Campaign Update on HIV/AIDS
	Goodwill Ambassador Goedele Liekens Inspires Parliamentarians
	Goodwill Ambassador Mikko Kuustonen Produces Landmark Television Series
	French Red Cross Addresses HIV/AIDS in Africa
	Plus: "Condom Cafes" in the Ivory Coast
	IPPF and UNFPA in Haiti
	Female-Controlled Contraceptives and STI Prevention

Face to Face International focuses this month’s Campaign Update on HIV/AIDS.

In the past several weeks, a diverse array of public figures including Jesse Helms of the United States and South Africa’s Nelson Mandela have championed efforts against HIV/AIDS. And a range of countries – from Jamaica to East Timor, Cameroon to India – have announced new initiatives to rein in the spread of the disease.

On the streets of Abidjan in the Ivory Coast and in the halls of the Belgian Parliament in Brussels, Face to Face and our Campaign Partners are united in the fight against HIV/AIDS. This month we bring you these stories.

Thanks to the interventions of Face to Face Campaign Spokesperson Goedele Liekens and Face to Face Campaign Partner CGSO, Belgian policymakers came face to face with Staphie, a young mother who recently died of AIDS in Botswana, leaving behind her two young daughters, Charity and Veronica.

ADVOCATING FOR CHANGE

Ms. Liekens, Goodwill Ambassador for the United Nations Population Fund (UNFPA) and popular Belgian television personality, introduced “Staphie,” a documentary film to Belgian Parliamentarians in a recent hearing before the Advising Committee for Social Emancipation of the Belgian Parliament and the Advising Committee for Equal Chances of the Belgian State. The video presentation was a compelling prelude to her testimony on the HIV epidemic in Botswana, and her request to the Parliament to raise the Belgian budget for development cooperation (which would fund HIV/AIDS related services in developing countries) to 0.7 percent of the gross national product.

WHY BOTSWANA?

Almost 35 percent of the population of Botswana is HIV positive. Over 55,000 children have been orphaned by the disease.

THE PROPOSAL

Ms. Liekens outlined interventions that would assist the thousands of families like Staphie’s suffering from HIV/AIDS in Botswana. The proposal included expanding and improving sexuality education and public health campaigns, ensuring that outreach efforts are consistent with social and cultural realities, and partnering with private industry and, when possible, religious institutions to provide pharmaceutical supplies and counseling services for populations in need.

PROMISING DEVELOPMENTS

It seems that Ms. Liekens' efforts are paying off. Three days after the hearing, the Belgian State Secretary announced that the Belgian budget for development aid would not only increase by 47 percent over the next three years, but also that the government approved the request for the development cooperation budget to reach 0.7 percent of the GNP by the year 2010. Good news for countries like Botswana and hopeful news for families like Staphie’s.

Compiled by Face to Face Volunteer Joanna Parzakonis

Finnish singer and songwriter Mikko Kuustonen brought national public attention to HIV/AIDS and other issues of concern to women and youth in two television productions marking International Women’s Day. The productions were produced in cooperation with Channel 4, Plan International, Face to Face International and Face to Face Campaign Partner Vaestoliitto the Finnish family planning association.

WOMEN'S ROOM

Mr. Kuustonen, Face to Face Campaign Spokesperson and UNFPA Goodwill Ambassador, hosted a 60-minute television special called “Women’s Room.” The show featured conversations with female guests, including Finland’s president, parliamentarians, a human rights activist, an actress, a journalist, and several refugees living in Finland.

Interspersed among the interviews were short documentaries giving witness to the plight of women around the world. One documentary explored “Memory Book” therapy for mothers dying of AIDS in Uganda. Others segments investigated girls’ education in India, violence against women in El Salvador, women’s work in refugee camps in Pakistan, and a statement about women’s rights from a woman of Afghanistan. In addition to hosting the show, Mr. Kuustonen was largely responsible for its content and script.

