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Positive prevention –the alliance experience

  1. Supporting community action on AIDS in developing countries Positive Prevention – the Alliance experience Supporting community action on AIDS in developing countries
  2. 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
  3. 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
  4. 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
  5. 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?
  6. 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
  7. 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
  8. 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
  9. 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
  10. Supporting community action on AIDS in developing countries Further resources Alliance website Toolkits, research, links to country sites with materials in other languages KHANA 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