BALI, Aug 15 (TerraViva) – Why is the popular drug Viagra so praised for its virtues and the condom often so villified by conservative religious and other groups the world over, drawing whole churches against its use?

Both are external technological interventions that relate to sexual activity, among the most prominent tools in the area of reproductive health and sexuality. But it is the gender and sexual ideologies behind them — especially when combined with conservative religious forces and aspects of patriarchal culture — that put them on opposite ends of the spectrum of public acceptance.

The result is a paradox that has huge implications for public health concerns, especially in relation to the HIV and AIDS pandemic that is now entering its third decade and affects 33 million people worldwide.As Michael Tan, a reproductive health activist and chair of the University of the Philippines anthropology department, put it: “Why is Viagra so desired and condoms so repulsive in many cultures?”

Yet, he stressed, condoms are in the World Health Organisation (WHO) list of essential drugs – unlike Viagra. In other words, the social and institutional acceptance levels of Viagra and condoms are “totally opposite to the biomedical truth”.

As has been stressed over and over in the hundreds of sessions at the 9^th International Conference on AIDS in Asia and the Pacific (ICAAP) that ended here this week, condoms remain the most effective way today to have safer sex, which is key to curbing the transmission of HIV and AIDS.

Condom usage campaigns have been central to efforts by countries like Thailand to slow the transmission of the virus and to achieve a reduction in the number of new cases today.

But in many countries, including in Asia, condoms continue to be a loaded word, a magnet for conservative groups that say they corrupt values and encourage early sexual activity, or go against religious teachings that sex should go with procreation.

Condoms and pills are also often linked to their contraceptive roles – which are of course absent in Viagra, packaged by pharmaceutical firms for improved sexual experiences.

There is also the argument by many men that condoms diminish sexual pleasure. This feeds into the gender and cultural bias that societies often have, that men’s pleasure is more important, Tan added.

“Condoms and pills tend to be resisted and demonised, blamed for promoting promiscuity and are sometimes even said to fuel HIV itself,” Tan explained at a discussion organised by the Institute of Population and Social Research at Mahidol University.

In India, studies show that condom use tends to be linked more to educated men, according to Jayashree Ramakrishna of the National Institute of Mental Health and Neuro Sciences in Bangalore, India.

While religion may not be such a big factor in this debate in India, Ramakrishna added that the focus on condoms in fighting the epidemic eased a bit after the Indian government revised its HIV prevalence figures some years ago.

Likewise, she says, taboos remain on the open discussion of sex, which makes it harder to deal with reproductive health and HIV and AIDS. “Women say ‘we might have sex, but we don’t talk about it’,” she said. Officials argue that sex education materials should not be too frank. Eight states have banned sex education in schools, Ramakrishna added.

In mainly Roman Catholic Philippines, the Church and religious groups argue that condom use breaks religious and moral values because it prevents pregnancies when sex is for having children within marriage — and that its health benefits cloak the fact that it promotes free sex.

This controversy is the reason why proposed laws on reproductive health in the Philippines — where population growth rate is a high 2.1 percent in a country of 92.2 million people — ignite a firestorm of campaigns by pro-church groups saying such are “anti-life’.

In the conservative Catholic context and in Philippine society, Tan explains, the importance given to extending the family line is key to male roles. Thus, “being ‘baog’ – the Tagalog word for both impotence and infertility – is to many a fate worse than death” because it is linked to male sexual prowess.

But this same focus on the need to reproduce also generates the view that men are the ones ‘responsible’ for it and women are mere receptacles in this process. Tan explained, “Males are seen as the source of life and are therefore privileged when it comes to pleasure, and women are seen as a source of pleasure or (receptacles) of men’s babies.”

In sharp contrast to the controversies around the condom, Viagra, the drug that was meant to cure erectile dysfunction but is also used to enhance sexual performance, is widely accepted. It has not drawn attention from conservative quarters that said they were worried about promiscuity or free sex, reproductive health activists say.

The most number of spam messages these days are even about Viagra-type medication, Tan says, pointing out how widely known and popular this has become.

But the obsession with male reproduction and pleasure in many societies leads to undercutting the usage of “life-saving devices” such as the condom, because it helps prevent the transmission of HIV, Tan said. “Shrill voices have been head about condoms, but they have been too silent on Viagra,” he argued.

Drug approval institutions in countries like the United States and Japan have also been quick in approving Viagra, which is manufactured by Pfizer, but slow in approving other reproductive health-related items.

For instance, Tan said, the U.S. Food and Drug Administration took six months to approve Viagra in 1998, but four years to give its approval for the abortion pill. In Japan, authorities approved Viagra for public use in a few months, but it had taken 35 years to approve the use of the oral contraceptive for women.

Some published reports allege that Viagra, or sildenafil citrate, was first being clinically tried for angina, but that was finally marketed for erectile dysfunction after trials showed this as the stronger result.

Looking into the Viagra versus condom paradox goes far beyond just these two particular products in order to show that “technology is much more than just a tool”, explained Rosalia Sciortino, a professor at Thailand’s Mahidol University and gender and reproductive health expert who chaired the session on this topic at ICAAP.

