Civil Society Monitors UNGASS-AIDS

Since 2001, Gestos – HIV+ Communication & Gender – follows the resolution of the United Nations General Assembly Special Session on AIDS – UNGASS-AIDS.

In 2003, during the National Meeting of AIDS’ NGOs (ENONG) in São Paulo, Gestos was ellected to be part of the UNAIDS Working Group of Brazil in the seat of Civil Society with a proposal of mobilization and monitoring of the UNGASS-AIDS Declaration of Commitment, signed by one hundred and eighty nine countries. The result of this work was the first Fórum UNGASS-AIDS, held in the same year, with the partnership with the NGO Forum of São Paulo. Since then, Brazilian civil society has been an international reference for monitoring UNGASS-AIDS (please see tables below), taking the issue to state and municipal levels in different parts of the country.

The UNGASS-AIDS Forum Brazil is coordinated by GAPA and Gestos.

There are scheduled for 2009 the state forums of Paraiba and Rio Grande do Sul.

Understanding the National UNGASS-AIDS Forums

Forum	Where and when	Demands	Achievements
I Forum UNGASS-AIDS Brazil	Recife/PE. September, 2003	• Present and discuss the Goals of the Commitment Declaration for HIV and AIDS signed in 2001, at the United Nations General Assembly Special Session.	• Production of a Political Letter of Civil Society – The Letter of Recife; • Participation of civil society representatives at the UNGASS meeting in NY, 2003.
II Forum UNGASS-AIDS Brazil	Recife/PE. March, 2005	• Broaden the knowledge on UNGASS-Aids among the AIDS Movement; • Raise civil society participation at the UNGASS process; • Setting up of a WG UNGASS-Brazil.	• Production of a Case Study with the theme: Access to Treatment in Brazil – A Civil Society Perspective, with the following axis: Technological capacity, the performance of Civil Society, Access to treatment by women, Sex Workers, MSM, People deprived of liberty, IDUs and Transvestites and Transsexuals
III Forum UNGASS-AIDS Brazil	Curitiba/PR September, 2005	• Raise Brazilian civil society participation at the UNGASS-AIDS monitoring process; • Discuss civil society’s contribution in the making of the Brazilian Government report and the preliminary presentation, of the Case Study “Access to Treatment”.  • Articulate civil society’s agenda for the official revision of UNGASS in 2006	• Publication of the Case Study, of which content was incorporated to the official Brazilian government report; • Civil society participation  at the UNGASS-AIDS – NY 2006
IV Forum UNGASS-AIDS Brazil	Recife/PE June, 2007	• Plan Brazilian civil society actions for monitoring UNGASS/AIDS in 2007 and 2008;	• Building of an advocacy agenda with the investigation theme: the Inclusion of Women’s Sexual and Reproductive Health Actions in the National AIDS Policy • Composition by different research groups by theme and regions • Report incorporated by the Brazilian Government in its Official Report to the United Nations Assembly held in June, 2008 • Civil society representatives in the Brazilian delegation
V Forum UNGASS-AIDS Brazil	São Paulo/SP. May 2008	• Evaluate the monitoring actions of UNGASS-AIDS developed by civil society in 2007 • Promote political incidence of the AIDS Movement, derived from the report produced on Sexual and Reproductive Health policies	• Building of an agenda to follow up the State Plans of Fighting the Feminization of HIV and AIDS • Production of the São Paulo Letter with remarks on the Brazilian Country Report, which was sent to the National STD and AIDS Program

 

