it is critical to make a breakthrough in prevention coverage among most at risk populations. In order to achieve this, countries will need to tackle legislative barriers and actively work with civil society organizations and people living with HIV to create an enabling environment and reach marginalized groups.

Michel Kazatchkine, Executive Director of the Global Fund for AIDS, TB and Malaria (GFATM), discussed the challenges to achieve Universal Access in the Asia Pacific. In the current scenario of global economic recession, resources are constrained even in the Asia Pacific region. But it is crucial that investment in the fight against HIV/AIDS continues. There is no excuse to decrease health spending, it is critical that gains made in the last eight years especially the progress made in scaling up prevention and treatment are not lost. Advocacy efforts are required at the national and global levels to continue the momentum and resource allocations for health. The Global Fund is currently providing support to 75 percent of those being treated for HIV in Asia. Asian economies even in this period of crisis are showing growth, and there is need for co-investment from multilateral organizations and the private sector.

Interventions have to be prioritized to reach high target groups, also protecting their human rights. More proposals that are dealing with vulnerable communities, IDU's, MSM, Sex-workers needed to achieve Universal Access targets. Legal reforms are necessary in the region that truly protect PLHIV and work towards removing legislations that blocks universal access by criminalizing the lifestyles of vulnerable groups. Civil society partnerships are essential; communities need to be at the core of policy making, planning and programme delivery. It is vital that civil society organizations have support and funds.

HIV and TB co-infection and drug-resistant forms of tuberculosis present the greatest health challenges in the Asia Pacific. TB kills more people with HIV than any other disease. There is a growing emergence of Multidrug-resistance TB (MDR-TB) in this region; 10 of the 22 highest burden countries are in this region, and only a few cases are getting appropriate treatment. Need for urgent and aggressive scale up for effective interventions for the prevention, treatment and care of TB and MDR-TB in the Asia Pacific. Failure of Asian nations to combat MDR is a threat to global health.

One of the most significant barriers to achieving universal access to HIV-AIDS treatment and prevention is the lack of health infrastructure. In order to achieve universal access to comprehensive HIV prevention, treatment, care and support services; drastically cut maternal and child mortality; and achieve the other health-related Millennium Development Goals by 2010, strong health systems are essential. To strengthen and build sustainable health systems, long term commitments are required from all stakeholders in the Asia Pacific region. Ratu Joni Madraiwiwi, member of the Solomon Island Truth and Reconciliation Commission, believes that "to achieve universal access we must be rid of prejudice, engage civil society more, be culturally sensitive and have political commitment".

Purnima Mane, Deputy Executive Director of the United Nations Populations Fund (UNFPA) stressed that the report of the independent Commission on AIDS in Asia published earlier this year found that it is vital that national responses are evidence-based and bring services to where it is most needed. Interventions are needed in marginalized groups – these include men who have sex with men, people who inject drugs, sex workers and their clients. Access to Sexual and Reproductive health services and information needs to be provided to youth and women living with HIV. Stating the slogan 'Nothing About Us Without Us', it is imperative that civil society be involved at each and every process in policy making and delivery on national programmes.

Online at: http://healthdev.net/site/post.php?s=5718

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11. ICAAP 2009: Break the silence on HIV - hepatitis C coinfection

"REFUSAL TO RECOGNIZE AND TREAT HIV-HEPATITIS C CO-INFECTION DAMPENS OPTIMISM ON UNIVERSAL ACCESS AT 9TH ICAAP"

Bali, 12 August 2009: Activists, drug users, people living with HIV from the Asia Pacific are calling on governments and international organizations to break the silence on HIV and Hepatitis C co-infection (HCV).

Hepatitis-C being (HCV) a blood borne virus is becoming an increasing public health emergency for drug users as it gets transmitted through sharing of not only needles and syringes but also other injecting paraphernalia. In the era of HAART, many People living with HIV and HCV coinfection are dying of HCV related complications rather than of HIV.

Speaking of his own experience in trying to access HCV treatment, Nanao Haobam of the Asia Pacific Network of People living with HIV (APN+) said, "Almost every month my friends are dying and just in the last two months, five of them have lost their battle with Hepatitis-C. Now, my doctor wants me to start on the treatment but it will cost me 1500 USD per month. Where do I get that money?"  

According to the WHO, globally 4 - 5 million people living with HIV are co-infected with Hepatitis-C.  

Shiba Phurailatpam of APN+ said that "despite increasing cases of HCV co-infections, governments are refusing to recognize the severity of the problem.  HCV counseling and testing must be offered free of cost through the HIV treatment programs of all governments."

Currently with no programs and interventions targeting Hepatitis C, the issue is bound to increase manifold.  Some of the current regimens for HIV are hard on the liver and need to be changed to alternative drug regimens. The current HIV prevention, Care and support programs can easily incorporate HCV related awareness, counseling, testing and Treatment literacy services without much extra cost.

Dr. Andrijansjah Ariefin from Indonesia said, "HIV and hepatitis C co-infection must be on the agenda of all stakeholders – from the government to donors."

As with ARVs, the high cost of Hepatitis-C medicine (pegylated interferon) is a major barrier in accessing treatment. "As a group working with drug users who are facing the dual challenge of HIV and hepatitis-C, we are opposing the patent on pegylated interferon in India. This is as much a concern for the HIV movement and we hope for their support on this," said Eldred Tellis of Sankalp Rehabilitation Trust in India.

"The World AIDS Campaign is very concerned with the lack of attention to this issue which is threatening to become a crisis for PLHIV co-infected with hepatitis-C. We fully endorse and support all initiatives from the community that will raise the awareness and Access to treatment for Hepatitis C," said Greg Gray, World AIDS Campaign's Key campaign Coordinator.

As we move towards achieving Universal Access, People living with HIV and HCV coinfection seem to be fighting a losing battle and question if Universal Access will be achieved when thousands of PLHIV would have died from HCV related complications.

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