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Differences between men and women are most important regarding perceptions of side effects and socialization of treatment. Mostly women face lipodystrophy and this may cause them to stop or start treatment. Women seem to speak more with their medical doctor then men (men just ask them a few questions at prescription renewal). Women seem to involve a significant other in treatment management while men hide their treatment and do not speak about it to family. According to health workers men are more hesitant than women to take their treatment whereas women are naturally more receptive; men don’t accept their disease, treatment and care. Djetcha didn’t come up with specific recommendations based on the results. Sakhumzi Mfecane (WISER, South Africa) presented results of a study on the implications of HIV on notions of masculinity since the experience of living with HIV can transform men’s masculine ideologies in significant ways. His paper examines changes in men’s masculine ideologies and lifestyles that followed HIV diagnosis and treatment and implications for help seeking were explored. The results showed that before testing for HIV, participants subscribed to locally dominant notions of masculinity such as being outgoing, dominant, promiscuous, and opposed to seeking medical help. The experience of living with HIV/AIDS and demands of ARVs, however, resulted in rejection of these notions and adoption of alternative lifestyles. The majority perceived the changes as having little or no bearing on their sense of masculinity. Other men out there were condemned for adopting ‘unhealthy’ and ‘risky’ lifestyles. Therefore Mfecane argues that HIV interventions should take into account social consequences of taking ARVs. The lifestyle changes demanded by ARVs may discourage some men from seeking help for HIV. Support structures are therefore needed for men to successfully adopt necessary lifestyle changes without feeling undermined by society and other men. A study by Blandine Bila (IRSS/CNRST, Burkina Faso) and colleagues (Desclaux) in Burkina Faso focussed on reasons for the low presence of men compared to that of women in health-care facilities. The study looked at social representations of HIV and masculinity to investigate the discrepancy and further looked at its consequences for men in accessing the best quality medical treatment and follow-up. The analysis showed a negative social representation of HIV infection that was considered by infected men as an undignified illness. In addition many men describe their infection as a defeat detrimental to their social image (feeling of failure) and they fear being seen in HIV health-care facilities (humiliating situation). Bila concludes that men feel much more difficulty than women about resorting to health-care facilities for PLWHA and that the quality of the follow-up is often lower. Conclusions and Recommendations -Several studies showed gender specific aspects that should be taken into account by tailoring programs and interventions (differences in perception side effects, contact with medical doctor, disclosure etc.) -Need for specific support structures for men to transform masculine ideologies and change lifestyle without feeling undermined by society and other men. References Bila, B. et al. 2007. Mens attendance in health care facilities and social representations in Burkina Faso. AIDS Impact Conference, Abstract #344. Djetcha, S. 2007. Gender, perceptions and experience of antiretroviral treatment in Cameroon. AIDS Impact Conference, Abstract #297. Mfecane, S. 2007. Mens experiences of antiretroviral drugs in a South African rural site: implications for masculinity. AIDS Impact Conference, Abstract #117. Sexual and reproductive health needs of PLWHA The issue of sexual and reproductive health needs of PLWHA is not addressed in most intervention programs while PLWHA do experience desire for sex and children. Based on research in Indonesia Irwan Hidayana argues that illness perception, reproductive health knowledge, sexual pleasure and issue of disclosure are factors that influence sexual practices among HIV-positive couples. All couples in the study continued sexual activity (with or without condom use). The desire to marry is strong for both HIV-positive men and women (whether they are single, widow or widower ) and the primacy of desire to have children often means putting aside the transmission risk among HIV-positive discordant couples and intertwines with desire for love and intimacy. HIV positive women fear their CD4 count before deciding to get pregnant while they are not able to check regularly due to economic status. HIV positive men perceive sexual transmission risk in relation to their healthy body (not based on CD4 count). Based on the results Hidayana points to several implications for policy. First it is needed to address sexual and reproductive health needs and rights of PLWHA and their partners in gender-sensitive ways. Secondly the existing PMTCT program should not only focus on pregnant women but must also reach men as husband or partner. Thirdly the need to enhance the quality of post-test counselling for the HIV-discordant and concordant couples, particularly in addressing their reproductive and sexual health needs. On the fourth place it is important to increase not only access to treatment (HIV test and ART) but also access to CD4 and VL tests, which are important for couples that desire to have children. In addition it is important to deconstruct the current gender ideology that heterosexual