Understanding the Regional, State and City UNGASS-AIDS Forums

Forum	Where and when	Demands	Achievements
I Forum UNGASS-AIDS Maranhão State	São Luís/MA. 2004.	• Contribute to community answers  facing the monitoring of UNGASS/AIDS Goals and strengthening the National AIDS Movement in the State	• Perception of a dramatic AIDS panorama in the State, with total chaos in Health and Educational Policies • Need to involve more social actors in the process of fighting the epidemics and articulate a partnership with the University in order to broaden researches on the subject and build indicators to advance in the local monitoring
I Forum UNGASS-AIDS Pernambuco State	Recife/PE. December, 2005	• Broaden local knowledge on UNGASS-AIDS and discuss how the Declaration’s commitments may influence public policies on HIV/AIDS control at State end City level.	• Building of a work agenda with action directed at the setting up of the II Forum UNGASS/AIDS Pernambuco; • Need to mobilize a greater number of policy makers in STD/HIV and AIDS • Discussion and deepening about the relation between local and international policies • Setting up of a reference WG to systematize and analyze the proposals related to STD/HIV and AIDS made at the conferences of Health, Women, Human Rights, and children and Adolescents
II Forum UNGASS-AIDS Maranhão State	São Luís/MA. 2005	• Strengthen community answers against STD/HIV and AIDS	• Building of monitoring indicators through most vulnerable groups • Advance towards strengthening and politization of AIDS activism in Maranhão; • Production of a more political diagnosis of the social political economic conjuncture in Maranhão that points out the epidemics impact in the State.
I Forum UNGASS-AIDS North and Northeast Regions	Recife/PE. February, 2006	• Raise knowledge of AIDS NGOs and PLWAs Leaderships in the regions on UNGASS-AIDS, TRIPS, international policies and their impact on national policies on AIDS epidemics control and prevention.	• Production of an Action Plan for 2006 and setting of the participants priorities related to the axis of UNGASS-AIDS.
II Forum UNGASS/AIDS Pernambuco State	Recife/PE. December, 2006	• Give continuity to the monitoring agenda of the Declaration of Commitment and broaden knowledge on UNGASS/AIDS in the State, under the perspective of following up the epidemics interiorization	• Aprovação de várias propostas para ação de execução em 2007 pelo GT de Referência do UNGASS-AIDS PE
III Forum UNGASS/AIDS Maranhão State	São Luís/MA. 2006.	• Strengthen civil society participation in Maranhão on the process of monitoring the Declaration of Commitments of UNGASS-AIDS • Analysis of a political scenario in Maranhão (HDI – Epidemics – Public Policies/Epidemics) • Discuss Civil Society participation in this process; •  Set up a group with several social segments to give continuity to Monitoring in MA	• Setting up of a permanent WG with representations from the capital and interior and a more organized Work Plan
I Forum UNGASS-AIDS São Paulo State	São Paulo/SP. May, 2008.	• Report under construction	• Building of na Action and Monitoring Plan. (Report under construction)
I Forum UNGASS-AIDS North Region	Belém/PA. September, 2008	• Evaluate UNGASS monitoring actions developed in the region for the past two years • Plan UNGASS monitoring actions for the next two years;	• Building of a Monitoring Plan to monitor HIV/AIDS Public Policies in the region
I Forum UNGASS-AIDS Campinas/SP City	Campinas/SP. November, 2008	• Present the Declaration of Commitments to civil society and policy makers of the city	Report under construction
I Forum UNGASS/AIDS Acre State	Rio Branco/AC. March, 2009	• Discuss the importance of Implementing the AIDS Feminization Fighting Plan in Acre and the monitoring performed by Brazilian Civil Society	Report under construction

Sources: UNGASS-AIDS Forums Reports (Nationals, Regional, State and City); Case Study: ARV Treatment in Brazil: the Civil Society Perspective, and National Program on STD and AIDS.

 

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HIV and Maternity in Pernambuco

The housewifre P.J.S, thirty-five years old, born in Recife, northeastern state of Pernambuco, could not imagine that the happiness attached to having a baby could become a judicial nightmare.

When fnding out she was pregnant of her second child, in 2003, she took all medical pre-natal care. She did all blood tests, including the HIV reagent. The doctor at Maternity Barros Lima, northern area of the city, assured her she had nothing to worry about.

The child had a normal birth delivery. Two months later, to a complete surprise, the tests came back with the news that both her and the baby were HIV positive.

Ms Kariana Guerios, attorney of Gestos, who is following the case, says this is one of four similar cases in the Juridical Counseling department of the institution. She points to the fact that prevention of mother to child transmission is still failing in the health system and that this is somewhat frequent. “For the lack of appropriate assistance, my client was told to breast feed, what is completely inappropriate for HIV positive mothers for raising the risk of the baby getting infected. But fortunately such cases are becoming more rare,” explains Ms Guerios.

The attorney filed a case of moral damage and negligence against the County in the Civil Court, asking for a pension for the child because the mother has no financial condition for the treatment and care. “They are poor. It is necessary to try and repair a damage the municipal competence because this child, that could have been born healthy, was infected with HIV because of a sloppy pre-natal.”

Data from the report of monitoring the goals of the United Nations General Assembly Special Session on AIDS – UNGASS-AIDS – in sexual and reproductive health, prepared by the UNGASS-AIDS Forum Brasil, in 2008, shows that, despite the government’s efforts, reducing “vertical transmission” or PMTCT has a wide regional fluctuation in both care and eduction.

Based on the Plan for Preventing Mother to Child Transmission of HIV and Sifilis of the Ministry of Health, 2007, there is a 0,41% prevalence of HIV infections in mothers. There is an estimate of 12,456 newborns are exposed to HIV yearly. The transmission rate of HIV from mother to child, when the treatment intervention with prophylaxis is not done, reaches about 25% of newborns of HIV+ mothers, but it can lower to one or two percent with the application of the necessary measures during pre-natal care, delivery and post-delivery procedures. Such interventions are: the use of anti-retroviral medicines starting at the fourteenth week of gestation; use of injected AZT during labor; perform cesarian section when advisable; give oral AZT to the newborn exposed to HIV from birth to forty-two days and do not breast feed, use mild substitute instead.

