Release Type: News Article

SASOD fine-tuning proposed revision of Discrimination Act

Contributor: Joel Simpson, Managing Director, SASOD 

The Society Against Sexual Orientation Discrimination (SASOD) is seeking “technical consultations” geared at refining their proposed revision of the Prevention of Discrimination Act (1997).

The organisation last year engaged in consultations with stakeholders on the proposed legislative amendment, which provides legal protection from discrimination in relation to the right to work for lesbian, gay, bisexual and transgender (LGBT) people in Guyana.

SASOD’s Managing-Director Joel Simpson, however, related, “Based on the feedback [the revision of the bill] isn’t ready as yet.”

The organisation is lobbying for an amendment to the 1997 act to protect vulnerable persons within the LGBT community; the inclusion of “sexual orientation” will legally protect persons identifying as lesbian, gay and bi-sexual, while “gender identity” will offer protection to transgender persons.

Currently, the bill prohibits only discrimination in the workplace based on “race, sex, religion, colour, ethnic origin, indigenous population, national extraction, social origin, economic status, political opinion, disability, family responsibilities, pregnancy, marital status or age…”

Simpson explained to the Guyana Chronicle that while stakeholders across the board have signalled their support for this cause, the feedback garnered was that the bill needs additional “technical work” geared toward fashioning the bill for presentation.

“Yes, we’re addressing discrimination based on Sexual Orientation, Gender Identity and Expression (SOGIE), but there are other kinds of things that are wrong with the bill,” he highlighted. “Now it’s not about whether you support non-discrimination for the right to work for LGBT people — we’ve gone past that– it’s about how should we fashion the bill.”

Part of these modifications needed would be the harassment provisions detailed in Section Eight of this legislation. Presently, the legislation allows for a narrow interpretation of harassment based on one’s sex and as such, only cisgenders (people whose gender identity matches the sex that they were assigned at birth) may be able to benefit from this provision.

“We have to look at the definition of harassment in the context of SOGIE, because as it is now it is very narrowly defined based on sex,” the director stated.

SASOD will be reaching out to “sexual rights lawyers”, such as lawyers who’ve worked in the area of sexual offences, human rights and sexuality to garner this prerequisite technical feedback.

In addition to the technical consultations, the organisation has planned to conduct a bipartisan parliamentary workshop, including the United Nations Development Programme (UNDP) that has been instrumental in this revision process and the Parliamentary Standing Committee on Social Services.

The aim of this is to make parliamentarians on both sides of the aisle “champions” for the bill, according to Simpson, who is optimistic that the bill will enjoy widespread support if it reaches Parliament.

“This is a human rights issue,” he said and he posited that a “very very strong message” will be advanced, contributing to how social norms are shaped around discrimination in relation to employment if all parliamentarians act in unison to support this amendment.

Representatives of SASOD met with Minister of Legal Affairs and Attorney General Basil Williams last June and it was reported that the minister requested that the organisation draft the proposed amendment and discussion paper for his and cabinet’s consideration.

While there have not been follow-up engagements with the minister, draftspersons representing him were part of the initial consultations and indicated the ministry’s general support for this bill.

SASOD had reached out to the United Nations Development Programme (UNDP) Guyana office for support in the form of a legislative drafting consultant to draft the proposed amendment bill and discussion paper to engage key stakeholders.

While the amendment of the legislation is in the pipeline, SASOD has taken steps to provide some pro bono (or voluntary) support to the vulnerable groups. Under its ‘Community Paralegal Services Initiatives’, the organisation currently has a pool of five lawyers offering their support vis a vis rights’ awareness and legal redress to the LGBT community.

SASOD launches project to provide free legal aid to vulnerable persons

The Pan Caribbean Partnership against HIV and AIDS (PANCAP) congratulates the Society Against Sexual Orientation Discrimination (SASOD) on the launch of a 12-month project to provide legal assistance to a range of vulnerable persons.

For a full description of the initiative click here.

