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1. Quality of care and access to treatment is dependent on useful and adapted information which should be accessible at the most decentralised level. AfriCASO and UNAIDS have an urgent need to:

• seek and gather relevant information and to make it available to community-based organisations and individuals;
• ensure a broad dissemination of this information and to share it broadly through various methods;
• increase the numbers of conveyers of processed information through the creation of information resource or documentation centres (such as NGOs and support organisations); and
• enlarge and optimise the use of electronic networks which would reduce the cost of communicating and increase information flow.

2. AIDS Service Organisations and community groups of PWA need to enhance their advocacy and lobbying skills. AfriCASO and UNAIDS must organise appropriate training in this area. Targets should include governments, bi-laterals, private sector, scientific community (specifically for the human and ethical-social dimensions of the epidemic), wherever there is an opportunity for interaction and communication, through local, national, regional and international meetings, or by creating the opportunity, through strategic alliances.

3. AfriCASO and UNAIDS need to promote the formation of strategic alliances. These should cover:

• Within the community sector and its different forms or organisation which share common goals and visions, and in respect of each others own specificities;
• With other stakeholders, based on the interests that link us to them and the environment in regard to access to care. This concerns governments, leaders, the private sector, the cultural sector of society, the medical and academic worlds, places where civil society mobilisation occurs, etc…at the local, national, regional and international level.

Feedback will be gathered on the progress of these issues by September 1999 to inform the Durban 2000 conference report-back.

ASIA/PACIFIC REGIONAL NETWORKING

4. That all conference co-sponsors, particularly UNAIDS and ICASO, ensure that every action plan in response to HIV/AIDS includes:

• Inclusion of migration related issues (eg cross-border, mobile/migrant populations, trafficking of women and children);
• Access to treatments as a fundamental non-negotiable priority including essential medications related to opportunistic infections;
• Lobbying for increased funding from highly developed countries for international activities on HIV/AIDS;
• Attention to strategies to reduce global price of treatments and increased support and research for the role of traditional medicines.

5. That IAS in conjunction with all conference co-sponsors, particularly UNAIDS and ICASO, ensure that at Durban 2000, sessions on issues for particularly marginalised communities eg, adolescents, sex workers, injection drug users, be designed and presented by representatives of those communities rather than organisations or researchers working with those communities.

LATIN AMERICA AND THE CARIBBEAN REGIONAL NETWORKING

6. LACCASO, GNP+, ICW and the AIDS Working Party of ILGA will co-organise the Community Forum of the next Pan-American AIDS Conference which will take place in 1999 in Brazil. This Community Forum will take place immediately prior to the Conference.

7. The four networks, as co-sponsor of the Pan-American Conference, request IAS and UNAIDS as organisers, to integrate membership of all the Committees of the Conference, and, as in Geneva, to have a Community Planning Committee Chair.

8. NACASO will develop a mailing list and distribute, to begin creation of a mail and electronic communication tree for the region, by the end August 1998.
Key areas of future collaboration and networking will include, but not be limited in any fashion to:

• Increased communication
• Increased linkages
• Information dissemination
• Networking and skills building strategies

9. Key organisations and individuals within North America will seek to increase knowledge and understanding of the cultural context(s) in which we undertake our single and joint activities within Canada, United States and Mexico.

10. NACASO will host a further regional meeting by February 1999, planned to reach agreement on action items for the year 2000, following additional "dialogue".

COMMUNITY BASED RESEARCH NETWORKING

11. That IAS in conjunction with all conference co-sponsors ensure that at Durban 2000 symposia, round-table discussions and rapporteur summaries in conference plenaries be used to bridge the gap between discussions on community-based research, theory, methods, practice and ethics in the CRV and discussions on theory, methods, practice and ethics in the general conference proceedings (all tracks).

12. That IAS in conjunction with all conference co-organisers ensure that a forum on community-based research be reconvened at Durban 2000 to study progress on discussions since Geneva and Vancouver on issues of theory method, and ethics practice.

13. ICASO, Geneva 1998 Liaison Committee and Durban 2000 Liaison Committee to give ongoing support for the electronic discussion forum on community-based research with the purpose to identify, document, and disseminate community-based research, theory, method and practice.

GAY MEN’S and other MSM NETWORKING

14. It was agreed that current HIV/AIDS decision making networks do not reflect cultural, religious economic and sexual diversity. Effective networking must acknowledge and respond to this diversity by extending links and dedicating resources to develop new fora and networks both inside and outside the gay, lesbian, bisexual and transgender communities. These must include other minority and religious identities, positive youth, and human rights organisations, at all levels.