Girls United Against Violence and AIDS

There is a direct relationship between HIV/AIDS and violence affecting all social strata, be it through sexual exploitation or abuse – that many times have roots at home. “It is crucial to teach the girls how to defend themselves and to denounce the violence they are victim of,” says one of the participants of the workshop Girls United Against Violence and AIDS that reaches the counties of Recife and Cabo. The campaign, beyond the workshop, has a blog that is used by them to post their views on cases of violence reported by the media, or just to show their views on ways to comfort victims of peculiarly violent situations for being a girl.

The campaign, launched in 2007, has a pioneer approach when interfacing violence and AIDS. The actions include monitoring the system of the Children and Adolescent Rights Act – ECA –, the care structure for youth victim of violence, while reinforcing the need for preventing violence and the HIV/AIDS with youth victim of abuse and sexual exploitation through a sequence of “dialogue roundtables” on the issue at public schools.

Even though there are positive response, the Campaign identifies many challenges such as the lack of unified database system that would ease the monitoring of violent cases, that are badly monitored for the sheer lack of basic information entry. The health care professional resist to write down the cases in detail. And the worst case scenario, the lack or limited prophylaxis medication for HIV in cases of rape.

Sexual and Reproductive Health and the ICPD+15

Between 30 March and 03 April, the United Nations held in New York the 42nd Session of the Commission of Population and Development (ICPD+15.) After a week of debates, the government heads present confirmed the Cairo Action Plan and broadened the reach of the International Conference for Population and Development, held in Cairo in 1994, fifteen years ago, hence ICPD+15.

The resolution the Commission reached in 2009 advanced in the sense of proposing more inter-sectorial approach for AIDS and sexual and reproductive health policies, recognizing the rights of the youth and adolescent populations and, even without citing reproductive rights, strengthening the issue as something to be present in the policies for population and development.

Other important aspects were the specific reference to the assurance of the human rights and the confrontation of stigma and discrimination of people living with HIV/AIDS; the confirmation of the commitments made at UNGASS-AIDS and the affirmation that sexual and reproductive health must be contemplated in the strategic national policies for preventing the spread of HIV and for caring for the people living with HIV (see paragraphs 16, 17, 18, and 19.) In the three months prior to the session, Gestos was active in many discussion groups about Cairo+15 and participated in the elaboration of the Latin American civil society shadow report, organized by the National Feminist Health Network, that, among other themes, focused on sexual and reproductive health of women, violence against women, and the feminization of the HIV/AIDS epidemic. According to Ms Alessandra Nilo, Gestos’ representative in the ICPD+15 Brazilian delegation, “civil society’s presence was fundamental for advancing the commitment.”

“Confronting the AIDS Feminization” plan is still ONLY A PLAN

Since March, representatives of different social strata of Pernambuco have come together to discuss the Integrated Plan to Confront the Feminization of AIDS and other Sexually Transmitted Disease, result of a partnership between the Ministry of Health and the Special Secretary of Policies for Women of the State. The meetings have happened at Gestos.

The plan, that has as a fundamental element the confrontation against the multiple vulnerabilities that contribute for the Brazilian women to become susceptible to HIV or other sexually transmitted diseases, was launched in 2007 March. It has had much publicity in international events, but until today it has not been realized. In 2007 there were macro-region evaluation about the proposal, but the final version of the plan, with the contributions of those consultations, has not been made available either by the Ministry of Health or the State Special Secretary of Policies for Women, whose web site still has the old version of the plan.

In Pernambuco, the Secretary of Health, through the State Coordination of STD/AIDS, was responsible to present the proposal for the State Plan until 2007 December – deadline that has been long gone – and up until today, nothing.

For the organized civil society it is clear that the lack of publicity of the Plan among the social organizations and the lack of articulation between health and women policy managers, even though the plan was confirmed in the last National Conference for Public Policies for Women, 2007 August, has contributed to the demise of the plan’s realization.

Among the organizations that follow the debate are the Health Municipal Council of Recife and of the state of Pernambuco, Women Municipal Council of Recife, Race Equity Council, RNP+, Articulation Pernambuco AIDS, Women’s Forum of Pernambuco, Women Federation of Pernambuco, Young Feminists Colective, Sex Workers Association of Pernambuco and the Family and Gender Nucleus of the Federal University of Pernambuco (UFPE).

