FEEDBACK Living 2008 Summit & XVII International AIDS Conference Universal Action Now

1. FEEDBACK Living 2008 Summit & XVII International AIDS Conference Universal Action Now Mexico City August 2008 Silvia Petretti Community Development Manager

2. LIVING 2008 • On July 31st and August 1st • Nearly 400 HIV-positive people • 88 countries, 5 continents • In Mexico City • To set our strategic agenda for a comprehensive response to the AIDS pandemic.

3. Key advocacy themes: • Criminal Prosecution of HIV transmission • Sexual Health and reproductive rights • ACTS • Positive prevention

4. KEY CONCLUSIONS • Criminalization of HIV+ people doesn’t work • Positive Prevention won’t work until stigma and discrimination directed against HIV positive people are eradicated, the concept of positive prevention cannot focus on prevention of HIV transmission. • Until HIV positive people, especially women, claim the sovereignty of their sexual and reproductive health lives and have access to comprehensive health care many will continue to needlessly die • Treatment will fail without basic social determinants of health including food and water

5. ‘The transformative power of the movement of PLWHA plays an vital part in the larger struggle for democracy and social justice’ Peter Piot Living 2008 OpeningPlenary

6. Mexico 2008 UNIVERSAL ACTION NOW!

7. 25.000 people!

8. Adults and children estimated to be living with HIV, 2007 Eastern Europe & Central Asia 1.5 million [1.1 – 1.9 million] Western & Central Europe 730 000 [580 000 – 1.0 million] North America 1.2 million [760 000 – 2.0 million] East Asia 740 000 [480 000 – 1.1 million] Middle East&North Africa 380 000 [280 000 – 510 000] Caribbean 230 000 [210 000 – 270 000] South & South-East Asia 4.2 million [3.5 – 5.3 million] Sub-Saharan Africa 22.0 million [20.5 – 23.6 million] Latin America 1.7 million [1.5 – 2.1 million] Oceania 74 000 [66 000 – 93 000] Total: 33 million (30 – 36 million)

9. Estimated number of adults and children newly infected with HIV, 2007 Eastern Europe & Central Asia 110 000 [67 000 – 180 000] Western & Central Europe 27 000 [14 000 – 49 000] North America 54 000 [9600 – 130 000] East Asia 52 000 [29 000 – 84 000] Middle East&North Africa 40 000 [20 000 – 66 000] Caribbean 20 000 [16 000 – 25 000] South & South-East Asia 330 000 [150 000 – 590 000] Sub-Saharan Africa 1.9 million [1.6 – 2.1 million] Latin America 140 000 [88 000 – 190 000] Oceania 13 000 [12 000 – 15 000] Total: 2.7 million (2.2 – 3.2 million)

10. Over 7400 new HIV infections a day in 2007 • More than 96% are in low and middle income countries • About 1000 are in children under 15 years of age • About 6300 are in adults aged 15 years and older • of whom: • almost 50% are among women • about 45% are among young people (15-24)

11. Number of people receiving antiretroviral therapy in low- and middle-income countries 2002-2007 Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, June 2008

12. ANTIRETROVIRAL THERAPY COVERAGE IN SUB-SAHARAN AFRICA, 2003-2007 WHO (2008). Towards Universal Access :Scaling up priority HIV/AIDS interventions in the health sector; progress report 2008

15. Mony Pen Opening Ceremony

16. Elena Reynaga

17. Edwin Cameron

18. 10 Reasons • Criminalisation is ineffective • Criminal laws and criminal prosecutions are a poor substitute for measures that really protect those at risk • Criminalisation victimises, oppresses and endangers women • Criminal laws are often unfairly and selectively enforced • Criminalisation places blame on one person instead of responsibility on two

19. 10 Reasons • Criminal laws targeting HIV are difficult and degrading to apply • Many of the laws are extremely poorly drafted • Criminalisation increases stigma • Criminalisation is a strong disincentive to testing • Criminalisation assumes the worst about people with HIV, and so punishes vulnerability

20. When condoms are available, when women have the power to use them, when those with HIV or at risk of it can get testing and treatment, when they are not afraid of stigma, ostracism and discrimination, they are far more likely to be able to act consistently for their own safety and that of others Edwin Cameron HUMAN RIGHTS

21. Greater involvement of people living with HIV in healthcare “Those of us who are living with HIV and have come to terms with that diagnosis […] in terms of our own ability to survive the traumas of our diagnosis and daily fight for our rights to existence. Each and every one of you who live and breath HIV is a leader, people with other health conditions look up to us for inspiration […] Do not give up, when life knocks you flat on your face get on your knees. Stand to your feet hold your head high, and keep going” Rolake Odetoyinbo

22. Infectiousness and treatment

23. Swiss Statement • Undetectable Viral Load for at least 6 months • Excellent adherence • Regular viral load monitoring • Monogamous relationship • No STDS • Discordant couples Can have unprotected sex with a risk comparable to using a condom with a detectable viral load.

24. ART is comparable to condom use Sex w/o Condom Partner under HAART Mono- / Bi- Therapy Triple- therapy None Always with condom >1/Mt. <1/Mt. Infection rate partners (%) Vernazza IAC 2008 3/8/08 Castilla, et al. JAIDS 2005; 40:96-101

25. What the statement did not say No advice against using condoms No change in prevention messages Vernazza IAC 2008 3/8/08

26. The Hierarchy of Transmission Risk..from ~36-39 Million People with HIV INCREASING RISK Acute HIV Infection (only 8 weeks) ? ? AIDS (untreated) Established infection (untreated + STDs) ? 30,000,000 people (Fraser et al, PNAS, 2007) Established infection (unrecognized) Established infection (on ART) Myron S Cohen IAC Plenary 2.5 million people

27. Coates, Richter et al., 2008 Highly Active HIV Prevention Myron S Cohen IAC 2008 Plenary

28. Policy Implications • Increase VL testing • Increase Testing • Decrease undiagnosed HIV • Increase Treatment Nikos Dedes EATG IAC Satellite 3/08/08

29. Key implicationsfor PLWHA • “the realization that we will no longer consider ourselves to be a lifelong threat to others” • Serodiscordant couple can have children easily • Remove fear of condom break • Reduce prosecution of HIV transmission/exposure • PLHA are not vectors of transmission • It allows the taboo subject of condomless sex to take centre stage • “Allowing HIV+ people to regain the right to unhinibited experience of sexual pleasure” Nikos Dedes EATAG IAC Satellite 3/08/08