marriage is a safe place (since marital transmission is an increasingly significant element). Currently moral and religious grounds strongly influence HIV/AIDS policy in Indonesia (which is now focussed on high-risk populations) and disregards the reality that many married men engage in extramarital sex, polygamy and prostitution. Early marriage (for women) and polygamy also shows how traditional and religious conceptions on gender and sexuality influence the HIV/AIDS epidemic. And finally Hidayana argues that there should be VCT services for married-to-be couples through religious and government institutions to increase awareness of the heterosexual marital risk. In one of the plenary sessions Annabel Desgrees Du Lou (IRD, France) also point out the need for new strategies involving the partner and that pressure for procreation in heterosexual relationships needs to be taken into account (gender sensitive approach). Desgrees Du Lou argues that there should be better integration of HIV/AIDS prevention in reproductive health services, there is need for conjugal counselling and the development of and scale up of PMTCT programs can play an important role in bringing in new elements in prevention and access to care. Another study in Senegal by Khoudia Sow on social impact of HAART also showed that the desire for children is alive and that there is an increase in the size of the families of patients on ARVs. Christiana Noestlinger (Institute of Tropical Medicine, Belgium) argued that with regard to sexual and reproductive health (SRH) needs, there are different perceptions between health care workers and PLWHA and it is important to rethink patient-provider interventions. PLWHA perceive SRH-related problems as decreasing their quality of life by influencing SRH-choices and future life perspectives. While for patients SRH is a priority, these issues rarely come up during routine HIV care in health care settings (which have a dominant bio-medical approach). Noestlinger therefore argues that adequate counselling training is needed for health care workers (to tackle SRH-related issues) and “a better integration between HIV care programs and SRH care settings is needed to improve the effective service provision”. Pauline Oosterhoff (ASSR/MCNV, Vietnam) also looked at child desire and factors influencing decisions about fertility in families with an HIV-infected member. Although health services around the world have many guidelines for HIV positive women who are pregnant (or want to become pregnant) and for women with HIV infected partners, these guidelines do not address the role of family in making decisions. Oosterhoff argues that in Vietnam the whole family takes a crucial role in deciding whether a woman should become pregnant and whether she will keep her child. This decision is taken in the context not only of the close family but also under the influence of ancestors and their weight in the culture. Key in this regard is the need for parents and grandparents to have male offspring. Health workers share these ideas about preferred family composition and support men and women in the quest for male offspring. Policies and guidelines should therefore take into account these additional family factors and targets as a basis for the design of appropriate interventions to reduce the spread of HIV. Conclusions and Recommendations -Need to address sexual and reproductive health issues in intervention programs since it is a fact that PLWHA have desire for children and sex. -Need for better integration HIV/AIDS prevention and care in sexual and reproductive health settings and services -Need to increase awareness of heterosexual marital risk (for example offer VCT services for married to be couples through government and religious institutions) -Need to address the role of family in fertility decisions in various cultures and adjust policies and guidelines accordingly and take these family factors into account in design of interventions. References Desgrees Du Lou, A. 2007. Women facing HIV/AIDS in their couple : reproductive and sexual issues. AIDS Impact Conference, Abstract #641. Hidayana, I. 2007. Fertility desire and sexual transmission risk: sexuality and reproduction among PLWHA in West Java, Indonesia. AIDS Impact Conference, Abstract #284. Noestlinger, C. et al. 2007. Differences in Perceptions on Sexual and Reproductive Health between Health Care Workers and Persons Living with HIV: A Qualitative Study in the framework of the Eurosupport V Project. AIDS Impact Conference, Abstract #201. Oosterhoff, P. 2007. Holding the line: Vietnamese family responses to pregnancy and child desire when a family member has HIV. AIDS Impact Conference, Abstract #353. Children Prevention Elizabeth Brown (MADaboutART, South Africa) argues that traditional educational approaches do not work anymore for youth. Refreshing, innovative approaches that involve young people in learning and teaching others are required to address individual vulnerability to HIV. MADaboutART is a community-led approach to HIV education designed by young people for young people. Innovative, child-friendly interventions build self-esteem through expressional art and narrative therapy to ensure a strong foundation at the individual level. Their toolbox of techniques is adapted from those developed by narrative therapy practitioners and include Hero Booking, ME Boxes, Body Mapping and Art Attacks. Brown argues that involving young people (in structured programme that provides information followed by skills development and application) supports risk-reduction through empowerment