They are loaded with different societies’ thinking and “there are a lot of angles and a lot of politics around the gender ideologies around them,” she said.

These two well-known tools offer a lens that show how gender values influence expressions of sexuality and how these can in turn have key impacts on public health risks like HIV and AIDS, Sciortino added. (END/IPSAP/TV/JS/09)

BALI, Aug 13 (TerraViva) – The prescription that thousands of participants effectively issued at a just-ended AIDS conference here Thursday was clear: It’s time for heavy doses of fighting social and structural inequities so that the medical gains in curbing HIV and AIDS can work with maximum efficacy.

The recognition that it is time to look far beyond the medical and scientific dimensions of the region’s battle against HIV and AIDS is the theme that flowed through the more than 200 sessions at the 9^th International Conference on AIDS in Asia and the Pacific (ICAAP), which was held from Aug.9-13, 2009.Indeed, there were many more sessions in the conference addressing issues such as stigma and discrimination, sexuality and gender, resource shortages, community involvement, harm reduction, human rights, men who have sex with men, drug users, and laws that criminalise behaviour by certain groups — rather than medical therapies.

In closing ICAAP at the Bali International Convention Centre, the World Health Organisation’s regional director for South-east Asia, Samlee Plianbangchang, also gave more room in his speech to the social aspects of the epidemic than the biomedical ones.

“Equity and social justice are of paramount importance for responding to the HIV/AIDS epidemic,” Samlee told the some 3,600 participants at the conference. His remarks reflected how HIV is as much as social and development disease as it is a health one.

“HIV remains one of the most formidable public health challenges of our times. In the Asia-Pacific region, HIV affects mostly vulnerable and difficult-to-reach populations, especially sex workers, men who have sex with men and injecting drug users,” he said.

It is because of this characteristic of the epidemic – there are 5 million people living with HIV and AIDS in the region – that special efforts need to be made to change societal attitudes so that hard-to-reach groups get the same opportunity to know about and be treated for the infection.

“The main message has been that to address AIDS, we need to tackle the socio-political and economic inequities that drive the epidemic and restrict access to information, treatment and care,” explained Rosalia Sciortino, professor at Thailand’s Mahidol University and the chairwoman of the social track of ICAAP.

Addressing the “structural conditions” of the epidemic would help reduce the gaps between North and South, rich and poor, women and men, among diverse sexual communities, majority and minority populations and among citizens and non-citizens, such as migrants and refugees, she said.

“Social change is needed to control AIDS,” Sciortino pointed out. “Groups are not born vulnerable, but are made vulnerable by societies that marginalise and exploit them.”

Groups like drug users, sex workers and men who have sex men, often stigmatised as not deserving of attention or treatment or as bring social ills, have been falling through the cracks despite major gains made over the last decade in pushing up the numbers of people with HIV who have access to anti-retroviral therapy.

The discussion around HIV and AIDS used to be more along the lines of  ‘access for all’, which was the theme of the 15^th International AIDS Conference in Bangkok, Thailand in 2004.

Overall, the Asia-Pacific has seen the number of people getting anti-retrovirals increase more than threefold from 2003 to some 565,000 today, going by figures from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Worldwide, the number of people on anti-retroviral therapy stands at 4 million.

Many U.N. officials stressed this week that the region is poised to meet by next year the targets of universal access to treatment, as agreed upon by the world’s governments in 2006.

Among the better performers are countries like Thailand, Laos and Cambodia, where more than 80 percent of the people who need anti-retrovirals get them. As expected, however, much of the resources for making these drug therapies available in developing countries come from aid funds.

In many countries too, Samlee explained, progress in national response to the AIDS epidemic over the last two decades is being reflected in declines or leveling off of HIV prevalence, and longer lifespans among those with the virus.

But alongside the positive overall figures, statistics also show worrisome trends. These include increasing infections especially among men who have sex with men, and also among intravenous drug users.

About a third of men who have sex men report having been harassed in some way, studies say, making it difficult for them to be reached by prevention and treatment campaigns. In Asia, Indonesia has the highest proportion of drug users having HIV at 60 percent, followed by Burma at nearly 50 percent.

Then there are the silent groups like women, especially those in intimate relationships whose partners engage in risky behaviour and infect them.

Women make up 35 percent of all new infections among adults in Asia, up from 17 percent in 1990. UNAIDS also says that more than 90 percent of women living with HIV acquired the virus from their partners in long-term relationships.

Looking ahead, Samlee encouraged HIV researchers to be aware of social gaps in working on responses to the pandemic. “Research addressing equity and benefitting marginalised populations should receive high priority,” he added.

ICAAP also saw discussions around conservative approaches to religion and gender biases that make it even more difficult to reach and address the needs of the weakest, most shunned groups.

However, there were not many representatives from conservative religious groups at the conference – or many representatives from the pharmaceutical sector, which drew a lot of flak here this week. For instance, activists staged lightning protests Wednesday to demand a stop to patents on HIV drugs.