Head of SASOD, Joel Simpson said the Community Paralegal Services Initiative targets lesbians, gays, transgenders, and sex workers. He said officials would be fanning out to entertainment spots, bars and clubs where sex workers frequent as well as communities to educate persons about their rights and redress services that are available.

The organisation will also provide legal aid for victims of intimate partner violence, juvenile delinquents, parties in family disputes, drug users and orphans.

SASOD Board Secretary, Attorney-at-Law, Mishka Puran said currently five Guyanese lawyers are providing free legal services.

Puran, who is the Guyana focal point and member of the Caribbean Lawyers for Social Justice, urged other interested lawyers to join the network.  To read a full transcript of Mishka Puran’s remarks click here.

The efforts are part of the work of the University of the West Indies-based Caribbean Vulnerable Communities Initiative.

To read remarks by Devanand Milton, President of Guyana Trans United (GTU), click here. 

SASOD Community Paralegal Services Initiative

The Society Against Sexual Orientation Discrimination (SASOD) is a human rights organisation and movement, leading change, educating and serving communities to end discrimination based on sexuality and gender in Guyana. SASOD implements three (3) key programmes which are described as the 3 ‘H’ agenda: Human Rights, Homophobia(s) Education and Human Services programmes. SASOD’s primary beneficiaries are lesbian, gay, bisexual and transgender (LGBT) people.

SASOD has won several awards for its human rights and advocacy work. At the 2014 International AIDS Conference in Melbourne, Australia, SASOD became the first and only Caribbean organization to date to win the globally-coveted Red Ribbon Award in Advocacy and Human Rights. The Red Ribbon Award is the world’s leading award in community-based responses to HIV. In 2015, SASOD copped the Guyana Business Coalition on Health Awareness Annual Award for Business Excellence in Partnerships. In 2016, SASOD received the Victoria Regina Award at the Second Annual El Dorado Awards for “work/life characterized by a unique focus on humanitarianism, protection, and/or activism” from the regional, diaspora-based, non-for-profit organisation, The Caribbean Voice.

Objective(s):
1. To provide legal support to vulnerable groups who cannot necessarily afford legal representation and to act as mediators, organizing community education and advocacy and to bridge the gap between the formal and often-distant justice delivery systems.

2. To work closely with other non-governmental organizations in the Guyana Equality Forum – a local civil society network for which SASOD is the secretariat – and pro-bono lawyers from CariBono: Caribbean Lawyering for Social Justice to develop an active Guyana network that refers cases, provides pro-bono assistance and brings strategic cases to advance legal gains.
Description:

The intention of this initiative is to provide and address unmet needs of vulnerable groups and to strengthen the capacity of vulnerable populations to understand and act on their rights. To address complex rights abuses such as inter-partner violence, societal discrimination, domestic abuse, child sexual abuse and family violence, civil society groups are an invaluable link to accessing justice. As SASOD implements an active human rights documentation system, potential cases for strategic litigation are coming to the fore. This initiative provides an opportunity to link these complainants to legal services in an effort to access justice.

The initiative also aims to increase awareness of human rights by educating vulnerable populations about the local laws, redress mechanisms and opportunities for legal services.

ACTIVITIES DIRECTLY CONNECTED WITH THE COMMUNITY PARALEGAL SERVICES INITIATIVE

i. Targeted outreach exercises and information dissemination: This will comprise visiting recreational and entertainment spots (clubs, bars etc) where key populations socialize. Brochures and other public education materials will be reproduced and distributed.
ii. Conduct workshops in 3 administrative regions (Regions 3, 4 and 10) of Guyana in partnership with local groups and key stakeholders who work with key populations.
iii. Conduct referrals to pro-bono attorneys of the Guyana network of CariBono through the country liaison and focal point who maintains an active roster of willing lawyers.
iv. Hold consultations with key state institutions such as the Guyana Police Force,
Ministries of Public Security, Legal Affairs and Social Protection to sensitize these duty bearers to the human rights of key populations who are historically marginalized.

Impact

The main project impacts from the Guyana Community Paralegal Programme are:
i. Bringing resources, training and support directly to marginalized communities.
ii. Integrating robust community engagements with strong, focused support systems.
iii. Fosters strong collaborations between civil society and legal fraternity to advance rights.

