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2002: The Health Action AIDS Campaign - Report

Physicians for Human Rights - Mobilizing Health Professionals
From May 3-5, 2002 Physicians for Human Rights (PHR) convened leading medical and public health experts and activists working to combat global HIV/AIDS in the first John Lloyd Summit on HIV/AIDS at Stony Point, New York. The purpose of this meeting was to launch a U.S.-based medical and public health leadership group for PHR's Health Action AIDS Campaign and to forge a consensus on critical policy questions concerning the U.S. response to the global pandemic. The group will provide expert advice, practical and strategic input and will advocate for far greater engagement of members of the health professions in the United States to stop the global pandemic.

Dr. Helene Gayle from the Bill and Melinda Gates Foundation has a sidebar conversation with
Dr. Peter Lamptey of The Implementing AIDS Prevention and Care (IMPACT) Project.

Participants included leading scientists who have monitored the spread of HIV/AIDS; physicians and nurses who have pioneered in treatment efforts both in the United States and in developing countries; public health specialists carrying out key prevention programs; foundation executives sponsoring major HIV/AIDS initiatives; and advocates working to increase dramatically US funding for HIV/AIDS.

The meeting occurred in an atmosphere of extraordinary expectation and possibility following the announcement of the first grants awarded by the Global Fund to Prevent HIV/AIDS, Tuberculosis, and Malaria. Many of the initial awards included treatment programs in addition to prevention.

The following areas of consensus and direction for a future campaign among health professionals emerged:

1. Need for this Campaign
A louder and stronger health professional voice in the United States is required on this issue. As the single largest epidemic in human history, HIV/AIDS challenges the medical, nursing and public health professions like no other issues. At the same time, history has shown that when the medical, nursing and public health professions organize around a global health challenge, such as smoking or the threat of nuclear war, their authority and influence can be enormously powerful. It is a critical time for the voice to health professionals to be heard.

There is a pressing need to bring together different perspectives within the medical, nursing and public health communities on the AIDS crisis to speak with one voice. The Health Action AIDS Campaign will bring necessary coordination and clarity from the medical, nursing and public health communities, in addition to a message to mobilize the corps of professionals in these fields who are not yet engaged in advocacy. The leadership of the campaign is convinced that the Global AIDS requires the full engagement of health professionals nationwide
The Health Action AIDS campaign has four key objectives:

  • to organize a large-scale public education initiative to raise awareness in the health professions and mobilize their support for a comprehensive AIDS strategy;
  • to encourage the U.S. Administration to increase its financial commitment to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, gaining a U.S. contribution to the Fund of at least $2.5 billion annually;
  • to provide up-to-date research that informs advocacy and public education efforts about the connection between human rights and AIDS; and
  • to develop opportunities and avenues for health professionals in the U.S. to support the struggles of health professionals and AIDS activists around the world to develop the local capacity to meet the challenges AIDS poses.

The next steps in the campaign will be to achieve the support of all of leading medical, nursing, public health and allied professional associations and their members and to participate actively in advocacy for a strong commitment by governments to act.

In addition to launching and coordinating a national campaign among health professionals to gain greater investment by the US in the global HIV/AIDS crisis, Physicians for Human Rights is conducting investigations into human rights violations as they relate to HIV/AIDS. The organization will issue reports and conduct advocacy on specific human rights abuses, especially abuses against women and within the health sector itself. Health professionals may also have a unique capacity to influence policy regarding youth and sexuality, examining successful campaigns on HIV/AIDS within the military, and reporting and raising an alarm about the loss of health professionals due to the impact of HIV/AIDS (including deaths and attrition due to frustration).

2. Core Principles of a Unified Health Professional Approach
The Summit supported several fundamental principles to bring to policy makers in a message for stepped up funding:

  1. A comprehensive approach to HIV/AIDS, embracing prevention and treatment, is not only possible, but essential, if this plague is to be stopped. A comprehensive response must combine prevention, capacity building, procurement of pharmaceuticals and technical services, long-term treatment and care, as well as research on vaccines, microbicides, and dissemination of information about programs that work.

