Programme Supplement [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Late Breaker Abstracts

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revealed.that many organisations involved in HIV/AIDS programme
do not have any specific gender and HIV policy. Knowledge about
existing national and international policies varied widely among the
key players, PLWHAs and vulnerable groups. Most national policies
are gender neutral and so broad that focus during implementation
was lost and women PLWHAs were often left out. Nonetheless,
few activities at the field were gender sensitive. But the degree of
sensitivity reqyired to ensure equitable access of women to HIV/
AIDS services was insufficient.
Lessons learned: Presence national and international policies
alone was not enough to have gender sensitive HIV/AIDS
programming unless backed up by sustained programmatic
support. Superficial understanding existed among policy makers
who believe that they have the best policy. They appeared to be
the most complacent about the gender inequity. Interestingly,
mid-level managers and grass roots implementers were better
sensitive in ensuring equitable access of women to HIV/AIDS
services. Many vulnerable community and PLWHAs were not aware
about policies and programmes, therefore unable to exercise their
rights. Existing policies have not made any meaningful impact on
their lives.
Recommendations: Periodic social/gender audit will ensure
proper programming and resource allocation for equitable access
to HIV/AIDS services. Secondly, capacity building of grass roots
organisation is crucial to ensure gender sensitive delivery of
the services. Guidelines and technical support on translating
national and international policies into gender sensitive action is
necessary.
THLBO503
Women and the '3 by 5' initiative: a policy analysis
H. Worth. University of New South Wales, National Centre in HIV
Social Research, Sydney, Australia
Background: In March 2006 the '3 by5' initiative ended with an
estimated 3 million on antiretroviral therapy, mnay of whom were
women. But success of the initiative cannot be judged by numbers
alone.
Methods: The paper will use UN/WHO policy documents together
with country reports for the June 2006 UNGASS to undertake a
gender analysis of the initiative.
Results: This paper will show that overall women fared poorly in
the initiative for a number of reasons: >The association of the rollout with routine HIV testing assumed a reduction in HIV-related
stigma and violence >Making HIV a clinic-based routinised part of
healthcare particularly in the antenatal setting exacerbates the
view of women as solely child-bearers and therefore having fewer
rights in their own person.
Conclusions: Stigma and discrimination against women are
central to the fight against HIV not an adjunct to the acceleration
of ART.
THLB0504
Exceptional protections still needed
Qiu R.-Z.1. 'Chinese Academy of Social Sciences, Program in
Bioethics, Beijing, China
Reently it has been argued that exceptional protections for HIV
testing should be replaced by the normalisation of HIV, becasue
the exceptionalisation of HIV may constitute a barrier to diagnosis
and treatment. In this argument there is something confused.
Exceptional protections were orginated from the fact that a quite
number of people treated people living with HIV as suffering
from a disease with exceptioanl nature. So policy-makers and
heathcare professionals have to provide exceptional protections
to them to prevent stigma and discrimination agianst them. The
same is with the inner disvowel of those HIV positive which is
the result of the stigma and discrimination imposed on them by
others. The barriers to effective accessible testing and treatment
is mainly not due to exceptional protection, nor the inner disvowel
of those HIV positive, but the stigma and discrimination against

them still exist in some countries like China. Being faced with

the alternative, many of them prefer not to be tested and not to
be treated rather than non-voluntary and undignified treatment
which leads them to uinbearable sufferings. The conclusion is that
the pace of normalisation of HIV should be kept proportionally with
the pace of anti-stigmatisation and anti-discrimination.
THLB0505
Assessing the role of treatment support specialist (TSS) in
PEPFAR adherence program in Nigeria
H. Ibrahim1, J. Kohler', S. Gurumdi', A. Habib', P. Dakum2, J.
Farley2, W. Blattner3, M. Eng3. 'Institute of Human Virology, Clinical
Services, Abuja, Nigeria, 2Institute of Human Virology, Abuja,
Nigeria, 3Institute of Human Virology, University of Maryland,
Boltimore, United States
Issues: Inadequate adherence may result in inadequate drug
concentrations, incomplete inhibition of HIV replication and may
accelerate viral resistance. Drug resistance is a cause for concern
in Nigeria, particularly because of the few options for second- and
third-line therapy. A patient who fails on his or her first regimen
due to drug resistance will have few treatment options left. Non
adherence is one of the major factors of drug resistance.
Description: This is an observational study of the adherence
activity at one of the PEPFAR- ACTION project sites in the North.
Prior to the ACTION project, adherence services for HIV patients
on medication did not exist, though the Government of Nigeria
started its ART program in 2000 in hospitals across the states.
According to ACTION, if a physician places a patient on ARVs, the
adherence counselor prepares the patient to develop a treatment
plan. An increasing number of patients' get access to care and
treatment at ACTION sites, and many of these patients come from
the local/neighboring communities. Adherence requires continual
attention and monitoring, requiring exploration of additional
avenues to assist with patients' medication adherence.
Non clinicians do provide adherence support to overcome possible
barriers. These are HIV+ peers referred to as Treatment Support
Specialists who can relate to patients in a different way from
formal health-care workers' style. They counsel patients both in
the facility and at home.
Lessons learned: This approach has a positive impact on
patients' adherence efforts because of increased treatment
literacy, which is evident by the less time, spent with adherence
counselors especially those visited and assisted at home by TSS.
Family members are motivated to give social support to clients
thereby reducing the problems of stigmatization.
Recommendations:
1) Reinforcement of treatment adherence at multiple levels of
interventions.2) enhancement of TSS on health care team system
for social support.
THLB0506
The WHO framework for monitoring progress towards
universal access to HIV/AIDS prevention and treatment in
the health sector
K. De Cock', T. Boerma2. 1World Health Organization, HIV/AIDS,
Geneva, Switzerland, 2World Health Organization, Measurement
and Health Information Systems (MHI), Geneva, Switzerland
Issues: The G8 leaders and UN General Assembly have called for
scale-up towards universal access to treatment by 2010. A clear
international monitoring strategy is required to focus attention on
effective programme development and monitor international and
national commitment.
Description: The WHO framework for monitoring progress focuses
on six health sector interventions: anti-retroviral treatment (ART)
of people with advanced HIV infection, voluntary HIV testing and
counseling including all TB patients, prevention of mother to child
transmission (PMTCT), prevention of nosocomial transmission
(blood safety and universal precautions), interventions among
Most At Risk Populations and second generation HIV/AIDS
surveillance. Monitoring progress singles out three components:

Availability - reach-able and affordable services that meet a

Late Breaker
Abstracts

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XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * PROGRAMME SUPPLEMENT