ASEAN urged to prioritize HIV/AIDS prevention, treatment and care June 29, 2006Posted by lagablab in hiv/aids.
The next ASEAN Summit will be held in Cebu, Philippines, on the first week of December this year, and here the heads of governments and states of Southeast will sign a new Declaration on HIV/AIDS. The latest Declaration on HIV/AIDS was signed in Brunei Darrusalam on November 5, 2001.
A Work Programme supposedly gives flesh to these Declarations by putting down in paper specific commitments on HIV/AIDS made by ASEAN Member Countries. The ASEAN commitment on HIV/AIDS, based on the Brunei Declaration and its Work Programme, was ambitious; unfortunately, as noted by the Coalition of Asia Pacific Regional Networks on HIV/AIDS (also known as the7Sisters), it was not translated into effective national programs on HIV/AIDS. What makes it alarming is that the last Work Programme precluded effective and evidence-based interventions for vulnerable communities, i.e., men who have sex with men (MSMs), transgenders, drug users, sex workers, migrants and mobile populations.
In the Philippines, where the prevalence of HIV infection is considered ‘low and slow’, the laidback attitude of most ASEAN governments in dealing with the virus is evident. The government relies on the work being done by civil society groups, with the support international institutions like UNAIDS and other donors. The little that the government does to address the issue of HIV/AIDS prevention, treatment and care goes to faith-oriented programs. It is quite likely, for instance, for the government to allocate resources to support Couples for Christ’s campaign for abstinence than supporting efforts to encourage the use of condoms and lubricants among gay men or men who have sex with men.
The ASEAN Secretariat in Jakarta, Indonesia had a consultation with 7Sisters last month and the coalition issued a statement on ASEAN’s HIV/AIDS program. 7Sisters is composed of Asia Pacific Network of People Living with HIV/AIDS (APN+), Asia Pacific Network of Sex Workers (APNSW), Asia Pacific Rainbow (APR-LGBTIQ Network), Coordination of Action Research on AIDS and Mobility in Asia (CARAM-Asia), Asian Harm Reduction Network (AHRN), Asia Pacific Council of AIDS Service Organisations (APCASO) and AIDS Society of Asia Pacific (ASAP).
Several members of LAGABLAB sit in the Advisory Council and Executive Committee of the Asia-Pacific Rainbow.
7 Sisters Statement on the 2nd Special Session on HIV/AIDS of the ASEAN Summit on December 2006
The Coalition of Asia Pacific Regional Networks on HIV/AIDS (also known as the Seven Sisters) is a broad-based alliance of seven regional networks representing and working with communities vulnerable to HIV/AIDS.
The Coalition is pleased to continue its engagement with the ASEAN Initiative on HIV/AIDS. We take this opportunity to reflect, and more importantly, to put forward our recommendations and inputs to the Second Special Summit on HIV/AIDS.
We acknowledge the efforts undertaken by the ASEAN to carry out a regional response to HIV/AIDS, as signified in the ASEAN Summit Declaration on HIV/AIDS, signed by State/Government leaders at the ASEAN Special Session on HIV/AIDS held in Brunei Darussalam in November 2001. This pioneering initiative in the Asia-Pacific region bore witness to the commitment of Heads of Governments/ States to mitigate the impact of HIV/AIDS.
While there is recognition that HIV/AIDS is a regional problem, the review of the ASEAN Work Programme II reflects that the actions undertaken have not achieved many of the objectives. Evidence and direct experiences of people living with HIV/AIDS (PLWHIV) and vulnerable communities in the last five years illustrate that the commitments made by the leaders in Brunei have not resulted in the reduction of the spread of HIV and mitigation of impact on those infected and affected. This is a clear illustration that the commitments have not been translated into effective national programmes on HIV/AIDS.
The populations of ASEAN countries, particularly those coming from vulnerable communities such as men having sex with men, transgenders, drug users, sex workers, migrants and mobile populations, among others, are more at risk than ever. While we have seen government leaders who have moved forward and proactively undertaken responses to critical issues related to HIV/AIDS, such as harm reduction initiatives for drug users, we have also seen leaders who contradicted their commitments and promoted policies and practices that are misguided, misinformed and not based on evidence, such as abstinence only approaches, resulting in maintained and/or increasing HIV prevalence rates.
Governments have not instituted adequate mechanisms to resolve denial, stigma, discrimination and criminalization of these vulnerable communities. Until today, only two ASEAN member states have legislation specifically addressing HIV/AIDS. Current interventions and policies often lack grounding on principles of gender equity, human rights and greater involvement of people infected with and affected by HIV/AIDS.
While various stakeholders have made pronouncements and calls to involve civil society, vulnerable communities and people living with HIV, the processes, mechanisms or structures to enable this involvement have been inadequate and limited. This has constrained our capacity to be meaningfully involved in interventions and responses to HIV/AIDS.
Resources for HIV/AIDS programmes in the region have been woefully insufficient and mostly externally sourced, with governments allocating inadequate or decreasing internal resources. Data from UNAIDS show that coverage has remained dismal and scale up of prevention, care, treatment and support services has been limited. In 2004, only 19% of sex workers were covered by outreach prevention programmes, only 5.4% of injecting drug users were receiving HIV services and only 1% of men who have sex with men were covered by HIV prevention programmes. Well under half of people needing antiretroviral (ARV) treatment actually received it in almost all ASEAN countries.