In future conferences, Sciortino proposed a more open and “more daring” discussion of sexuality and touchy issues such as condoms and safe sex.

But participants like Monica Abo from Fiji said that AIDS conferences over the years have already done a lot of talking, referring to past ICAAPs such as the last one in 2006 in Colombo, Sri Lanka, where the theme was ‘waves of change, waves of hope’.

From the theme of this year’s ICAAP here in Bali, which is’ strengthening movements, empowering networks’, she suggested that perhaps the next ICAAP should have the slogan ‘less talk, more action’.

Held once every two years, the next ICAAP will be held in Busan, South Korea. (END/IPS/TV-AP/JS-LC/JS/09)

By Lynette Lee Corporal

BALI, Aug 13 (TerraViva) – “Thank God for condoms!” Donald Messer of the U.S.-based Centre of Church and Global AIDS declared during one of the many sessions at an AIDS conference for the Asia-Pacific here, which ended Thursday.

Conservative religious leaders would certainly frown at Messer’s remarks, but many activists and health advocates here say there are far too few of them that get involved in fighting HIV and AIDS despite the heavy toll these have taken on people’s lives and well-being.

Instead, Messer says, some faith-based leaders and their communities stigmatise men who have sex with men (MSM) and injecting drug users – among whom HIV infection rates have been rising – and contribute to the obstacles that make it harder for them to get information, and access to treatment they need.

“Many religious groups and leaders are unwilling to address HIV/AIDS and make it a priority,” explained Messer, who is executive director of the Colorado-based centre. “Their commitment level is quite low particularly when compared to the size of their budget and the amount of work they do.”

Thirty-three million people worldwide are living with HIV/AIDS and more than 15 million children have been orphaned due to the disease, he added, criticising what he called the apathy of many Christian groups.

“We’ve been talking about HIV/AIDS and the religious groups’ response for three decades now. We’re still talking too much even now,” noted Dominica Abo of Fiji.

Abo believes that the “most powerful contribution” church leaders in efforts to curb HIV and AIDS is to use their clout in societies the world over to eradicate stigma and discrimination and address biases that make ‘silent’ groups like women at risk.

More than 50 million women in the Asia-Pacific are put at risk by male partners who have unprotected sex with commercial sex workers, share drug needles or have sex with other men, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“At the end of the day, in all cultures, it is the women that are blamed for the spread of HIV/AIDS,” Abo added.

Everyone should look at women and children from a faith-based perspective, points out Rev Youngsook Charlene Kang of the United Methodist Church in the United States.

“Women account for nearly half of HIV/AIDS infections worldwide and almost two-thirds of those among young people. Twenty-five years into the global epidemic, there is still no widely available technology that women can both initiate and control to protect themselves from HIV/AIDS,” she argued.

What the world needs, she adds, is more female control in HIV/AIDS prevention through new strategies and developments in technology. These can include the use of microbicides, which are expected to block 40 to 60 percent of the HIV virus from the moment it enters the body, and improved female condoms. “Microbicides could be developed within five to seven years. The closest control at the moment is the female condom,” Youngsook said.

Messer says it does not help that that more often than not, violence against women is “tolerated by the religious community” because of the status quo and the avoidance of taboo topics. “Some religious leaders are more eager to preserve the purity or correctness of theological perspectives than their task to save human lives,” he remarked.

While women should be able to be more assertive in their relationships with their partners and husbands, Youngsouk adds that the sensitisation of men to reproductive health and rights issues is equally important.

Many conservative Muslim and Christian groups, as well as the Roman Catholic Church, continue to preach against the use of ‘artificial’ reproductive health methods, including condom use, which they believe promote promiscuity.

“(Yet) when used directly and consistently, condoms are humanity’s best protection and weapon against HIV/AIDS,” Messer said.

In the end, he argues, the failure to use protection methods violates a fundamental premise on which all religions are based – the basic protection of life.

Zahid Hussein, president of the Sustainable Resource Foundation in Pakistan,  agreed: “We have to fight the supremacist message in all levels. Religion and sexuality have always had an integral relationship and to recognise these things is a very personal matter. Sexual orientation is extremely personal.”

“Silence kills, but it can also be broken. Blind idealism is dangerous but it can also inspire as it attracts people to higher ideals,” said Messer.

Added Youngsouk: “We need to call on religious leaders to educate and create new pathways within our churches for parishioners to learn the role that faith communities can play.” (END/IPS/AP/TV/DV/HE/PR/HD/LLC/JS/09)

Morauta

Papua New Guinea accounts for some 96 percent of all HIV infections in the Pacific, owing to factors ranging from lack of resources to heterosexual modes of transmission and need for more education and prevention. Here, PNG Coordinating Mechanism chair Lady Roslyn Morauta tells TerraViva’s Lynette Lee Corporal about the ills of the health system around HIV and AIDS and how the picture looks ahead.

TerraViva: How is Papua New Guinea addressing problems in the health system and the lack of health workers in many rural areas?