and self-advocacy and enables them to Make A Difference through peer-led educational projects. HIV Infected Children Philippe Msellati (IRD, Burkina Faso) presented an overview during the closing ceremony of where we are in 2007 when it comes to HIV infected children. Despite progress in PMTCT there are still more then 1000 children that become infected each day while there seem to be few resources in social sciences that are allocated to research on HIV and children (except clinical psychology). In the last ten years there has been significant progress in medical care management but there is still a lot to do. For example there is still a lack of policies for early testing in children and absence of paediatric formulation of many medicines. In addition there has been progress by NGOs in management of social and psychological needs of HIV infected and affected children (home visits, school support, nutritional support, discussion groups for teenagers and parents etc) but again is still a lot to do. For example need for more strategies and support concerning disclosure of HIV diagnosis of child to parents, need for specific counselling for families. Further Msellati presented a framework and 10-point package for comprehensive care of an exposed/infected child (and their families) and referred to a handbook on paediatric AIDS in Africa. Finally, it was good that he focussed on several important groups; impact on families, newborns (infants), teenagers and orphans/vulnerable children. Counselling and therapy for children Juliana Thornton presents the work of the NGO Noah (Nurturing Orphans of AIDS for Humanity, South Africa). This NGO works at forming community-based models of orphan care. One service is the home visit. Together with another NGO (Wozobona) 4 pilot projects were initiated to train volunteers with the skills to identify or support children psychosocially by making use of drawing techniques (well known method in early childhood development). Both volunteers and children responded positively to the new system and the method provided a medium through which the volunteer and child could communicate, thus improving the relationship and providing a climate of trust which allowed volunteers to clearly identify the major issues in the child’s life. “However, the new method also revealed more gaps in the system. Most notably the need for further training in bereavement counselling for the volunteers, so that they could counsel the children where needed, as well as a need for the volunteers to, in turn, be psychosocially supported and debriefed on a regular basis.” Therefore the initiative is expanded to include partnership with another NGO (RSBSC), whose Play Skills training program has been recognized as best practice by UNICEF and others. The aim is for the RSBSC training to be rolled out in conjunction with the Wozobona training; thus providing volunteers with a package of methods and skills to handle difficult and emotional topics that emerge from home visits and from the children’s drawings. Karen Vance-Wallace (The Teresa Group, Canada) presented an overview of the evaluation of project Leading the Way (LTW) which is a group therapy program offering psychosocial support to children/youth affected by HIV and AIDS. They address the gap in knowledge on the value of group therapy programs for children/youth affected by HIV and AIDS, where either they or a family member has HIV/AIDS. They aim to contribute to evidence-based practice and inform efforts to best serve this increasing and high-need population group by systematically analyzing information routinely collected (including pre and post qualitative surveys as well as individual and group reports). One of the important findings is that support for children should be developed in a family centred approach. In addition they demonstrated that there is a difference in psychosocial functioning of children who have been disclosed to about HIV status (own or family members) versus children who have not been disclosed to. Results showed that children that don’t know about status have higher level of anxiety. To conclude the results also showed that a psychological counselling session reduces the children’s depression. Children and stigma Lucie Cluver (Cape Town Child Welfare and Oxford University, South Africa) presented results that showed that children orphaned by AIDS have more psychological problems than other children (both non-orphans and children orphaned by causes other than HIV/AIDS). Stigma is also faced primarily by those children who are orphaned by AIDS. Therefore Cluver argues that reducing community-level stigma, and improving provision of positive recreational activities, is likely to improve outcomes for this vulnerable group. But this presentation did not give any solutions on how to reduce stigma at the community level. Therefore we need research that sheds more light on how to provide feedback on heavily stigmatised issues. The presenter does suggest that interventions aiming to alleviate mental health problems may be more feasible on community, rather than individual levels in the context of high numbers of orphans (19% child population in South Africa by 2010). Vera Paiva (University of So Paulo, Brazil) argues that universal and free access to medication has made AIDS orphans in Sao Paulo an invisible problem. Due to access to treatment people are able to conceal their condition in daily life and secrecy about parents death caused by AIDS was actively pointed out as a coping strategy/mechanism for AIDS related stigma. Some children simply