15. Gay, lesbian, bisexual and transgender issues remain important for this and future conferences. Similarly, HIV/AIDS remains an issue important to gay, lesbian, bisexual and transgender communities. These concerns should be more adequately reflected in the program at the next conference. There must also be a recognition of the differing needs of different regions of the world, especially those within the global South.

HUMAN RIGHTS NETWORKING

16. UNAIDS to work with the Office of the High Commissioner for Human Rights to establish and promote mechanisms for the documentation of HIV-related human rights abuses/omissions and best practices at the national and international levels including a Special Rapporteur on HIV/AIDS and Human Rights by Durban 2000.

17. UNAIDS to provide technical and financial support to strengthen communication and networking amongst existing and emerging networks on HIV and human rights, including:

• national workshops;
• e-mail capability;
• materials development;
• and that a report be submitted to Durban 2000.

18. UNAIDS to establish an international task force to monitor the application of the International Guidelines on HIV/AIDS and Human Rights through the development of specific national and international workplans and strategies.

The first report of the Task Force is to be presented at Durban 2000.

MIGRATION ISSUES NETWORKING

19. We call on governments to stop the deportations of people living with HIV and to abolish the double punishment of prison sentence followed by deportation. Deportation is inhumane and degrading treatment. Deportation is a form of torture. Deporting a person living with HIV to a country where treatment doesn't exist means condemning that person to a death sentence.

We call on UNAIDS, in partnership with front-line immigrant rights organisations doing work around this issue, from both North and South, to initiate a consultation about this issue to document the practice of deportation and to bring together NGOs, international organisations, and governments to discuss what will have to be done for deportations to be stopped.

20. We demand that governments, pharmaceutical multinational companies, and international organisations respect the principle of access to the best available treatment and care on the basis of need (and not immigration or economic status).

21. Third World communities settled in the North face extreme vulnerability to HIV due to their social and economic conditions. They face violent racism and structural domination on a daily basis. In the North, Third World people often find out about their HIV status only upon falling ill, because they are the last in line for access to HIV testing. They are often the ones whose HIV infection remain untreated. Worse, in some cases, they face the threat of deportation, often after they have started treatment, to a country where treatment simply doesn't exist. There can be no "Bridging the Gap" without equality and recognition for HIV prevention programmes for Third World communities settled in the North, as well as equality in support, care, and access to treatment.

We call on GNP+ and ICW to support self-organisation efforts by Third World people living with HIV in the North. We expect these organisations to come to the forefront to offer their support in the defence of immigration rights and access to care for our communities.

We call on GNP+ and ICW to contribute to ongoing efforts by immigrant rights organisations to document human rights violations (including deportations and denial of treatment) which are responsible for thousands of unnecessary AIDS deaths of Third World people living in the rich countries of the North.

We call on Governments to stop the inhumane and degrading practice of deporting people living with HIV and to respect their fundamental human rights.

LIVING WITH HIV NETWORKING

22. ICW key contacts and GNP+ Board will work together to ensure, by January 1999, good collaboration at the grass-roots level between local groupings of ICW and GNP+.

23. ICW and GNP+ will:

• make "crystal clear" to their constituencies each of their capabilities, policies, and structure; and
• strengthen communication from the global through the regional to the national level, and back again through to country representatives.

24. We call on the IAS and UNAIDS to make a sustained commitment to bridge the gap in perspective between objective science and the subjective experiences of people with long term HIV.

In particular, we call on them to see to it that institutions and governments develop and sustain research programmes to increase understanding of HIV as a long term condition, of the psycho-social needs of people with long term HIV, and to the preservation of forms of social protection of people with long term HIV for as long as they are needed.

25. We call for action at the community level for the creation of options for living, for example in regard to return to work, tailored to individual circumstances and needs, and for respect and support for treatment decisions, whether they be to treat or not to treat.

26. Due to the complexity and multiplicity of issues relating to HIV as a long term disease, we recommend that a conference be held devoted to the topic.

27. Donors must recognise the value of networking and make funds available to appropriate networks of sex work projects at global, regional and country level. Appropriate networks are those which recognise commercial sex as valid employment and sex workers’ right to self determine.

28. Those conducting research concerning sex work rarely use epidemiological methods of evaluation of such projects, and when used are insufficient. Researchers must develop a method of evaluation that is based on sex worker perceptions of project success.

29. This Community Symposium expresses great concern and condemns the actions of the Hungarian police in Csongrad County that have resulted in greater local STD/HIV risk. These actions include arrests and harassment such that sex workers are forced to sell unsafe sex to meet fines and avoid imprisonment. This requires working long hours so sex workers are prevented from accessing sexual health services. We appeal to all regulatory authorities to prohibit any act of policing that may impact negatively on HIV prevention amongst sex workers and to fund programs for police education.

30. Government must explore means to reduce the reliance of transgenders on sex work as their sole source of income and enact laws which provide a non discriminatory environment for transgender citizenship.