Morauta: It is true that the health system is not that great, but it’s not true that we’re not doing anything about it. Papua New Guinea has a very complicated health system in that it has a divided function between the national and the provincial governments. Money is given but there is not enough control over the expenditure, no accountability.

TerraViva: How serious is the lack of health personnel in remote areas in PNG?

Morauta: It’s one of the biggest problems the country is facing right now. Apart from a lack of doctors, we have also a growing number (in the) ageing work force. Much attention also needs to be given to training young health workers. It is being done now but we still need a comprehensive analysis of the work force and where they are being placed.

TerraViva: How difficult is it for women’s groups to promote HIV/AIDS awareness?

Morauta: Papua New Guinea is still a male-dominated society but we’ve so many strong women that are pushing for reforms and there are a lot of activities involving women as well. People generally are aware of the HIV/AIDS issue now. Our problem is the lack of access to treatment. While there is treatment available now in the provincial level, this is only found in the main centre. We need to get the antiretroviral treatment out to the district levels as well. At the moment, more than 6,500 people are on treatment. But we know that it’s very expensive to run health care services in PNG. Provinces are big and transport is hard and expensive. We need to improve infrastructure to deliver basic services. We also need to train people how to properly administer anti-retroviral therapy.

TerraViva: What is the impact of PNG’s diverse cultural traditions on the HIV awareness campaign?

Morauta: Traditionally, PNG culture is very inclusive. There are a lot of good things there such as how families and communities care for sick people, for instance. But what is it about HIV/AIDS that causes so much stigma and discrimination? Perhaps it has to do with the topic of sex being considered taboo. Sometimes, this is compounded by religious attitudes. Not everybody speaks the same language as well, and talking about HIV/AIDS has to be done in different ways.

TerraViva: How do you assess the participation of Pacific island nations over the years in efforts to curb HIV/AIDS?

Morauta: I think we’re seeing more Pacific countries’ representation, particularly in recent years of ICAAP. In this year’s congress, we’ve seen some good political representation, which we didn’t have before in the past. After this, we expect to strengthen the drive against the spread of HIV/AIDS with the help of various sectors.

PNG does not really suffer from a lack of financial resources for HIV/AIDS work, but how this budget is utilised that is a challenge. But the good thing is, despite these challenges, we are achieving the goals that we have set up. (END/IPSAP/TV/LLC/JS/09)

Yuni Shara

Yuni Shara of Yogyakarta, Indonesia has been in transgender advocacy work for 10 years. Before setting up her own NGO with five friends in 2006, she was a volunteer for a transgender community support group under Perkumpulan Keluarga Berencanna Indonesia (Indonesian Planned Parenthood Association). Today, Kebaya works for the welfare of transgenders in that Indonesian city. Shara talks to TerraViva about the challenges she and other transgender face, and her motivation to fight for her rights. TerraViva: How did you get involved in the transgender advocacy work?

Shara: I used to be a sex worker. After attending an outreach programme for sex workers, I got more interested and wanted to learn more in order to contribute something back to the community. Soon after that, I joined the Planned Parenthood Association of Indonesia as a volunteer teaching about reproductive health.

TerraViva: Tell us more about Kebaya.

Shara: Kebaya aims to involve transgenders in a variety of activities, including interaction within and outside the community. We are engaged in information dissemination, advocacy, outreach and assistance to marginalised transgenders, as well as networking with the government. Through Kebaya, we also were able to send transgenders to a boarding school where they are taught how to read the Koran and recite prayers, take part in religious talks about important issues, to name a few. We’d like to make Kebaya a conducive place for transgenders where their rights are recognised and their individuality affirmed.

TerraViva: What was the response like from the local community when your launched Kebaya?

Shara: We got very positive feedback. Not only did we receive invitations to take part in community activities and festivals — we also were able to link with the academe and conduct discussions with students about transgenders.

TerraViva: How difficult is it to try to introduce changes within the transgender community and outside?

Shara: One of the most difficult parts is to deal with the internal struggles in our community. Self-respect and self-acceptance are two very important things for a transgender to develop if he or she wants to be respected and accepted by others.

I have a friend who likes to dress flamboyantly and is always being teased by people. She got mad and became defensive. So we discussed it and I told her that if she doesn’t want to be teased, then she could stop wearing flashy clothes so as not to attract attention, and that if she doesn’t want to do that, then just ignore the teasing. It’s all a matter of accepting oneself first; everything else will follow.

TerraViva: What is the biggest challenge right now for transgenders?

Shara: The biggest challenge I think is for the transgendered to be recognised as different from both men and women and have it reflected in, say, the Indonesian identity card. The card gives one access to many services. It’s to be able to use the card without one being grouped either into male or female. If this happens, then it would signify society’s acknowledgment and acceptance of transgenders.

TerraViva: There are still so many who are confused and do not know about transgenders. How do you dispel these misconceptions?