WOMEN OF THE CENTURY

The second media event consisted of a series of three 30 minute shows entitled “Women of the Century.” This series built upon Mr. Kuustonen’s 1999 Face to Face documentary entitled “Women on the Edge of the Millennium” by updating the information and combining stories around Face to Face’s themes. The series tells the story of ten women around the world facing life-threatening challenges, such as genital mutilation, domestic violence, and drug addiction, and focuses on the actions taken by these courageous women to control their destiny. The series aired around Women’s Day, with the support of Face to Face, the Ministry of Foreign Affairs Development Cooperation and Channel 4 (Nelonen).

POSITIVE RESULTS

The impact of these landmark programs continues. Both are generating a great deal of coverage in the Finnish media. In addition, viewers were given the Face to Face web site address and encouraged to act in partnership with women around the world.

Equilibres et Populations, Face to Face’s Campaign Partner in France, reports on new developments and emerging needs for treating HIV/AIDS.


AIDS: AFRICAN HEADS OF STATES WANT TO ACCELERATE THE ACCESS TO TREATMENT.

At a time when the distribution of retrovirus treatments is starting slowly in only one out of five African countries, the politicians accountable for the continent affirmed, in December at the time of the Ougadougou conference, that their infrastructure was capable of taking charge of their country’s patients. Back from the 12th international conference on AIDS and sexually transmitted diseases (Cisma), the President of the French Red Cross, Marc Gentilini, shared his impressions of the meeting at the scientific council of Equilibres & Populations.

This official report has established that: 95% of the patients are in the South and 95% of the treatments are in the North, but the key theme at the time of the Ouagaoudgo Conference was looking towards the future. On the theme, “Accelerate access to care,” tritherapy was at the heart of the debate of the gathering, which brought together more than 5,000 people, from scientists, to politicians, humanitarians, traditional healers, and representatives from the major pharmaceutical companies. A total of sixty-one countries were represented.

Africa has now taken a new step towards demonstrating that it could and would manage the spread of AIDS on its soil. Back from Ouagadougou, Professor Marc Gentilini briefed his colleagues at the scientific council of Equilibres et Populations over which he co-presides.

In his opinion, heads of states can be exonerated from the responsibility for their late reaction. He said, “I had become used to asking the AIDS World Organization to question the delay it took to inform the African heads of states on this tragedy while the organization is supposed to influence and advise the leaders regarding their decisions. If the heads of state waited for 1992 to officially declare in Dakar that AIDS was a serious disease and should be controlled, it is because they were told that it was not that serious and that the focus ought to remain on real sanitary problems such as small pox, multiple causes diarrhea, etc…The truth was that all of these were of major importance, but so was AIDS.”

Today, awareness is rising. Marc Gentilini knows that the positions adopted by various governments are related with the nature of these states and their leaders. He explained, “When we met with President Bongo in an attempt to install a Red Cross ambulatory treatment center in Libreville, Gabon, it was easy because of his personal belief and conviction. Now, he wants some in all the shanty towns. In Burkina Faso, President Campaore was even quicker to accept. But every situation is different. In Brazzaville, Congo, there is no population growth, there is oil, water, etc, but they are constantly at war. We had to reconstruct our health centers three times.”

Political awareness is necessary to any progress in the fight against AIDS. The example of Uganda shows that even an epidemic can be controlled as soon as the prevention efforts are based on the commitment taken by leaders at all levels and on the mobilization of the community. According to AIDS-UN, the prevalence of HIV positive pregnant women in urban areas is declining for the eighth consecutive year, going from 30% to 11%. Due to news, education, communication and decentralized outreach programs in villages, Uganda’s efforts resulted in the wide spread use of condoms throughout the country.

However, enormous problems remain. New cases appear at a fast rate. Most HIV positive people do not have access to the anti-disease therapy and, at the end of 1999, 1.7 million children had lost their mothers or both parents due to AIDS.

PHARMACEUTICAL COMPANIES LOWER THE PRICES.