Expected outputs/Results:

The expected results of this initiative include the following:
i. Enhanced relations between the uniformed services and key populations.
ii. Increased access of key populations to the legal system and the likelihood of justice.
iii. Increased knowledge among key populations of their human rights and local laws.
iv. Establishment of an active Guyana network under the U-RAP – led CSJPBLG.

Competencies and Experiences:

Over the past 14 years SASOD has built up strong competencies in providing rights-related services. SASOD’s current cadre of staff and board are highly skilled in human rights law, criminal and civil practice, social work, case management and financial administration. This Programme includes:

1. Joel Simpson is the founder and Managing Director of the Society against Sexual Orientation Discrimination (SASOD). He holds Bachelors of law Degree from the University of Guyana. He is a Chevening Scholar with a Master of Laws Degree in Human Rights Law from the University of Nottingham in the United Kingdom. He has over 14 years’ work experience.

2. Anil Persaud is a distinction graduate from the University of Guyana with a Diploma in Social Work, who is currently completing his Bachelor’s degree in Social Work. By virtue of the profession, Anil is qualified as an educator, counsellor, activist and advocate. Anil holds the position of Homophobia(s) Education Coordinator where he documents human rights cases.

3. Paige Cadogan is SASOD’s Finance and Operations officer who brings with her a wealth of knowledge and decades of experience in the field of accounting. Cadogan has worked with a number of companies in St Vincent and the Grenadines, before re-migrating to Guyana.

4. Valini Leitch is SASOD’s Human Rights Coordinator. Leitch has worked for many years in the private sector and civil society. She brings a wealth of knowledge in the areas of resource mobilisation, legislative lobbying, strategic advocacy and monitoring and evaluation.

5. Mishka Puran is an attorney-at-law admitted to practice since 2005 and is the Secretary on SASOD’s Board of Directors. She also serves as the Guyana focal point and the country representative on the regional steering committee of CariBono. Puran is also counsel on SASOD’s legal team on constitutional challenge to Guyana’s laws criminalizing cross-dressing which is currently filed for an appeal hearing before the Caribbean Court of Justice this year.

PANCAP Champion for Change Dr Arif Bulkan sworn in as Justice of Appeal

The Pan Caribbean Partnership against HIV and AIDS, PANCAP, congratulates Human rights lawyer, Dr Christopher Arif Bulkan on his appointment as an acting Justice of Appeal, Georgetown Guyana.

In September 2017, Dr Bulkan was nominated by Cabinet for candidature to represent Guyana on the United Nations Human Rights Committee (UNHRC). He also was a former lecturer at the University of the West Indies with specialisations in Public Law, Constitutional Law, Caribbean Human Rights Law, and International Human Rights Law.

He also co-founded the Faculty of Law UWI Rights Advocacy Project (U-RAP) at the Cave Hill campus, which is a group of law professors who engage in both litigation and advocacy aimed at promoting human rights.

Dr Bulkan has been involved in human rights advocacy for many years and has worked to establish and defend the rights of vulnerable and marginalised communities, including indigenous peoples, LGBT persons and persons living with HIV and AIDS. He has also been involved in public advocacy against the death penalty, both regionally and at events sponsored by the United Nations High Commissioner for Human Rights.

Dr Bulkan was appointed a PANCAP Champion for Change on September 12, 2017 during the relaunch of the initiative, Champions for change IV: ending AIDS by 2030’.  Read about the event here. 

Biography 

Dr Arif Bulkan is an attorney-at-law who formerly practised law in Guyana as a prosecutor and then criminal defence lawyer. He subsequently obtained a PhD in Law from Osgoode Hall Law School in Toronto, Canada, and currently lectures constitutional law and human rights law in the Faculty of Law of the St Augustine campus of the University of the West Indies. He is the author of ‘The Survival of Indigenous Rights in Guyana’, published by the Institute of Development Studies of the University of Guyana in 2014, and a co-author of ‘Fundamentals of Caribbean Constitutional Law’ along with Tracy Robinson and Adrian Saunders, published by Sweet and Maxwell in 2015; as well as the author of several articles in regional and international journals in the areas of constitutional law and human rights. As a consultant for PANCAP, Arif Bulkan produced a National Assessment of laws and policies impacting on HIV/AIDS in Guyana in 2004.