do not know status because their primary care taker never told them and most of those who do know, conceal this information at school or community. The research showed that in some way access to medicines could thus reduce stigma but is attached to non-disclosure and secrecy. So on one hand we see that AIDS orphans are more stigmatized in South Africa then non-orphans and orphaned children by causes other then AIDS, while on the other hand research in Brazil shows that access to medicines could reduce stigma due to possibility of concealing the condition (secrecy as coping strategy). What are the consequences of this? How should we look at secrecy as coping strategy and means to eliminate stigma? And how should we deal with this effect of access to medicines while disclosure of HIV/AIDS status is so prominent in many programs and policies? Long term survivors of perinatally acquired HIV Judith Dorrell (Open University, UK) presented a paper based on a review of existing social science literature on perinatally infected children who are living into adolescence and adulthood and how HIV affects this group. Advances in medical treatment have shifted life expectancy but this does not match the ‘lived experience’ and the complex issues they face. In the HAART era, we should start thinking about the future of perinatally transmitted children and young people. Issues such as treatment, adherence, disclosure, psychosocial issues, sexual relationships; and mental health should be addressed. Stephanie Marhefka (Columbia University, United States) also argued that we are now three decades into the epidemic and that due to roll-out and scale-up of ART we need to think longitudinally since AIDS babies live into adolescence and adulthood. The study explored how girls with HIV experience sexual development and behaviour while living with a perinatally acquired, chronic, life threatening, and highly stigmatized sexually transmitted disease. Although some girls living with perinatal HIV may delay sexual debut due to HIV transmission concerns, others lack specific knowledge about transmission risk and lack skills for negotiating safe sex. More research in this area is needed and it is important to specifically develop interventions to increase knowledge of these HIV+ girls and resolve tensions around disclosure and condom use. Joint Learning Initiative on Children and HIV/AIDS (JLICA) JLICA is an international alliance of practitioners, scholars and policymakers committed to protect and fulfil the rights of children affected by HIV/AIDS by mobilizing the scientific evidence base and producing actionable recommendations for policy and practice. JLICAs Founding Partners include the Bernard van Leer Foundation, Franēois Xavier Bagnoud International and UNICEF. JLICAs scientific and technical work is conducted by four thematic learning groups: -Strengthening families (will analyze variations in family response to the pandemic and develop evidence-based recommendations for programming to support families as children’s primary source of care and protection) -Community response (will compile evidence on the efficacy and cost-effectiveness of different community-based services for affected children and propose models for how government can support community-based initiatives without undermining local agency) -Access to services and human rights (will collect evidence on strategies to overcome bottlenecks in implementing essential health and social services for children in low-income, high-burden settings) -Social and economic policies (examine options at the level of social policy, including how universal access to AIDS treatment can be combined with integrated health and welfare programs to address other dimensions of children’s well-being) JLICA will issue expedited reports and policy briefs over the coming year and release a final report to coincide with the IAS conference in Mexico City (August 2008). More information on this initiative can be found at  HYPERLINK "http://www.JLICA.org" www.JLICA.org Coalition on Children Affected by AIDS (CCABA) John Miller of CCABA organized a satellite session on strengthening the evidence about children. He argued that the world is beginning to focus on children as a key under-serviced group within the epidemic but that good evidence is in short supply. Sufficient evidence and critical analyses of the many funded projects is needed in order to find the best models. Many projects don’t seem to either have the capacity or the needed resources for proper evaluation. Therefore the satellite aimed to discuss new approaches to support front-line service providers to ‘beef up’ the evidence base. Lorraine Sherr presented a study that analyzed abstracts and accepted papers of the IAS AIDS Conference held in Toronto, Canada. She concluded that the highest rejection chance was for the following topics: Orphan, Side Effects, Children, Adolescent, and Migrant. The lowest rejection chance for randomised control trials, microbicides, vaccines, Clinton/Gates. In addition medical papers were significantly likelier to be accepted than psychosocial papers. This means that drivers of acceptance for Toronto seemed to be: medicines and North American politics. Therefore Sherr called for more research on children and deliver the papers to the next IAS Conference in 2008 to get children back on the agenda. Wairimu Mungi from an intervention organization in Kenya presented the challenges in the field. Mungi argued that extended families care for 90% of the orphans and that CBOs play a key role in supporting these families (“It