The next stage is therefore better access to treatments. For Marc Gentilini, this is urgent. Gentilini explained, “The actual impact of the spreading of the disease is extremely concerning. In several African countries, the number of deaths due to AIDS is higher then those from malaria. We are in a corridor of death between the Central African Republic and South Africa: Although it only constitutes 5% of the world population, it makes up 70% of AIDS patients on the planet. We are facing a sort of concentration camp. We are aware of it, but we do not denounce it enough and people are dying. We are certainly not indifferent since we are even questioning the term genocide, but they are dying in such vast numbers. The means to cure the disease do not yet exist, however means to stop the spread of the disease do exist, but they are not utilized.”

The president of the French Red Cross does not, however, blame the pharmaceutical companies, although he believes they should lower the price of treatment more quickly. “If we can bring tritherapy to Africans today it is because the prices of some of the treatments were lowered up to 95%. Now, what is the solution so that pharmaceutical companies which are not NGOs or humanitarian organizations can continue to do the research that we know to be extremely beneficial? I believe that the funds allocated by Kofi Annan before September 11th could be used to buy medications to be distributed free of charge. In exchange, the countries would agree to spend the money saved for the benefit of their citizens.”

Pierre Joly, president of the medical research foundation also notes that, “research costs a lot of money and that patents have been invented to bring discoveries to humanity so that they do not remain private property. Under the pressure of time, pharmaceutical companies need to allocate very high funds. On the other hand, developing countries should not be treated with less respect than developed countries. We must think of two independent and complementary strategies for the future”.

Michele Barzach, adviser to the World Bank and president of the Glaxo Welcome foundation confirms that lowering prices is necessary and that pressure must be maintained in order to reach the goal. Barzach explained, “I won’t work if the patents are taken in consideration by the richest countries. We need to establish the principle of the “differential pricing” so that the wealthier countries do not start demanding lower prices because poorer countries pay less.”

AFRICANS ARE CAPABLE.

“AIDS permitted Africa to take one step backward and two steps forward”, says Marc Gentilini. “The shortening of the average lifespan in Africa is drastic, even if it may be seen by a callous few as a natural form of population control. On the other hand, this disease has brought together and mobilized a community of African researchers and doctors. And when I see the French government sending twelve experts to Libreville to see if the center functions as intended, I would like to say that there are trained staffs entirely capable of handling quality evaluations.”

Besides the financial restraints, the main reason for not caring for patients in developing countries was based on the assumption of the inability of these countries to handle the follow up of their patients. But studies on African patients who underwent “tritherapy” in Ouagadougou show the contrary. Dr Ibra Nboye heads the African society against AIDS.
He followed patients for several years in Senegal and says, “out of the 350 HIV positive observed, 70% to 80% of the patients have followed up on their treatments.” For him, “African doctors not only are able to treat AIDS patients, they also know how to offer the necessary follow up care.”

For the time being, the AIDS World Organization testifies that one out of five countries have received an important reduction on the cost of the medicine. According to the UN, ten African countries have already signed such agreements with the pharmaceutical companies. However, access to treatments still requires the assistance of wealthier nations. If the costs are the business of the industry and the follow up the responsibility of the African health personnel, it is necessary that the proper infrastructure be adapted and the staff sufficiently trained and the financial means still reside in the North.

International aid must assist this effort while taking into consideration the fact that programs are the patient’s responsibility. Marc Gentilini, however, believes that, “the Ouagadougou conference that received no media attention has not been followed by open commitment from France in the fight against AIDS in Africa.”

As he compares the 40,000 French victims to the 25 million African victims, the president of the Red Cross regrets that the magnitude of the epidemic in the south does not call more people to action. He mentions the example of the city of Paris that changed its funding for fight against AIDS in Africa from FF one million (US$7M) to FF 800,000 (US$5,600,000) and finally FF 400,000 (US$2,800,000). He explains, “These FF 400,000 taken away are the equivalent of a third of the salary for one of the Paris St Germain soccer players, who are funded generously by the city of Paris”.

For the president of the French Red Cross, it is necessary, now more than ever, to make political decisions: “I read that the war in Afghanistan costs $ 1 billion per month, or $12 billion per year. This is far greater than the funds granted by Kofi Annan to fight AIDS and the indigence that makes the disease worse, for a year for the entire world.”

