AIDS is not over, turning a dream into reality, how to reduce sex work risks and more . . .

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AIDS is not over: All right, so maybe nobody said it was, but all the same the massive, “super-human” effort of the 2010 Global Burden of Disease Study in The Lancet December issue is a timely reminder that in the era of evolving and effective treatment, and talk of an AIDS-free generation, the disease continues to take a toll of what this article calls “a persistent, significant, and egregious burden of avoidable death.” It continued at the time covered by this study, in 2010, to be the leading cause of death of women aged 15-49 years old, the sixth most common cause of death worldwide, the leading cause of death in southern and eastern Africa, the third leading cause of death in eastern Europe. The article, penned by Michel Sidibé, Peter Piot, and Mark Dybul says those realities must be confronted with others: current funding levels will not sustain an effective response, investments to address the epidemic must be more strategic, health programs must be integrated, and communities must be engaged in new ways, with “democratization of opportunity.”

A realistic target or just a dream?: All but two of the articles — the overview/introduction and a look at the similar demands of HIV and and noncommunicable disease burdens in poor settings — have a paywall in this Current Opinions in HIV & AIDS series that asks “15 million on ART by 2015: A realistic target or just a dream?” The overview, by Joep M.A. Lange is a concise but thorough summing up of the issues, that need to be addressed to answer what he points out is the more compelling question: “how can we turn our dream of having 15 million HIV-infected people receiving adequate antiretroviral therapy in 2015 into reality?”

And Lube: Using condoms with lubricants is essential to safer vaginal and anal sex, but in much of the world condom compatible lubricants are inaccessible. Makeshift responses, such as bringing home suitcases filled with the stuff after trips abroad are unsustainable, the authors of this publication note. Their answer: a “toolkit” to help activists work with government and nonprofit agencies as well as donors to integrate lubricant access into their responses. Presented by IRMA (International Rectal Microbicide Advocates), Project ARM (Africa for Rectal Microbicides, AVAC, and amfAR, this handbook will be updated, the authors say, with new information as it emerges, and, they hope, success stories.

WHO Recommendations for public health approach to HIV, STI prevention among sex workers: Preventing transmission of HIV and other sexually transmitted infections is critical, not only to preserve the health of particularly vulnerable populations that are too often ignored, but to protect the wider population as well, this set of recommendations from the World Health Organization notes at the beginning. That part is just common sense. But it clears the way for what follows, a set of public health based recommendations that are equally obvious, but all too often ignored, or made impossible by policy obstacles including PEPFAR’s anti-prostitution pledge and the U.S. ban on visas that would allow people who have practiced sex work to travel here. The recommendations include:

  • All countries should work toward decriminalization of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers;
  • Governments should establish antidiscrimination and other rights-respecting laws to protect against discrimination and violence, and other violations of rights faced by sex workers in order to realize their human rights and reduced their vulnerability to HIV infection and the impact of AIDS. Anti-discrimination laws and regualtions should guarantee sex workers’ right to social health and financial services;
  • Health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health;
  • Violence against sex workers is a risk factor for HIV and must be prevented and addressed in partnership with sex workers and sex worker led organizations.

The Case of Dudley Lee: During his five years at Pollsmoor Prison outside of Cape Town, South Africa, Dudley Moore shared dark, dirty and suffocatingly overcrowded cells in a place built to hold half as many people as it did, where medical screening and treatment were scarce, and where, according to this story about his case, when he became sick with tuberculosis he “begged, bullied and bribed” to get his medicine. When he got out he sued the state for causing him to get tuberculosis. In spite of the conditions at Pollsmoor a court ruled he couldn’t prove that the prison caused his infection. Backed by the Treatment Action Campaign, and other organizations, he took the case to a higher court and won. This article looks at the victory in light of the accountability it establishes for prisons to observe basic human rights to health, and how that in turn, will benefit public health.

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