Strengthening sexual and reproductive health actions in AIDS policies

Between February 2007 and June 2008, Gestos, with support from the Ford Foundation, among other partners, acted upon to consolidate the formation of a network of sixteen countries, from Africa, Asia, Latin America and the Caribbean, and Eastern Europe, with the objective of monitoring and evaluating public policies of sexual and reproductive health and rights of women with HIV/AIDS.

There was a total of 433 groups and national advocacy networks of the Women’s, AIDS’ and Human Rights’ movements that acted politically on the issue, having as reference the monitoring of the Declaration of Commitment signed at UNGASS-AIDS 2001.

The results of the experience were systematized at Monitoring the UNGASS-AIDS Goals on Women’s Sexual and Reproductive Health comparative report, launched at the UNGASS-AIDS review meeting, June 2008, New York. The Comparative Report was sent officially to UNAIDS as a civil society shadow report. According to the then UNAIDS Executive Director, Dr Peter Piot, “this was the only document produced for UNGASS-AIDS that deals with critical questions to sexual and reproductive health of women living with HIV/AIDS or in a vulnerable situation.”

Ms Alessandra Nilo, Coordinator of the Political Pedagogical Program of Gestos, announced that, in the period of 2009–2011, besides articulating with the partners network to participate in the national processes of monitoring UNGASS-AIDS, the main strategy will be to design advocacy plans in each one of the countries aiming at including sexual and reproductive health as a priority axis in the National AIDS Plans. “The objective is to include the issue of the interface of sexual and reproductive health and AIDS in the political agendas in the countries participating in the project; in the moments of UN reviewing Universal Access, in the strategies of monitoring International Conference on Population and Development (ICPD+15) and the IV Women Conference (Beijing+15), as well as the next International AIDS Conference, to be held in Vienna in 2010.” Concludes her with what it seems her monitoring advocacy mantra.

Because of budget constraint, not all countries that participated in the first phase of the project will participate in the second phase. Raising funds in a time of economic crisis has become ever more difficult. In the new phases the countries where there will be UNGASS-AIDS Forum: Women’s Sexual and Reproductive Health are: Argentina, Brazil, Uruguai, Peru, Nicaragua, Belize, Indonesia, Ukraine, Thailand,  South Africa, Kenya and Uganda.

Project Engages Second Gear

The project of Monitoring Sexual and Reproductive Health in the UNGASS-AIDS Goals has reached, in 2008, its two-year objective for articulating organized civil society to produce knowledge and participate in the international foreign affairs at the United Nations. The report summarizes the findings in each country as singularities and presents a comparative understanding of structural processes that resonates with similitude and repetitive differences. Whether in diverse places such as Indonesia and Uruguay or Belize and Uganda, it is possible to read a general context that, with specific exceptions, reveal the health sector as a bastion for the worst of bad politics and management.

Managing health systems resources and priorities has been a challenge since its inception as a programmatic public policy, a result of the Illuminist Revolution with the birth of the clinic. It has been a little more than two hundred years of sharp development of the medical apparatus in most advanced countries, though even now they are still facing challenges for managing it in a constant combination of centralized state backed health system, such as in Britain, Spain and Canada, and a completely market driven private insurance supported such as in the US. In less developed countries the medicine gap has mostly progressed as in Brazil, changed as in Thailand, evolved as in Cuba, but also remained as exorbitant as ever as in India. The AIDS epidemic has revealed how the precariousness of approaches results in disaster counted in human lives. The sheer lack of trained physicians and nurses makes it even more difficult in rural Kenya – 5.6% prevalence in 15-49 yrs – to reach the country’s goal of installing CD4 counting machines or making sure the medicines reach the patients. Whereas in Thailand human trafficking is jeopardizing the lives of hundreds of thousands of young vulnerable women, in South Africa century old gender and ethnicity unbalance drives the prevalence rate to calamitous stage.

The job of monitoring public policies and practices is not glamorous or pleasant because it definitely points out more problems than highlights advances, whilst the government is focused only on pointing out the positive aspect of hard data, of percentage growths whether in medicines or prevention kits distributed. If the numbers look OK for the institutions, then it is left for civil society to show what is behind the numbers, to expose the actual life processes behind the cold virtual information of statistics alone. This is exactly what the UNGASS-AIDS Forum aims to provoke in each and every country where it is held. It utilizes the strategic Declaration of Commitment as a tool to mobilize activists to focus on what and how such commitments are being implemented.

The first phase of our monitoring project on women’s sexual and reproductive health and rights was concluded with the participation in the UNGASS-AIDS high level meeting, last June, in New York. Our amazing tour-de-force for gathering important civil society produced and analyzed data in sixteen countries was well received and recognized as an important resource of knowledge about sexual and reproductive health in its interface with HIV/AIDS.