  2. A comprehensive approach must entail protection of human rights that are necessary for prevention, treatment and care. These include the right to information, prevention of violence against women and sex trafficking, promoting the rights of women in marriage, and eradicating discrimination against vulnerable groups.

  3. To gain greater investment to combat the global AIDS crisis, one region should not be pitted against another, nor should funding that would otherwise be directed to a myriad of global health needs be diverted to HIV/AIDS. Funds for AIDS prevention and treatment should be new. Appropriating such funds would represent a dramatic increase in U.S. investment in global health, with the recognition that this must be a long-term commitment.

  4. The investment should promote public health generally, and should respond to the needs and plans developed by those closest to the problems and specific challenges in their own countries.

  5. Money alone will not solve the AIDS crisis; enormous human resources need to be mobilized, developed, supported and protected.

  6. The challenge of AIDS is complex and difficult, but the obstacles should not stand in the way of bold and prompt initiatives, especially in light of evidence of successes to date.

  7. No discrimination based on gender, race, ethnic or religious group affiliation, or level of income should occur regarding who gains access to prevention and treatment programs and efforts to reach vulnerable and marginalized groups, including women, children, the poor, and the sickest.

Dr. Jim Kim of Partners in Health presents information about treatment, care and prevention of HIV/AIDS.

3. Components of Comprehensive Response: Prevention
A comprehensive approach to HIV/AIDS is required. This means that:

  1. Although prevention programs in developing countries are far more advanced and supported than treatment efforts, they require expansion and enhancement to become more effective and reach those most at risk, including marginalized groups.

  2. The quality of programs requires improvement and investment to ensure that education is reaching all populations, and that means of prevention, including both male and female condoms and microbicides, are available. Ambitious comprehensive programs cannot be effective when basic prevention tools such as condoms are still largely unavailable to a population.

  3. Simple prevention messages are currently geared towards and are more easily acted upon by men, but complex strategies are necessary to address women's common inability to act upon prevention information due to their lack of power in relationships and in society. Health professionals must become engaged in pressing for laws that guarantee women's rights as a critical component of prevention.

  4. Human rights measures must be essential components of HIV/AIDS proposals and donors should monitor the progress of governments in addressing crucial human rights related to HIV/AIDS. Without the assurance of women's rights to negotiate the terms of sexual engagement, the right to be treated without discrimination, and the right to all available information about the epidemic and its transmission, the epidemic cannot be stopped. Pressure on governments to uphold the human rights essential for prevention and treatment of HIV/AIDS should not, however, take the form of human rights conditionality on life-saving aid programs.

  5. Treatment enhances existing prevention efforts. People come forward for testing and may be more receptive to prevention education when treatment is available. Testing is a crucial component of prevention, including mother to child transmission prevention.

4. Components of a Comprehensive Response: Capacity Building
Capacity building necessarily entails health system improvements, including a network of regional and local clinics with links to hospitals, laboratories with trained personnel and sufficient resources, and management capacity. Collaborative projects between institutions in the developed and developing countries must be supported to build and improve this infrastructure, which is vital for health care programs generally.

The shortage of trained personnel to work on prevention and treatment of HIV/AIDS in developing countries threatens to impede all efforts to address the crisis. The Health Action AIDS campaign will press for greater human resource development and support as an essential component of a comprehensive strategy.

The medical and public health communities can provide crucial support to demoralized, isolated, and infected colleagues. Led by a group of leading physicians and other health professionals, the Health Action AIDS Campaign will also promote the critical training and empowerment of non-physicians such as nurses and nurse practitioners, health promoters, traditional birth attendants and midwives. Physicians and medical groups must lead the way to support other health professionals in assuming greater responsibilities, recognizing that in developing countries, much of health care is provided by non-physicians.

