Day 4: Listening, Learning from Marginalized Populations

After 3 days of plenaries — complete w/ scientists & rock stars, challenges & solutions, and a call for focusing on women & girls — Thursday’s plenary focused on some of the most vulnerable & at-risk populations: men who have sex w/ men (MSM), sex workers, injection drug users, and transgenders.

Related Reading: Reaching the Most Vulnerable Populations: A Health and Human Rights Imperative

Reaching the Most Vulnerable Populations: A Health and Human Rights Imperative

Debbie McMillan of Transgender Health Empowerment speaking at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington DC. © IAS/Steve Shapiro -

Debbie McMillan of Transgender Health Empowerment speaking at the Thursday plenary. XIX International AIDS Conference (AIDS 2012) Washington DC — as delegates wearing “Statue of Liberty” crowns listen. © IAS/Steve Shapiro –

Related Reading: Listening, Learning from Marginalized Populations (via Storify)

After three days of plenaries — complete with scientists and rock stars, challenges and solutions, and a call for focusing on women and girls — the day four plenary focused on some of the most vulnerable, marginalized, and at-risk populations: men who have sex with men (MSM), sex workers, injection drug users, and transgendered people.

Men Who Have Sex with Men

Paul Semugoma of the Global Forum on MSM and HIV opened Thursday’s plenary with the stark facts about men who have sex with men (MSM). Semugoma urged delegates to “move from being friendly to MSM to being competent in getting them care.”

MSM are at particular risk of HIV, sexually-transmitted infections (STI), and high viral load partners. “If you don’t ask about sexual orientation in the examining room, then you don’t know the patient is high risk. Health workers are uniquely placed gate keepers, but when they don’t know about MSM, they are blind.”

Interventions needed to decrease HIV risk in MSM include: behavioral change, pre-exposure prophylaxis, condoms, and antiretroviral therapy (ART). MSM also are affected by criminalization and targeted by stigma.

Semugoma issued an urgent call to action to end invisibility of MSM in the epidemiology, service delivery, and decisionmaking. We must “take our heads out of the sand,” Semugoma implored. “We cannot achieve an AIDS-free generation without MSM. We need to fight stigma, ignorance, and stand in solidarity with colleagues who are beaten or killed for advocating for MSM, such as David Kato in Uganda.”

No drug users? No sex workers? No international AIDS conference

Cheryl Overs at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington, DC. © IAS/Steve Shapiro -

Cheryl Overs at the Thursday plenary, XIX International AIDS Conference (AIDS 2012) Washington, DC. © IAS/Steve Shapiro –

People distributed green Styrofoam “Statue of Liberty” crowns along with signs stating: “No drug users? No sex workers? No internat’l AIDS conference” as Cheryl Overs of the Global Network of Sex Work Projects, and a researcher from Melbourne, Australia, began speaking.

Drug users and sex workers have been banned from attending the XIX International AIDS conference due to travel restrictions currently in place in the US.

Overs spoke about the social exclusion, rejection, poverty, and lack of information facing sex workers. HIV tests can often lead to criminal prosecution of sex workers and sex workers have less rights and less choice. “The HIV epidemic is being fueled by repression,” said Overs. “The greatest threat to the health and human rights of sex workers is the inability to find a safe place to work.”

She showed a video taken of a “rescue” of sex workers and said these raids ignored the agony and the rights of the sex workers. “We need a law that gets commercial sex out of dangerous places and into safer ones.” She urged sex work to be made legal and called on governments to make the decision to do this — “the decision is free”.

She cited networks of sex workers helping other sex workers. “We need meaningful participation. Sex workers represent ‘real life’ — not epidemiological categories.” She called for a repeal of the PEPFAR Anti-Prostitution Pledge and for a revision to laws so that sex workers could legally enter the US.

Nothing About Us, Without Us

Debbie McMillan, risk counseling specialist at Transgender Health Empowerment, began by showing videotaped remarks from sex workers and injection drug users gathered in Calcutta and Kiev, because they were barred from entering the US to attend the conference. “We are all human beings, we all have rights.” Lifting the travel ban was not an achievement but a mistake that was fixed, she said.

Debbie is a transgender African-American woman who used to be a drug user and sex worker. She is convinced she contracted HIV in prison. She said that she represents people at the “height of the crisis” that should be included in the programs and conferences.