Cedran De Sainte Laurette
Translation: Face to Face volunteers Anne Topenot and Elizabeth Richardson

The following is a special report on HIV/AIDS fieldwork in Africa from French Campaign Partner Equilibres et Populations.

The Ivory Coast is the West African country most affected by AIDS, with roughly 11% of the adult population infected with HIV. Equilibres et Populations has partnered with a local NGO, Ruban Rouge, in an innovative project in the capital, Abidjan.

RUBAN ROUGE

Ruban Rouge supports youth in their fight against AIDS throughout the country. It runs an AIDS Information and Documentation Center focused on youth health issues where volunteers educate fifty visitors each day about sexual health. In addition, Ruban Rouge’s volunteer doctors care for people living with HIV/AIDS at the Health Plus Center.

CONDOM CAFES

In 2000, Equilibres et Populations supported Ruban Rouge in creating a Kpote Kafe (Condom Cafe) in Abidjan. This café offers drinks, sandwiches, and sweets at competitive prices – and a condom for each customer. In addition to generating revenue to support Ruban Rouge’s other efforts, the café targets customers with “indirect prevention.” The sales staff promotes contraceptives/AIDS prevention and stimulates discussion of reproductive health with youth who often do not visit specialized information centers. Their motto is, “One customer, one condom free of cost.”

NEXT STEP: CONDOM KIOSKS

In light of the positive results from the Kpote Kfe project, Ruban Rouge decided to install a Kpote Kiosk (Condom Kiosk) in two villages of the capital. Like the Kpote Kfe, the Kiosks will work to increase awareness among the general public about HIV/AIDS prevention and raise funds for the two health centers. The ultimate objective is to install 10 Kiosks over the next three or four years within the 10 separate villages of Abidjan.

RECENT PROGRESS

The first Kpote Kiosk was installed in the village of Kombassi, where the Mayor offered a site free of charge and exempt from taxes. The Kiosk began its activities in February 2002. The second Kiosk is currently under construction.

International Planned Parenthood (IPPF) and United Nations Population Fund(UNFPA) are Face to Face’s international Campaign Partners. We bring you a report on a unique collaboration between the two that is improving the sexual and reproductive health of adolescents in Haiti.



Why Haiti?

60% of the population is 24 years old or younger
43% of the population completes their primary education
25% have never gone to school
23% of boys and 15% of girls have their first sexual relations before they are 10 years old
4.5% of women (15-29) tested positive for HIV in prenatal testing
4.9% of men (15-24) tested positive for HIV

IPPF and UNFPA’s program

International Planned Parenthood Western Hemisphere (IPPF/WHR) and the UNFPA have teamed up to develop a program focusing on improving the sexual and reproductive health of adolescents in Haiti. In the mostly rural Northeast and Northwest provinces of Haiti, there are few health or educational resources available to anyone, much less resources that are specifically designed for youth. So the construction of 13 youth houses, equipped with libraries and staffed with trained youth educators who give workshops on sexual and reproductive health issues, was a welcome addition for youth in these small towns. Some young people have walked up to six miles to attend a training workshop at one of the youth houses, and the effects are changing people’s lives.

Peer Educators Experiences

“A few months ago we knew nothing about sexuality and these things,” said one peer educator in Terrier Rouge Youth House. “Now we know how to protect ourselves and behave responsibly.”

All of the peer educators have permission from their parents to participate in this capacity and they have reported that their experiences have been positive. When asked how their parents reacted about them talking about things like sexuality and family planning, one male peer educator said his parents ask him what he learns at the youth house. He felt that the information was important because it was information he wasn’t getting at home. One female peer educator said that in the beginning her parents did not want her to come to the youth house and talk about sexuality. However, after she started going and participating in trainings, they saw her behavior change and told her she could go to the youth house as often as she wanted. She reported that she was less angry and confrontational with her parents and friends because she now understands the changes she was experiencing related to puberty.

