Health and HIV/AIDS – Prevention, care and treatment, stigma and discrimination – four years of action against HIV/AIDS by Red Cross and Red Crescent
Workshop 6, 28th International Conference of the Red Cross and Red Crescent, Geneva, 2 to 6 December 2003
Note : The present report doesn't necessarily reflect the views of the ICRC.
Key Issue 1. HIV Response needs to become core RCRC business.
There were many interventions noting that Red Cross Red Crescent has arrived late to the HIV issue, but at last it has arrived strongly and it has a tremendous contribution to make. The consensus was that the Federation has made excellent progress in the last two years particularly, and that the strong links made between food security and HIV/AIDS impact are very appropriate. The view was put that we need to ‘declare war and strike hard’, and follow the example of those who have been courageous.
RC has a strong role to play to ensure the vulnerable, those who already have barriers to access, are not just left out. This means strong advocacy work to ensure universal access.
The point was made that RCRC is good at looking death in the face in conflicts, emergencies and disasters, and it going to have to get used to this on a larger scale as part of its development work as its moves into HIV/AIDS programming.
Key Issue 2. Treatment
A key debate was the question of whether the cost of treatment is sustainable. Many interventions emphasised that if we start in treatment then we are involved for the long hall, and that donors must commit to very long term involvement. It has happened many times in RCRC that a particular response is treated as a project, and once ‘out of fashion’ is left to collapse. Ethically we cannot do this with treatment. The research based d rug industry needs to make the drugs available to developing countries at extremely reduced prices, or assist countries to develop their own manufacturing capacity.
Speakers talked of the large sums of money being promised, but the consensus was that little of that money is actually available, particularly at grass roots level where RCRC works best. RCRC must involve itself in local co-ordination mechanism to ensure funding actually reaches the vulnerable.
It was highlighted that RCRC needs new skills to be able to operate effectively in this changed approach to funding health programmes. RCRC cannot replace the role of Government, and Government must be actively involved in treatment programmes.
Government representatives expressed appreciation for the support of RCRC where this has enabled them to establish ‘light’ clinics of high quality with rigorous monitoring, and psychological support and nutritional care. Local professionals are recruited and trained. It was noted that RCRC volunteers in the community are essential to make the work carried out in clinics effective in the home. There are challenges for RCRC in how to define the role of volunteers, and train and co-ordinate them, so that their assistance with compliance issues, psychological support and other practical matters is effective. Experience has shown that RC volunteers from outside the community are often not accepted – community volunteers from the local level are essential.
One national society which runs pharmacies shared that it has been difficult to get reliable delivery of the drugs, but that stock outs are not acceptable for people on HIV treatment as if the drugs are not taken on time then resistance develops. It is difficult to develop a system that delivers with 100% reliability.
Interest was expressed in getting together all the RCRC supported treatment clinics to share learni ng and best practices e.g. for patient selection where demand outstrips capacity. There was disagreement about how important this is, and whether the ‘little’ resources available should be used instead to make ARV available to as many people as possible.
In relation to the Masambo Fund the debate from Commission B3 was not full reopened, but views were expressed that RCRC should not just treat those close to itself, it needs to develop large-scale interventions for communities, particularly communities that will otherwise miss out. Such programme responses will actually reach far more people in vulnerable communities than a Masambo Fund type of mechanism could reach.
Key Issue 3 Prevention
It was emphasised that prevention complements treatment – in fact treatment programmes without strong prevention work in parallel are dangerous and will lead to treatment becoming ineffective for the public.
It was agreed in many interventions that prevention strategies need to match the type of epidemic, and this varies around the world. In all countries a certain level of information is needed for the whole population, ensuring women and young people are reached. However, in countries where sharing injecting equipment drives the epidemic then a peer education approach involving IDU is needed along with needle and syringe exchange and drug substitute treatment programmes. The harm reduction approach was strongly endorsed by all speakers. Likewise in countries where the epidemic centres on men who have sex with men, then RCRC has to be ‘open to all’ in a non-judgemental way. Where the epidemic is driven by heterosexual sex, then gender imbalance has to end, and women must have control over their reproductive health. Leaders need to work with men and social role models, to change ‘male culture’ so that men in general are committed to these objectives.
The point was ma de strongly that no matter which type of epidemic is occurring in a country, then people living with HIV are the key. Respect and involvement of PLWHA is the key to minimising transmission of the virus. Exclusion and the resentment it breeds are dangerous.
An opportunity to involve youth from RCRC with youth of other mass movements of young people (Scouts, YWCA, YMCA, Girl Guides etc) totalling 30 million members, was highlighted with the hope that involving young people as peer educators will be a powerful force, particularly as young people do not often listen to old people on such matters. Young people need to know ‘how’, real skills development is needed.
Key Issue 4. RCRC attracts stigma to itself by working with marginalized groups.
A number of national societies have faced public criticism, and a kind of stigma, from working with marginalized groups such as IDU and migrants, particularly where the migration is illegal. Such groups are unpopular with the public, but RCRC cannot be diverted from its mission because of this. People working with IDU and PLWHA have to face the likelihood that others will assume they are HIV+ or an IDU. Governments need to appreciate the role of RCRC in humanitarian work with such marginalized and ‘unpopular’ groups, and RCRC needs to be bold in carrying out its mission, but devote some energy to explaining this work to the public.