Inter Press Service - August 6, 2008
Zofeen Ebrahim

Why do policies ostensibly put in place to protect sex workers end up penalising them and why are policy makers bent on sanitising them? experts asked. Why have drug users been denied key HIV prevention services?

Billions of dollars have been poured into interventions but the result is far from satisfying. The persecution of gay men -- who are now at the greatest risk of HIV infection -- continues. It seems the demonising of disenfranchised populations has only intensified.

In 2007, 2.5 million people contracted HIV, bringing the total to over 33 million. Less than one in ten injecting drug users and only one in five sex workers has access to HIV prevention treatment.

Policies are shaped by "fashion, politics, financial constraint, economic theory and then supplemented by evidence," according to Gerry Stimson, executive director of the International Harm Reduction Association. At times, there is an outright rejection of facts because they do not comply with a particular value system -- much to the detriment of those for which policies are made.

There are more than twenty years of evidence that harm reduction programmes are an effective strategy to reduce the risk of HIV among injecting drug users, why isn't every country implementing these programmes? experts asked. In the same way, since comprehensive sexuality education programmes have been found to decrease unintended pregnancy as well as reduce the risk of sexually transmitted diseases including HIV/AIDS -- as opposed to abstinence programmes -- why are educational policies not supporting sex education?

On example involves the administration of U.S. President George W. Bush consistently withholding funds for the U.N. Population Fund (UNFPA) -- primarily for domestic political reasons.

The 34 million dollars that the U.S. has withheld each year is close to 10 percent of UNFPA's regular income. By not funding the leading voice for women needing reproductive health care and family planning, "the U.S. is significantly crippling efforts to improve women's lives across the globe," according to the U.N. Foundation.

In Iran, Arash Alaei and Kamiar Alaei -- both doctors -- have played a role in putting the issues of drug use and HIV/AIDS on the national health care agenda. They have worked closely with government and religious leaders to ensure support for education campaigns on HIV transmission, including those targeting youth, and for HIV and harm reduction programs in prisons.

At the end of June both doctors were reportedly detained by Iranian authorities. Their whereabouts are currently not known.

Arash was scheduled to speak at the International AIDS Conference here. A coalition of groups -- including Physicians for Human Rights -- have sponsored an empty chair with his name, to bring attention to the detentions.

Researchers and advocates are calling for governments to implement policies on controversial issues like sexuality, education, homophobia, harm reduction and sex work -- based on evidence.

Given the track record of public policy on HIV/AIDS, Nandinee Bandyopadhyay, associate director for HIV and SRH (Sexual and Reproductive Health) at the Indian non-profit PATH, contends that evidence is unable to drive policy.

It is time to base policies on "rights rather than what is perceived right or scientific or effective or even cost-effective " because public policy may not always be about "public good" and evidence can be "wrongly focused", Bandyopadhyay said.

Policies are often influenced by interest groups, religious and business leaders based on their ideology or moral beliefs. Data is often seen "catering to competing constituencies of the elite," Bandyopadhyay stressed.

Bandyopadhyay said a recent amendment made to the Indian Immoral Traffic Amendment Bill 2006 is in contradiction to the facts and restricts penalties only to trafficking of persons for prostitution. "There is evidence that a majority of sex workers are in the profession by consent and a very small minority are trafficked," Bandyopadhyay explained.

"Evidence is crucial, but just one small part of the on-going advocacy for fairer, better and more effective global responses to drug use," said Stimson.

Sometimes policy makers are stumped by the policy guidelines made by U.N. agencies and donor countries.

For example, the longstanding stance of the Joint U.N. Programme on HIV/AIDS (UNAIDS), that sex work should be decriminalised, sex workers mobilised and health and workplace conditions regulated, as a central HIV prevention strategy, contrasts starkly with a UNAIDS guidance note on sex work released last year focusing on "rescue" and "rehabilitation" of sex workers -- an approach which the agency had earlier emphatically criticised as being harmful to HIV prevention.

Punitive drug polices are given priority, according to Stimson, because of international drug control conventions, guidance from at the International Narcotics Control Board (INCB), activities of the U.N. Office on Drugs and Crime (UNODC) and aid restrictions.

According to experts here the time has come to integrate human rights and public health imperatives, to look at on-the-ground evidence of what works and what does not, while framing policies and guidance on HIV prevention.

With 22,000 experts and activists gathered in Mexico City for the International AIDS Conference, policy makers should not have a hard time finding examples of best practices and lessons learned from all over the globe.

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+ IranFreeTheDocs.org flyers distributed at the International AIDS Conference. Credit: Zofeen Ebrahim/IPS (http://ipsnews.net/pictures/AIDSdocs080608hr.jpg)

+ Stepping Up the Response to AIDS (http://www.aegis.org/news/ips/2008/IP080803.html)

+ Q&A: "The Momentum of AIDS Prevention Is Waning" (http://www.aegis.org/news/ips/2008/IP080801.html)

+ IPS In-Focus: HIV/AIDS (http://ipsnews.net/hivaids.asp)

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