Shara: It’s highly complex, trying to explain what a transgender is all about. For instance, some Indonesian transgenders find transsexual operations not useful because although they will look like women, they still won’t be able to bear children but in terms of identity, she’d rather be called a woman. In general, a transgender is called ‘wariya’, or a transgender who has the option to have a sex change operation or not. (END/IPSAP/TV/LLC/JS/09)

Activists interrupt Wednesday's ICAAP plenary session -- twice. Photo by: J Son

By Johanna Son

BALI, Aug 12 (TerraViva) – Pharmaceutical firms have developed drugs that have lengthened lives and cut death rates from HIV and AIDS, but their financial clout in no way overrides their social responsibility in fighting the pandemic, a key advocate argued Wednesday at an Asian conference on AIDS here.At the 9^th International Conference on AIDS in Asia and the Pacific (ICAAP), Javed Jabbar, a former senator and minister from Pakistan, called on governments and communities to remind drug firms of the fundamental difference between owning patents on goods such as designer items or mobile phones, and life-saving HIV drugs.

“These are medicines that make for life and death,” argued Jabbar, also a global vice president for the International Union for the Conservation of Nature. By applying the patent system to the drug product and the process, “we create inherently unjust monopolies and block knowledge transfer” that could save so many lives around the world.

Jabbar

Instead of intellectual property rights, a pillar of the world trade system, it is time to rewrite global rules, critics like Jabbar argue. “In the context of HIV and AIDS, we need a new concept of people’s property rights instead of intellectual property rights.”

Toward the end of his remarks, activists pushing for the removal of drug patents trooped in front of the hall and unfurled banners that said ‘no patents on AIDS drugs’. Lambasting several drug companies to refusing to let generic drugs be made of drugs needed by HIV, they chanted, ‘Shame on you!’.

Jabbar expressed support for a proposal by economist Joseph Stiglitz to recognise people’s property rights, including by setting up a fund to pay fees to scientists who come up with cures for key diseases, after which the drugs would go into the public domain instead of being ‘owned’ by pharmaceutical companies.

In an interview, Jabbar said that the idea of people’s property rights would include giving drug companies payments to continue producing needed medication.

Echoing criticism by many activists here at ICAAP, he cited studies saying that only 15 percent of the cost of drugs actually goes to their development, the rest going to marketing. Quoting from academic studies, he said that patent protection pushes up drug prices by an average of 400 percent or often exceed 1,000 percent.

“They can make money but they don’t have to make 400 percent profit,” said Jabbar. “It’s greed; it’s shameful.”

At the same time, Jabbar says there are signs that the “concept of the people’s will” is gradually making some headway in putting some pressure on drug firms.

In July, the drug firm GlaxoSmithKline (GSK) granted a free voluntary licensing agreement to a South African company to produce abacavir, a second-line anti-retroviral drug, on a generic basis. Earlier this year, it put several of its patents on tropical diseases into a free pool but excluded drugs for HIV and AIDS.

Then, there are the examples such as Brazil, India and Thailand taking key roles in producing more affordable treatment for HIV.

“These (drug) corporations are being forced to acknowledge that there is public demand, that there is hostility, so you can bring about change,” he said.

Ironically, Jabbar observed, it is the “great gains” in science and medical health, including HIV/AIDS in the past, that has given drug companies such strong clout in virtually shaping public health policies for the world.

While World Trade Organisation (WTO) rules allow room for breaking patents and resorting to compulsory licensing for public health needs, including HIV and AIDS, many health advocates say that these are far from enough today.

The world trade regime has also put in place a system where corporate intellectual property rights, especially those of pharmaceutical firms, are “strongly enforced” at the expense of the public good, Jabbar maintained.

Raids and clampdowns on breaking patents or making generic formulations of drugs attract quite strong action from companies — much more than when copies are made of movies or books – even if the public health interest in the case of medicines is crystal clear, Jabbar added.

While the idea of people’s property rights is not something drug firms will embrace, “it doesn’t mean that we shouldn’t campaign for it”. “Today’s fantasies become tomorrow’s facts.”

To drive home the seriousness of the pandemic nearly three decades after the first HIV cases were reported and despite huge medical leaps made in the last decade, Jabbar used the analogy of a ‘sexy’ development term these days: climate change. “What climate change means for our planet’ survival, HIV/AIDS means for human health,” he said. (END/IPS/AP/TV/JS/09)

BALI, Aug 12 (TerraViva) — “There has been so much confusion going around transgenders. We are not MSMs (men who have sex with men) and don’t lump us under the transvestite (category either) because we have different needs,” declared Kartini Slemeh at the 9th International Conference on AIDS in Asia and the Pacific (ICAAP) here. A transgender, Slemeh heads a transgender support programme in Malaysia that is under the Network of Sex Work Projects (NSWP), an informal alliance of sex workers and organisations active in 40 countries.

Slemeh and other transgenders from the region said their cause was being taken for granted by many due to lack of knowledge and indifference.

A transgender identifies oneself with another gender other than what the person is biologically born into. Transgenders may identify themselves as homosexuals, transvestites or transsexuals, but some consider conventional sexual orientation labels inapplicable or inadequate for them.