Arif Bulkan is a co-founder, along with Tracy Robinson and Douglas Mendes SC, of the University of the West Indies Rights Advocacy Project [U-RAP], which aims to promote human rights, equality and social justice in the Caribbean through litigation and advocacy. U-RAP initiated two ground-breaking cases seeking to promote the rights of LGBT persons in Belize and Guyana, both of which are currently under appeal. Between 2011 and 2015 Arif Bulkan served as a director of Transparency Institute of Guyana, an affiliate of Transparency International, which aims at monitoring and promoting accountability and transparency in public affairs. For his regional contributions to human rights and democracy, Arif Bulkan was conferred with the Anthony N Sabga Award for Public and Civic Contributions in 2017.

AIDS out of isolation — rights are for everyone

Early in the response, people living with or at risk of HIV were denied their right to health because of who they are or what they do — sex workers, people who use drugs, gay men and other men who have sex with men, women and young girls, transgender people — or because of the disease they were affected by. They were denied their right to health services, their right to medicines, their right to protect themselves from infection. In being denied these rights, they were also denied their right to dignity, their right to a voice, their right to justice and their ability to live happy and fulfilling lives.

Rather than standing by and allowing increasing numbers of people to be denied services and dignity, the AIDS response utilized the power of health and human rights frameworks to leverage change. The AIDS response positioned the demand for access to HIV treatment as a right to health, showing that health services are not a privilege for the few but rather the right of everyone, regardless of their HIV status. Activists used laws and the courts to protect individual rights — when sex workers were being criminalized for carrying condoms, they took cases to court to defend the right of women to protect their own health. Communities of people living with HIV and people affected by HIV became very skilled at knowing and using the law to defend and protect themselves. Groups of people living with HIV were able to use the knowledge of their rights and the law to argue for access to new medicines. The success of the AIDS response established a path for people living with other conditions, such as diabetes, tuberculosis, hepatitis or cervical cancer, to raise their voices and demand services and
treatment.

People living with or affected HIV have led the way in demonstrating the power of the right to health, but also the power of health to realize wider rights. In seeking and securing access to justice in the courts and creating the space to make their voices heard in political and scientific forums, people living with and affected by HIV have also able to realize their right to fair
treatment and their right to participate and contribute to their communities and society. People living with HIV demanded their right to work in a safe and non-discriminatory environment, to earn a decent wage and to contribute to the economy. Building on the foundation established by HIV rights-based arguments, people living with disabilities, migrants and people affected by
tuberculosis have been able to make progress in realizing their rights.

Today, a young woman may be focused on her right to a quality education and her right to seek the information and means to protect herself from HIV, sexually transmitted infections and pregnancy. However, her focus is not just on her current needs, but also on enabling her longer-term hopes and aspirations. Her immediate ability to realize her right to education and health
has consequences for her longer-term capacity to realize her right to decent work, her right to form her own opinions and the safety to express them publicly, and when and if she chooses, her right to get married and start her own family.

Similarly, an older man living with HIV will focus on his right to quality health services. In addition to his antiretroviral therapy, he will also have concerns about ensuring that he is able to benefit from the highest attainable standards of treatment and care for older people. He may need services and treatment for hypertension and diabetes. As he is getting older and is not able to work or earn money to pay for food and housing, he will be concerned about his right to be treated with dignity and respect and to be protected from discrimination in his old age. He will be focused on ensuring that his right to safety and security is fulfilled.

People living with or affected by HIV are first and foremost people, with busy and diverse lives and needs. Like all people, their lives change and evolve throughout their life, and with those changes come evolving needs that focus on different aspects of the right to health.

Read more in UNAIDS’ new report Right to Health.

Free services for people living with HIV and AIDS

Image: Rev Garth Minott, Programme Director, Religious Groups Steering Committee of the Jamaica Council of Churches.