A local development organization, the Volontariat pour le Developpement d’Haiti (VDH), runs the youth houses with funding from the UNFPA-Turner project. A house manager is responsible for the daily activities of each house, coordinating workshops and trainings and supervising the work of peer educators.

Results

IPPF/WHR’s role in Haiti has focused on assisting VDH in assessing its data collection efforts and interpreting and analyzing results. Focusing monitoring and evaluation efforts is particularly important in Haiti because all data collection and analysis is done manually, a time-intensive process that should be streamlined as much as possible. In addition, IPPF/WHR brings years of expertise in implementing youth programs to Haiti, a country where youth-specific programs are relatively new.

Although the youth houses were intended to specifically address sexual and reproductive health issues, youth in this region of Haiti have so few other resources that the houses have become informal gathering spots for a variety of activities. Because each house has its own electric generator, many students who don’t have electricity at home find it a great place to study. In addition, most of the units now host youth, sport, theater, and literature clubs. Many youth way that if they didn’t have the youth house in their communities, they would probably spend more time on the street, or they would simply go to bed earlier.

The youth houses have gained the support of the ministries of Health and Education, Youth Sports, local government officials, and many parents and community leaders. The mayor of Fort-Liberte, for example, is working to donate land or a house to ensure the permanency of the project in his community. “The ties between VDH and UNFPA-Haiti are benefiting this community. The youth house is a good thing, because there used to be a lot of youth just hanging out in the streets,” said the mayor.

The following article by Face to Face volunteer Kate Staples is the third in a series of special reports commissioned by Face to Face. This piece tells us exactly what is at stake in the development of new methods of birth control and STI prevention. Additional research was provided by Face to Face volunteer Amy Norton.


Female-Controlled Contraceptives: What’s Available and What’s Needed

There is no question that contraception has improved since the days when some women relied on suppositories made of crocodile dung melted over the cervix. Today’s options are safer and more effective than ever before. Yet by the most crucial standards – widespread availability of inexpensive, easy-to-use, female-controlled contraception which protects against Sexually Transmitted Infections and HIV – we’ve got a long way to go.

The need for more birth control options is global, but is of particular concern in developing countries, where HIV is spreading rapidly and acceptance, availability and expense are issues.

Each method currently on the market has its pros and cons, the most common downside being the lack of protection against STI’s and HIV. Here is a brief rundown:


CURRENTLY AVAILABLE CONTRACEPTION

Behavioral Methods
Popular because most involve little or no expense, these methods vary in effectiveness and none offer protection against STI’s and HIV.

With training, Fertility Awareness Method in which a woman charts her menstrual cycle to predict days on which she is fertile, then abstains on those days, can be up to 99% effective, though it entails extensive training, plus daily monitoring of temperature and cervical mucus.

Withdrawal, in which the man pulls out before ejaculating, is anywhere from 81-96% effective, though it requires great discipline in a partner, and the woman has little to no control over the execution of it.

Sterilization in women involves an operation in which the fallopian tubes are blocked. While nearly 100% effective, it is very expensive and reversibility cannot be guaranteed.

Barrier Methods
Although these forms of contraception prevent the sperm from reaching the egg, most are ineffective against diseases.

The Diaphragm (a shallow latex cup) and Cervical Cap (a small cap shaped like a thimble) are placed over the cervix before intercourse. When combined with spermicides, they are 80 – 94% effective, the margin of error due largely to slippage or incorrect use. Women are fitted at a clinic or doctor’s office. Some women find the cervical cap in particular unwieldy and difficult to insert – plus there are only four sizes, so there can be issues with correct fit. Both can be messy, though they are relatively inexpensive and last for years.

A more recent introduction (in 1992) to the selection of barrier methods is the Female Condom. On the plus side, it’s 95% effective and is at least as effective as its male counterpart at preventing STI’s. It’s also estimated to reduce the risk of contracting HIV by 97%. Many users find it less distracting than the male condom because it can be inserted before foreplay and doesn’t have to be removed immediately after intercourse.

