African LGBTI People Demand a Strong Response to AIDS

For Immediate Release, December 5, 2008
Media Contact: Hossein Alizadeh, 212-430-6016, halizadeh@iglhrc.org

Dakar, December 5, 2008- A group of lesbian, gay, bisexual, transgender and intersex (LGBTI) people from more than 25 African countries has demanded an urgent response to the HIV pandemic affecting their communities. At a pre-conference held 3 days before the start of the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), delegates voiced concern about various human rights violations experienced by LGBTI people in Africa and the diaspora. These included socio-political exclusions related to HIV/AIDS, sexually transmitted infections (STIs), access to adequate health services and other related issues.

Men who have sex with men (MSM) in Africa are nine times more likely to be HIV positive than their heterosexual counterparts. In Dakar, Senegal where the ICASA conference is being held, the prevalence of HIV infection among MSM is 21% versus less than 1% for the total population. "The deliberate refusal to address the needs of men who have sex with men in Africa or anywhere in the world will never help us end the spread of AIDS," said Paula Ettelbrick, Executive Director of the International Gay and Lesbian Human Rights Commission (IGLHRC), which organized the pre-conference, "The refusal to treat the health needs of this population blatantly defies the human rights obligations incumbent on states."

Despite the theme of this year's ICASA, "Africa's Response: Face the facts," there are still few prevention programs targeting sexual minorities on the African continent. Only seven African countries have included MSM in their national plans for AIDS prevention, and among these countries only South Africa has made the commitment to include women who have sex with women as part of its response to addressing the HIV/AIDS pandemic. According to Fikile Vilakazi, Director of the Coalition of African Lesbians, "the gendered nature of the limited interventions seeking to address LGBTI people's needs on the African continent aggravates the situation even further."

More than two-thirds of African nations still explicitly criminalize same-sex conduct. The East African nation of Burundi recently passed a bill that moves the country closer to adopting a new sodomy law. The United Nations Human Rights Committee, UNAIDS, the Global Fund for AIDS, Malaria and Tuberculosis and other key organizations have made clear that laws against homosexuality fuel the spread of HIV.

"Same-sex practicing people have always been excluded from major African policy meetings because of homophobia," said Joel Nana, IGLHRC's Program Associate for Southern and West Africa, "We are invisible when serious matters such as HIV are concerned."
Workshop participants will attend the ICASA conference, where they will submit their concerns to international donors, national organizations dealing with HIV/AIDS, and African governments, which have thus far failed to respond to the challenges of HIV/AIDS among sexual minorities.

Issued by:
International Gay and Lesbian Human Rights Commission (IGLHRC)
Behind the Mask (BTM)
Coalition of African Lesbians (CAL)
Alternatives-Cameroun
Gay and Lesbian Coalition of Kenya (GALCK)
Aids Project of the East Bay (APEB)
Center for the Right to Health (CRH)
Lesbians, Gays and Bisexuals of Botswana (LEGABIBO)
Sexual Minorities of Uganda (SMUG)
Arc-en-ciel Plus
African HIV Policy Network
OUT-Well Being

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The International Gay and Lesbian Human Rights Commission (IGLHRC) is a leading human rights organization solely devoted to improving the rights of people around the world who are targeted for imprisonment, abuse or death because of their sexuality, gender identity or HIV/AIDS status. IGLHRC addresses human rights violations by partnering with and supporting activists in countries around the world, monitoring and documenting human rights abuses, engaging offending governments, and educating international human rights officials. A non-profit, non-governmental organization, IGLHRC is based in New York, with offices in Cape Town and Buenos Aires. Visit http://www.iglhrc.org for more information

Figures of AIDS related deaths

Ministry of Health

AIDS cases and deaths

The total number of reported cases of AIDS in Jamaica between January 1982 and December 2007 is 12,520.
The total number of reported AIDS deaths in Jamaica between January 1982 and December 2007 is 6,993.

In July 2005, the national HIV/STI program began monitoring cases of advanced HIV to reflect the need for treatment at an earlier stage of disease. Persons with advanced HIV include persons with CD4 count < 350. Figures reported for AIDS cases between July 2005 and December 2007 include persons with advanced HIV.