takes a village to raise a child”). But there are many challenges: Limited technical and financial support to facilitate base line studies and operational research that informs on quality and high impact programming Limited engagement of NGO/CBO in utilizing lessons learned in project work to inform social sciences research work and national response. Difficult to monitor and evaluate desired change in child due to complex contributing factors at community and household levels No linkage between how project results contribute to the national strategic framework Limited level of engagement between researcher, policy maker and community based programs. External evaluators and researchers often contracted by donor with limited feedback loops. These challenges need to be resolved and tackled as soon as possible. The session ended with things that are needed: Toolkit on how to write an abstract and present a paper for conferences. Also a pre-conference symposium on children. Extended families and kin are assuming 95% of the care, and any intervention by NGO, CBO represents a small share. We should aim to alleviate the burden. Working group on evidence aimed at changing the design of research. We need to know what the evidence is and how we can use it. Need for slogan and campaign to put issue on the map (“Unite for children, unite against AIDS”) We need to find out what to do to get the attention of policy makers and we need political leaders who will be heroes for children (Nelson Mandela and Graca Machel are the only example, but they are retiring). Conclusions and Recommendations -Look at disclosure and psychosocial functioning -Use of family centred approach to support children -Use of Art and drawing techniques for children in prevention and counselling -Community-based approaches -More research on perinatally infected children who are living into adolescence and adulthood -Relation access medicines, stigma and secrecy -Literature review based on results of Joint Learning Initiative on Children and HIV/AIDS -Evaluation of projects and development evidence based research References Brown, E. et al. 2007. Thina Abatwana Siyaqoba Together we the children can beat it. AIDS Impact Conference, Abstract #288. Cluver, L. et al. 2007. Psychological distress amongst children orphaned by AIDS: Effects of stigma and other community factors in South Africa. AIDS Impact Conference, Abstract #23. Dorrell, J. 2007. A Hidden Population - A review of the literature on long term survivors of perinatally acquired HIV. AIDS Impact Conference, Abstract #252. Marhefka, S. et al 2007. "They might get it- and I can't tell them I have it:" Understanding sexual behaviors of girls living with perinatally acquired HIV. AIDS Impact Conference, Abstract #474. Miller, J. 2007. Strengthening the evidence about children a roundtable discussion. AIDS Impact Conference, Abstract #690. Msellati, p. 2007. HIV infected children: where are we in 2007? AIDS Impact Conference, Abstract #685. Paiva, V. 2007. The impact of AIDS related stigma and discrimination on AIDS orphans and their caretakers in So Paulo, Brazil. AIDS Impact Conference, Abstract #495. Richter, L. 2007. The Joint Learning Initiative on Children and HIV/AIDS. AIDS Impact Conference, Abstract #193. Thornton, J. 2007. Innovative and simple techniques to deliver psychosocial assessment and support to Orphans and Vulnerable Children (OVC) in resource-poor settings. AIDS Impact Conference, Abstract #442. Vance-Wallace, K & Shindeler, S. 2007. Leading the Way: Evaluating a group therapy program for children/youth affected by HIV and AIDS. AIDS Impact Conference, Abstract #403. Elderly In the ‘Ageing and Changing’ session at the conference the concept of ‘growing with AIDS’ emerged as a theme at different levels. Three decades into the epidemic we need to start thinking longitudinally, especially since HIV/AIDS is now considered a chronic disease and PLWHA will grow older and almost no research has been done on this topic. The results of the presentation by Marhefka on girls with perinatally acquired HIV are discussed in the ‘Children’ section of this report (Vulnerable groups, page 39). In this section I will specifically focus on elderly, as there still seems to be little research on this topic. Josien de Klerk (ASSR, University of Amsterdam) presented results from a study on experiencing old age in the Kagera region in Tanzania. The literature on the social consequences of AIDS is characterized by the concept of a disappearing middle generation. Due to high adult mortality older people are left with the care for their grandchildren and lack a support network in old age. De Klerk critically examined the concept of a missing middle generation and its consequences for older people and argues that this concept is rooted in a structural kinship perspective in which older people are seen as victims. This obscures the way older people use and negotiate their position in an era of high adult mortality. De Klerk argues that old people have multiple social roles at the same time. For example, an older man might be spouse, father, grandfather, sibling and child to their parent. All these roles carry their own expectations. Differences in expectations reflect conflicts, which might be countered by society or communities. AIDS reconfigures relationships but this takes place in a larger change in social relationships. Due to the disappearance of a middle generation there is a shift in care and support relations and instead of old people as victims bearing the care burden they should be seen as actors negotiating