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Living 2008 Summit

&

XVII International AIDS Conference

Universal Action Now

Mexico City August 2008

Silvia Petretti

Community Development Manager

•On July 31st and August 1st

• Nearly 400 HIV-positive people• 88 countries, 5 continents•In Mexico City•To set our strategic agenda for a comprehensive response to the AIDS pandemic.

LIVING 2008

Key advocacy themes:

•Criminal Prosecution of HIV transmission

•Sexual Health and reproductive rights

•ACTS

•Positive prevention

Criminalization of HIV+ people doesn’t work

Positive Prevention won’t work until stigma and discrimination directed against HIV positive people are eradicated, the concept of positive prevention cannot focus on prevention of HIV transmission.

Until HIV positive people, especially women, claim the sovereignty of their sexual and reproductive health lives and have access to comprehensive health care many will continue to needlessly die

Treatment will fail without basic social determinants of health including food and water

KEY CONCLUSIONS

‘The transformative power of the movement of PLWHA plays an vital part in the larger struggle for democracy and social justice’

Peter Piot

Living 2008 OpeningPlenary

Mexico 2008

UNIVERSAL ACTION NOW!

25.000 people!

Total: 33 million (30 – 36 million)

Western & Central Europe

730 000730 000[580 000 – 1.0 million][580 000 – 1.0 million]

Middle East & North Africa

380 000380 000[280 000 – 510 000][280 000 – 510 000]Sub-Saharan Africa

22.0 million22.0 million[20.5 – 23.6 million][20.5 – 23.6 million]

Eastern Europe & Central Asia

1.5 million 1.5 million [1.1 – 1.9 million][1.1 – 1.9 million]

South & South-East Asia

4.2 million4.2 million[3.5 – 5.3 million][3.5 – 5.3 million]Oceania

74 00074 000[66 000 – 93 000][66 000 – 93 000]

North America1.2 million

[760 000 – 2.0 million]

Latin America1.7 million1.7 million

[1.5 – 2.1 million][1.5 – 2.1 million]

East Asia740 000740 000

[480 000 – 1.1 million][480 000 – 1.1 million]Caribbean230 000

[210 000 – 270 000]

Adults and children estimated to be living with HIV, 2007

Estimated number of adults and children newly infected with HIV, 2007

Western & Central Europe

27 00027 000[14 000 – 49 000][14 000 – 49 000]

Middle East & North Africa40 00040 000

[20 000 – 66 000][20 000 – 66 000]Sub-Saharan Africa

1.9 million1.9 million[1.6 – 2.1 million][1.6 – 2.1 million]

Eastern Europe & Central Asia

110 000 110 000 [67 000 – 180 000][67 000 – 180 000]

South & South-East Asia

330 000330 000[150 000 – 590 000][150 000 – 590 000]Oceania

13 00013 000[12 000 – 15 000][12 000 – 15 000]

North America54 000

[9600 – 130 000]

Latin America140 000140 000

[88 000 – 190 000][88 000 – 190 000]

East Asia52 00052 000

[29 000 – 84 000][29 000 – 84 000]Caribbean

20 000[16 000 – 25 000]

Total: 2.7 million (2.2 – 3.2 million)

Over 7400 new HIV infections a day in 2007

• More than 96% are in low and middle income countries

• About 1000 are in children under 15 years of age

• About 6300 are in adults aged 15 years and older of whom:

— almost 50% are among women— about 45% are among young people (15-24)

Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, June 2008

Number of people receiving antiretroviral therapy in low- and middle-income countries 2002-2007

ANTIRETROVIRAL THERAPY COVERAGE IN SUB-SAHARAN AFRICA, 2003-2007

WHO (2008). Towards Universal Access : Scaling up priority HIV/AIDS interventions in the health sector; progress report 2008

Mony Pen

Opening Ceremony

Elena Reynaga

Edwin Cameron

10 Reasons

1. Criminalisation is ineffective

2. Criminal laws and criminal prosecutions are a poor substitute for measures that really protect those at risk

3. Criminalisation victimises, oppresses and endangers women

4. Criminal laws are often unfairly and selectively enforced

5. Criminalisation places blame on one person instead of responsibility on two

10 Reasons

6. Criminal laws targeting HIV are difficult and degrading to apply

7. Many of the laws are extremely poorly drafted

8. Criminalisation increases stigma

9. Criminalisation is a strong disincentive to testing

10. Criminalisation assumes the worst about people with HIV, and so punishes vulnerability

HUMAN RIGHTS

• When condoms are available, when women have the power to use them, when those with HIV or at risk of it can get testing and treatment, when they are not afraid of stigma, ostracism and discrimination, they are far more likely to be able to act consistently for their own safety and that of others

Edwin Cameron

“Those of us who are living with HIV and have come to terms with that diagnosis […] in terms of our own ability to survive the traumas of our diagnosis and daily fight for our rights to existence.

Each and every one of you who live and breath HIV is a leader, people with other health conditions look up to us for inspiration […] Do not give up, when life knocks you flat on your face get on your knees. Stand to your feet hold your head high, and keep going”

Greater involvement of people living with HIV in healthcare

Rolake Odetoyinbo

Infectiousness and treatment

Swiss Statement

•Undetectable Viral Load for at least 6 months

•Excellent adherence

•Regular viral load monitoring

•Monogamous relationship

•No STDS

Discordant couples Can have unprotected sex with a risk comparable to using a condom with a detectable viral load.

ART is comparable to condom use

Partner under HAART

NoneMono- / Bi-

TherapyTriple-therapy

Sex w/o Condom

>1/Mt. <1/Mt. Alwayswith

condom

Castilla, et al. JAIDS 2005; 40:96-101

Infe

ctio

n r

ate

par

tner

s (%

)

Vernazza IAC 2008 3/8/08

What the statement did not say• No advice against using condoms

• No change in prevention messages

Vernazza IAC 2008 3/8/08

The Hierarchy of Transmission Risk..

from ~36-39 Million People with HIV

Established infection (on ART)

Established infection (unrecognized)

Established infection (untreated + STDs)

Acute HIV Infection (only 8 weeks)

INC

RE

AS

ING

RIS

K

2.5 million people2.5 million people

30,000,000 people30,000,000 people

((Fraser et al, PNAS, 2007)Fraser et al, PNAS, 2007)

??

??

??AIDS (untreated)

Myron S Cohen

IAC Plenary

Highly Active HIV PreventionCoates, Richter et al., 2008

Myron S CohenIAC 2008 Plenary

Policy Implications

•Increase VL testing

•Increase Testing

•Decrease undiagnosed HIV

•Increase Treatment

Nikos Dedes EATG IAC Satellite 3/08/08

Key implications for PLWHA

•“the realization that we will no longer consider ourselves to be a lifelong threat to others”

•Serodiscordant couple can have children easily

•Remove fear of condom break

•Reduce prosecution of HIV transmission/exposure

•PLHA are not vectors of transmission

•It allows the taboo subject of condomless sex to take centre stage

•“Allowing HIV+ people to regain the right to unhinibited experience of sexual pleasure”

Nikos Dedes EATAG IAC Satellite 3/08/08