As representatives of civil society organizations and regional networks, we hereby put forward the following recommendations to ASEAN Heads of Governments and States:
I. Political commitment and Advocacy
- Provide leadership and actively participate in National AIDS Committees, where this is not currently the practice;
- Prioritize HIV/AIDS alongside other development and social issues;
- Ensure ample emphasis in policies, resource allocation and programming on containing the epidemic among vulnerable populations including drug users, injecting drug users, men who have sex with men, transgenders, sex workers and their clients, migrants and mobile populations, and indigenous groups;
- Prioritize the sharing of lessons, good practices and policies that worked using evidence-based approaches;
- Ensure that national HIV/AIDS programmes adhere to the principles of GIPA
- Facilitate and enable active and meaningful participation of people living with HIV/AIDS, affected communities and civil society in development, implementation and evaluation of national HIV/AIDS programmes and relevant ASEAN consultations and summits;
- Ensure and sustain the development and implementation of impartial and evidence-based public information campaigns.
- Acknowledge inextricable association of risk behaviour with HIV/AIDS and poverty
II. Human Rights, gender equity and enabling environment
- Protect vulnerable groups and PLWHIV from stigma and discrimination, especially those committed by health care providers, law enforcement agencies and the general public;
- Review national legislation for consistency with evidence-based and internationally recognized principles of Universal Access. This should result in the creation of national comprehensive AIDS policies that decriminalize HIV-associated risk behaviour, improve protection of privacy and confidentiality of PLWHIV and prohibit discrimination on the basis of gender or sexual identity and expression;
- Integrate gender equality and equity across all programme areas, including budget and human resource development. Ensure that women and girls have access to services, information and commodities, e.g. male and female condoms and PMTCT programmes;
- Establish, expand and sustain programmes and services to prevent mother-to-child transmission;
- Support preventive technology research, including vaccines and microbicides;
- Promote and support human rights education of PLWHIV and vulnerable groups. Establish accountability mechanisms that address human rights violations and facilitate access to justice for PLWHIV and vulnerable groups.
III. Sustainable financing and programming
- Prioritize and allocate resources in proportion to epidemiological realities with emphasis on service delivery;
- Develop multi year national AIDS budgets;
- Allocate funding from the national budget for Sexually Transmitted Infection (STI) and HIV/AIDS programming by non-health sectors;
- Immediately implement a regular and detailed cost analysis of expanded national programmes and interventions, including civil society responses;
- Earmark sustainable and long-term funds for civil society including funding for institutional development and strengthening and capacity building for service delivery, research, programme management and networking;
- Lobby donors and financial institutions to provide foreign debt relief.
- Involve and mobilize other relevant regional actors operating in similar or overlapping fields to contribute to and support national and regional action plans on HIV/AIDS.
IV. Human resources, systems and infrastructure
- Develop and expand programmes to train health workers including those working for civil society organisations, needed for supporting scale up of prevention and treatment, with special attention for outreach, community, hospice and home care health workers and providers);
- Appoint competent personnel with technical and managerial capacity to head the National AIDS Programmes with fixed tenure and clear lines of accountability;
- Establish baseline data and surveillance with inclusion of population size estimates, and set national and regional goals for prevention, treatment and care (consistent with UN General Assembly Special Session on HIV (UNGASS) targets, Universal Access targets and Millennium Development Goals (MDG);
- Define Universal Access in a manner which is ‘user friendly’ and easily understandable to stakeholders, and could facilitate political advocacy;
- Share strategies to advocate and support private sector and civil society involvement in responses to the HIV epidemic, and integrate non-discriminatory HIV and AIDS workplace policies among private sector companies working across the region. This requires autonomy and self-determination as well as safe space for civil society organizations to organize, consult, engage and implement programmes;
V. Commodities, services and partnerships
- Establish a regional and global mechanism for price negotiation and cost effective procurement of all HIV related commodities, with special reference to affordability of second generation ARV drugs, paediatric formulations, diagnostic equipment, substitution drugs and clean needles;
- Increase production capacity of generic drug manufacturers within the region by maximizing flexibilities under the Trade-Related Intellectual Property Rights (TRIPS) Agreement to produce cheap drugs for life threatening diseases. Ensure equitable access by vulnerable populations to these drugs;
- Secure high coverage of prevention, care and support services for vulnerable groups such as drug users, injecting drug users, men who have sex with men, transgender, sex workers and their clients, migrants and mobile populations, and indigenous groups through involvement of civil society organisations representing and/or working with these groups;
- Expand the provision of voluntary counselling and testing (VCT) and referral services through health care settings and community networks.
We also call on the ASEAN to:
- Create regional-level technical support facilities to support national and local programmes;
- Develop mechanisms that ensure compliance to regional and international commitments on HIV/AIDS;
- Establish independent monitoring bodies (‘AIDS Watch’) to monitor government and civil society commitments and performance on STI and HIV/AIDS, human rights violations against PLWHIV and vulnerable groups;
- Ensure South-South collaboration between member states on the provision of services to migrants and mobile populations, including VCT, treatment and care services;
- Institutionalize multi-sectoral engagement and buy-in, including that of the private sector;
- Integrate HIV/AIDS principles and strategies in ASEAN Senior Officials on Drugs (ASOD) agenda and programmes.