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HIV/AIDS Conference: "Wall of silence" helping spread HIV in Pacific

Tue 25 Oct 2005 In: HIV

With a thinly-veiled call for Pacific nations to address issues of prejudice and intolerance, the head of the United Nations AIDS initiative in the Pacific Region today helped launch the first Pan-Pacific HIV/AIDS conference. JVR Prasada Rao's observation that "cultures of exclusion" are fuelling a blowout in HIV infections carried a special message for gay conference delegates, given that the country in which he is based, Fiji, has just witnessed a mass public march against homosexuality by that country's major churches, and reports continue of police harassment of safe-sex educators. Rao called on the region's "traditional and religious leaders" to coopertae in finding solutions to the spread of HIV. "We won't win this battle," he said, "without an all-out effort against the stigma, the shame, the rejection, the discrimination, and the exclusion that is associated with AIDS." However, he stopped short of acknowledging that some high risk groups, such as gay men, are frequently stigmatised for their sexuality and that this discrimination is internationally acknowledged as working against safe sex awareness and education. While some countries are only slightly touched by the HIV epidemic - Tuvalu reports nine cases in a population of just on 10,000 people - the epidemic has a firmer grip on some Pacific countries. The latest available official figures indicating 35,000 people are living with HIV in Pacific nations are now considered to be wildly out of date, with Papua New Guinea alone recently reporting 47,000 cases. HIV has been only poorly addressed in most Pacific countries due to religious opposition, conservative political climates and unhelpful social structures. Speaking at the formal welcoming ceremony on Orakei marae, Rao said governments in the region must question why there is a “wall of silence” surrounding HIV and must immediately invest in HIV prevention programmes. An edited version of his speech follows this report. Today was the opening day of the four day conference which has attracted 467 delegates from throughout the Pacific, from nations as small as Tuvalu and as large as Australia and PNG, to Auckland's Aotea Centre. Speakers at the marae welcome included retired MP Joe Hawke, gay Labour MP Tim Barnett, NZ AIDS Foundation kaumatua Henare Te Ua, Fiji's Speaker of the House, Ratu Epeli Nailatikau and Body Positive Auckland's Bruce Kilmister. Barnett, who read a supportive message from Prime Minister Helen Clark, was a last-minute ring-in for Pete Hodgson who was unable to attend after replacing Annette King as minister of health and facing a scheduling conflict. Though HIV infections are prevalent amongst men who have sex with men in Australia and New Zealand, Pacific nations are facing primarily heterosexual epidemics, with Papua New Guinea already facing a catastrophic infection rate. Tomorrow,'s reporters will cover a number of conference sessions of interest to men who have sex with men and people with HIV, and will report back online in the evening. Opening Speech to the Pan Pacific Regional HIV/AIDS Conference, Auckland, 25 October 2005 by JVR Prasada Rao of UNAIDS (edited by The HIV epidemic in the Pacific is a serious threat and one that we must all face together. Across the Pacific the epidemic is at different stages. Some nations have barely been touched; in others, a generalized epidemic across particular groups is already under way. At the end of 2004 the latest WHO / UNAIDS epidemiological estimates suggested that over 35,000 people were living with HIV in the Pacific. We already know that these estimates will need to be revised taking into account the frightening new data emerging from Papua New Guinea – where the latest National consensus report revealed an estimated prevalence of 1.7% which equates to approximately 47,000 people living with HIV in Papua New Guinea alone. We simply do not have adequate data from other countries in the Pacific to make accurate estimates. But one thing has become clear – research has shown that the behaviours that put people at risk for HIV, and the social environment that makes them vulnerable, are all present in this region. There is evidence of rising prevalence of sexually transmissible infections, which are the marker for behaviours that put people at increased risk of HIV infection. WHO data of 2000 from surveys of pregnant women attending antenatal clinics in Fiji, Samoa and Vanuatu indicate a 21-30% prevalence of Chlamydia and Trichomonas. This means that we are at risk in the Pacific of a serious HIV epidemic. The question is not whether this will happen, but when this will happen. Whether it does so or not will depend on the decisions made now, not in ten years. That is why this conference is so crucial. It presents a unique