“It’s a very complex thing trying to describe what a transgender is because it goes way beyond mere appearances or sexual preference,” Yuni Shara, who heads Kebaya, a non-government organisation based in the Indonesian city of Yogyakarta, told TerraViva.

Shara said that societal structures make it very difficult for transgenders to be accepted in society. “For instance, I have a difficult time deciding whether to join male or female worshippers.”

Stigma and discrimination for a transgender starts at an early age, said Luluk Surahman. “The lack of knowledge and information about reproductive health are compounded by confusion about one’s sexuality, resulting in the individual often being ostracised within the community,” said Surahman.

According to Surahman, there are 4,500 transgenders in Jakarta and 1,500 of them are under 25 years old. “Often they are undereducated, have no adequate skills to support themselves, which is one of the reasons why they turn to sex work,” Surahman explained.

The lack of support system and awareness among transgenders have contributed to the rise of HIV/AIDS cases. “Almost 40 percent of transgenders in Jakarta are already infected,” added Surahman.

Zhao Jian’gang of the Yunnan-based Alliance of Chinese Transgenders disclosed that about 200 transgenders engage in sex work in the south-western province. Like their counterparts in Jakarta, most of them have low educational background and move frequently from place to place.

Misconceptions about their straight clients and the low use of condoms even with their partners make their behaviour at high risk for HIV/AIDS.

Subject to arbitrary arrests and ridicule even by the media, which sensationalise their cases, transgenders often experience abuse.

“A friend of mine who got breast implants was arrested because of sex work. They cut off her hair at the detention and rehabilitation centre and placed her with male prisoners,” he said.

People Like Us (PLUS) representative Utpal Chakraborty talked about the darker and dangerous side of being a transgender in India.

“Transgenders live under threat of rape and other forms of abuse. Many join the ‘hijra’, the eunuch community, and undergo illegal, secret and crude castration operations,” said Chakraborty, whose organisation works for the “promotion, protection and advancement” of young men’s health and rights. He said that 30 percent of those who undergo such operation die.

Support groups like Kebaya believe that even if it is a slow process, doors are opening for dialogue not only within the transgender community but also in the wider population.

“Apart from family meetings, we conduct regular dialogues once a month with the local community and also with religious leaders,” said Shara.

Surahman and fellow advocates have also started getting in touch with religious leaders and explaining to them the facts about transgenders. Although complete acceptance may be a long time in coming, she realises that baby steps are better than nothing.

“We’ve also tried to lobby for the basic rights of the transgender in the parliament. Everything is still in the process and we don’t see any clear result as of yet,” she said. “But we’re not about to stop pursuing this.”

Perhaps one of the biggest hurdles that advocacy groups face right now is how to change the mindset of transgenders themselves.

“We often ask them about their concerns and dreams and oftentimes they would tell us their dreams, such as having a big house, a handsome boyfriend or even be able to start a salon. No one said anything about wanting to know more HIV/AIDS, for instance,” said Surahman.

Experts say it is important that skills and educational programmes fit the needs of the transgender community and, in the process, elevate their economic status and protect them from human rights violations.

The most important thing, of course, is for them to feel empowered and accepted by society. “We are really advocating for full inclusion of our own gender identity within the present societal framework,” agreed Zhao. (END/IPSAP/TV/LLC/JS/09)

A bit uncomfortably later on, Malley said to the audience that surely been ‘woken up’ by the protest: “Thank you for that brief intervention.”

But just when it seemed things had settled down, the same group filed back in with placards against patents on HIV drugs that were marked ‘Lives Before Profit’. This time, the protesters came in at the end of the remarks by Pakistan’s Javed Jabbar, who had just railed against the intellectual property rights structure on drugs.

“Thank you for not doing this in the middle of presentation,” he said, gratefully. Then, Mahathir quipped: “We like spontaneity in the HIV world.”

From the plenary hall, this set of ‘breaking news’ came knocking loudly at the Media Centre’s door. “No to patents!” they shouted over and over outside, before barging into the cramped room to give a brief statement. “Do you want news? Then follow us, we will be making a statement next door,” said Shiva P, a spokesman for the group.

Before the journalists could gather their thoughts — and their pens, notebooks and cameras — the group made its way down to the Exhibit Hall and ‘invaded’ the Abbott Industries booth, where activists proceeded with their impromptu mini press conference.

*****

Breathe in. . . breathe out

Some ICAAP sessions were just meant to lull people to sleep. At a discussion that gathered religious leaders from the region to talk about faith-based groups’ response to the HIV and AIDS, one of the speakers noted that the already sparse crowd was starting to fall into a mid-afternoon stupor. So he did the next best thing — conduct a brief meditation session.

