UN Response To HIV/AIDS

November 2004
 

 

Young Ambassadors for HIV/AIDS 1

With approximately 35% of all reported AIDS cases in India occurring in the 15-29 age group, it is important to engage young people in the response to HIV/AIDS. Young people are especially vulnerable to infection as sexual activity begins in adolescence for the majority of people and studies from across the globe have established that the vast majority of young people have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease. When equipped with knowledge and skills young people can, however, play a strong role in the response to the epidemic.

Recognizing this, the Parliamentary Forum on HIV/AIDS called a two-day `National Student and Youth Parliament Special Session on HIV/AIDS' bringing together 3,000 student and youth leaders from 600 districts across the country to deliberate and present to the Government their recommendations on a draft law on HIV/AIDS. Representatives of student unions, universities, bodies such as the Nehru Yuva Kendra Sangathan (NYKS), National Service Scheme (NSS), and rural youth participated in the event.

The youth gathering, held in New Delhi from November 6 to 7, 2004, was organised with support from India's National AIDS Control Organisation (NACO), Ministry of Health and Family Welfare, Ministry of Youth Affairs and Sports, Ministry of Human Resource Development, UNIFEM, UNDP, UNFPA, UNICEF, UNODC, UNESCO, WFP, ILO, UNHCR, WHO, World Bank, DFID, Sida, IAVI and UNAIDS. Civil society organisations including the Lawyers' Collective, Population Foundation of India, Indian Network for People living with HIV/AIDS and Mamta were also involved in the Youth Convention.

On 6 November the 3,000 young people assembled in Vigyan Bhawan to discuss issues of HIV/AIDS and deliberate on the role of young people in the response to HIV/AIDS. On 7 November the Youth Parliament was inaugurated by Hon'ble Prime Minister Dr. Manmohan Singh, Executive Director, UNAIDS, Dr. Peter Piot, Hon'ble Minister of Health and Family Welfare, Shri Anbumani Ramadoss, Hon'ble Vice President of India, Shri Bhairon Singh Shekhawat and Convenor Parliamentary Forum on HIV/AIDS, Shri Oscar Fernandes. 543 selected young people acted as MPs in a Mock Parliament and had intensive discussions on HIV/AIDS related issues. They went through question hour, zero hour, call attention motion, short duration discussion before they unanimously adopted a Bill to prevent and control the HIV/AIDS epidemic and protect the rights of people living with HIV/AIDS in India.

At the closing session State Youth Forums were formed to take forward the initiative at the state and district level. Among other things the State Youth Forums will replicate the national Youth Parliament and engage young people in the discussion on HIV/AIDS at the state level. Furthermore, the forums in partnership with NYKS, district collectors and youth leaders are planning activities at the district level for World AIDS Day.

"We have organised this event to enable the students and youth representatives to have a national debate on the legislation on AIDS. The involvement of young people in framing the law is critical."

— Oscar Fernandes, Convenor, Parliamentary Forum on HIV/AIDS

 

Reproductive Health and Prevention of HIV/AIDS in UNFPA Programme  2

The Programme of Action endorsed during the Cairo conference in 1994, articulated a dramatically new approach to address population issues. Under the rubric of reproductive and sexual health, it called for expansion of existing services to include prevention and management of sexually transmitted infections (STIs), address reproductive and sexual health needs of adolescents and moving away from a narrow fertility control driven programme for a more comprehensive reproductive health programme. Reproductive health programmes serve millions of sexually active women, men and adolescents in developing countries. There is mounting evidence regarding benefits to be accrued by supporting integration of HIV preventive services with mainstream reproductive and child health programme.

Initiatives such as Three by Five (treating 3 million persons by 2005) and interventions to promote access for anti-retroviral therapy (ART) has raised concerns about simultaneously expanding prevention efforts alongside with care and treatment. Clearly in the absence of strong prevention interventions to check the transmission of diseases, which is predominantly through sexual routes, treatment services will be unable to keep pace with number of people who need treatment.

UNFPA's 6th Country Programme supports interventions for the prevention of HIV/AIDS through health systems. In the Integrated Population and Development Projects, reproductive health interventions such as enhancing access to quality contraceptive services, increasing the unmet need for Emergency Obstetric Care, establishing quality assurance systems, support for community empowerment and adolescent reproductive health. It is envisaged that these intentions will help in enhancing access and improving quality of services leading to client satisfaction.

HIV prevention services included in the Integrated Population and Development projects include public education on causation, transmission and prevention of HIV/AIDS through mass media campaign, behaviour change communication, risk reduction counselling and condom provision,voluntary counselling and testing centres (VCTC), case management and referral of RTIs and STIs etc.

Set of activities to promote adolescent reproductive and sexual health such as life skills education, prevention of gender based violence and organising demand side with special reference to reduction of vulnerability for young women will also result in synergy in interventions to achieve established programme outputs.

