Type: Position papers and guidance

Zambia is one of the more urbanised countries of sub-Saharan Africa with a high rate of population growth. The country has ten provinces that are subdivided into ninety-five districts. Within the districts, the administrative units are Chiefdoms and Constituencies and the latter is made up of Wards.

• Almost 40 percent live in urban areas .
• Average household size is 5.2 .
• Life expectancy is 51.2 years .
• 45.4 percent of the population below the age of 15 years .
• 60% live below the national poverty line (2006).

The epidemic

The HIV prevalence among adults 15-49 years was 14.3% in 2007. Prevalence varies across regions, ranging from 7% in North-Western province to 22% in Lusaka province. The prevalence was about twice as high in urban (20%) than in rural areas (10%). In Zambia, HIV disproportionately affects more women than men, with women constituting 57% of the 1.2 million adults est mated to be living with HIV (UNAIDS, 2008). Women aged 20-24 are 2.3 times more likely to be HIV-positive than men of the same age group (Central Statistical Office, CSO, 2008).

Progress Since 2005, with support of development partners, the Government has provided free anti retroviral therapy (ART) in all public health insƟ tuƟ ons. The proportion of people who are both eligible for and able to access ART has increased from 38.9% in 2007 to 68% in 2009 (NAC, 2010). Over the years, the number of public and private facilitates providing ART related services such as CD4 counts has increased, resulting in improved services in both rural and urban areas. According to the 2009 Zambia Sexual Behaviour Survey,2 levels of HIV-related stigma and discrimination have in general been declining since 2005. Modest positive changes have been observed in proxy indicators to measure the level of stigma and discrimination (CSO, 2010).

The 2012 Zambia Country Report,3 listed several indications of the HIV epidemic being reversed including: a slight reduction in the percentage of the adult population living with HIV from 15.6 in 2001-2002 to 14.3 percent in 2007; a significant reduction in the percentage of young women 20-24 years living with HIV from 16.3 in 2001-2002 to 11.8 percent in 2007; in the antenatal sentinel surveillance the percentage of pregnant HIV-positive women in this age group dropped from 34.3 percent in 1994 to 28.1 percent in 2008-2009.

Among children born to mothers living with HIV, the percentage of infants contracting HIV reduced from about a peak of 7.72 per cent in 1997 to about 1.99 per cent in 2011 because of the reduction of HIV infection among pregnant women and the prophylaxes administered to women living with HIV in the prevention of vertical transmission. National coverage for this programme in 2011 at about 80 per cent was approaching near universal levels.

Challenges

The report also summarised challenges remaining: There are still sub-optimal numbers of children accessing ART, due to challenges in relation to the availability of infant diagnostic tests. Although the percentage living with HIV reduced among all the groups by sex and area of residence, it increased among men 15-49 years in rural areas from 8.9 per cent in 2001-2001 to 11.0 per cent in 2007. In fact, the gains in rural areas where the level of the epidemic can be said to be about half of that in urban areas were modest. Although the level of the epidemic in rural areas is much lower than in urban areas, the population affected is quite high since about 65 percent of the population lives there.

South African society continues to be seriously affected by HIV, together with its related diseases, especially tuberculosis. South Africa currently ranks the third highest in the world in terms of the TB burden, and the incidence has increased at alarming rates in the past decade. There have been signs of a steady decline in the HIV infection rate but South Africa continues to have the highest number of people who are living with HIV in the world, with an estimated 5.7 million people living with HIV.

The Positive Health, Dignity and Prevention report review the results of the different GNP+ evidence gathering tools that were applied in South Africa in recent years to assess whether the HIV response works within a human rights framework respectful of people living with HIV.

The Republic of Moldova is the poorest country in Europe (in terms of per capita income). The country is divided into 32 districts, five municipalies, the autonomous territorial region of Gagauzia and the administrative-territorial region located on the left  bank of the Dniester River known as Transnistria.

While Moldova registered a growth in GDP in recent years, unemployment remains high, wage arrears increased dramatically and external migrantion continues. There is a widening gap between rural and urban areas and also high levels of gender inequality. Moldovan women are mostly employed in low- paying jobs and occupy lower positions in the job hierarchy where they are employed.

