(a) Canadian Prime Minister Stephen Harper Needs Hard Dose Of Reality
Prime Minister should make life-and-death decisions based on evidence, not ideology, says Legal Network
Excerpts from: http://www.newswire.ca/en/releases/archive/August2006/15/c5887.html

TORONTO, Aug. 15 /CNW/ - The Canadian HIV/AIDS Legal Network called today on Prime Minister Stephen Harper to make evidence-based and potentially life-saving decisions to keep Vancouver's safe injection site open and to implement needle exchange programs in Canadian prisons.

"The Canadian government's head is in the sand on the problem of HIV among people who use drugs and prisoners," said Joanne Csete, Executive
Director, during a press conference at the XVI International AIDS Conference. "Proven harm reduction measures such as Insite, Vancouver's supervised
injection facility, are under threat of cancellation by Ottawa. In Canadian prisons, such measures are nonexistent - and people are paying the price with
their lives."

The news conference also featured Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS and president-elect of the
International AIDS Society, Diane Tobin of the Vancouver Area Network of Drug Users, Gillian Maxwell, spokesperson for Insite for Community Safety, and Jim Motherall, a former prisoner and founding co-chair of the Stony Mountain Penitentiary Health Awareness Group.

The HIV- AIDS Conference in Toronto
Why is Uganda interesting?
Excerpts from : http://www.avert.org/aidsuganda.htm

Uganda is one of the few African countries where rates of HIV infection have declined, and it is seen as a rare example of success in a continent facing a severe AIDS crisis. Uganda's policies are credited with helping to bring adult HIV prevalence (the proportion of adults living with HIV) down from around 15% in the early 1990s to around 5% in 2001. At the end of 2005, UNAIDS estimates that 6.7% of adults had the virus. The country is seen as having implemented a well-timed and successful public education campaign.1

Gradually, more and more countries around the world are starting to realise that they must take decisive action if they are to avert a major AIDS crisis. More and more money is being channelled into Africa, especially by the US which has pledged $15 billion to fight AIDS in resource-poor countries. Uganda is lucky enough to be one of the countries on President Bush's list and, given the decline that has been seen in its HIV prevalence, is being held up as an example of good planning and action that others should emulate.

But the results seen in Uganda don't have a simple recipe, and with so many lives and such large sums of money at stake, it is important to look carefully at what has been done there.

AIDS in Uganda was initially known as 'slim' due to the physical wasting it caused. HIV was already spreading in Uganda on the shores of Lake Victoria in the late 1970s. It is from here that some theories suggest HIV spread to the rest of the world. If this is true then Uganda's HIV epidemic might be said to have had something of a 'head start' on other national epidemics.

The first AIDS case in Uganda was diagnosed. Between 1982 and 1986 there was little understanding of what AIDS was, and it was not known that it was caused by HIV. During this period the epidemic was largely addressed at local levels with communities caring for those infected and affected.

In 1986 President Yoweri Museveni responded to the emerging HIV crisis in Uganda swiftly, embarking on a nationwide tour to tell people that avoiding AIDS was a patriotic duty, and that they should abstain from sex before marriage and then go on to remain faithful to their partners and to use condoms. Uganda's Health Minister announced to the World Health Assembly that there was HIV in Uganda, and the first AIDS control programme in Uganda was established. It focused on providing safe blood products, and educating people about risks.

Dr. Alex Coutinho

Dr. Coutinho, a Ugandan-born public health physician, has been working with HIV since 1983. From 1989–2001, he worked in various capacities in Swaziland and was involved in setting up the early responses to the HIV epidemic there. From 2001 to present, he has served as the Executive Director of The AIDS Support Organization (TASO), the largest HIV care and treatment organization in Africa. TASO cares for 50,000 HIV+ people; of which 8,000 are on antiretroviral therapy (ART) through PEPFAR funds. Dr. Coutinho has been the vice chair of the Technical Review Panel (TRP) of the Global Fund and is currently the co-chair of the board for the International Partnership for Microbicides. In addition, he has served on several national and international committees to develop strategies and policies on HIV prevention, care, treatment, and impact mitigation. He is married and has three children.

Interview
Dr. Alec Coutinho
The AIDS Support Organization (TASO)
Kampala, Uganda
February 2004
http://www.pos4pos.org/croi2004/coutinho1.htm

IFARA: We're here with Doctor Alec Coutinho, Executive Director of the AIDS Support Organization in Kampala, Uganda. Can you tell us just a little bit of background about your organization?

Dr. Coutinho: The AIDS Support Organization, or TASO as it is known worldwide, was the first real civil society organization in Africa to tackle HIV and AIDS in Uganda. It was established in 1987 by a person whose husband had died of AIDS, and since then it has grown to support a cumulative total of over 100,000 people who are HIV positive. Currently, we look after about 50,000 people. We provide a whole range of care and support activities. This year will be a landmark year, because we will be scaling up antiretroviral therapy for at least 3,000 people this year.

