Delegates enjoy performances at the Global Village stage throughout AIDS 2006. Photo: Lise Beaudry/IAS

17 August 2006

TORONTO, Canada — “AIDS is in the same league with the other big issues like global warming and poverty,” Dr. Peter Piot, Executive Director of UNAIDS said in a conference panel. “It is an exceptional problem that demands an exceptional response.”

The XVI International AIDS Conference was exceptional as well. Twenty-five thousand people representing nearly every country in the world participated. It was a place where one could find out about any aspect of the epidemic or response.

The energy and the sheer scale of the event were at times overwhelming: All day long, streams of people flowed up and down the escalators and skywalk that connected the six floors and two buildings of the convention centre. Finding a meeting room could become an adventure. The printed programme ran 500 pages and weighed in at a couple of pounds. The kick-off nearly filled the stadium next door.

If the experience was taxing for most people, it was especially difficult for people living with compromised immune systems. But their needs were not overlooked. Down one long hall, past the Internet café and the exhibition booths, they could find refuge from the noise and excitement and energy of the day’s events.

The lounge for people living with HIV and AIDS was an oasis of calm away from the crowds. Spaces were divided by long curtains. Low couches were draped with brocade cloths and cushions. Dimmed light coupled with soothing music and a bubbling fountain gave the room the feeling of a spa. Free massages were offered. Quiet spaces were available for prayer and meditation; privacy was afforded for those taking their medications. Nurses and wheelchairs were on hand.

People living with HIV have very special – but often overlooked – needs with regard to their reproductive health as well, says Steve Kraus, chief of the HIV/AIDS branch for UNFPA, especially given the feminization of the epidemic.

“The sexual and reproductive health needs for women living with HIV is gathering greater attention,” he says. “As their numbers increase, so does the need for services tailored to their needs – for family planning, safe delivery and for breastfeeding counselling.”

Most of these women don’t know they have the virus. Many will not have any symptoms for years. But they should be routinely offered voluntary testing and counselling when they come in for services such as pap smears and antenatal care, he said.

Panelists at Tuesday's plenary session present data on proven prevention strategies while exploring the need for new technologies. Photo: Lise Beaudry/IAS

This kind of routine care would have helped Juliet Ajav-Nyior, who was a delegate to the conference from the Centre for the Right to Health in Nigeria. When she was pregnant five years ago, no one offered HIV testing during her prenatal care. After the birth of the child, her second, she diligently prolonged breastfeeding for two full years, thinking it was the right thing to do.

But it was at some point during those two years, she now believes, that her baby contracted the virus. Then she discovered that she and her husband were HIV positive as well. Both tested negative before their marriage and had no reason to think they were at risk.

“We don’t know how we got HIV,” she said. “Maybe we should have been tested a second time. But now HIV is here and we have to accept it, not blame one another.”

One of the most heartbreaking aspects of Juliet’s situation is that she could have kept her baby healthy if she had only received appropriate health care.

HIV-positive women have the right to protect their own health and the health of their families, Kraus said. But 90 per cent of people living with the virus do not know they are infected. Those who do know and want to avoid pregnancy often have no access to contraception. Services to prevent mother-to-child transmission reach fewer than 10 per cent of the women who need them, even though mothers-to-be are desperate to protect their unborn childen.

“The situation cries out for greater integration of HIV prevention with maternal health care,” Kraus said. “Even in resource-poor countries, most women get some form of maternal care. It’s a perfect point for HIV interventions.”

UNFPA is the lead agency within UNAIDS with responsibility for addressing the reproductive health and rights of this critical group, including their right to be sexually active and to bear children. And as treatment in some places is prolonging the lives of some people for decades, more and more HIV-positive women want to exercise this right.

“I’m 22 years old now,” said one young woman at the conference. “I was diagnosed when I was three. I’m in college. I date. I hope to marry and have children. My future is bright.”

— Janet Jensen

What works in HIV prevention? Throughout the conference, different people were asked what they have learned about preventing HIV based on their own experiences. Their answers show that a broad range of strategies can help fight the epidemic. Juliet Ajav-Nyior Centre for the Right to Health, Nigeria We need to use people who are HIV-positive to work on the issue. We need to give HIV a human face and fight stigma. The most essential thing is education and learning that women are human beings with human rights. Women’s rights hardly exist in Nigeria. The man calls the shots, not the woman. The man will even decide how many children the woman should have. Phindi Nhleko International Community of Women Living with HIV, Swaziland I would say advocacy is the best way to fight against HIV. In my country we use workshops to give women information about their rights. We want women to be represented in decision-making. Advocacy is powerful. Chaiyos Kunanusont UNFPA Technical Adviser on HIV/AIDS and Sexually Transmitted Diseases for East and South-East Asia One thing that works is preventing mother-to-child transmission. We have to emphasize that to do this we have to first prevent women who are HIV-negative from being infected while pregnant and that HIV-positive women are able to get informed access to contraception. Both of those things require male involvement. And we also have to make sure that women with the virus have access to antiretroviral treatment. Constance Shumba Chairperson of the National Youth Executive Programme, YWCA, Zimbabwe I believe ABC [Abstain, Be faithful, use Condoms] will not work alone. You also need to empower young women socially, economically and politically. Unless we address those issues we cannot make progress. Girls have to be educated, have access to information, reproductive health services, opportunities and resources.