In 2007, one thousand one hundred and four persons with advanced HIV (595 males and 509 females) were reported compared to 1,186 in 2006. Of these1104 persons, seven hundred and eighty-one (781) persons were diagnosed with AIDS compared to 1,112 persons in 2004. This represents a 30% decline in AIDS cases and is largely due to an increased access to treatment.
The number of AIDS deaths has also decreased with three hundred and twenty (320) AIDS deaths (201 males and 119 females) reported in 2007 compared to 514 in 2005 (Figure 1).

A decrease in AIDS deaths and cases is attributed to the introduction of public access to antiretroviral treatment in 2004, prophylaxis against opportunistic infections and improved laboratory capacity to conduct investigations such as CD4 counts, viral load and PCRs. These factors have resulted in a general improved quality of care.

Among reported male AIDS cases on whom data about sexual practices are available,
homosexual or bisexual activity is reported by 14% of men. However, the sexual practice of
42% of men with AIDS is unknown. This is due to inadequate investigation and reporting of
cases as well as unwillingness of cases to reveal their sexual orientation.

R U at risk for HIV??
Take the HIV/STI RISK ASSESSMENT Quiz

1. Do you use a condom correctly everytime you have sex? Y/N

2. Are you absolutely sure that you did not get a sexually transmitted infection during your last sex act? Y/N

3. Do you know your HIV status? Y/N

4. Do you know your partner’s HIV status? Y/N

5. Do you know for sure whether your partner is having or has had sex with only you? Y/N

6. Can you always convince your partner to use either the male or female condom every time you have sex? Y/N

7. Did you take an HIV test recently? Y/N

If you answered no to any one of these questions, you could be at risk for HIV or another Sexually Transmitted Infection. For more information call the HIV/STD Helpline at 967-3830/3764 or toll free 1-888-991-4444.

Sexual Encounters With Undetectable HIV-Positive Men

By Daniel S. Berger, M.D.

Many HIV experts have recently become embroiled in a new controversy: Does an undetectable viral load translate to significant reduction in HIV transmission during sex? If so, are condoms necessary? What message should be imparted by physicians to their patients who confront this situation in their daily lives?

In January 2008, an important and prestigious panel of experts from the Swiss Federal Commission for HIV/AIDS boldly produced the first-ever consensus statement saying that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. This opinion was also published in the Bulletin of Swiss Medicine (Bulletin des médecins suisses). Hotly discussed at the International AIDS conference in Mexico City this summer, it was soon followed by a rejection statement by a joint Australasian group of experts.

The members and authors of the Swiss Federal Commission for HIV/AIDS are made up of the most reputable Swiss HIV experts, including professor Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV/AIDS, and professor Bernard Hirschel from Geneva University. Their opinion was based on a review of the medical literature and extensive discussion. They concluded with this statement: "An HIV-infected person on antiretroviral therapy with completely suppressed viremia ('effective ART') is not sexually infectious, i.e. cannot transmit HIV through sexual contact." The Swiss also considered study data from Rakai, Uganda, where no transmission event occurred in individuals who had viral loads lower than 1,500 copies/ml, although this was a relatively small study.

In laymen's terms, this means that barebacking among HIV-infected persons who are on the cocktail who have undetectable viral load, would not transmit HIV to their partners.

However, the Australasian group soon rejected the Swiss expert consensus and responded that condom use and effective treatment of STIs is the only way to prevent HIV spread. They went further to suggest that there could be a fourfold rise in transmission if condom use is left awry. They based this on a mathematical model that utilized published data estimating relationships between viral load and HIV transmission risks; they also assumed that transmission does occur at all viral load levels, regardless of how low they may be. Without true data, many question the utility of using mathematical models to form factual declarations. One doesn't forget the mathematical model that was used by Dr. David Ho to regrettably forecast HIV eradication in patients who were at undetectable levels of HIV on treatment. HIV latency was not well understood at that time.

With these two differing opinions at hand, a more balanced editorial commentary which was more practical emerged from the UK. Drs. Geoffrey P. Garnett and Brian Gazzard state that ignoring the effect of undetectable viral load would be dishonest. They welcomed the Swiss statement for having opened up the discussion to where we can further suggest to patients to consider HIV treatment and urge better adherence. This may promote a reduction in the risks for HIV transmissions and other infections.