position in care and support. Therefore De Klerk concludes that the concept ‘missing middle generation’ is not sufficient. A more dynamic approach is needed with attention to how mutual dependent relationships are being disturbed by AIDS death. This will lead to more subtle understanding on the impact of AIDS in the live of elderly people. Frederick Lawrence Okello (Elderly Home Care, Tanzania) did not present at the conference but based on the abstract I will add the results of the study in Tanzania in this report. Okello argues that most HIV/AIDS prevention initiatives do not target older persons since they are not assumed to be sexually active. But the lack of education, information and knowledge on HIV/AIDS renders older people more vulnerable to the HIV/AIDS infection. Especially since older people care for infected orphans or due to sexual contact with young brides or newly inherited wives. Therefore Okello identified older people (65+) providing care to PLWHA (including HIV/AIDS orphans) and looked at level of awareness in HIV/AIDS prevention and management. The study found a high percentage of ignorance levels (especially among older Masai men) and older people seem to neither know nor understand the use of condoms or other conventional preventive measures. This makes them a highly vulnerable population. Poverty and the inability to engage in income generating activities due to the caring role also adds to the vulnerability of this group. In conclusion more research is needed on this topic and further it is important to target old people in interventions (prevention but also treatment and care). In addition it was apparent that there is no agreement on the definition of old age. Without an agreement on the definition, ‘elders’ may be difficult to target. Conclusions and Recommendations -Need to target old people in interventions (prevention but also treatment and care) since they are vulnerable for HIV/AIDS as carers but also as sexually active persons. -Need agreement on definition of ‘elders’ to be able to target them as a group in interventions References Klerk, J de. 2007. A world without compassion: experiencing old age in Kagera Region Tanzania. AIDS Impact Conference, Abstract #110. Okello, FL. 2007. The HIV/AIDS Socio-Economic Paradox: The Negative Impact on Older Carers. AIDS Impact Conference, Abstract #48. Counselling and Testing In the conference session on counselling and therapy most presentations focussed on different forms of counselling (mostly psychosocial and PMTCT) and further there was a strong focus on therapy for children. PMTCT counselling and testing is discussed in the prevention section of this report (page 9-10) and the presentations on children are discussed in the vulnerable groups section of this report (page 37-38). Therefore this section on counselling and testing will focus mainly on VCT and PITC/RCT. VCT Proscovia Wakyikye (National Community of Women Living with HIV/AIDS in Uganda) presented results based on a study that explored why Ugandan youths do not accept voluntary counselling and testing (VCT) for HIV/AIDS. Wakyikye argued that the following factors hinder VCT: “a) Lack of access to tailor made counselling programmes (b) Poverty, hindering consistent attendance of counselling and testing services (c) Assumed social rejection in case of possible results due to ignorance (d) Alcohol and drug addiction (e) Idleness, leading to disorderliness (f) Excessive love feelings towards sex partners, leading to boy cot of VCT programmes.” Therefore Wakyikye recommended to create testing and counselling programmes specifically for youth. In addition there is a strong need for empowerment and projects for poverty reduction. It is a pity there were no recommendations or results on how to tailor programmes for youth (how youth felt they could be reached best). Further the statement that it is ignorant of youth to assume social rejection does not reflect sensitiveness to the problem of stigma and discrimination. Prabha Chandra (National Institute of Mental Health And Neuro Sciences, India) presented the results of a study that assessed whether spousal violence or HIV risk perception influenced voluntary confidential HIV testing among women at risk in an urban slum in south India. Both factors seemed to be insignificant and Chandra argues that stigma and confidentiality seem to be more important. In addition culturally accepted patterns of decision making (always consulting spouse and family) may also be influencing factors in India and this has important implications for testing policies and practices in India. VCT versus PITC/RCT Mukuzi Muhereza (The AIDS support Organisation TASO, Uganda) presented results from a study in an area in which geographic features present a barrier to the usual health facility based VCT of HIV/AIDS in Uganda. The paper specifically assessed the rise in uptake of Routine Counselling and Testing (RCT) since the introduction in 2004 in this hard to reach region. The main barriers for VCT between 1996-2004 included transport fees, distance to health service, fear of results and unaware of service. There was a more then 100% increase in people who had undergone RCT between 2004-2006 then people that undergone VCT in period 1996-2004. The most important factor for the increase in testing numbers was mass education and mobile clinic outreaches by hospital staff. The biggest success was in maternity ward with an uptake of 96% of all mothers coming to deliver there upon suggestion of PMTCT services. The biggest gap that needs to be addressed in RCT group is