Despite tremendous hype and a splashy introduction (On International Women’s Day in Paris, for example, side-by-side male and female condom machines were unveiled), the female condom hasn’t been widely accepted. Some fear a stigma – of being considered promiscuous for wearing one – plus it takes practice to insert it properly and some users complain that it’s noisy. There is also a cost issue, approximately five times as much per use as a male condom, though researchers are studying the effectiveness of the condom when it is cleaned and reused.

Spermicides
When used in conjunction with one of the barrier methods, a spermicide can be extremely effective. On its own, however, the prevention rates vary from 72-94%. Of greater concern is the previously-touted spermicide Nonoxynol-9, which has recently been discovered not only to be ineffective in protecting women against STI’s but -- because it can cause genital ulceration -- may even raise her risk of contracting HIV.

Hormonal Methods
This is where the greatest amount of activity has taken place, though again, hormonal methods offer no protection against STI’s and HIV.

The Birth Control Pill has been around for decades, but new innovations in amounts and types of hormones (combination pills contain estrogen and progestin; others contain only progestin) allow women to find the pill which works best for her. Taken regularly, the pill is 95-99.5% effective. There are still health risks involved – blood clots, heart attack and stroke. Less severe but still inconvenient side effects include weight gain or loss, depression, nausea and breast tenderness.

The IUD is a small plastic device which contains copper or hormones which prevent the sperm from entering the egg or prevent the fertilized egg from implanting in the uterus. Its downsides are an increased risk of tubal infection, more cramping and heavier periods.

Other hormonal contraceptives work on the same principle – preventing the release of the egg or prevent the egg from implanting in the uterus. All are 97-99% effective. They include:
Norplant, in which a physician inserts small caplets containing hormones into the patient’s arm. They work on time release and protect against pregnancy for five years.
Depo-Provera is a progestin shot injected into the buttocks every twelve weeks.
Lunelle, a combination estrogen and progestin shot every month.
Ortho Evra, which was approved by the FDA in November 2001, is a patch containing estrogen and progestin. It can be placed on the buttocks or lower body and worn continuously for a week, at which point it is replaced.
NuvaRing was also recently approved. About 2 inches in diameter, it contains estrogen and progestin and is inserted into the vagina, where it remains for three weeks.

Sometimes called second-chance birth control, Emergency Contraception involves taking hormones similar to those found in birth control pills, but in higher doses. It can be used up to three days after intercourse. Though emergency contraception can be useful after unprotected sex or in case of a slipped diaphragm or broken condom, it is only effective 75-89% of the time.

WHAT’S NEEDED

Microbicides
The list of various contraceptive methods currently available to women is varied, however the one thing almost every one of those options has in common is the lack of protection against HIV. With AIDS rates in some developing countries nearing 30% in women, the most urgent need is for a prevention technology which women can control themselves.

Scientists are currently attempting to develop substances called Microbicides, which can substantially reduce the transmission of STI’s and HIV when applied (in the form of cream, gel or suppository) to the vagina or rectum. Particularly when a condom is not used, microbicides could prevent disease by either killing them on contact or preventing infection from taking place.

Nearly a dozen microbicides are in various stages of development, being funded with about $230 million from non-profits, universities and small drug companies. So far, large drug companies, and the sums of money which could make a huge difference, have remained uninvolved. The United Kingdom, working with agencies in five African countries, recently announced a five-year, $22 million program to find an effective microbicide. The goal is to make it widely distributed, particularly where condoms are not used, for as little as a few cents per application.

Future Contraception
There are several organizations focussing specifically on improving and expanding choices for contraception and STI/HIV prevention. Population Council, an international non-profit, is working to develop new methods. Expanding Contraceptive Choice (ECC) (funded primarily by USAID) works on the community and individual level to bring options where they might not otherwise be available.

Currently, there are more than 100 experimental contraceptive methods being studied around the world. However it takes time (10-15 years) and money ($20 - $70 million) for research, development and approval before a new method can be introduced and funding can be hard to come by unless a method is backed by a large pharmaceutical company. More independent funding is needed to research and develop these new methods.