(Kingston, Jamaica) People living with HIV and AIDS are expected this year to have access to free services at the AIDS Healthcare Foundation (AHF) office located on Hagley Park Road in Kingston.

A recent release said the services to be provided by AHF are expected to include clinic, pharmacy, counselling, and a food bank.

The promotion of these services, particularly in communities with a high concentration of people living with HIV and AIDS, is a collaborative effort between the Religious Groups Steering Committee of the Jamaica Council of Churches, which focuses on HIV and AIDS-related matters and the AHF — a not-for-profit, non-governmental organisation with headquarters in Los Angeles, California, USA, the release said.

“The AHF’s mission is to focus attention on the HIV and AIDS epidemic and the right to health, through the provision of cutting-edge medicine and advocacy regardless of ability to pay. The strengthening of the capacity of religious agencies to adequately and appropriately respond to HIV and AIDS issues, is critical, especially in areas with a high concentration of persons living with HIV, most of whom are also of limited economic means,” said Dr Kevin Harvey, AHF Caribbean regional director, is quoted as saying in the release.

In preparation to launch the AHF services, a number of religious leaders from Rockfort to Six Miles, have undergone a sensitisation session on the urgency to continue to focus attention on the context, spread and impact of the HIV-AIDS epidemic, the importance of a healthy lifestyle, awareness of the right to health, together with the importance of adherence to and availability of free anti-retroviral drugs and other medications and services.

“Religious leaders have great influence at the community level through their continuous social intervention programmes, so we hope that with AHF’s guidance and support we will be better equipped to enable persons to activate the right to health and, in the process, advance the mission of promoting positive values and affirming respect for all,” said Rev Garth Minott, programme director, Religious Groups Steering Committee of the Jamaica Council of Churches.

According to the release, HIV/AIDS remains a public health concern and priority for the Ministry of Health and the Government of Jamaica. It is estimated that about 32,000 Jamaicans are living with HIV and as many as 50 percent are unaware of their status. Although the epidemic affects more men than women, over time the number of female victims has been increasing annually, the release said.

UNAIDS welcomes Gunilla Carlsson as new Deputy Executive Director, Management and Governance

GENEVA, 12 December 2017—United Nations Secretary-General António Guterres has appointed Gunilla Carlsson as the new UNAIDS Deputy Executive Director, Management and Governance, and Assistant Secretary-General of the United Nations.

“Gunilla Carlsson is known for her dynamic leadership and deep knowledge of the issues,” said UNAIDS Executive Director Michel Sidibé. “She is not a business-as-usual leader. I know her innovative approach and extensive network will be critical in taking UNAIDS to the next level.”

Ms Carlsson served as an elected member of the Swedish Parliament from 2002 to 2013 and as Minister for International Development Cooperation from 2006 to 2013. She also served as an elected member of the European Parliament from 1995 to 2002.

A strong leader in global health and development, Ms Carlsson was a member of the UNAIDS and Lancet Commission: Defeating AIDS—Advancing Global Health and a member of the World Bank Gender Advisory Council and served on the United Nations High-Level Panel on the Post-2015 Development Agenda. Currently, she is a senior adviser to the African Development Bank and serves on the board of Gavi, the Vaccine Alliance, as Vice-Chair.

Ms Carlsson will assume her new role in early 2018. She succeeds Jan Beagle, who was appointed United Nations Under-Secretary-General for Management in June 2017.

“I wish to extend my sincere appreciation to Joel Rehnstrom for serving UNAIDS as Acting Deputy Executive Director,” added Mr Sidibé.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

PAHO/WHO, UNAIDS call for stepping up HIV prevention efforts and offering all available options to prevent new infections

Washington, DC, November 29, 2017 (PAHO/WHO) — A new report from the Pan American Health Organization (PAHO), Regional Office for the Americas of WHO, and UNAIDS says that expanding access to all HIV prevention options that are now available would reduce the number of new cases of HIV in Latin America and the Caribbean, which since 2010 has remained at 120,000 every year.