accurate information. In addition Muhereza also argued that delicate groups like adolescents, children and handicapped should receive VCT. In conclusion TASO recommends RCT approach to testing for HIV and group counselling to reduce cost and time. In addition it is important to scale up PMTCT and ART services in difficult to reach areas and there is a need for increased human resources capacity. In the prevention section of this report Debby Imelda also showed positive results in using mobile VCT services as part of a PMTCT program in Indonesia (page 9). In the closing ceremony of the conference Kevin de Cock from the WHO argued that universal access means nothing without knowledge of HIV serostatus. Therefore part of his presentation focussed on the new WHO report on provider-initiated HIV testing and counselling (PITC). In the report the World Health Organization and UNAIDS strongly support the continued scale up of client-initiated HIV testing and counselling, but recognize the need for additional, innovative and varied approaches towards universal access to HIV Prevention, treatment, care and support as endorsed by G8 leaders in 2005 and UNGASS in 2006. They argue that evidence from both industrialized and resource-constrained settings suggests that many opportunities to diagnose and counsel individuals at health facilities are being missed and that provider-initiated HIV testing and counselling (PITC) facilitates diagnosis and access to HIV-related services. Therefore they recommend an “opt-out” approach to provider-initiated HIV testing and counselling in heath facilities, including simplified pre-test information. The WHO does recognize concerns about potential coercion of patients and adverse outcomes of disclosure. Therefore WHO underscores the importance of adequate training and supervision for health care providers and the need for close monitoring and evaluation of these programmes. Simultaneous with implementation of PITC efforts must be made to ensure that a supportive social, policy and legal framework is in place to maximize positive outcomes and minimize potential harms to patients. Conclusions and Recommendations -Need for tailored VCT programs for youth -National testing policies should consider culturally accepted patterns of decision making that go beyond the individual (influence of spouse and family in decisions) -Use of mobile testing and counselling services for areas that are hard to reach -Need to assure accurate information in CT services -Positive results for PITC/RCT using opt-out strategy (versus VCT) -Use of rapid HIV tests in resource constrained settings should be encouraged References Chandra, P. et al. 2007. Do partner violence and risk perception influence voluntary HIV testing in women?A community study from South India. AIDS Impact Conference, Abstract #612. Muhereza, M. 2007. Rise in Uptake of Routine Testing and Counselling in a hard to reach, poor community in south western Uganda. AIDS Impact Conference, Abstract #153. Wakyikye, P. 2007. Factors Hindering VCT for HIV/AIDS among Young People in Uganda. AIDS Impact Conference, Abstract #68. Recommendations for reading World Health Organization. 2004. Rapid HIV tests: guidelines for use in HIV testing and counselling services in resource-constrained settings. Geneva: World Health Organization. World Health Organization. 2007. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: World Health Organization Media Maria Nengeh Mensah (Université du Qubec Montreal, Canada) presented results from a comparative analysis of the changing media messages and discourse about men and women living with HIV in Qubec. They analysed messages over a period of 23 years of press coverage (1982-2004). The goal of the study was to identify how media and community responses can contribute to the development of empowering social environments for PLWHA and Mensah argued that this is an important tool in reducing stigma and discrimination. The results revealed that there are key moments of visibility for PLWHA in press over time, ranging from scientific discovery to aids events and public personas disclosing their HIV status. In addition messages seem to focus on certain gender, sexuality and race categories. Further results show 3 different types of media visibility: diagnostic (epidemiological), classificatory (exposure identities) and activist (messages about community building and individual and collective involvement). In diagnostic messages there seems to be a feminisation of pandemic wile men are only mentioned related to socially marginalised practices (MSM etc). In classificatory messages women are portrayed as innocent victims of gender inequality and violence while men are seen as guilty victims with risky behaviours. And in activist messages women are mostly represented for their individual involvement and access to care treatment and support. This while messages on men seem to focus on community responses, government inaction and misrepresentation. The project is now in the phase of planning joint responses by organizing discussions with media professionals, examining impact of PLWHAs ‘testimonials’ and by developing local and international collaboration. Marietjie Myburg presented results based on a ‘Media, AIDS and Governance’ project in South Africa aimed at strengthening the communication between media, political and government communicators. This in order to build an environment for informed interaction between citizens and the government on HIV/AIDS. Since 2004 the project “reached more than 100 media workers in four countries, strengthening