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Daily News from AIDS 2022. July 30

Day two has wrapped-up. Here are some key highlights!

What can we learn from Indigenous science and research in responding to viruses?

1. For indigenous peoples, problem starts at the testing phase (lack of access due to structural barriers), resulting in indigenous people disproportionately falling behind 90-90-90 target.
2. Indigenous peoples have solutions to improve HIV Cascade of Care on local levels.
3. Greater and sustainable funding for culturally appropriate localized rapid testing, immediate follow-up and culturally competent care is required.
4. There’s need for stringent accountability measures to ensure confidentiality which is a significant barrier among indigenous communities.
5. Heterosexual men need to be targeted and women need women-only spaces.

In it together: How to integrate health services for specific populations

1. Due to widespread stigma and discrimination in public healthcare settings a trans-led clinic was established in Bangkok, Thailand – Tangerine – which offers stigma free & integrated healthcare services. All staff is trans identified and trained appropriately.
2. This clinic was created based on a consultation with trans people where there was an idea of an integrated model: Gender affirming care + HIV services were defined as the most appropriate.
3. The Tangerine clinic now offers gender-affirming care along sexual health care, mental health and wellbeing services. This integrated model contributes to improved health outcomes – testing, care and prevention numbers have increased significantly.

Launch of the Technical Brief on Transgender People and HIV in Prison

The Technical Brief on Transgender People and HIV in Prison was presented by UNODC, UNAIDS, WHO, UNDP and Penal Reform International. The document provides more than just a technical brief, as it includes key policy messages, and addresses the root cause of why so many trans and gender diverse people are in prison. Stigma and discrimination lead to abuse and inadequate HIV service delivery, and are still a major barrier to addressing HIV prevalence in prisons.

Key statistics relating to the prosecution of transgender people include the fact that there are 24 countries globally that criminalise/prosecute transgender people, 70 countries that criminalise same sex relations, and 153 countries that criminalise sex work. These criminal laws are designed as a form of social engineering that serve no purpose other than to disproportional discriminate against Key Populations.

The Key Interventions in the document are based on close consultations with transgender community members lived experiences, and include addressing housing issues within prison settings, access to gender affirming healthcare and HIV testing and treatment, and ensuring that transgender people in prison are part of the decision making process and implementation of HIV treatment and care.

GATE’s Interim Executive Director, Erika Castellanos, noted in particular the importance of how this document can be used to advance ICD-11 implementation in prison settings in relation to changes in transgender classifications. Drawing upon her own personal experiences of being imprisoned for “behaving against moral values,” she highlighted the importance of ensuring access to gender affirming care.

“We can’t cut the lives of transgender people just because they are in prison, because we were placed there because of who we are and who we love.”

Erika also commented that “people pretend that sex doesn’t happen in prison settings, but it happens a lot and it’s not always consensual,” highlighting the necessity of HIV prevention, testing and treatment in prison settings.

The Technical Brief will be released publicly soon on the UNODC website.

Optimizing the HIV Care Continuum

Many presentations addressed progress towards the 95-95-95 UNAIDS Targets in different country contexts, including Great Britain, US, Southern Africa, and Malawi.

Three of the four presentations did not disaggregate gender categories or mention other key populations, which was quite disappointing.

One presentation focused on transgender women in the United States and found that stable housing, regular HIV care visits, access to welcoming educational opportunities, and assistance with healthcare costs were associated with higher viral suppression.

It is important that we advocate for fully inclusive data collection that reflects trans, gender diverse, and intersex communities so that we know the progress being made to address the UNAIDS targets and hold our governments and health care providers accountable.

HIV and Integration: new WHO Strategies for a sustainable health sector response for 2030 and beyond

Introducing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030

  • 70% of new infections take place among key populations.
  • Scaling HIV, Hepatitis and STI responses has the potential to save 2 million lives by 2030.
  • The new document is community-centered, delivering a people centered approach, ensuring linkages with key institutions and stakeholders.
  • Rapid progress on COVID-19 vaccines has reenergized the global community and has provided renewed hope for innovations.
  • The WHO is looking to ensure policies and guidelines follow the science, in coalition with USAID

Community engagement for impact – from the perspective of Indigenous Peoples

According to Doris Peltier indigenous peoples should be prioritized as Key Populations. Colonization has contributed to the invisibility of indigenous peoples around the world. There’s a need for holistic approaches to improve life quality, not just the physical aspect of human life, but also the mental, spiritual and emotional spheres should be considered.

Optimizing integration based on the country context – reflections from southeast Asia

  • An overwhelming majority of people living with HIV are geographically located in five countries: India, Myanmar, Indonesia, Nepal and Thailand. More than 90% of infections occur in key populations.
  • I-RAP provides a comprehensive regional framework of shared disease-specific actions , individual countries are encouraged to select priorities
  • There’s an implementation plan aimed at financing integrated programmes for HIV, Hepatitis, and STIs.
  • WHO’s Regional Office in SEA in collaboration with Member States will report to the Regional Committee regarding the process of implementation in RAP in 2024 and 2026.

Responding to emerging health threats including Monkeypox

  • Medical institutions and professionals are in denial of the illness. 
  • There’s questions about how to generate connections between activists and scientists to respond to Monkeypox
  • Human-rights based approach is vital to inform data

Metabolic consequences of ARV

Women in menopause

  • Cis women represent 23% of all people living with HIV. Late diagnosis is still a pressing issue
  • Cis women with HIV have a higher rate of comorbidity than other populations
  • Cis women living with HIV have higher levels of inflammation that cis men
  • HIV expression is most evident in post-menopause
  • Bone fragility is at risk

Considerations around hormones and trans populations, and metabolic consequences

Trans people have a disproportionate burden of HIV worldwide, including trans women and trans men who have sex with men. HRT and ARVS raise concerns such as potential drug interactions and adverse effects, even more in a context where lack of trans-specific data is prevalent. This is partially informed by the medical mistrust of trans communities

Older people

There isn’t enough research to have a clear picture. Physical activity is important to maintain well-being. 

Medical professionals are encouraged to monitor factors affecting inflammation, protein-processing capacity. Comorbidity and polymarphacy increase with age.