Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 44267-44271 989

Project: An analysis of activities and events around breast feeding was done.
The activities included 2 public meetings where there were discussions by women
PWAs (some of whom had children who died of AIDS), MCH service providers,
AIDS activists, women NGOs and lactation specialists. There were focus group
discussions held with women both infected and affected by HIV/AIDS. A national workshop was held for MCH service supervisors and reproductive health
researchers. There were discussions with HIV/AIDS support groups on the draft
policy document on breast feeding. Both print and electronic media provided fora
for debate on the topic.
Results: All the women PWAs prefer not to breast feed their babies once they
know that they are HIV positive. Most of them suffered a lot of guilt after their babies died of AIDS. MCH service providers, through the Baby Friendly Initiatives,
continue to reinforce the view that good mothers breast feed. This manifests
through prominent breast feeding posters in health institutions and breast feeding
day celebrations. Generally, most women do not exclusively breast feed and by
the third month of life, supplementary foods are already introduced.
Lessons learned: Despite policy guidelines proposing discussion of personal
circumstances and options, reinforcing breast feeding as good motherhood remains strong. Advocacy programs are needed to influence breast feeding policies
so that they include discussion of alternatives. Health workers need guidance
in presenting these complex issues. The presumption that women prefer to be
protected from difficult decisions should be avoided. Women living with HIV must
be involved in the policy discussion.
44267 Progress through partnership: Regional HIV voluntary
service organisations working to overcome inequalities
John Nicmolson. MIV Alliance UK, 75 Ardwick Green North, Mancmester,
England, UK
Issue: There is no even geographical spread of the population living with HIV,
across the regions of Great Britain. Local delegation of Government funding
results in unequal service provision.
Project: Surveys of Health and Local Authorities' "purchasing" of services for
people with HIV, across North West England, 1990-98, reveal organisational
upheaval and inconsistent approaches; while HIV as an issue has been pushed
down (or off) the decision-making agenda. Analysis of the Government's White
Paper, "The New NHS", shows the creation of another tier, of "Primary Care
Groups" (or Trusts) at local level; within which people with HIV will be invisible,
outside of main prevalence areas. An "HIV Alliance" has thus been formed, of
regional HIV voluntary service organisations, working together to aggregate information and argue for change, in order to make senior health and social service
planners, including Government, address the issue of imbalance.
Results: All the main HIV voluntary service organisations, in the regions outside
London, have joined the HIV Alliance. These cover the regions with the highest
incidence of HIV. Joint working, sharing of information, and development of policy
have shown early successes; and the Alliance now liaises closely with its London
counterparts, as a national organisation able to represent the diversity of experience outside the capital. The Alliance has also started to influence individual local
"purchasing" authorities, from an independent stand-point, in order to develop
services where none exist and to rationalise current local funding approaches
through comparison with other regions.
Lessons Learned: Authorities will not easily work with each other, across sectors or geographical boundaries. Voluntary organisations coming together to put
pressure for strategic planning can make a difference; as well as offering possible
economies of scale and maximisation of resources for their own agencies. This
improves both the level of service and the equity of access for people with HIV,
which otherwise may depend on where someone lives or who their consultant is.
44268 Building a broad response to the dilemmas of access to
treatment in resource poor countries
Susan Lucas1, H. Curtis2. UK NGO AIDS Consortium 37 Great Guildford Street
London Seioes; 2BMA Foundation For AIDS London, UK
Issue: Access to treatment for people with HIV in resource poor countries
Project: Anti-retroviral drugs have changed the lives of many in the developed
countries, but sustained supplies, health infrastructures and trained personnel are
lacking in developing countries. The UK NGO AIDS Consortium brought together
PLHA groups, development agencies, essential drugs experts, clinicians and
academics for 5 seminars in late 1997, to seek a joint approach. An international
workshop is planned for spring 1998.
Results: The seminars identified 5 main areas to be brought into thinking about
treatment access:
The place of treatments within wider care/support, eg how giving drugs may be
used to symbolise caring.
Examination of health care systems (including private sector) rather than specific drugs, eg whether to build HIV-specific systems or work with generic ones.
How community mobilization concepts used by development agencies compare
with treatment activism.

The essential drugs strategy and lessons from other diseases (eg cancer, TB)
about palliative care, alternative treatments, community involvement.
How treatments impact on the relationship between care and prevention.
Lessons learned: Expensive drugs can have an impact on individual wellbeing, but other considerations also need to be addressed if quality of life is to be
improved in resource poor settings. The Consortium will pursue these further at
an international workshop, results of which will be presented.