People of Moldova:

• The average birth rate is 1.5 children per woman
•  Life expectancy is 69 years
• 29 % live below the poverty line.

The epidemic
The HIV epidemic in the Republic of Moldova is a concentrated one, mainly affecting people who use drugs. The results of the last HIV sero-prevalence survey among people who use drugs carried out in 2009 showed an HIV prevalence of 16.4% in the capital of the country. However in the last three years, the number of newly registered HIV cases among the tested people who use drugs is decreasing, according to the 2012 Country Progress Report.

Ethiopia is the second most populous country in Africa. The country has nine Regional States and two City Administrations. These are subdivided into over 800 administrative woredas (districts), which are further divided into kebeles, the smallest administrative unit. Ethiopia is one of the countries with the lowest per capita income, estimated at 390 USD per annum and over a third of the population live below the absolute poverty line. Nevertheless, it has one of fastest growing economies among non- oil producing countries in sub-Saharan Africa. In recent years, the country has seen rapid progress in economic growth, expansion of social infrastructure, and in improving healthcare.

People of Ethiopia:

•  The majority (83.9%) reside in rural areas
• The average household size is 4.7
• The average life expectancy is 51 years for males and 53 years for females
• Women in the reproductive age group constitute 24% of the population

The epidemic
With an estimated adult prevalence of 1.5%, Ethiopia has a large number of people living with HIV (approximately 800,000) and about 1 million children orphaned by AIDS  There is wide variation in HIV prevalence among administrative regions, and between urban and rural settings as confirmed by Demographic Health Survey (DHS) 2011: urban adult HIV prevalence was 4.2% (women 5.2%, men 2.9%) while rural adult HIV prevalence was 0.6% (women 0.8%, men 0.5%).

The People Living with HIV Global Advocacy Agenda, 2013-2015, was launched in December 2012. The Global Advocacy Agenda has guided networks of people living with HIV and other organizations in their advocacy since 1999.Throughout 2012, people living with HIV across the globe took part in an extensive consultation process, informing the development of this renewed Global Advocacy Agenda.

The Global Advocacy Agenda is a groundbreaking document for the movement of people living with HIV, guiding efforts to achieving Positive Health, Dignity and Prevention. Capturing the unmet needs of people living with HIV with respect to Prevention, Treatment, Care and Support; Human Rights; and Community Mobilisation, Strengthening and Activism, the Global Advocacy Agenda is designed to strengthen and enhance existing advocacy initiatives, in this critical period leading up to 2015. It reflects the diversity of the advocacy efforts within the community and as such is more than just an advocacy resource but a tool which galvanizes and unites people living with HIV and allies.

Despite the varied needs of people living with HIV the Global Advocacy Agenda focuses on the commonalities and principles that are pre-requisites to realizing a truly effective HIV response. However, as the rights and involvement of people living with HIV are still too often ignored for political, ideological and economic reasons, people living with HIV must take a lead in shaping the advocacy that effects change in all our lives – our meaningful involvement is crucial.

Available in English, French, Spanish, Russian and Chinese.

We are people living with HIV.

Over three decades into this epidemic, we are angry that still 4500 of us are dying of AIDS- related illnesses every day. Sixteen years after developing effective treatment, more than half of all of us who need it cannot access these life-saving drugs. The progress that has been made in treatment access is under threat.

People without access to treatment die!

We are angry that our human rights are increasingly being violated. We are faced with involuntary testing, forced sterilization and being treated as criminals because of our HIV status. Every day we are thrown out of our homes, our schools and our workplaces.

This is an assault on our humanity!

We pay tribute to the women and men who started the people living with HIV movement. Because of them, we are alive today. As people living with HIV, we have achieved so much. It is people living with HIV who have:

• created harm reduction and safer sex
• inspired a whole new movement for health care
• linked health care to human rights
• brought visibility to LGBT issues
• broken big pharma’s monopoly on medicine
• brought back social and economic rights into the global conversation; and
• stimulated the creation of the Global Fund to Fight AIDS, TB, and Malaria.

