Plenary Session

Speakers:

• Clement Malau, National AIDS Council Secretariat, Papua New Guinea, Clean Needles, Clean Blood, Condoms & Sex Education: How do we Overcome Political and Cultural 'Sensitivities' to Effective Work?
• Margaret Johnston, National Institutes of Health, United States, Will There Ever be a Vaccine? Will we be Able to Use it? Who will be Able to afford it?
• Rajiv Kafle, Prerana, Nepal, Breaking Down the Barriers to Harm Reduction for Drug Users in the Region;
• Susan Paxton, Positive Response, Australia, Parent to Child Transmission - Breaking Down the Barriers to Implementing Effective Models

Dr Clement Malau's overview of the situation in Papua New Guinea illustrated the need for a multi faceted, multi sectoral and sustained response. The challenges of HIV prevention in a country as diverse as PNG are extraordinary. The concept of using the mass media, information, education and communication strategies (IEC), peer education or counselling for prevention takes on a whole new meaning in a country with over 800 language and culture groups. Dr Malau emphasised the need for empowerment and capacity building at a local level, particularly through community based organisations, churches and local NGOs, to really address prevention and risk reduction in these many different cultural contexts. There will be a HIV vaccine - one day!!

Dr Margaret Johnston presented a very clear overview of progress towards the development of a vaccine to prevent the transmission of HIV. Whilst there is optimism that a vaccine will become available in the future, it is also quite clear that this future is not immediate. Prevention through vaccines is not some magic bullet just around the corner. And even when the day of the vaccine does arrive, there are questions about who would want to use it, access, and whether the result would be to benefit the individual or to protect public health.

Mr Rajiv Kafle from Nepal gave a very personal account of the barriers to HIV prevention for drug users. The limited availability of needles and syringes; criminalisation of drug users; police harassment; government policies which prevent harm reduction; lack of relevant IEC; the social ostracism of drug users; and the reluctance of donor agencies to support harm reduction programs, are all barriers to prevention which need to be broken. Advocating for the greater involvement of people living with AIDS, and the greater involvement of drug users in program development and policy making, Mr Kafle seized the opportunity to advocate for legislative change in his native Nepal.

No stranger to the advocacy arena, Dr Susan Paxton spoke compellingly of the need to change our approach to preventing the transmission of HIV to infants. Challenging the language used in talking about mother to child transmission, Dr Paxton advocated for a broader prevention model recognising the vital role men have in preventing the transmission of HIV from parents to children. Dr Paxton highlighted the difficult choices that HIV positive women face, describing the many women who decide not to have children after receiving their HIV diagnosis, but yearn for a baby, and the guilt experienced by women with infected babies. She described the stories she has heard from other positive women - stories of abuses of women's rights: mandatory testing, pressure to terminate wanted pregnancies, sterilisation without consent. These abuses, and the discrimination often experienced by positive pregnant women from health care providers and society, are often based on ignorance. There is a huge need for health worker training and community education about parent to child transmission. Susan talked about the hope that the advent of anti- retroviral prophylaxis has brought for those women who can access this intervention. Highlighting that many programs only target the few HIV infected women who know their status, Dr Paxton urged efforts to prevent the transmission of HIV to infants to be expanded to include prevention, treatment and care of women, and to include men.