IFARA: You're now doing what they said for so long you couldn't do... their infrastructure....

Dr. Coutinho: Absolutely. We're trying to take out antiretrovirals, particularly to our clients who are poor, mainly women who live in rural areas, and as I put it trying to move antiretrovirals from a hospital to a setting under a mango tree.

HIV can be transmitted in the sexual fluids, blood or breast milk of an infected person. HIV prevention therefore involves a wide range of activities including prevention of mother-to-child transmission, harm reduction for injecting drug users, and precautions for health care workers.

What exactly is the ABC approach?

A roadside sign in Botswana - late 1990s

One of the difficulties with the ABC approach is the lack of a clear definition. The slogan seems to have first been adopted by the Botswana government in the late 1990s. Seen on billboards around the country it exalted the fact that:

The ABCs of Kenya's war on AIDS
Aug. 16, 2006. 01:00 AM
IBRAHIM MOHAMMED AND MARK DYBUL
More details

The challenges of HIV/AIDS prevention in the developing world are daunting. To turn back the rising tide of infection, we need a public health approach that respects the people we serve so they can make their own decisions.
The HIV/AIDS strategy of the government of Kenya emphasizes an evidence-based approach rooted in "ABC": abstain, be faithful, and the correct and consistent use of condoms. Americans, through President George W. Bush's Emergency Plan for AIDS Relief, support Kenya's prevention strategy.
In much of Africa, HIV/AIDS is a generalized epidemic affecting all age groups and segments of society.
A comprehensive approach is needed to combat a generalized epidemic.
The evidence is clear — in such an epidemic, all three components of ABC are essential to combat HIV/AIDS. In concentrated epidemics, e.g. Thailand and Brazil, more targeted approaches can be effective.
The Kenyan health ministry estimates that HIV prevalence has dropped markedly from 1998 to 2003. While the causes are complex, the data point to:
• Increased male faithfulness — among men aged 20 to 24, the percentage who reported more than one sexual partner dropped from more than 35 per cent to 18 per cent.
• Delayed sexual debut, with median age for first sex among women rising from 16.7 years of age to 17.8.
• High levels of both primary and secondary abstinence (people who were sexually active who have abstained for at least one year) in teenagers of both sexes.
• Increased condom use among women who engage in risky activity.
Similarly, a study published this year in the journal Science reported sharp declines in HIV prevalence in eastern Zimbabwe, associated with striking changes in sexual behaviour.
As Dr. Peter Piot, head of the Joint United Nations Program on HIV/AIDS, remarked, "(T)he declines in HIV rates have been due to changes in behaviour, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having fewer sexual partners."
In other words, the ABC behaviours.
As data from these and other nations such as Ethiopia, Uganda, Zambia, Malawi, and South Africa demonstrate, ABC is good public health.
It also respects local culture — ABC was developed in Africa, not in North America — and respects the people whom we serve.
To focus programs on only one component of ABC would be dangerous and patronizing, reflecting an assumption that intelligent people who care about themselves and their families cannot make decisions for themselves.
ABC provides hard data so people can decide how to protect themselves: the only 100 per cent effective way to avoid HIV is to abstain or to be faithful to a single, HIV-negative partner, while correct and consistent use of condoms reduces risk by approximately 90 per cent.
With that knowledge, if one chooses risky behaviour, condoms must be made available to that person.
Kenyan policy promotes the common-sense, public health approach of ABC, which the U.S. government supports throughout the world.
In generalized epidemics, however, other interventions, in addition to ABC, are needed.
The Kenyan strategy recognizes this by promoting programs to minimize gender inequality, which often makes it difficult for women to negotiate A, B, or C.
Kenya is also increasing HIV counselling and testing to ensure that HIV-negative couples maintain fidelity and that HIV-discordant couples receive counselling and condoms.
Beyond sexual transmission, Kenya is focusing on prevention of mother-to-child transmission, blood safety, safe medical injections, and other key issues.
The U.S. government supports this comprehensive approach to prevention in generalized epidemics in Kenya and many other countries.
Treating people with respect by providing them with HIV prevention education and services is good public health. It fosters the democratic value of personal responsibility that leads to healthy behaviours.
The governments of Kenya and the United States, together with our partners in civil society, will remain committed to providing people with the information and tools they need to protect themselves from HIV infection.
As Kenya is demonstrating, only a comprehensive, public health approach will turn the tide against HIV/AIDS.

Dr. Ibrahim Mohammed is director of Kenya's National AIDS/STI Control Program. Dr. Mark Dybul is U.S. Global AIDS Co-ordinator of the President's Emergency Plan for AIDS Relief.

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