31. Those carrying out HIV and STD prevention work amongst sex workers must recognise that such work must be done concurrently for clients.

TREATMENT ACCESS BY THE SOUTH FOR THE SOUTH

Africa

32. Recognising that:

• The health infrastructure in the majority of African countries is inadequate in meeting the challenges of HIV and AIDS care
• Antiretroviral drugs are already finding their way into these countries through diverse channels

The group strongly feels that this should not handicap initiatives to introduce availability of sophisticated care including the use of antiretroviral drugs.
The group recommends that access to treatment for HIV/AIDS should be integrated into existing health care systems, into health policy development and into existing forms of family and community care, while retaining a particular focus on it within these systems.
Communities and governments should work together to answer the following questions:

• How do we make voluntary testing and counselling widely available?
• How can we improve the quality of diagnosis and care?
• How can we best access available care and prevention services in both formal and social and traditional systems?
• How can we mobilise communities and involve their organisations in improving compliance to antiretroviral treatment?
• How can breakthroughs in HIV research and resources allocated to HIV and AIDS benefit the health care system as a whole and improve the care of other health conditions?
• How can the personal, familial and professional cost of being an HIV activist be minimised?
• How could the cost of optimum treatment be best shared?

The group recommended also the establishment of a mechanism through which optimum services in terms of diagnosis, drugs, monitoring, counselling and support as well as training can be provided . This would take different forms in different countries.

33. The Latin American group noted that there are several issues to be recommended to the countries in the region in order to improve the access to treatment.

A. Social recommendations:

i) We understand that advocacy has to be encouraged; therefore we recommend that the governments in the region should recognise:

• the importance of advocacy by the community;
• the recommendations of the scientific community;
• the participation of PWAs in political making fora as a legitimate social group to discuss the issues.

ii) advocacy has to be encouraged in practical terms:

• financing the actions of groups working in the area, both in the scientific community as well as from the community as a whole,
• formation of medical ethical group specialized in AIDS issues in the different regions in Latin America,
• stimulate the creation and financing of NGOs and other social movement manifestations to work in this issues.

iii) advocacy in the region should address its political actions with practical arguments, such as: it is cheaper to provide access to treatment (medication for prophylaxis, for opportunistic infections and anti-retroviral medication) than keeping the AIDS patients in the hospital; reminding financial decision-makers of the impact on the economy as a whole, if a significant part of the population are removed from the workforce.

iv) advocacy should include a media strategy to create favourable public opinion for AIDS issues.

v) AIDS issues have to include additional areas to only medical, since it is not only a health issue, but an educational and economical issue.

B. Political recommendations

i) The group understood that there is the necessity to formulate legislation in the region to allow specific access to treatment for people with AIDS. This has to be done by:

• identifying individuals in the government sympathetic to the issue (key persons);
• creating a media strategy by the government;
• participation of the community and HIV+ people in the design, implementation, and follow-up of policies.

ii) Policy should include specific budget allocation and accountability to implement the action in research, prevention and care.

iii) Budget allocation should not be made by cuts in other health areas.

iv) We also recommend that the local governments establish regulations:

• on medical/pharmaceutical protocols and trials
• on medication price limits for anti-retroviral and medication for opportunistic infections as well as for prophylaxis.

Medical/Ethical Recommendations

i) Creation of medical-ethics protocols to ensure to respect confidentiality, privacy, right to counselling and guarantee of continuation of treatment whenever started, including for post-partum women (women who have recently given birth).

ii) Empowering of health and care professionals on AIDS issues should be largely provided by government.

iii) Access to treatment should be affordable and available nation wide.

iv) Access to information should be accurate, practical, and in accessible language to ensure that people with HIV and AIDS are able to make informed decisions.

v) Research in alternative and traditional medicine should be encouraged.

34.

i) In the view of the very limited information on Eastern and Central Europe, it is crucial that all information compiled by international organisations (mainly UNAIDS) be made available at country level to NGOs.

ii) NGOs should be encouraged to analyse this data and to set up an action plan for their country highlighting the deficits, and identifying areas where international assistance is needed.

iii) information must be carefully translated so that it may be used by all interested parties.

iv) UNAIDS and other international agencies should provide technical assistance and support for NGOs.

v) EU is encouraged to directly support those initiatives.

35. The 12^th World AIDS Conference should press governments/world leaders to ensure informed access to treatments, i.e. informed access means dissemination of information enabling persons with HIV/AIDS to make knowledgeable decisions.
Suggestions:

• Press governments/world leaders
• Intensify networking opportunities
• Regional conference (Asia/Pacific) should adopt Access to Treatments as its direction
• Pharmaceutical manufacturers should declare their pricing mechanism and distribution system
• Patent rights should be less than 5 years to avoid monopoly
• Increase training for care staff
• More availability/ lower price of basic palliative medicines
• Support research on alternative therapies
• Set up laboratory facilities in sub-regions
• Increase dialogue on treatments access issues.