Launched on the eve of World AIDS Day, the report, HIV Prevention in the Spotlight – An Analysis from the Perspective of the Health Sector in Latin America and the Caribbean, analyzes progress made and challenges facing health systems in preventing HIV transmission.

“We have seen important progress in the fight against AIDS in Latin America and the Caribbean, with major reductions in childhood infections, improved treatment and fewer deaths from AIDS. But we have not yet seen the same success in terms of reducing new cases in adults,” said PAHO Director Carissa F. Etienne. “Preventing new infections requires intensifying efforts and ensuring that the most vulnerable people have access to all options and new technologies in a discrimination-free environment.”

The report advocates what is known as the combination prevention approach, which is based on scientific evidence, respect for human rights and non-discrimination, and which includes three elements: offering a comprehensive package of biomedical interventions to users, promotion of healthy behaviors, and establishment of enabling environments that facilitate access to and use of prevention measures.

According to the report and UNAIDS data, the majority (64%) of new HIV cases occur in gays and other men who have sex with men, in sex workers and their clients, in transgender women, in people who inject themselves drugs, and in couples belonging to those key population groups. In addition, one-third of new infections occur in young people aged 15 to 24.

“Reducing new HIV infections among key population groups and the most vulnerable, including women and young people, will require specific high-impact HIV prevention actions, access to evidence, treatment for all, and joint actions against discrimination,” said UNAIDS Regional Director for Latin America and the Caribbean César Núñez. He added that it is equally important to have “an unwavering commitment to respect, gender equality, protection and the promotion of human rights, including the right to health.”
Offering a range of prevention methods

Currently, there are many scientifically proven prevention options that health services can offer to help people prevent HIV infection and protect their health. These measures include new options such as self-administered HIV testing, which can be done at home, and the availability of HIV testing in places other than health centers. In Latin America, 2 in 10 people with HIV and 4 in 10 in the Caribbean do not know they have the virus, which represents an improvement over last year. Early diagnosis improves the quality of life of people with HIV and also helps prevent new infections.

Other recommendations include providing pre-exposure prophylaxis (PrEP), to people at high risk of contracting HIV and offering post-exposure prophylaxis (PEP) in emergency situations, such as when someone has sex with a partner without knowing that person’s HIV status. Although the Region of the Americas pioneered early research that supported WHO’s 2015 recommendation to adopt PrEP, only three of the region’s countries currently offer pre-exposure prophylaxis in their public health service.

The report also advocates distribution of condoms and lubricants, offering syphilis testing at the same time as HIV testing, and providing universal access to treatment, which significantly improves the health of people with HIV while also reducing the risk that they will infect their partners. The report also recommends the promotion of peer-led community outreach activities and providing health information and education.
The publication warns against dependence on international funding for prevention actions (such as peer education and provision of condoms and tests by NGOs) for key population groups, while also highlighting the decisive role that civil society can play in making the HIV response more effective, particularly in the area of prevention.

The report calls on governments, civil society and international organizations to work together in partnerships to accelerate the introduction of new prevention technologies, expand the availability of prevention options and ensure universal access to HIV prevention services to reduce new infections and end the AIDS epidemic by 2030.

Elimination of mother-to-child transmission of HIV and syphilis in the Caribbean

On December 1st, Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and St. Kitts and Nevis will receive validation from WHO for having eliminated mother-to-child transmission of HIV and syphilis. Experts from the Pan American Health Organization (PAHO), World Health Organization (WHO), UNICEF, UNAIDS, PANCAP/CARICOM and the Regional Validation Committee, along with the Prime Minister of St. Kitts and Nevis, Timothy Harris, will announce this achievement and describe efforts made to reach it, in addition to progress at the regional level. Participants will include health ministers and other high-level officials from the honoured islands.

After Cuba in 2015, this group of six countries and territories are the second in the Region of the Americas to receive this recognition. Until now, only two other countries in the world, Thailand and Belarus, have received WHO validation for dual elimination, while Armenia and the Republic of Moldova achieved global elimination goals for mother-to-child transmission of HIV, and syphilis, respectively.

