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The 11th International Congress on AIDS in Asia and the Pacific | 1823 November 2013 | Bangkok, Thailand Queen Sirikit National Convention Center (QSNCC)
Uraiwan S.
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Window on ICAAP11
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Host
Co-Host
Convener
Co-Convener
Organizing Partners
02 | 22 November 2013
Continued from p.1
Dr BB Rewari
Bobby Ramakant
Jeanne Hallacy/ICAAP11
Mr Wilas Lohitkul
22 November 2013 | 03
Oral substitution therapy (OST) saves lives, improves quality of life, and
helps people who use drugs to lead functional lives, advocates say. It is
like insulin for a diabetic, argues Dr M Suresh Kumar, a psychiatrist
from Chennai, India, who has worked on substance use disorder for over
30 years. Beneficiaries of OST agree that it turns drug use into a chronic
condition, which can be managed with medical and psychosocial help. By
taking care of withdrawal, it saves them from doing desperate things.
Though OST is offered in South Asian countries (except Sri Lanka), the
coverage is low. While pilots have been done in Afghanistan and Pakistan,
Bangladesh has just a small intervention restricted to Dhaka. In India, OST
is going from pilot to scale, with the next phase of the national programme
in 2014 and aiming for a coverage of 40%.
Project ORCHID has done pioneering work on harm reduction and OST
in Manipur and Nagaland in North-East India for over 10 years. Lessons
from the project are now being used in the national programme.
Daily Telegraph
OST involves replacing a short acting opioid such as heroin with a long
acting substitute drug methadone or buprenorphine. Taken orally once
a day in a clinical setting, dose and adherence are critical to effectiveness.
By taking care of withdrawal it helps users to lead functional lives. Drug
users living with HIV are also able to adhere better to long-term treatments
for HIV, tuberculosis or hepatitis. It reduces the risk of acquiring new
infections by doing away with injecting.
Equity in service delivery is a major challenge since beneficiaries must
visit the centre every day to receive the dosage, says Melody Lalmuanpuii,
Project ORCHID. The population is dispersed, there are a large number
of users in rural areas, and women drug users are hidden since they are
stigmatized more.
Although buprenorphine costs over 10 times more than methadone,
countries such as India use it because it does not carry any risk of overdose.
Advocates of OST say beneficiaries can be on OST as long as they need to,
and this can vary considerably between users.
SCAN ME!
Nafsiah Mboi
www.ilo.org/zero
(Indonesia)
Minister of Health and Chair of the
Board of the Global Fund to Fight AIDS,
Tuberculosis and Malaria
04 | 22 November 2013
Bobby Ramakant
the impact of HIV programmes and human rights in the context of key
affected populations, explained Dr Dhaliwal.
We have also done a regional judicial sensitization for judges of high
courts in 16 countries of the region. Similarly there was a follow up
consultation in the Pacific, which included governments, civil society, and
judiciary from Fiji, Kiribati, Papua New Guinea, Samoa, Solomon Islands,
and other parts of the Pacific, to help look at HIV, laws and its impact in
the region. In India, there has been a follow up too to decriminalize samesex behaviour.
A lot has become possible in the region as a result of the leadership
of UN Economic and Social Commission for Asia and the Pacific, or
UNESCAP. Its resolution and political commitment from leaders to
remove discriminatory laws that are impeding effective HIV responses in
the region have brought in real positive change.
The Commission also brought together people who make the law
[governments] and enforce the law [judiciary, police] with the communities
and the service providers in ministries of health. There is a dialogue to
develop solutions now. Political commitment is really important because
changing laws is a political process.
Dr Dhaliwal pointed out that laws alone are not a magic wand: It is not
just about the laws. The law is an important tool but we also have to think
whether the policing is right, people have access to justice, and that people
know about their rights and the law, so that in case of a violation they can
access available legal recourses. We also need to change social attitudes in
society and ensure there is acceptance of key affected populations.
22 November 2013 | 05
SCAN ME!
Mark Dybul
Executive Director, The Global Fund to Fight
AIDS, Tuberculosis and Malaria
www.ilo.org/zero
06 | 22 November 2013
Community involvement in
implementation research
By Shobha Shukla
knowledge about treatment, and lack of family support are major barriers
to adherence and often result in PLHIVs quitting treatment. Some are also
overwhelmed with the side-effects. In many cases the simple gesture of
being reminded by a family member to take the medicine was enough
incentive to continue treatment.
Rebecca Kubu Navanua of the Pacific Positive Group of Women felt that
PLHIV, who are trained as community and outreach workers, play an
important role by way of community outreach, advocacy and governance.
They facilitate education sessions in the community focusing on safe sex,
the need for acceptance and love from family and friends, ensuring that
people can live normal lives on treatment and can have children free of
HIV. The outreach workers also give inputs in drafting HIV laws/policies;
work with church leaders; and do training on human rights including
right to treatment without discrimination so that people with HIV get the
respect they deserve. They have meaningful involvement in governance
as members of several decision-making bodies like national AIDS
committees, national HIV boards and national networks.
Dr Moale Kariko, of the PNG National AIDS Council Secretariat,
summed up the way forward. Since 2011, access to testing, treatment and
information on HIV has improved considerably. HIV is now concentrated
in certain geographical regions and in key populations such as sex
workers. However risk factors exist with the potential for the virus to
spread more widely. Rates of STIs are very high and gender inequality,
stigma and discrimination add fuel to fire. 26% of those in need of ART
are still not accessing it, loss-to-follow up is high and condom use is low.
More investment is required for prevention interventions in most at risk
populations.
Window on ICAAP11
22 November 2013 | 07
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08 | 22 November 2013
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