Past and Present
Sexual behavior has been an evolution throughout the AIDS epidemic. During the first years of the HIV epidemic, without the knowledge of how HIV transmission occurred, most gay men continued to have unprotected sex. Without a clear dissemination of information, there was little caution during sex. Places such as bathhouses were a booming business. Eventually, as the AIDS epidemic progressed, individuals were in fear of contracting the virus and practiced safe or safer sex. "Safe sex" became a household term. HIV was at that time an incurable, progressive disease. Thus bathhouses were closed in various cities such as New York and San Francisco, and clientele dropped sharply since bathhouses were felt to be a reservoir for HIV transmission.

Real progress finally occurred in the field of HIV treatment with the arrival of the "cocktail" and soon coincided with many patients achieving undetectable levels of virus. The practice of safe sex was still heavily promoted. But this eventually led to a "safe sex fatigue," especially since HIV infection was no longer viewed as a "death sentence." Not safe sex but safe sex fatigue (which I am coining here) has become the pervasive attitude. In the real world, many patients admit that condoms hamper spontaneity during sex and have become too much of an inconvenience, not to mention the resulting reduction or loss in pleasurable sensations during anal intercourse, for some individuals. Not uncommonly, condoms are also a "turn off" and cause some individuals to lose their erections.

Not confronting safe sex, too many HIV-positive individuals avoid having the "conversation" about their HIV status. They've grown tired of feeling the need to re-assure their negative partners about reduced transmission. There's already been the consensus in the men-having-sex-with-men (MSM) community that undetectable patients only remotely pose risk for HIV seroconversion. Also, oral sex has never been considered to be of significant HIV risk nor has it ever been adequately proven to cause HIV seroconversion. However, a common solution for HIV-positive men had been to act as the receptor of anal intercourse or "bottom" for someone HIV-negative, thereby further limiting exposure to their partner.

It is unfortunate that MSMs avoid discussing HIV status during first sexual encounters. One would expect that encountering HIV-positive men within the gay community is not uncommon. It should be a positive experience for a partner to disclose their status and have a reasonable discussion. In particular situations, it's usually a relief to both partners when discovering what they're each dealing with. If it is revealed that both partners are HIV-positive, it's a tremendous relief and stress reducer for both. Alternatively, if only one partner is positive, it opens a conversation about harm reduction during sex. The absolute worst that can happen is that a negative person does not want to proceed with the situation and thus neither need waste the other's time. HIV status is a personal issue, but individuals should all act responsibly without being inhibited about disclosure from the start.


Undetectable Viral Loads and Transmission
The Swiss expert statement had been originally downplayed in the media for fear of encouraging more unsafe sex. One applauds the Swiss for encouraging individuals to get tested and begin effective treatment, thereby slowing the transmission of the virus within the community. The Swiss statement and referenced studies, however, were also criticized due to being heterosexually based and debated as to its application to the MSM population or gay community. But it also generated irrational fear that HIV transmission would get out of control.

Hence the Australasian rejection and conclusion of only the strict use of condoms plus early treatment of STIs being the only means to reduce transmission of HIV. However this continues to beg for further debate. It is fruitless to ignore that effective antiretroviral therapy eliminates HIV from genital secretions, and that HIV RNA, measured in sperm, declines below the limits of detection on antiretroviral therapy. HIV RNA also falls below the detection limits in female genital secretions during effective antiretroviral therapy. Moreover, usually sperm cell viral particles rise only after an increase in viral load from the blood. The cell-associated viral gene particles, present in genital secretions during effective antiretroviral therapy, are actually non-infectious virions; HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA.

Thus it's logical to abstract that less virus (undetectable) translates to less ability to transmit HIV to others. There can never be a prospectively conducted ethical study since one can't ask HIV-negative individuals to participate in having unprotected sex with undetectable positives. However, patients infected with hep C are usually not undetectable and can also transmit hepatitis C sexually. Thus, unsafe sex, although protective for HIV if the partners are undetectable, does not protect against hepatitis C or syphilis.


Harm Reduction
Let us reconcile ourselves to the widespread existence of safe sex fatigue. While many HIV-positive men abandon safe sex, some do this while engaging themselves primarily with other HIV-positive men. Incomprehensibly, many HIV-negative gay men have accepted the idea that they'll eventually seroconvert to HIV and thus avoid safe sex.