“Shake your hands and move your shoulders. . . relax. Close your eyes, breathe in love. . . and breathe out love. . . ,” he said over and over until everyone in the room was silent. Whether half of the audience fell asleep or not, no one will ever know for sure. (END/IPSAP/TV/09)

Kumar (left) and Saxena

By Lynette Lee Corporal

BALI, Aug 12 (TerraViva) — ”We’ll bang on the door and force them to open it,” enthused 21-year-old youth leader Ankit Saxena, frustrated by the difficulty of penetrating the world of policymakers to get them to take more action on HIV/AIDS.Saxena’s statement might well describe the sentiments of others at the Asia-Pacific Village on the ground floor of the Bali International Convention Centre, where exhibitors are making their voices heard amid the din of discussions on the medical, socio-cultural, legal, economic, political and religious aspects of the pandemic going on in different rooms in this venue.

This they are doing via creative means, as evident in the vibrance and richness of the village booths and displays, which range from stalls with slogans on HIV and AIDS, plays and visual exhibits.

“We want a meaningful youth involvement on the national level but they’re not listening. Yes, we do see a few youth representatives sitting in councils in the national arena. But oftentimes this is just a token,” 23-year-old Nepali youth Ajay Kumar.

Kumar and Saxena are members of the Bali Youth Force (BYF), an alliance of local and international youth organisations pushing for the recognition of the rights of young people, especially in the HIV/AIDS campaign.

The BYF, which brought more than 130 youth delegates to ICAAP, gathered recommendations from young people across the region, including on the need to reduce stigma and discrimination against people living with HIV/AIDS. These also sought more financial support for youth-led projects and a recognition of the need to fulfill young people’s sexual and reproductive rights, to name a few.

“So far there have only been policies, but they haven’t been implemented,” said Saxena.

For Australian artist Kim Davis, the implementation of policies without being sensitive to local culture and tradition is ineffective. The founder of Globally Aware, an HIV/AIDS education and advocacy group based in Bali, Davis has been involved in HIV work for the last 15 years.

“We want to enable people to have their own unfettered voice. Our goal is to engage the community and create a dialogue via art and health (education) in the context of the culture they are in,” Davis told TerraViva.

While she is glad to see positive changes, especially in growing access to anti-retroviral treatment, Davis is still dismayed by the lack of infrastructure, testing and HIV/AIDS-trained doctors in the country. Stigma, discrimination and other forms of human rights violations also need to be addressed, she added.

But Davis’ biggest gripe is the disconnect between programmes and the need of the communities. “Programmes and projects created by developing countries should be adapted culturally. Sex workers, street children, intravenous drug users all have specific, very localised needs, which more often than not are not being met,” said Davis, who has also begun a birthing programme for HIV-positive women.

Meaningful consultations with the local people, she said, are needed. Funders have a tendency to just look at the amount and the desired result and see the whole process as just a project and not a living, breathing community with specific needs and sensibilities, she added.

It is this same need for localised services that prompted a group of nurses in Taiwan to form a foundation that trains medical staff on interacting with people with HIV and AIDS. The Nurses’ AIDS Prevention Foundation (NAPF) looks not only at HIV/AIDS education for nurses, but promotes nurses’ rights and gives better treatment services to people with HIV/AIDS.

“There used to be a time when nurses in hospitals were afraid to treat HIV-positive people for fear of contracting the disease themselves,” said NAPF secretary Ku Shu-Fang.

Thousands of copies of the ‘AIDS Nursing Handbook, AIDS Nursing and Care and Counselling for People Living with HIV/AIDS’ have already been printed and distributed to nurses in Taiwan since 1997. Founded in 1995, the NAPF has trained 14,654 nurses in AIDS nursing and has conducted academic exchanges with other cities in mainland China, its brochure said.

“When we started the project, the most difficult thing to overcome was good communication with HIV-positive people and the nursing staff,” Ku said, adding that stigma and discrimination against PLHIV has been decreasing over the years.

According to Taiwan’s Centres for Disease Control, Taiwan has 17,680 HIV cases as of July 2009 and 5,735 people have full-blown AIDS. More than 1,400 HIV-positive cases are women and 16,192 are men. Forty-one percent of those with HIV got the infection through heterosexual sex, 21 to 26 percent from injecting drug use. A total of 20.31 percent were homosexuals.

Over at the Youth Corner Commitment Desk are messages from a mix of ICAAP participants who wrote down their thoughts after days of attending the conference.

“Stop discrimination!!! Talk less, do more!!!” wrote ‘Melly’ from Indonesia. An anonymous writer was more hopeful: “Youth, the force to make (the) impossible possible.”

Another noted the irony of increasing pressure on developing countries’ resources for fighting the pandemic against the backdrop of the global financial crisis, scribbling that “HIV is not in recession”. “Avoid the virus, NOT the people!” said another on stigma and discrimination faced by those living with HIV.

Over at the HIV/AIDS education campaign board, signatures have begun to pile up from delegates from countries such as Indonesia, Bangladesh, India, Malaysia, and Thailand, to name a few. The symbolic signature board aims to encourage people to intensify efforts “to ensure that effective health and sexuality education is accessible to all young people at school”.

