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HIV Response

PAHO Electronic Bulletin on HIV          No. 16          October - December 2007


Latin America and Caribbean Begins Preparation for AIDS 2008


A videoconference linking 11 countries of the Region was held in November, with the aim of ensuring the visibility of Latin America and the Caribbean at the next International AIDS Conference (AIDS 2008).


The panelists were Pedro Cahn, President of the International AIDS Society, Jorge Saavedra, Director of Mexico’s National HIV Program, and Juan Jacobo Hernández, Co-President of the Community Program. Speaking from a location in Mexico City, they motivated the audience to prepare early for the event, present quality abstracts, and develop publications and materials.


PAHO Director, Mirta Roses, who participated through a recorded message, urged the audience to use occasion to boost the regional response. “Mexico 2008 is a good opportunity for increasing the global visibility of Latin America and the Caribbean, presenting the many lessons learned in the Region and its renewed commitments as well,” she said.


The panelists described the new developments that had been announced at the meeting of Conference’s Coordinating Committee held two days earlier, including the donation of US$4 million by the Mexican government and confirmation that President Felipe Calderón will participate in the opening ceremony.


The panelists also highlighted the fact that this will be the first conference with plenary sessions dedicated to men who have sex with men and sex workers, two important topics for the response to the epidemic in the region. They also mentioned the need of registering early for the conference, since the total number of participants cannot exceed 25,000. Abstracts and applications for financial assistance submitted earlier have greater chances of approval, they said.


Pedro Cahn explained that the theme of the conference -- Universal Action Now! -- stresses the need for a continued state of emergency in the response to HIV and for action by all the parties involved at the global, national, regional, and local levels. Jorge Saavedra informed that visa applications will be facilitated for participants who sign up to attend the conference, whether or not they are speakers.


The videoconference was a PAHO/World Bank initiative and had the support of the Regional Director and the Theme Groups of the United Nations system in the Region. The participating countries were Brazil, Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, and Uruguay. A DVD with the content of the videoconference will be available in late December in PAHO Country Offices.  In order to ensure the presence of the English-speaking Caribbean, the panelists recorded a session in English with a special focus on the needs of that subregion. That session will also be included in the DVD.




AIDS 2008 Now Accepting Abstracts


Registration to participate and submit abstracts for the International AIDS Conference (AIDS 2008) has been open since 1 November.


More than half of the sessions at the conference will be based on abstracts. The deadline for submitting abstracts is 19 February, but the organizers expressly recommend that they be submitted earlier.


The conference is structured around three program committees (Scientific, Community, and Leadership) and four working groups, which are responsible for major program activities such as the Global Village, youth and cultural programs, and skill-building workshops.


The vision of the AIDS 2008 scientific program is to provide new, research-based evidence, and to synthesize already available evidence in order to inform and guide the global response to these challenges. This vision will guide the work of each of the five scientific tracks: Biology and Pathogenesis of HIV, Clinical Research, Treatment and Care, Epidemiology, Prevention and Prevention Research, Social, Behavioral and Economic Science and Policy & Political Science.


The Community Program offers an opportunity to reach and involve diverse communities affected by HIV and provide spaces for wide-spread representation and dialogue. The conference must be a catalyst for those communities most affected by HIV to regain an urgency and momentum to their activism in order to reclaim ownership of the agenda through the creation of strategic alliances and articulation of each others’ needs.


The Conference’s Leadership Program provides a platform for leaders from all walks of life to engage in dialogue and debate to identify solutions to the challenges we face in addressing the HIV epidemic.


More information:




New PAHO HIV Office for the Caribbean


To improve the PAHO response to HIV and STIs in the Caribbean, and as part of the Organization’s policy to decentralize resources to the subregional and country levels, the PAHO HIV Coordinating Office for the Caribbean (PHCO) has been created, with headquarters in Port-of-Spain, Trinidad.


The PHCO will be a decentralized office of the PAHO Headquarters and will be responsible for the development and coordination of technical support and for the monitoring of PAHO Caribbean HIV/STI Plan for the Health Sector, 2007 to 2012.


The PHCO will also serve as a primary contact point with partners working on the HIV response in the Caribbean, including PANCAP, UNAIDS, and CRN+, and will work in coordination with PAHO’s Caribbean Program Coordination Office (CPC), based in Barbados. The PHCO became operational in late 2007 and is headed by Gottfried Hirnschall, former Chief of SPSTI/CAREC. The new office will maintain direct relations with all Caribbean countries.



PAHO Adapts Guidelines for Antiretroviral Treatment for LAC


PAHO has completed the adaptation to the Latin American and Caribbean context of the 2006 WHO guidelines for antiretroviral treatment for HIV in adults and adolescents, in order to support the standardization of medical care and antiretroviral treatment in the Region of the Americas.


The review and adaptation took into consideration that the countries of the Region of the Americas, especially those in Latin America and the Caribbean, have a wide range of capacities of health services and systems This helped to ensure relevance and applicability and facilitate the adaptation and the use and implementation of the guideline by the countries of the region. The guidelines will support the development of national directives, as well as the process of harmonization of guidelines at the subregional level.


The PAHO Guidelines: Guidelines for Antiretroviral Treatment for HIV Infection in adults and adolescents in Latin America and the Caribbean: on the road to universal access, 2007 version, Spanish only


The original WHO Guidelines: Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach. 2006 revision (



Latin American Develops Strategy to Address Drug Resistance


In collaboration with the Ministry of Health of Brazil and the Public Health Agency of Canada, PAHO/WHO organized a workshop on evaluating and preventing the emergence of HIV drug resistance (HIVDR) in Latin America. Fifty participants from 16 PAHO member states and the PAHO suregional Adviser for the Andean Area Dr Bertha Gomez attended this 3 day workshop which was held from November 26 to November 28, 2007 in Rio de Janeiro, Brazil.