36. That future Conferences give higher priority to interactive cultural activities in terms of both budget and program, and that these be integrated into all aspects of the programme.

ALTERNATIVE AND TRADITIONAL HEALING PRACTICES SYMPOSIA

37. We call on all Conference co-organisers (GNP+, IAS, ICASO, ICW, UNAIDS) to acknowledge the role of natural medicines and traditional medical practitioners, as well as alternative and complementary medicines, in AIDS prevention and treatment, and to advocate that this health sector be allocated an equitable share of AIDS research, treatment and prevention resources.

38. We call on the organisers of future regional and international AIDS conferences to set aside venues and opportunities for the exchange of ideas and experiences related to traditional and alternative therapies, and further urge that they support regional and global networks related to traditional and alternative therapies.

The Natural, Alternative, Traditional and Complementary Medicines (NATC) Caucus of the International AIDS Society (IAS) will be responsible for follow-up on the response to resolutions 37 and 38, and for promoting relevant action.

39. In order to assure a stronger linkage between AIDS issues and Human Rights issues all co-organisers of the 13^th World AIDS Conference should:

i) Identify partners in Human Rights, ethics and law

• to exchange staff and board members and
• promote mutual relationships.

ii) Have more interactive sessions on human rights, ethics and law during the core-time of the next AIDS Conference (i.e. between 9.00 and 17.00).
iii) Ensure material on AIDS and human rights, legal and ethical issues is distributed to all partners, including through UN Theme Groups on AIDS at country level.

HUMAN RIGHTS SKILLS BUILDING

40. Issues pertaining to the field of human rights should be fully integrated in the fight against HIV/AIDS.
41. Human rights monitoring mechanisms must be reinforced.
42. Women’s rights must be stressed in the fight against HIV/AIDS.
43. Vulnerable populations have the right to be educated and informed about HIV/AIDS.

ICW

44. Young women are the fastest growing population of people infected with HIV. ICW believes that people in the world, from governments to communities and families, must acknowledge the special vulnerabilities that young women with HIV face – in all regions of the world.
We must all seek out and listen to the experiences and voices of young women who are living with HIV/AIDS. We are all responsible for protecting young women from exploitation economically, sexually, and emotionally. Resources must be invested to empower, educate, and support HIV positive young women.

ICW’S Position on the Key Issues Affecting Women Living With HIV/AIDS

ICW is totally opposed to mandatory testing in all its forms. ICW advocates for universal pre and post test counselling, testing with informed consent and access to test results. Sentinel surveillance testing is not cost effective. We oppose unlinked testing of women and children for the purpose of monitoring the epidemic.
Women with HIV/AIDS need health care providers to act responsibly before dispensing treatment to women and to provide adequate monitoring and follow up with proper counselling and support.
ICW opposes trials using placebo controls where studies elsewhere have demonstrated efficacy of the trial drugs. Such trials should be designed to compare with other interventions of proven efficacy.
ICW advocates for research that is of direct benefit to the women with HIV/AIDS who are involved, includes us in the development of trial protocols in our countries, and preserves the rights and dignity of ourselves and our children.
ICW opposes research that is irrelevant to or which exploits women with HIV/AIDS who are poor, uninformed or lack resources, unless this research will result in direct benefit to them and their children. For example, we oppose vertical transmission trial on women with HIV/AIDS if treatment is withdrawn immediately after they have given birth.
Regardless of what is or is not accessible to them in their situations, women with HIV/AIDS have a right to know that monotherapy is not an optimal or a recommended treatment – combination therapy is.
ICW calls for all women with HIV/AIDS to have up to date accurate information.
Women with HIV need information on all therapies and strategies which reduce vertical transmission and access to these if we choose to use them.
Women with HIV/AIDS need information about affordable female controlled prevention methods such as female condoms and microbicides with access to them when they become available.
Women with HIV/AIDS need information on and access to affordable health care (conventional and alternative therapies) and research into how the virus and treatments affect us.
ICW calls on governments and international alliances to re-focus strategies such as prophylaxis against opportunistic infections and nutritional support to prevent progression of HIV disease.
ICW calls for urgent research into the issue of breastfeeding.
Women with HIV/AIDS have a right to know that breastfeeding is a mode of transmission. We need clarity on the percentage rates of transmission through breastfeeding and consistency in the information given in different parts of the world.
Women with HIV/AIDS need more information and training on traditional and other affordable and accessible alternatives to breastfeeding other than commercial formulas.