The ceremony will take place at 4:00 p.m. EST Time in St. Kitts Marriot Resort and will be transmitted live on livestream.com/pahotv/EMTCT
The AIDS epidemic in the Caribbean 2016 *
• An estimated 310,000 (280,000-350,000) people were living with HIV in the Caribbean as of 2016
• Approximately 18,000 (15,000-22,000) new HIV infections occurred in the region.
• Some 9,400 (7,300-12,000) people died from AIDS-related illnesses in the Caribbean.
• Between 2010 and 2016, the number of AIDS-related deaths in the region declined 28%.
• Treatment coverage reached 52% (41% -60%) of all people living with HIV in the Caribbean.
• Fewer than 1,000 new HIV infections occurred in children in the Caribbean.
* UNAIDS data: www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf

Click here for the 2017 World AIDS Day Infographic.

PAHO works with all the countries of the Americas to improve the health and quality of life of people throughout the region. Founded in 1902, PAHO is the world’s oldest international public health agency. It serves as Regional Office for the Americas of the World Health Organization (WHO) and is the specialized health agency of the inter-American system.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.
Links

HIV Prevention in the Spotlight – An Analysis from the Perspective of the Health Sector in Latin America and the Caribbean
http://iris.paho.org/xmlui/handle/123456789/34381
World AIDS Day 2017 (PAHO):
www.paho.org/world-aids-day
World AIDS Day 2017 (UNAIDS)
www.unaids.org/en/resources/campaigns/right-to-health

Contacts
PAHO/WHO
Leticia Linn,  Tel. + 1 202 974 3440, Mobile: +1 202 701 4005, Email:  linnl@paho.org; Sebastián Oliel, Tel: +1 202 974 3459, Mobile: +1 202 316 5679, Email: oliels@paho.org; Daniel Epstein, Tel. +1 202 974 3579, Email:  epsteind@paho.org. PAHO/WHO: www.paho.org

UNAIDS
Michela Polesana, Tel. + 507 3014626 Mobile: + 507 69494371 Email: polesanam@unaids.org; Daniel De Castro, Tel: +55 61 3038-9221, Mobile: +55 61 99304-2654, Email: decastrod@unaids.org; Cedriann Martin, Tel: + 1 876 396-7610, Email: martinc@unaids.org

Starting ART immediately after HIV diagnosis cuts mortality risk by two-thirds for people with high CD4 cell counts

People with a high CD4 cell count who start antiretroviral therapy (ART) immediately after diagnosis with HIV cut their 12-month mortality risk by two-thirds, according to research conducted in China and published in Clinical Infectious Diseases.

The retrospective study involved over 35,000 people who were newly diagnosed with HIV between 2012 and 2014. All had a CD4 cell count above 500 cells/mm3. Over 12 months of follow-up, individuals who started antiretrovirals within 30 days of their diagnosis had a 63% reduction in their mortality risk compared to people who remained antiretroviral-naïve. Delayed treatment (initiation after 30 days of diagnosis) also reduced mortality, but only by 26%.

“Our results demonstrate that PLWH [people living with HIV] with a CD4 cell count > 500 cells/mm3 who initiated ART within 30 days of diagnosis…experienced a 63% decrease in mortality,” write the investigators. “Additional risk factors for mortality in this study were older age, being male, having lesser education, and becoming infected via injection drug use or heterosexual contact.”

Since 2015, the World Health Organization has recommended that all people with HIV should take antiretroviral therapy, regardless of CD4 cell count. This is because research has proved that treatment, even at high CD4 cell counts, reduces the risk of illness and death. Moreover, people taking treatment who have an undetectable viral load have an effectively zero risk of transmitting HIV to their sexual partners.

Investigators in China wanted to see if immediate ART cut the mortality risk for people with a high CD4 cell count (above 500 cells/mm3) at the time of their diagnosis. They, therefore, designed a retrospective study involving approximately 35,500 adults newly diagnosed with HIV between 2012 and 2014. All had a CD4 cell count above 500 cells/mm3 and were followed for 12 months after their diagnosis. Study participants were divided into three groups according to their use of HIV therapy:

Immediate ART: initiation within 30 days of diagnosis.
Deferred ART: initiation more than 30 days after diagnosis.
No ART: no HIV treatment.