But we are now facing more barriers to our health and our rights. We face:

• punitive laws and policies, resulting in a hostile and disabling environment
• withdrawal of funding and new trade rules and regulations, dramatically reducingour access to drugs and care
• fragmented and complacent communities, resulting in weakened advocacy.We stand side by side as young activists living with HIV and long-term advocates to tear down these barriers. If we don’t act now new infections will rise; we will never achieve “universal access”, “get to zero” or “end AIDS”.

We are in a state of emergency!

We will have access to the best available prevention, treatment and care for ourselves and our children.
We will enjoy all human rights and freedoms.
We will not stand idle and watch our sisters and brothers die.

We, as a coalition of people living with HIV, unite around the People Living with HIV Global Advocacy Agenda, which was developed by our communities around the world. The Global Advocacy Agenda describes what we all still need to ensure access to prevention, treatment, care and support, to protect our human rights and strengthen all of our communities.

This is a call to reinvigorate and galvanize the movement of people living with HIV in the face of this unprecedented global crisis that affects us all.

We urge all people living with HIV, networks of people living with HIV, and networks of key populations, to commit to join together in solidarity.

The next struggle of the People Living with HIV Movement has begun. For success, we need an even greater and more forceful movement that spans every region and every country with its roots embedded deep in each of our communities.

Please join us!

Available in the Arab, Chinese, Dutch, English, French, Russian and Spanish

Prosecutions of people living with HIV who have, or are believed to have, put others at risk of acquiring HIV continue to occur in many countries around the world under outdated or overly broad HIV-specific criminal statutes or the inappropriate application of a wide range of general criminal laws.

These laws and prosecutions are often perceived to be about deterring or punishing malicious, intentional HIV transmission when, in fact, the vast majority of cases have involved neither malicious intent nor transmission.

Such laws and prosecutions for alleged HIV non-disclosure, potential or perceived exposure and non-intentional transmission (‘HIV criminalisation’) are of concern in the following ways:

Prosecuting consensual sex between adults even when there was prior disclosure of HIV-positive  z status;5 or, in the absence of disclosure, the alleged exposure posed a very low risk of HIV infection,6 and/or HIV transmission did not occur.

Effectively treating sex between a person living with HIV and an HIV-negative partner as a physical or sexual assault in the absence of disclosure of known HIV-positive status, regardless of whether there was any malicious intent to harm.

Applying harsh prison sentences to alleged HIV “exposure” during non-consensual acts that pose  very little or no risk of HIV infection, e.g. biting, spitting or scratching.9 Applying increased prison sentences to people living with HIV who are convicted of sex work, even when there is no evidence that they have intentionally or actually put their clients at risk of acquiring HIV.

Applying the criminal law to vertical transmission of HIV during pregnancy or via breastfeeding.

In July 2012, the Global Network of People Living with HIV (GNP+) and the HIV Justice Network presented an analysis of trends in global HIV criminalisation at the 19th International AIDS Conference in Washington DC.

Option B+ is a prevention of vertical transmission approach for expectant mothers living with HIV in which women are immediately offered treatment for life regardless of their CD4 count. This approach offers advantages such as protection of partner(s) and (unborn) child, as well as benefits to the woman’s health, but also carries with it risks.

In the report GNP+ and ICW present the results of 8 different focus group discussions that discussed these issues in Uganda and Malawi. Below poster summarises the results.

For  additional information on Uganda and Malawi, visit the stigma index website

In the 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection (2013 Guidelines), the World Health Organization (WHO) takes a
welcomed step in recommending that people living with HIV everywhere be offered a standard of antiretroviral treatment and care that is closer to what is available in resource-rich countries.

Together with STOP AIDS NOW and the HIV Alliance, we have summarised the guidelines and noted recommendations and key issues from a community and civil society perspective.

To inform the 2013 revision of the WHO Guidelines on HIV treatment GNP+ and the HIV Alliance conducted community consultations.

Expanding antiretroviral therapy (ART) access is a cornerstone of reducing mortality and improving health outcomes among people living with HIV (PLHIV) in all settings. Given recent advances in scientific evidence on the use of antiretroviral drugs (ARVs) for HIV treatment, including their impact on health outcomes and HIV prevention, the World Health Organization (WHO) has reviewed and consolidated all ARV-related guidelines into a single compendium for publication in 2013.

