FEEDBACK Living 2008 Summit & XVII International AIDS Conference Universal Action Now Mexico City August 2008 Silvia Petretti Community Development Manager

On July 31 st and August 1 st Nearly 400 HIV-positive people 88 countries, 5 continents In Mexico City To set our strategic agenda for a comprehensive response to the AIDS pandemic. LIVING 2008

Key advocacy themes: Criminal Prosecution of HIV transmission Sexual Health and reproductive rights ACTS Positive prevention

 Criminalization of HIV+ people doesn’t work  Positive Prevention won’t work until stigma and discrimination directed against HIV positive people are eradicated, the concept of positive prevention cannot focus on prevention of HIV transmission.  Until HIV positive people, especially women, claim the sovereignty of their sexual and reproductive health lives and have access to comprehensive health care many will continue to needlessly die  Treatment will fail without basic social determinants of health including food and water KEY CONCLUSIONS

‘The transformative power of the movement of PLWHA plays an vital part in the larger struggle for democracy and social justice’ Peter Piot Living 2008 OpeningPlenary

Mexico 2008 UNIVERSAL ACTION NOW!

people!

Total: 33 million (30 – 36 million) Western & Central Europe [ – 1.0 million] Middle East & North Africa [ – ] Sub-Saharan Africa 22.0 million [20.5 – 23.6 million] Eastern Europe & Central Asia 1.5 million [1.1 – 1.9 million] South & South-East Asia 4.2 million [3.5 – 5.3 million] Oceania [ – ] North America 1.2 million [ – 2.0 million] Latin America 1.7 million [1.5 – 2.1 million] East Asia [ – 1.1 million] Caribbean [ – ] Adults and children estimated to be living with HIV, 2007

Estimated number of adults and children newly infected with HIV, 2007 Western & Central Europe [ – ] Middle East & North Africa [ – ] Sub-Saharan Africa 1.9 million [1.6 – 2.1 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania [ – ] North America [9600 – ] Latin America [ – ] East Asia [ – ] Caribbean [ – ] Total: 2.7 million (2.2 – 3.2 million)

Over 7400 new HIV infections a day in 2007 More than 96% are in low and middle income countries About 1000 are in children under 15 years of age About 6300 are in adults aged 15 years and older of whom: — almost 50% are among women — about 45% are among young people (15-24)

Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, June 2008 Number of people receiving antiretroviral therapy in low- and middle-income countries

ANTIRETROVIRAL THERAPY COVERAGE IN SUB- SAHARAN AFRICA, WHO (2008). Towards Universal Access : Scaling up priority HIV/AIDS interventions in the health sector; progress report 2008

Mony Pen Opening Ceremony

Elena Reynaga

Edwin Cameron

10 Reasons 1.Criminalisation is ineffective 2.Criminal laws and criminal prosecutions are a poor substitute for measures that really protect those at risk 3.Criminalisation victimises, oppresses and endangers women 4.Criminal laws are often unfairly and selectively enforced 5.Criminalisation places blame on one person instead of responsibility on two

10 Reasons 6.Criminal laws targeting HIV are difficult and degrading to apply 7.Many of the laws are extremely poorly drafted 8.Criminalisation increases stigma 9.Criminalisation is a strong disincentive to testing 10.Criminalisation assumes the worst about people with HIV, and so punishes vulnerability

HUMAN RIGHTS When condoms are available, when women have the power to use them, when those with HIV or at risk of it can get testing and treatment, when they are not afraid of stigma, ostracism and discrimination, they are far more likely to be able to act consistently for their own safety and that of others Edwin Cameron

“Those of us who are living with HIV and have come to terms with that diagnosis […] in terms of our own ability to survive the traumas of our diagnosis and daily fight for our rights to existence. Each and every one of you who live and breath HIV is a leader, people with other health conditions look up to us for inspiration […] Do not give up, when life knocks you flat on your face get on your knees. Stand to your feet hold your head high, and keep going” Greater involvement of people living with HIV in healthcare Rolake Odetoyinbo

Infectiousness and treatment

Swiss Statement Undetectable Viral Load for at least 6 months Excellent adherence Regular viral load monitoring Monogamous relationship No STDS Discordant couples Can have unprotected sex with a risk comparable to using a condom with a detectable viral load.

ART is comparable to condom use Partner under HAART None Mono- / Bi- Therapy Triple- therapy Sex w/o Condom >1/Mt.<1/Mt. Always with condom Castilla, et al. JAIDS 2005; 40: Infection rate partners (%) Vernazza IAC /8/08

What the statement did not say No advice against using condoms No change in prevention messages Vernazza IAC /8/08

The Hierarchy of Transmission Risk.. from ~36-39 Million People with HIV Established infection (on ART) Established infection (unrecognized) Established infection (untreated + STDs) Acute HIV Infection (only 8 weeks) INCREASING RISK 2.5 million people 30,000,000 people ( Fraser et al, PNAS, 2007) ? ? ? AIDS (untreated) Myron S Cohen IAC Plenary

Highly Active HIV Prevention Coates, Richter et al., 2008 Myron S Cohen IAC 2008 Plenary

Policy Implications Increase VL testing Increase Testing Decrease undiagnosed HIV Increase Treatment Nikos Dedes EATG IAC Satellite 3/08/08

Key implications for PLWHA “the realization that we will no longer consider ourselves to be a lifelong threat to others” Serodiscordant couple can have children easily Remove fear of condom break Reduce prosecution of HIV transmission/exposure PLHA are not vectors of transmission It allows the taboo subject of condomless sex to take centre stage “Allowing HIV+ people to regain the right to unhinibited experience of sexual pleasure” Nikos Dedes EATAG IAC Satellite 3/08/08