Addiction has also had a major impact on behavior. Methamphetamine addiction often results in irrational and relentless search for lust and sex with multiple partners by means of higher risk behavior. It is also associated with HIV seroconversions; other STIs while using is also associated with non-adherence to antiviral treatment. As a physician engaged in the research and treatment of HIV infection within the MSM community, I have observed a burgeoning epidemic of increasing HIV, hepatitis C, syphilis, and MRSA (resistant staphylococcal) infections.

Individuals who take extra precautions are always better off. Once becoming HIV and/or hepatitis C infected, there are tough consequences to face. Sexually active men should be responsible and have frequent HIV, hepatitis, and STI testing. Anal warts should be treated quickly to discourage the transmission of HPV. Anal Pap smears should be done when indicated. Finally, vaccination for HPV in gay men as a preventative step against development of anal cancer should be studied. At Northstar Healthcare in Chicago, Gardasil, the HPV vaccine, is currently offered to patients for this reason but is pending further study. HPV is the cause of anal cancer (and anal warts) and is a quickly rising problem among HIV-infected individuals.


Conclusion
Sexually active HIV-positive individuals are better off knowing their status and undergoing effective treatment and therefore reducing HIV transmission. Although HIV transmission has been curtailed among individuals who are undetectable and barebacking may be considered safe in some situations, there is still the prevalence of hepatitis C, syphilis, and resistant staph infection. On the other hand, HIV-positive persons in stable relationships with HIV-negatives, or individuals who understand the importance of adherence to HIV treatment while getting frequent STD (sexually transmitted disease) screening may provide effective harm reduction. Still, condoms should always be considered when sexually interacting with unknown partners.

Dr. Daniel Berger is a leading HIV specialist in the U.S. and is Clinical Associate Professor of Medicine at the University of Illinois at Chicago. He is the founder and medical director of Northstar Medical Center, the largest private HIV treatment and research center in the Greater Chicago area. Dr. Berger has published extensively in such prestigious journals as The Lancet and the New England Journal of Medicine and serves on the Medical Issues Committee for the Illinois AIDS Drug Assistance Program and the AIDS Foundation of Chicago. Dr. Berger has been honored by Test Positive Aware Network with the Charles E Clifton Leadership Award. Dr. Berger can be reached at DSBergerMD@aol.com.

Lightbourne promises improvements to justice system

WE HAVE HEARD THAT B4

JUSTICE Minister Dorothy Lightbourne has promised increases in the number of judges in the Supreme and appellate courts, courtrooms and paralegals to allow for speedier trials.

Lightbourne, who was speaking at a human rights public forum Tuesday at the Knutsford Court Hotel in St Andrew, said provisions have been made to increase the number of judges in the Supreme Court from 26 to 40 and appeal court judges from six to 12, including the president.

She said three temporary courtrooms have also been established for the Supreme Court, while the number of judges in the Resident Magistrate's Courts had also been increased by eight and that trained court reporters were being deployed on a timely basis.

"To date, one set of four courtrooms at the Supreme Court has been completed with trained court reporters. What this means is that as of this term, the judges in the criminal division who preside in these courtrooms have been able to have real-time access to the notes of evidence," Lightbourne said.

At present, most judges take their own notes by hand during trials which result in cases being dragged out for long periods. To save time, cases in the Resident Magistrate's Courts will soon be recorded and transcribed via a newly acquired software, Lightbourne explained.

Modern computer software is also expected to be introduced in the higher courts to modernise the current laborious tasks of record-keeping and file management.

Lightbourne also said the courts were being refurbished to allow for easier access for disabled persons. She said the Supreme Court in Kingston and the Cambridge Resident Magistrate Court in St James already had wheelchair ramps and elevators.

"We have also installed elevators in the Supreme Court, thereby facilitating greater access to persons facing physical challenges," Lightbourne said.

She said the Office of the Director of Public Prosecutions, the Justice Training Institute and the Jamaica Constabulary Force would also benefit from new technologies as the state moves to revamp the justice system.

Tuesday's forum was a joint effort by the Inter American Commission on Human Rights, Jamaicans For Justice and the Justice Ministry.

