International AIDS Conference 2008 Mexico – Day 3

Hi everyone,

So today was Day 3 at the conference and a really good (though thankfully short) day. I had my poster to do today, so after that finished this afternoon I skipped the last sessions of the day to relax! But considering I was there at 6:30am, it felt like a pretty full day. So here’s what I did/thought about today:

(1) I went to the early morning satellite session that Hans suggested on ARV Best Practices for IDUs run by the Open Society Institute. I had no idea that OSI was doing this session and found out after the fact that one of my really good friends back in NYC who works for OSI organized it. They are in the process of publishing a book based on the subject of this session (all the presenters have written a chapter), so I will make sure my friend gets that in my hands as soon as it’s published (which should be very shortly). The session was really excellent and I left them my business card so they can send me the presenters’ PPT slides, but here are the highlights.

– Background: IDUs are often put in the position of choosing between oral substitution therapy (OST) and ART because too often services are not integrated; however, ongoing injection has been found to be associated with non-adherence to ART. In addition, because IDUs generally do not seek out health and social services while using, harm reduction programmes serve an important role as a bridge between hard-to-reach drug using populations and these clinical and support services.

– A one-site model for comprehensive care is ideal. This approach should ideally include: treatment for psychological co-morbidities (depression), management of ART and OI side effects and pain (because IDUs are accutely sensitive to pain and this may push them back into medicating with injectable drugs), adherence counseling (which ideally also includes peers and family, when possible). There is also some suggestion that DOT (directly observed therapy – basically a community health worker administering/observing client taking daily ART) may improve ART adherence with this population, however, the drawbacks to this approach are increased staff time and further stigmatization of the IDU. In particular, programmes should also seek to reach out to women IDUs through reproductive health services, PMTCT, and OST for pregant women.

– Strategies for developing integrated care sites for ARV/HR/OST delivery: find a partner clinical site for ARV delivery (TB/AIDS centre), make sure OST site is properly licensed to deliver narcotic meds, provide intensive training to staff (particularly case management team), make sure that TB/HIV diagnostic capacity is adequate, develop inviting and comfortable drop-in space (guitar or tea test – if a DIC has tea and/or a guitar you know people spend time there which allows for adequate interaction between IDUs and PEs). The Brazilian DIC model presented offered both AA, NA, and other self-help meetings, food and hygeine, sleeping quarters, and waiting rooom activities like debates on issues relevant to IDUs.

– Presently, we need: better advocates for policies affecting IDUs, better advocates for health and social services for IDUs, better leaders from within the IDU community, outreach to IDUs via home-based care when necessary, proper psychological follow-up during treatment, improved social support for IDUs, and empowerment of civil society to connect IDUs and government policy makers.

– Lastly, I asked a question of the panelists about how to deal with the challenge of partnering with a clinical site for ARVs in countries where ARVs are dispensed by public sites (which may not be particularly accessible or welcoming to IDUs, and of course, also tend to be bureacratic and poorly managed). The suggestion was to try as much as possible to work with public hospitals and sites to improve facilities and assist in staff training, as well as to try to persuade the public site to allow a peer educator provided by the IDU centre to be on-site to work with IDUs accessing ARVs at that venue. Not sure that’s very likely to work in India, but that’s what they said!

(2) I went to a pretty lame session on PLHIV in Arab Countries. It was mostly useless, but it was a skills building workshop so they did an ice breaker to start that was really good. I will have to write up a more detailed description if you think it’s something worth trying in bootcamp, but basically everyone lined up against a wall and each person was given a piece of paper with a social role written on it. So like ’11 year old orphaned girl’, ‘HIV+ activist’, ‘human rights lawyer’, ‘president of a country’, etc. And then the person running it reads off statements like ‘I can see my family anytime I want’, ‘my friends and community accept me’, ‘I can access medical care anytime I need it’, ‘I feel hopeful about my future’, etc. And if you think the statement applies to your character, you step forward. It basically demonstrates social stratification of people living with HIV/AIDS and/or in poverty, and then at the end everyone reveals their character and it leads to a discussion of why some people stepped forward for certain statements and not others and how age/gender may have influenced these decisions. It was pretty interesting.

(3) I also spoke with a bunch of poster presenters during the poster session (I got bored standing at my own poster for 2 hours) and also some people from various foundations, NGOs, UNAIDS, etc. and got lots of resources on IDUs, nutrition programmes, monitoring and evaluation, etc., plus some business cards of people I’m going to follow up with to get some additional resources for us. I’ll do that once I get back to Pune and have some more free time.

(4) As I was leaving, I stopped by a booth of an organization called the Condom Project. They basically work to educate people on condoms and to break down the stigma associated with them. They were making condom pins. I’ve seen these many times before, but it never really occurred to me how important these might be in a place like India where there is so much stigma surrounding condoms and people are so uncomfortable talking about them, touching them, etc. Maybe we could work with them to do something similar – making funky artsy condom pins at events in Pune – to try to get people to have fun and be more comfortable with condoms, while also dispensing with information about how to use them. Here is their website:

Okay, that’s it for now. Tomorrow will be a short day as I’m only going to afternoon sessions (plus having lunch with Azzi – that’s important too!). But one of the sessions is on HIV and disabilities, particularly working with the physically disabled, blind, and deaf communities on HIV prevention and as PLHIV. Sounds really interesting!


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