www.aidsalliance.org
Supporting community action on AIDS in developing countries
Positive Prevention – the Alliance
experience
Supporting community action on AIDS in developing countries

Supporting community action on AIDS in developing countries
A Framework for Prevention with PLHA
Themes
•Individually focussed
health education and
support
•Ensuring access, scaling
up, improving service
delivery
•Community mobilisation
•Advocacy and policy
change
Principles
•Based on realities and
perspectives of PLHA
•Focus on communication,
support, policy change
•Meaningful involvement
of PLHA
•Integration with existing
programmes
•Promotes human rights
•Recognises inequalities
•Shared responsibility

Supporting community action on AIDS in developing countries
UNICEF
Access
to ART
ART
management
OI prevention
Quality of life
issues:
-income security
-OVC for PLHA
parents
Palliative
care
Grief and
mourning
Community
rejection & self
acceptance
issues
Other staying
healthy issues:
Nutrition & food
security
Physical & mental
health
STI prevention
Sex partners
MTCTFellow
IDUs
Primary prevention
of HIV infection
secondary prevention
tertiary prevention
MOPH
ACCESS
MSF
HIV prevention, treatment and care are interdependent – not reciprocal
Context

Supporting community action on AIDS in developing countries
Prevention priorities identified by PLHA - ‘Real Life’ Thailand
PLHA HIV prevention STI prevention
Symptom recognition,
social realities and service
orientation
Babies
safe pregnancy options
Community rejection
and self acceptance
issues
Concrete real life
situations
External and internalised
issues
7 different
prevention”profiles” eg
Serodiscordant, HIV+ sex
workers, IDU

Supporting community action on AIDS in developing countriesPrevention of sexual transmission for PLHA
A,B,C – not AB vs C
Abstinence
1. Stop having sex
Be faithful
2. One partner: use condoms
3. One partner: no condom
More than one partner
4. Condoms all the time
5. Condoms with non-regular partners
6. Condoms some of the time
7. No condoms
Serostatus issues add complex interpersonal issues
− Disclosure with new partner: when, why, how?
− Both HIV-positive, or only one of us: what to do?
− Risk of re-infections resistant to treatment: what to believe?

Supporting community action on AIDS in developing countries
Links with wider HIV prevention
• Most ‘wider’ prevention messaging privileges or assumes a HIV
negative audience – this can intensify stigma and alienate PLHA
• Prevention programs must address interpersonal and community level
dynamics between HIV positive and HIV negative people (and those
who don’t know their status)
• A HIV+ diagnosis in itself changes the power dynamic between people
in previously ‘equal’ relation – especially noticeable among msm
• ‘Shared’ or linked prevention responses should be a goal – but need
safe ‘positive space’ to make this work
• Gender inequity and power imbalances have to be addressed at all
levels

Supporting community action on AIDS in developing countries
PLHA visibility and safety
• People with HIV are effective peer educators – of
other PLHA and their wider community peers
• However, they cannot be engaged unless they know
their status – and it is safe for them to know this and
to disclose this to whom they want.
• Testing rates remain dismally low in many places –
meaning much of the burden falls on the minority who
have been tested
• A visible, sustainable, inclusive PLHA presence
needs time, trust and money – fragmentation, stigma,
unpredictable funding, need for skills all limit capacity

Supporting community action on AIDS in developing countries
Key Populations
• Participation of KPs in prevention and PLHA programs –
especially sex workers, people who use drugs, msm and
transgender - is often restricted by legal status and
cultural values and constraints.
• Many people still believe that people with HIV have no
right to sexual expression or to have children
• Even more appear to believe that sex workers and
people who use drugs can never be good parents
• Positive prevention and visibility efforts need to be
mindful of the potential to further stigmatise or
marginalise most-at-risk populations and/or HIV+
members of those populations
• The SRHR and development needs of adolescents are
a source of anxiety in most cultures – even more so in
the case of HIV+ adolescents who may be unaware of
their status

Supporting community action on AIDS in developing countries
Key Lessons
• A holistic approach which places people with HIV at its centre
and addresses the reality they find themselves in is essential
• This takes time, trust and honest engagement and debate
• ‘Proving’ effectiveness is very hard and easily confounded – but
we shouldn’t trade access for methodological neatness
• Implementation bottlenecks, rushing things and poor co-
ordination can all slow things down
• Inclusiveness and diversity are critical – and sometimes need to
be balanced differently in prevention than in treatment and care

Supporting community action on AIDS in developing countries
Further resources
Alliance website www.aidsalliance.org
Toolkits, research, links to country sites with materials in other languages
KHANA www.khana.org.kh
PLHA standard package of activities (SPA) and other resources – in Khmer and
English
Alliance Ukraine for Russian language materials; see also Alliance India and
Frontiers Prevention Project materials