Press release by the Women Won't Wait Campaign for the World AIDS Day

World AIDS Day, Cape Town, 1 December 2008

As women around the world celebrate the international 16 Days of Activism Against Gender Violence, the Women Won’t Wait. End HIV and Violence Against Women. Now (WWW) Campaign today expressed concern at the alarming trend of governments criminalizing HIV exposure and transmission worldwide. More than 58 countries worldwide have laws that criminalize HIV transmission and/or exposure or use existing laws to prosecute HIV positive people for supposed transmission of the virus, with another 33 countries considering similar legislation.

The campaign noted that the trend to criminalise HIV transmission and exposure is short-sighted, ineffective and in violation of human rights. Further, it will undermine global AIDS prevention, treatment and care efforts.

According to Neelanjana Mukhia of ActionAid, the secretariat of the Women Won’t Wait campaign, laws that criminalize exposure and transmission compound women’s risk to violence. Women are likely to know their status first, as a result of their interface with prenatal and antenatal health services. Women’s ability to safely disclose their status and adhere to treatment is already severely limited by the threat of violence from their intimate partners and/or families. The threat of prosecution by the state will only increase their inability to manage their health and well being. We are very concerned that such laws will only result in disproportionate targeting and prosecuting of women for the spread of HIV/AIDS.

Secondly, existing stigma and discrimination HIV positive men and women face is likely to be reinforced by these laws making access to HIV prevention, testing and counselling and treatment services even more difficult.

Thirdly, women and men in sex work will be at even greater threat, especially in countries which criminalise sex work. According to Meena Seshu of SANGRAM, a member of the campaign in India, the law to criminalise HIV transmission and exposure will be sure to increase stigma and rights violations sex workers already face. This law has the potential to threaten or even reverse gains made to secure sex workers rights and their access to HIV services.

Finally, in some countries which have passed the law, women can be prosecuted for mother to child transmission of HIV. This is particularly outrageous when globally prevention of mother to child transmission coverage is only at 33%. In resource poor settings, criminalization puts the blame solely on the woman for transmission that she may be unable to prevent due to dismally poor PMTCT coverage. .

“Criminalization does nothing to address the real problem which is women’s overall lack of power in society. As a campaign we have said over and over again, there is no magic bullet or quick fix to address the growing pandemics. We already know that programs that address the rights of women and girls work. Instead of considering and passing ineffective laws, we call on governments to fulfil their longstanding and legally binding commitments to end violence against women and support survivors of violence. ” says Alessandra Nilo of Gestos, a member of the campaign in Brazil.
“At this point of our efforts to address HIV and AIDS, we have already learnt so much. We already know what works are interventions that uphold and advance human rights, generally and women’s rights specifically. We are asking governments especially in Africa to fulfil their responsibility to end the two intersecting epidemics. We are also asking them to stop couching these draconian laws as efforts to address violence against women, instead resource and implement laws that indeed respect, protect and fulfil women’s human right to be free of violence. ”says Christine Butegwa from Akina Mama wa Afrika, a member of the campaign in Uganda.


The WWW campaign adds that what is really needed is to channel more resources into strengthening efforts that address the driving force of the HIV&AIDS pandemic – gender inequality and violence against women. This includes increasing current funding for programmes that integrally address issues of violence, stigma, and discrimination that fuel this epidemic or we will continue to lose ground.

The use of criminal law to address HIV infection is inappropriate, ineffective and likely to undermine HIV prevention, treatment, care and support efforts and increase women’s risk to violence. All societies in the world should say no to this law.

The END--

The Women Wont Wait campaign is an international coalition of organizations and networks working to promote women's health and human rights in the struggle to address HIV and AIDS and end all forms of violence against women and girls. For more information on the Women Won’t Wait campaign: www.womenwontwait.org
Members of WWW: Action Aid; African Women’s Development and Communications Network (FEMNET); Association for Women’s Rights in Development (AWID); Akina Mama wa Afrika; Center for Women’s Global Leadership (CWGL); Center for Health and Gender Equity (CHANGE); Fundación para Estudio e Investigación de la Mujer (FEIM); GESTOS-Soropositividade, Comunicação & Gênero; International Community of Women Living with HIV&AIDS Southern Africa (ICW-Southern Africa); International Women’s AIDS Caucus; International Women’s Health Coalition (IWHC); Latin American and Caribbean Women’s Health Network; Open Society Initiative for Southern Africa (OSISA); Program on International Health and Human Rights, Harvard School of Public Health; SANGRAM; VAMP; and Women and Law in Southern Africa (WLSA).