Adolescents and youth are at high risk of STIs and HIV, as well as unwanted pregnancies as many do not have access to clinical reproductive health services. In many settings adolescents and youth feel unwelcome, embarrassed or apprehensive about privacy and confidentiality. UNFPA programme supports interventions to create conducive environment in community through engaging gate keepers and supporting interventions for increasing access to adolescents for clinical services.

Given the fact that there is "culture of silence" with respect to treatment seeking behaviour for common reproductive tract infections and sexually transmitted infections and only a fraction of people at risk of HIV exposure in resource poor settings have meaningful access to basic prevention services, strengthening reproductive health services would offer a window of opportunity. Community based contraceptive distribution programmes in the UNFPA supported IPD projects are designed with the objective of increasing access to HIV preventive education, risk reduction counseling and promotion of condoms as a method of dual protection.

Most women and men come in contact with health care systems either through clinical settings or community based interventions. Majority of women in rural areas at least make one visit during pregnancy to seek clinical care services. Similarly there is opportunity to offer HIV prevention services for family planning clients especially services eg VCT. UNFPA in India has supported pilot interventions for integration of VCT in Reproductive Health services at two sites. The results from pilots indicate encouraging results on feasibility of such an approach in public systems.

Steeping up interventions for prevention of HIV /AIDS through reproductive health services appears to be cost effective strategy. The provider's knowledge and skills for counselling, similar logistics systems and follow up mechanisms provide a sound basis for integration.

 

UNHCR Response to HIV/AIDS  3

The UN refugee agency has become the latest co-sponsor of UNAIDS, a collaboration that will help UNHCR include refugees in their host country's HIV/AIDS programmes, and enable UNAIDS to reach out to marginalized people especially in complex emergencies.

The UN High Commissioner for Refugees Ruud Lubbers and UNAIDS Executive Director Peter Piot signed a memorandum of understanding on 24 June 2004, that made UNHCR the 10th co-sponsor of UNAIDS, in addition to agencies like the World Health Organisation, the World Food Programme and the World Bank.

This move will broaden and strengthen the UN's response to the global AIDS epidemic.

"By becoming a co-sponsor, UNHCR will be able to advocate more effectively to include and integrate refugees into host countries' HIV policies and programmes," said Lubbers, noting that refugees have traditionally been excluded from such plans. "It will also contribute to reducing the stigma and discrimination of HIV often directed towards refugees."

He added that the refugee agency is in a unique position to contribute as it has substantial ongoing HIV/AIDS programmes and logistics in place to reach refugees as well as the surrounding host communities, which are often located in remote areas.

"UNHCR's added value is in its vast experience and active presence in many of the world's conflict zones, reaching out to the poor and neglected in areas ravaged by war, upheaval and AIDS," said UNAIDS in a press statement. "Its expertise is invaluable in developing and managing responses to the epidemic in complex humanitarian situations."

Over last two years, UNHCR's HIV/AIDS programmes have improved and become more comprehensive in areas like voluntary counselling and testing, as well as the prevention of mother-to-child transmission. In 2003, the agency conducted over 15 assessment and evaluation missions in 11 countries, which resulted in significant additional funding to improve their HIV programmes.

At its headquarters in Geneva, UNHCR has set up an HIV unit with two technical experts. This is in addition to regional coordinators in Africa, which has the highest HIV/AIDS prevalence rates and hosts the second-largest refugee population globally. Similar regional coordinators are planned in Asia in early 2005.

In India, UNHCR works through an NGO—implementing partner, the Voluntary Health Association of Delhi (VHAD) on AIDS awareness. VHAD is responsible for UNHCR's health programme for refugees in New Delhi. Raising awareness on HIV/AIDS through talks/workshops etc. is an integral part of the programme.

Refugees have access to voluntary testing and those living with the virus and their dependents to subsistence/medical and counselling support.

Among other challenges, UNHCR has learnt that social and cultural traditions that sustain gender inequalities can compound the problem of HIV/AIDS in refugee camps. It is working to ensure that gender-sensitive measures are adopted to prevent the spread of the disease and provide support for those living with it.

UNHCR also recognises the need to debunk the myth that refugees bring HIV/AIDS to their host communities. Recent studies reveal a lower prevalence of the disease in refugee camps compared to local communities living in the same area.

Even though the prevalence of HIV in refugee populations is often lower than in the surrounding host community, refugees are at risk of infection as they are a vulnerable population and can be exposed to sexual violence because of conflict. UNHCR considers HIV prevention an essential component of its overall protection of refugees.

"Protection and advocacy are essential elements to combat the rampant HIV discrimination and stigma that is often directed at refugees," said High Commissioner Lubbers. "Lessons from the repatriation of Angolan refugees have shown that a proactive approach is needed to convince governments and donors that refugees often have a lower HIV prevalence than their host populations and have much to offer when they return home."

UNHCR had been working with UNAIDS even before the co-sponsorship, producing tools and guidelines for coordinated action in regional crises like in the Great Lakes and Horn of Africa. The partnership will no doubt deepen with the co-sponsorship, as UNHCR benefits from the technical expertise and resources of UNAIDS and other co-sponsors.