The 2013 WHO Consolidated ARV Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection (2013 ARV Guidelines) focus on four areas:

(1) clinical guidelines for adults and adolescents;

(2) clinical guidelines for maternal and child health;

(3) operations and service delivery guidance (for the first time); and

(4) guidance for programme managers.

Abstract

There is growing interest in the evidence that antiretroviral therapy (ART) can be used not only as treatment for people living with HIV, but to prevent or reduce transmission of HIV.
This paper focuses on the prevention of sexual transmission from persons living with HIV through the use of ART. The paper focuses on what this means for people living with HIV (at an individual level) and what it means for public health (at the population level).

Informed by a consultation with GNP+’s Board and Secretariat, it articulates conditions needed for treatment as prevention to work effectively while protecting the rights of people living with HIV.

GNP+ has recently finalised and published two documents which aim to enhance the greater and more meaningful involvement of young people living with HIV within the HIV response. Supported by funding from the HIV Young Leaders Fund ( www.hivyoungleadersfund.org), GNP+ conducted research among 350 young people living with HIV, and among over 175 youth led organisations and networks living with HIV, to identify the key barriers faced by YPLHIV to engaging more meaningfully in the HIV response. The findings from this research led to the development of these two tools:

• the GIYPA Roadmap: Supporting Young People Living with HIV to be Meaningfully Involved in the HIV Response
• and GIYPA Guidebook: Supporting Organisations and Networks to Scale Up the Meaningful Involvement of Young People Living with HIV.

GNP+ developed two documents which aim to enhance the greater and more meaningful involvement of young people living with HIV within the HIV response. Supported by funding from the HIV Young Leaders Fund ( www.hivyoungleadersfund.org), GNP+ conducted research among 350 young people living with HIV, and among over 175 youth led organisations and networks living with HIV, to identify the key barriers faced by YPLHIV to engaging more meaningfully in the HIV response. The findings from this research led to the development of these two tools:

• the GIYPA Roadmap: Supporting Young People Living with HIV to be Meaningfully Involved in the HIV Response
• and GIYPA Guidebook: Supporting Organisations and Networks to Scale Up the Meaningful Involvement of Young People Living with HIV.

There is growing interest in the evidence that antiretroviral therapy (ART) can be used not only as treatment for people living with HIV, but to prevent or reduce transmission of HIV.

This paper focuses on the prevention of sexual transmission from persons living with HIV through the use of ART. The paper focuses on what this means for people living with HIV (at an individual level) and what it means for public health (at the population level).

Informed by a consultation with GNP+’s Board and Secretariat, it articulates conditions needed for treatment as prevention to work effectively while protecting the rights of people living with HIV.

Some recent studies suggest that women using progestogen-only injectable contraception, such as Depo Provera, may be at higher risk of acquiring or transmitting HIV. The science on the issue, however, is not clear as some studies do not show this relationship.

This brief explores the concerns of people living with HIV around the transmission risks of HIV when using hormonal contraceptives.

The GIPA Report Card is a means of generating evidence about the application of the GIPA principle in-country based on the views and experiences of people living with HIV. The evidence will contribute to monitoring and evaluating governments’ and organisations’ application of the GIPA principle, particularly in light of the 2001 United Nations General Assembly’s Special Session on HIV and the Declaration of Commitment.

The GIPA Report Card is an advocacy tool, which aims to increase and improve the programmatic, policy and funding actions taken to realise the greater involvement of people living with HIV in a country’s HIV response.

Available in English and French

For more information on the the specifics of the GIPA Report Card or on countries that have applied the GIPA principle, click here

The Human Rights Count! is an evidence-gathering methodology initiated and led by the Global Network of People living with HIV (GNP+) to document HIV-related human rights violations against people living with HIV and convert the evidence into advocacy, policy and programmes.

The aim of the Human Rights Count! is to decrease the number of human rights violations against people living with HIV by coordinating evidence-informed advocacy against these violations.

This Information Sheet explains what the Human Rights Count tool is and how it can be used.

Available in English and French