“Passion is a most important thing in HIV/AIDS work, because it’s what drives you to go on amid the challenges and it opens up opportunities for dialogue within the community,” added Davis. (END/IPSAP-TV/LLC/JS/09)

Gupta

Geeta Rao Gupta, president of the Washington-based International Centre for Research on Women (ICRW), explains to TerraViva’s Johanna Son why gender needs to be weaved in more tightly into the response against HIV and AIDS. “The epidemic is just feeding on the fault lines of inequality and discrimination that already existed in our society,” she said.

TerraViva: There has been a conscious attempt at ICAAP to look at the social aspects and gaps behind the HIV/AIDS epidemic. Is this is expected or normal, that the focus on AIDS would first go into the biomedical aspects and only after some time does it go into the other aspects such as inequities?

Gupta: My point is that those technical solutions (to HIV and AIDS), each of them independently, will have impact — but only what on what technical intervention is meant for. You need many of those happening simultaneously and all of those have to happen in the context of HIV treatment, prevention and care, the standard package of services. . . . You can’t do one thing here and something else there in your country and hope to dismantle gender inequity. It is not going to happen. All you will do is you will give some women access to credit, which is what that programme is intended for. But will that access to credit reduce the vulnerability of HIV? No, because they have violence against them, you have men who don’t believe in inequality, they have no access to education. . . .

TerraViva: You were saying that part of the weakness in the whole effort is that gender is often only seen as being about women and that this is a mistake women themselves make?

Gupta: Yes, all of us have all done it.

Q: So what’s the role of that in the HIV context?

Rao: So far, the way we have developed the understanding about gender and equality is by talking about women’s reality of that, how women experience inequality and how disadvantaged they are in access to productive resources like land, credit, employment, education, etc. — That was not wrong.  That is good; that is true. But it is also time now to see the other part of the equation because if you’re talking about sexual transmission of HIV, it’s two individuals, it’s not one, right?

If a lot of the disadvantages that women are experiencing in sexual relationships is because of men in some ways, because of the way masculinity is constructed, then while we’re trying to help women, we also need to change the norms of masculinity, male sexuality, work with men to understand the ways in which gender puts pressure on them to be a particular way, just as it puts women to be a particular way.

So (the thinking is that) men must be providers, men must be assertive in sexual interactions, men must know about sex – these are things that society perpetuates. And so men, in order to be seen as men, have to live up to those norms, and when do so, they actually fuel the epidemic. So how can we begin to have the community see that relationship and its negative consequences and begin to see how we can change? How can we make them more nurturing, more caring, and they have to understand that the consequences of violence against women are not just against women. They’re against everybody.

TerraViva: You’re saying that there has not been enough focus on looking into. . .

Gupta: On looking at both men and women, and helping men and women to come together to come up with solutions. We don’t live in communities of only women. We live in communities of women and men.

TerraViva: Is that like saying that it helps perpetuate the notion of women as victims, as objects (of others’ actions)?

Gupta: It puts all the pressure on them to come up with the solution. . .) but there is this other half of the equation that you’re not holding responsible.

TerraViva; There’s been a lot of discussion here about the biomedical approach where you say, ‘this is the problem, this is the drug’. But there is no drug for changing stereotypes.

Rao: There is no single magic bullet, but we do know what the ingredients are. You can identify what are the ingredients to lead to social change and success.

One ingredient is a legal enabling environment, so you cannot be criminalising and discriminating and stigmatising because then no matter what you do, you’re not going to succeed, because the environment is against you, right? So you need laws that decriminalise, that protect people’s rights, a human rights framework, that’s the first precondition. (It’s) necessary, but not sufficient. The second precondition is that you need services available to all, so treatment, care, all the AIDS services. Third is for communities to be involved in coming up with solutions.

TerraViva: But isn’t changing society’s prejudices like asking people to go against human nature?

Gupta: But I’ve seen this happen in some small local community in Mumbai, India. For example, I have seen a poor community of people start out by saying ‘no, no, no, women cannot be made equal to men, it will ruin our social fabric, this is the way society is organised’.

And then we started explaining to them that if your daughter gets married, if she doesn’t have information about how to protect herself, if she cannot leave a relationship that she knows to be risky, if she does not have a way to stay economically independent and her husband is HIV positive, she’s stuck. She’s going to get ill, and she’s going to die. And then your grandchildren will be orphaned. When you lay out the links with women’s empowerment and its implications to their community, people want to change. I have seen those same fathers stand in a line to say ‘please educate my daughter’, please educate her about sex, please tell her about condoms’.

It’s not difficult to bring about social change. I think we don’t give enough credit to communities and to people.

Look at this conference and the people at this conference and the kinds of topics that are being discussed. Would you have thought of this ten years ago in Asia? Would you have seen transgendered individuals and people who are homosexual and bisexual standing up and being absolutely confident about their identity? No, you wouldn’t have. It has brought about changes that were necessary in our societies – and these are necessary now because we’re dealing with an epidemic. And that epidemic now is just feeding on the fault lines of inequality and discrimination that already existed in our society. Now there is an opportunity to fix something that needed to be fixed a long time ago. (END/IPSAP-TV/09)