“I went to the street at age 14 and became a commercial sex worker because I thought it was the only place for someone like me. I got high to dull the reality.” She cited clean syringe programs as a key component to fighting HIV.

“My mother was the only person who completely accepted me. She had 1 cup, 1 fork, 1 spoon, 1 plate. At some point she got infected with HIV and died of complications from AIDS. I had to view my mother’s body while in shackles and handcuffs. Two months later, I was diagnosed with HIV at 20 years old.”

There is no bedside manner from health professionals for transgender people, noted McMillan. The Object Bridge LGBT Program for HIV people saved her life.

“I don’t want to be an outsider looking in. I collaborate with my peers in Calcutta and Kiev because they can’t be here. We need to have a conference where all can participate. Nothing about us, without us.”

Going Beyond 15 Million on Treatment by 2015

Gottfried Hirnschall, Director of HIV at the World Health Organization (WHO) in Switzerland, said that getting 15 million on treatment by 2015 was achievable and noted antiretroviral therapy (ART) scale-up successes in Rwanda, Malawi and Cambodia. He also noted that the evidence is now tipping toward earlier initiation of ART and said it has proven cost-effective.

Hirnschall said we need to work now to aaddress gaps for future scale-up, including considering Option B+, “test, treat and retain” method. He also noted the importance of provider initiated testing and counselling.

Reflections on AIDS 2012: Shameza David

Shameza David, AIDS 2012 Poster Presentation. (Photo credit: S. Holtz/MSH)

Shameza David, AIDS 2012 Poster Presentation. (Photo credit: S. Holtz/MSH)

The thrill of having the opportunity to participate in the XIX International AIDS Conference began some months ago. The International AIDS Society accepted an abstract I authored with colleagues for a poster exhibition. This excitement became more real when I learned that I was one of three winners of an MSH internal abstract contest, and would be given the chance to travel to Washington D.C. to attend the conference and present our poster, “Leadership and Management Training increasing male involvement in PMTCT.”

I could barely sleep on Sunday night. I was nervously thinking about presenting the poster at the conference the next day. (I would have been a lot more nervous had it not been for the practice session held by MSH that helped to prepare us for presenting our posters in a clear and concise manner!)

Coming from a small city like Georgetown, Guyana, I could not conceive the magnitude of the conference or the sheer size of the convention center structure.  From the opening day I was blown away by the number of delegates, presenters, exhibitors and speakers from literally all over the world — all involved in some way in the fight against HIV & AIDS — filling the Walter. E. Washington convention center.

I felt privileged to be part of Management Sciences for Health and be surrounded by warm, welcoming supportive colleagues from our global, hardworking family.

The theme of the AIDS 2012 conference, “Turning the Tide,” flowed throughout the week, from the opening plenary to the closing session. I had goose bumps listening to the passion and conviction with which panelists spoke about their personal experiences and struggles they fought and overcame in the pursuit of reducing the incidence and impact of HIV on lives and livelihoods. These plenary sessions were rich in content, and highlighted studies and interventions, and generated new perspectives that could enhance our existing programs at home to create stronger impact. For example, two plenary sessions on preventing HIV among commercial sex workers highlighted a key group that we’ve missed during our intervention: the regular clients of sex workers. The speakers underscored how initiating behavior change interventions with regular partners could make it easier for commercial sex workers to negotiate condom use in their regular relationships.

Being part of the MSH booth was an excellent way to get a picture of the diversity of people attending the conference. Interacting with those who stopped by revealed delegates from an array of organizations and groups: clinical, behavioral, social, academic, faith-based, and community-based, among many others. It was heartening to find that many people knew of our organization and took an interest in one or more of our several programs. Also, visiting the booths of other organizations was useful for knowledge exchange on programs and resources.

This week will resonate with me for a long time, and I will use the journey home to reflect on the wealth of information shared. I am grateful to MSH for affording me this opportunity, and I return home re-energized and invigorated to continue our work as we contribute towards the shared vision of an AIDS- free generation, and someday soon, the end of AIDS.

Shameza David is program officer for the second phase of the MSH-led Guyana HIV/AIDS Reduction and Prevention Program (GHARP II), funded by USAID.