At a meeting in the John M. Lloyd Meditation space were:
front row: Len Rubenstein (Physicians for Human Rights), Dr. Mark Kline (Baylor College of Medicine),
Dr. Joia Mukherjee (Partners in Health), and Dr. Richard Marlink (Harvard AIDS Institute)
visible in second row: Jim Palm (Stony Point Center), Melanie Havelin (John M. Lloyd Foundation),
Joseph Colagreco (Steinhardt School of Education, Division of Nursing, New York University),
Trish Karlin (Elizabeth Glaser Pediatric AIDS Foundation), and Dr. Nils Daulaire (Global Health Council).

5. Components of a Comprehensive Response: Procurement
There is an urgent need to procure quality pharmaceuticals in a manner that is efficient and affordable. This will necessarily involve bulk purchasing, and continued efforts to reduce prices, consistent with the Doha agreements. The simplicity of the twice-daily Anti-Retroviral regimen now produced by a generics-producing company will be enormously attractive. The campaign will promote new trade agreements and interpretations of existing agreements to permit compulsory licensing, parallel imports, and production of generic pharmaceuticals that allow access to HIV/AIDS treatment at affordable prices. Procurement strategies must also assure quality, including the financing of quality facilities production, adequate distribution, storage, and security, and procedures for accounting for unused drugs.

6. Components of a Comprehensive Response: Treatment
Treatment programs are proliferating and while the resource and scale up constraints are real, treatment in resource poor settings has been shown to be possible.

Pilot treatment programs in developing countries have provided early findings that phenomenal de-stigmatization of HIV/AIDS has been an unanticipated result these efforts. Treatment has produced a tremendous, positive impact on prevention programs and should be viewed as a necessary component of prevention. The potential positive effect on health care providers engaged in well-managed comprehensive programs is not to be overlooked or underestimated.

Dramatic expansion of treatment as MTCT prevention programs scale-up is inevitable and essential. As large-scale MTCT programs launch, parallel treatment for mothers should be quickly followed by necessary treatment of spouses, care providers and so on. MTCT must become MTCT "plus" to be viable in the long run.

Directly observed therapy (DOT) implemented with care by trained nurses and paraprofessionals is a viable way to initiate and maintain treatment programs.

The ethical questions arising in a scale-up in treatment are serious. An appropriate human rights and ethical starting point should be that all individuals deserve and thus should receive treatment. The possibility of achieving such a goal is, however, not feasible because of resources and absorption capacity. Accordingly, an ethical and human rights framework must be established for resolving difficult decisions regarding priorities for treatment. Initially, capacity and logistics specific to each country and program may determine who gets treated, where, and when, but it is essential that ethical and human rights criteria also come into play.

7. Components of a Comprehensive Response: Dynamics
Equity in resource allocation, sustainability of programs, long-term commitment of the wealthy nations (10-year commitments to programs is the desired minimum), balance between treatment and prevention initiatives, and the goal of developing more programs that integrate prevention and treatment are all essential dynamics and should be supported. The concept of an integrated approach must be better defined and developed as an important tool for policy-makers.

Other important dynamics include determining when approaches should be top down and when from the bottom up; that vulnerable populations need to be empowered to demand adequate responses and to implement effective programs, and that local variations in programs are inevitable and even necessary.

Special Issues for Health Professional Mobilization: Supporting and training colleagues

The pandemic presents a unique opportunity for health professionals and their associations and institutions to offer support in this time of global health crisis. Medical, public health, and scientific partnerships for capacity building must be encouraged. One proposal involves developing the framework and political support for an "AIDS Corps" of physicians, nurses, nutritionists, public health experts, and other professionals who could receive comprehensive training, as in the Peace Corps, and later train and work alongside local counterparts for extended periods of time-one year or more. The concept of debt forgiveness for students, and HIV/AIDS residencies should be seriously considered among medical schools and the US Government. Other priorities include the training of trainers, exchanges, and the training of more non-physicians to address the AID pandemic.


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