and supporting capacity to contribute to debate and to provide accurate, contextual and comprehensive coverage on the governance response to the epidemic in the southern African region.” Myburg argues that it is important to build new structures in which institutions need to re-conceptualize their role (requires shift in mindset). In addition it is important to build communities by training journalist and encourage citizens to join effort. Journalists have a role as agents and should be seen as catalyst of discussion on issues. The message that should be communicated is that HIV and AIDS is the work of whole society (not only government). Another interesting project focussed on radio as an effective platform to increase awareness of HIV/AIDS and to encourage healthy sexual behaviour among youth (aged 15 to 24 years) in Angola. Gary Mundy (BBC World Service Trust, United Kingdom) argued that the results showed that listeners of the radio spots and talk shows were more likely to buy and use condoms and that they were less likely than non-listeners to believe that promiscuous or immoral people own condoms. Results also showed that regular listeners scored higher than occasional listeners. Mundy did note that it is difficult to prove causality but argued that the differences across a range of outcome indicators suggest that the radio spots and talk shows do play a role in raising knowledge, and changing attitudes and behaviour. In conclusion Mundy stated that audience research is central to development of successful media campaigns, that understanding media landscape and media consumption patterns is key to maximising impact and that campaigns should creatively start from an evidence base. Further he said that it is not enough to look only at listenership and that there is a need to understand more about the contribution which media makes to risk reduction and behaviour change. Finally there was also presentation by Shankar Chowdhury (UNESCO, India) on a project that created a network of young television producers. The idea to create this network is based on the assumption that television is a powerful medium to change people’s perceptions and attitudes about HIV/AIDS and to give a human face to the epidemic. This resulted in 10 mini-documentaries in different countries in Asia (of which 2 won best picture award from EU). The young producers developed a healthy relationship with civil society organisations (including community networks of positive people) but despite that it proved difficult to dispel myths and misconceptions, to break stereotypes and provide basic facts. The producers face enormous challenges in accessing reliable, accurate and relevant information in the local context and it is very difficult to negotiate with TV network directors to keep HIV/AIDS on the agenda of television networks. Positive side is that most of the television producers do continue to work on HIV and AIDS related issues and that more film projects were started (success breeds success). In addition the continued support from media organizations and funders is also encouraging. It was a shame tough that there didn’t seem to be any follow-up on how the movies influenced the public perceptions and how the public reacted to the movies that were shown in the various countries. In conclusion we could say that the dominant theme for this session was re-vitalizing and orienting the media towards prevention and treatment of HIV/AIDS in a positive way (the media is now often associated with negative news). With interventions guided by donors, governments, NGOs, and the general public the media in the North America, Africa, and Asia has made important contributions to prevention and control of HIV through: Media visibility programs that change negative connotations and slogans into socially acceptable messages. Dissemination of PLWHA testimonials Guiding government on how to respond to the epidemic Comprehensive media reporting on key issues Creating awareness among journalists to avoid negative reporting associated wit HIV/AIDS (no dividing line between the affected and un-affected) There is a need to take keen interest in the role of the media in prevention and control of HIV/AIDS as well as access and adherence to ART. The media plays a pivotal role in changing peoples attitudes and perceptions and therefore have a key role in reducing stigma and discrimination. In addition the media plays a major role in enhancing the knowledge of the general public and therefore in prevention activities. Conclusions and Recommendations -Role of the media (newspaper, radio and film) in prevention and control of HIV/AIDS as well as access and adherence to ART (need for positive reporting) -Role of media in changing peoples attitudes and perceptions and therefore in reducing stigma and discrimination References Chowdhury, S. & Rawdin, S. 2007. Whats your story: Creating networks of young Television producers against HIV and AIDS in the Asian region. AIDS Impact Conference, Abstract #341. Mensah, M.N. et al. 2007. The VIHsibilit Project: Comparative Analysis of HIV-Positive Women and Men in Local AIDS Press Coverage and Community Responses. AIDS Impact Conference, Abstract #50. Mundy, G. et al. 2007. Radio as an Effective Platform to Increase Awareness of HIV and AIDS in Angola. AIDS Impact Conference, Abstract #389. Myburg, M. 2007. Strengthening media capacity to act as catalysts for meaningful interaction between policy makers and citizens on effective socio-economic and health responses to HIV and AIDS. 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