The researchers hypothesised that immediate ART would be associated with a reduced risk of mortality.

The participants had a median age of 32 years, 75% were male, 64% had a primary education or less, 39% were married, 60% acquired HIV through heterosexual contact. Median baseline CD4 cell count was 616 cells/mm3.

ART was started within 30 days of diagnosis by 5% of the cohort. A further 16% initiated therapy more than 30 days after diagnosis and the remaining people remained ART naïve.

A total of 790 (2% of the cohort) deaths were documented over 12 months of follow-up, a mortality rate of 2.31 per 100 person-years.

There were 19 deaths in the immediate ART group, a mortality rate of 1.04 per 100 person-years. A total of 58 deaths occurred in the deferred ART group, a mortality rate of 2.25 per 100 person-years. The remaining 713 deaths were documented in the treatment-naïve group, a mortality rate of 2.39 per 100 person-years.

Three-quarters of the deaths were attributed to non-AIDS-related causes. The most common non-AIDS-related cause of death was cardiovascular disease (37%).

Compared to the ART-naïve group, immediate ART provided strong protection against mortality (aHR = 0.37, p < 0.001). Delayed ART also provided modest protection against mortality (aHR = 0.74, p = 0.04).

“In addition to the direct benefit of ART for survival, it is also likely that regular follow up and comprehensive care services associated with ART use contributed to the decreased mortality observed,” suggest the investigators. “After ART initiation, patients entered into the stable care system and received multidisciplinary services including regular medical visits as well as psychosocial support.”

Other factors associated with death were older age (under 50 years vs over 50 years, aHR = 2.03; p < 0.001), being male (aHR = 1.90; p < 0.001), having only a primary education or less (aHR = 1.85; p < 0.001), infection with HIV via heterosexual contact (aHR = 4.16, p < 0.001) or injecting drug use (aHR = 5.07; p < 0.001).

“Our results highlight the significant negative impact of delays in ART initiation in a real-world setting in China,” conclude the authors. “Our results support the urgent need to increase the number of PLWH identified early, and started on effective, long-term ART immediately, as predicted by the UN 90-90-90 targets.”

Treat all: what the average person needs to know

Fact: Treat All policies could help avert more than 21 million deaths and 28 million new infections by 2030. 

In September 2015, the World Health Organisation (WHO) issued a new policy which stated that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible. With its “treat-all” recommendation, WHO removed all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.

The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.

WHO now also recommends that people at “substantial” risk of HIV should be offered preventive antiretroviral treatment. This new recommendation builds on 2014 WHO guidance to offer a combination of antiretroviral drugs to prevent HIV acquisition, pre-exposure prophylaxis (PrEP), for men who have sex with men. Following further evidence of the effectiveness and acceptability of PrEP, WHO has now broadened this recommendation to support the offer of PrEP to other population groups at significant HIV risk. PrEP should be seen as an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling and support, and access to condoms and safe injection equipment.

New recommendations on early use of ART and expanded offer of PrEP are contained in WHO’s “Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.” The new guideline stresses that, in order to effectively implement the recommendations, countries will need to ensure that testing and treatment for HIV infection are readily available and that those undergoing treatment are supported to adhere to recommended regimens and are retained in care.

The recommendations were developed as part of a comprehensive update of the “WHO consolidated guidelines on the use of antiretroviral drugs for preventing and treating HIV infection”.

Based on the new recommendations, the number of people eligible for antiretroviral treatment increases from 28 million to all 37 million people who currently live with HIV globally. Expanding access to treatment is at the heart of the set of targets for 2020 with the aim to end the AIDS epidemic by 2030. These targets include 90% of people living with HIV being aware of their HIV infection, 90% of those receiving antiretroviral treatment, and 90% of people on ART having no detectable virus in their blood.

According to UNAIDS estimates, expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million AIDS-related deaths and 28 million new infections by 2030.

CLICK HERE for the Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.