opportunity for people from diverse cultures and experiences to come together to face the potential threat of the epidemic. We recognise that we are all different – different in culture – different in lifestyles – and different in our behaviour. Often we exclude others who are different – we build barriers, which we think will protect ourselves. We deny the very existence of behaviours outside the cultural norm. However our experience in responding to HIV/AIDS shows that silence and cultures of exclusion fuel the epidemic. We won't win this battle without an all-out effort against the stigma, the shame, the rejection, the discrimination, and the exclusion that is associated with AIDS – and which is one of the main reasons we have an epidemic. This doesn't have to cost a lot of money but this is where leadership can make a difference. Responding to AIDS is one of the most significant leadership challenges of our time – globally, in each country and in each community – because it is an issue that often requires going against the stream of public opinion. It requires leadership in terms of courage, and it requires that leadership be translated into budget lines and concrete decisions. Decisions to provide education on safe sex and sexuality to young people. Decisions to provide quality condoms to all those who need them. Decisions to expand voluntary confidential counselling and testing and Decisions to make care and treatment widely accessible. This requires that the response be coordinated at the highest possible level. And when I talk about leaders, it isn't just the political leaders I mean, it's also the traditional leaders such as some of the distinguished members of this gathering and religious leaders. The time for strategies imposed from the outside is over. We need to address locally defined needs and find solutions from within. Are we ready for the challenge? Fighting AIDS on the political stage – where struggles over power and resources are fought – is crucial to winning the battle. We can only ignore this battle at the cost of being regarded by future generations as lacking the will, the foresight, the understanding to tackle this issue which threatens our very future. I believe success in this battle is possible. Prevention efforts in a growing number of developing countries demonstrate that significant declines in HIV rates are possible. For this we need a comprehensive response. We need to make sure people who are not infected remain uninfected. We need treatment and care for those who are already infected. We need to reach all young people with appropriate prevention information and services. We need to reach remote rural communities and mobile populations such as seafarer's. Finally above all else we need governments throughout the Pacific to make substantial commitments by investing now. Although some progress has been made, particularly in establishing national coordinating mechanisms there is still a major shortfall in funding for HIV/AIDS programmes. Governments and donors alike are still far from recognizing the potential impact of an accelerated HIV infection rate in a small island nation. We talk about the social and economic impact on high prevalence countries, but in small island nations we need to be talking about the very survival of peoples, cultures, languages, and security of nations. All UN member states in the Pacific recently endorsed a General Assembly Resolution for Universal Access to treatment and prevention by 2010, and the G8 have declared their commitment to mobilise resources to achieve this goal. Implementing this Resolution requires broad mobilization, building the coalitions and partnerships to deal with AIDS. This is a problem that can only be solved if everybody in society, in every sector, takes up their responsibility, and fights against AIDS shoulder by shoulder all together. No country has been successful in the fight against AIDS by approaching the epidemic as a medical problem only. We need the schools, the community groups, people living with HIV, the church and traditional leaders involved in the response. This must become everybody's business and if that isn't the case, then AIDS will take over the business of everybody in the Pacific. In undertaking this work, we must continue to confront some of the hard truths, such as why the HIV/AIDS pandemic is still shielded by an ongoing wall of silence. And we will have to bring both imagination and realism to defining the ways in which we can all make a difference. So let us leave [Orakei] Marae tonight committed to working together and walking together, recognising our cultural and intellectual strengths and the unique vibrancy of the Pacific. These are the keys to success. Tena koutou katua Jay Bennie - 25th October 2005    

Credit: Jay Bennie

First published: Tuesday, 25th October 2005 - 12:00pm

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