|AIDS - 5 years since ICPD: Emerging issues and challenges for women, young people & infants. A UNAIDS discussion document (UNAIDS, 1999, 24 p.)|
THE PAST FIVE YEARS have seen some exciting breakthroughs and impressive progress in reducing transmission of HIV to babies and young people. However there are clear and formidable challenges ahead in achieving the goals set by the Cairo conference. Many gaps remain in our basic knowledge of HIV, as well as in the policies and programmes developed to fight the epidemic.
Questions of science
Challenges for scientific research in the immediate future include:
· developing affordable, simple and non-invasive tests for the early detection of STIs in both symptomatic and asymptomatic women and men;
· developing new technologies for HIV prevention, with much greater commitment to the search for women-controlled methods including safe and effective microbicides;
· developing a range of clinical interventions for the reduction of MTCT, including simpler and more widely affordable antiretroviral (ARV) regimens;
· establishing the effects of breastfeeding in conjunction with ARV regimens on MTCT of HIV.
Issues of policy
There is a pressing need for countries to create an enabling environment for the reduction of MTCT and the reduction of HIV/AIDS among young people. This requires, inter alia, ensuring that national laws and the policy framework at national and community level are non-discriminatory and supportive of women and young people. A comprehensive review of existing laws and policies for their effect on women and young people is the first step, to be followed by active measures to improve the status of women and their economic independence, and to give them a genuine role in shaping policies that affect them. Governments need to adopt into law universal human rights instruments and ensure they are reflected in policies, with special attention to reproductive rights, the rights of the child, and the rights of young people. In addition, measures should be taken to ensure that all policies on HIV/AIDS are gender-sensitive and sensitive to the needs of young people.
With scope for protecting babies from perinatal transmission of HIV increasing all the time, governments need urgently to develop national policies on MTCT that provide for equitable access to interventions, and address also the complex and sensitive issues of infant feeding and the supply of infant formula. In many places, more studies will be needed to determine the best ways of minimizing the risks associated with replacement feeding.
The immediate challenge for most countries is to strengthen primary health care - particularly mother and child, family planning, and STI services - as the necessary foundation for HIV/AIDS interventions. The quality of care is a vital consideration, and special attention is needed also to making services user-friendly to women and young people, and accessible to all. In addition, countries need to identify what is required to introduce interventions such as voluntary counselling and testing (VCT) and programmes to reduce MTCT, and to ensure equity of access. Where services already exist but are underutilized, research should be carried out to identify the factors - psychological as well as practical - that inhibit potential clients. Much more research is needed also at the national and international levels, to understand how best to integrate services for STIs and HIV/AIDS into mainstream reproductive and primary health care services, and how to make them user-friendly. A common criticism is that too often these are stated as ideals without practical guidance on how they should be accomplished or due recognition of the constraints.
In many places, civil society could be playing a greater role in AIDS prevention and care and in meeting reproductive health needs. This should be actively encouraged everywhere. In addition, strategies are needed to ensure that men share responsibility for sexual and reproductive health, including family planning and the prevention and control of STIs and HIV. And efforts should be made to improve understanding of, and demand for female-controlled methods of disease prevention.
As far as young people are concerned, it is now possible, with the knowledge we have of what works, to formulate policies and programmes which deal directly with their vulnerability to HIV/AIDS. These are policies and programmes aimed at ensuring that young people:
· live in a safe environment which fosters their health and overall development to reduce their vulnerability to HIV, and provides assistance and support in times of crisis through family members, peers and concerned adults in the community;
· acquire the information and develop the skills necessary for healthy development and to become responsible adults, as well as to manage specific situations in which HIV poses a risk;
· have access to HIV-related services that are accessible, affordable and confidential, and include education, diagnosis and treatment of STIs, HIV and AIDS, as well as counselling, referral, and commodities such as contraceptives including condoms;
· have opportunities for genuine participation in developing and defining policies and programmes that affect their lives, including those related to HIV.
Widening the net: advocacy and partnerships
The role of advocacy in fighting the epidemic is as important today as it has ever been, for the threat posed by AIDS is still greatly underestimated by many decision-makers. Denial and lack of commitment at national level remain serious problems: unwillingness to confront the often sensitive and controversial issues raised by AIDS - such as teenage sexuality, prostitution, drug-taking behaviour and homosexuality - is common in the developed as well as the developing world. And the issues that most concern women in the epidemic, including the threat of passing on HIV to their children, have been widely neglected by researchers and policy-makers alike. Moreover, despite much lip service paid to human rights, their direct relevance to the AIDS epidemic is poorly understood by many people. Violation of human rights, including prejudice and discrimination, remain major barriers to effective campaigns for women and young people. Every opportunity should be taken to fight discrimination so that individuals and communities can openly acknowledge HIV/AIDS, and the epidemic can be addressed without shame or fear.
Strong advocacy is needed, also, to guard against the constant threat of waning public interest in a catastrophe in slow motion, for success in the future depends on increased commitment and a greatly expanded response to AIDS. This means, among other things, strengthening existing partnerships, and recruiting new partners from all walks of life who will bring additional expertise and resources as well as new perspectives to the global campaign against AIDS.
Ultimately, however, what is needed most is sustained commitment. HIV has lost none of its virulence, none of its ability to tear at the fabric of our societies. But given imagination, solidarity and the unflagging will to act, we know enough already to turn the tide on AIDS and save millions of lives.