442691 Involving aboriginal communities in HIV/AIDS
surveillance and research
Mai Nguyen', K. Barlow2, S. Laframboise3, D. Albert4, F. Andersen5,
D. Etienne6. 'Brooke Claxton Bldg., Room 0108B Tunney's Pasture, Bureau of
HIV/AIDS & STD, Health Canada; 2Canadian Aboriginal AIDS Network, Ottawa,
ON; 3 High Risk Project Society, Vancouver, BC; 42 Spirited People of the 1st
Nations, Toronto, ON; 5 Newfoundland & Labrador AIDS Committee, St-John's,
NF; 6Assembly of 1st Nations, Ottawa, ON, Canada
Issue: To involve Aboriginal people in the process of collection of HIV/AIDS epidemiologic information to better guide and evaluate prevention and care programs
for their communities.
Project: Three designed activities to involve Aboriginal people were developed: 1) an annual Aboriginal HIV/AIDS Surveillance and Research Meeting; 2)
an Aboriginal Working Group (AWG) to advice Health Canada (HC)'s Bureau of
HIV/AIDS and STD on surveillance and research issues; and 3) disseminating
HIV/AIDS information to Aboriginal communities. The 1st annual meeting was
held in March 1996 to discuss priority information needs and appropriate ways
to gather this information. The main outcome of this meeting was the creation
of the AWG composed of 8 members representing Aboriginal organizations from
across the country. The 2nd annual meeting was held in May 1997 to review
the AWG's activities, review current activities across Canada and ethical issues
related to HIV/AIDS surveillance and research among Aboriginal people. During
this meeting, a new AWG was selected by the Aboriginal caucus and was given
the following mandate: to advise the Bureau on priorities for HIV epidemiological
information needs and ethical issues; to review and solicit proposals on Aboriginal
people; to plan annual meetings; and to interpret data relevant to Aboriginal communities for the national/international conferences. The AWG is developing an
ethical evaluation checklist which will be submitted to the 1998 annual meeting for
endorsement. Between annual meetings, summaries of the AWG's discussions
and new HIV epidemiology information on Aboriginal people are regularly sent to
the participants of the meeting for information and comment.
Lessons Learned: The AWG has been helpful in giving HC advice and direction on the collection of HIV/AIDS epidemiology information in Aboriginal
communities. However, the process is complex and requires a continuing coordinated effort between government and the AWG's members, an emphasis on
Aboriginal ownership, clearly defined rules and policies for cooperation, genuine
communication, and flexible agendas. Aboriginal involvement in these types of
processes needs to be encouraged to find appropriate mechanisms for HIV/AIDS
studies in Aboriginal communities.
44270 Politics and health: Renewing Canada's national AIDS
strategy
Russell Armstrong. 400-100 Sparks Street Ottawa Ontario K1 P 5B7, Canada
Issue: Canada's national HIV/AIDS strategy expires on March 31, 1998 despite
rising infection rates, a more complex epidemic and a greater number of people
living with HIV/AIDS than ever before.
Project: In response to the looming expiration of Canada's national AIDS strategy, the Canadian AIDS Society developed and implemented a national lobbying
and public awareness campaign to secure a renewed commitment to HIV/AIDS
on the part the Government of Canada. The campaign involved typical grassroots advocacy techniques, proactive government relations with elected officials
including the Minister of Health and the Prime Minister, and a sustained media
relations and public awareness effort over an 18 month period. The campaign
also included building and leading a coalition of 10 other national stakeholders
organizations in HIV/AIDS.
Results: A commitment to renew the national AIDS strategy was announced
during the June, 1997, federal election. An extensive consultation and policy
development process was convened by the federal government in partnership
with the Canadian AIDS Society and ten other national non-goverment HIV/AIDS
stakeholder organizations. Details of the renewed Canadian HIV/AIDS Strategy
were made public on December 1,1997. The new strategy reflects in a substantial
way the challenges posed by an expanding, more complex HIV/AIDS epidemic.
Lessons Learned: Political advocacy is an essential component of the health
policy development process in Canada. The Federal Government of Canada and
external stakeholders can work as partners in key decisions on national policy.
Community/government partnership in the health policy development process
results in a more effective national response to HIV/AIDS.
44271 Development and dissemination of an HIV/AIDS policy
response from a drug user's perspective
Rod Bennison. Po Box 1522 Darlinghurst 2010, Australia
The New South Wales Users and AIDS Association (NUAA), of Sydney, Australia, is the largest drug user organisation in the World. It is funded by the State
Government of New South Wales and operates extremely effective HIV/AIDS and
Hepatitis C education and information campaigns.

Its objectives are to promote the health of people who use drugs illicitly, to
prevent the transmission of HIV/AIDS, to initiate community action and to forge
both national and international alliances. Further, NUAA is committed to the
development and dissemination of relevant policies from a drug user's perspective.
This policy response has contributed greatly to one of the lowest rates of
HIV/AIDS transmission in drug user communities across the developed world.