Dr Bilali Camara from the FCH/HIV Unit has coordinated this workshop and other facilitators included Dr Silvia Bertagnolio from WHO-HIVDR Team, Dr Chris Archibald and Dr James Brooks from the Public Health Agency of Canada, Dr Amilcar Tanuri, from the Ministry of Health, Brazil, and Michael Jordan from Tufts University, Boston.


The workshop helped to develop a Latin American strategy that enables countries to evaluate and prevent HIVDR in accordance with PAHO/WHO international protocols using the population based approach to measure the emergence of HIVDR strains.


By the end of the workshop, each country had prepared a draft “2008–2012 Plan of Action” for the evaluation and prevention of HIVDR, agreed to establish a National Expert Committee to finalize and implement this Plan of Action. The draft plans were based on the epidemiological situation in each country using the PAHO/WHO public health approach which contains three key strategies: Early Warning Indicators, Monitoring HIV Drug Resistance among people newly put under ART and using antiretroviral treatment sites based approach, and the threshold survey among newly HIV infected persons.




More than 2,000 Attend V CONCASIDA


Managua, Nicaragua was the site of the V Meeting of People Living with HIV and the V Central American Congress on STI/HIV/AIDS. More than 2,000 people from several Latin American countries participated in the event, held November 4-9.  During a week of discussions and presentations, the panels emphasized the need to center efforts around meeting targets for universal access.


Peter Piot, Executive Director of UNAIDS, pointed out that even though nearly 65% of people in Central America receive antiretroviral treatment, that still leaves out 35%  who do not receive treatment. He emphasized that this latter group represents “the true indicator of universal access.” Piot added that prevention is a critical intervention. According to him, treatment can not be neglected, but prevention should be given high priority in HIV response strategies, something that is not happening at present.


CONCASIDA also included a series of activities and satellite meetings promoted by PAHO. Among them were a satellite roundtable on gender-based violence and HIV, in which participated the First Lady of Honduras, Xiomara Castro de Zelaya, and another on pediatric AIDS, in which PAHO participated at the invitation of UNICEF. Another highlight was the presentation of instruments developed by PAHO to evaluate national HIV responses, as well as a panel on second-generation surveillance, in which representatives from UNICEF, the World Bank, and UNAIDS participated.


CONCASIDA was also the site of meetings of women leaders, ministries of education, and a meeting of Central American health ministers and authorities, at which a study on progress towards the agreements of the 4th CONCASIDA (El Salvador, 2005) was presented. The study, which analyzed 10 of the 11 recommendations of the Declaration of San Salvador, found varying degrees of progress in the countries.


The participation of PAHO staff at CONCASIDA focused on the topics of human rights and HIV, second-generation surveillance, gender violence and HIV, prevention of HIV infections in adolescents, HIV communication, and health service care models.




CONCASIDA Examines Sustainable, Quality Services for HIV


During a roundtable discussion on health service care models held at the V CONCASIDA, Amalia del Riego of PAHO noted that, despite significant efforts in the Region to guarantee access to antiretroviral therapy and the prevention of mother-child transmission of HIV, major challenges remain for health services to ensure access to quality services and the financial sustainability of universal care and coverage.


The PAHO expert explained that for health services to meet emerging needs, greater decentralization and integration is necessary, as well as and more strategic, efficient use of funds. She emphasized the opportunity represented by the renewed approach to primary health care, which facilitates greater participation by people with HIV and the community in supporting the health services supply, including gender, ethnicity, and intercultural approaches to service delivery.


Del Riego noted that it is urgent that countries integrate HIV into health surveillance and information systems, integrate interventions for HIV prevention, care, and treatment into existing services (for example, services for tuberculosis, STI, maternal and child health, domestic violence, etc.), expand critical programs such as sexual and reproductive health and human resources development, and explore new financing mechanisms. Achieving and sustaining these goals warrants the strengthening of health systems as a whole, including insurance and financing policies and mechanisms.




Second-Generation Surveillance:  a Closer Look at the Epidemic in CONCASIDA


Second-generation surveillance is increasingly becoming an effective tool for measuring the impact of the epidemic by monitoring the risk patterns of vulnerable populations or groups. This was one of the conclusions of the roundtable on second-generation surveillance held at CONCASIDA, with the participation of experts from PAHO and  the Centers for Disease Control and Prevention/Global AIDS Program (CDC/GAP).


Monica Alonso of PAHO explained that the exclusive use of first-generation surveillance has limitations in terms of reporting changes in the epidemic, since this surveillance focuses mainly on the general population and not on vulnerable groups. She also added that second-generation surveillance makes it possible to use the data obtained for better planning of the efforts to prevent and control the epidemic, because it provides more detailed information.


Edgard Monterroso of the CDC of Guatemala called attention to the constant migration of workers in the Region, which facilitates interaction between the Central American countries and the Caribbean islands, where infection rates are higher. In this regard, second-generation surveillance is a key factor in monitoring trends in the epidemic.


Roberto Flores of the CDC/GAP of El Salvador emphasized that second-generation surveillance poses new challenges, especially in terms of strengthening the laboratory network for HIV diagnosis and screening, which is necessary for the production of HIV incidence studies, the evaluation of current diagnostic algorithms to find cost-effective models, and the strengthening of laboratory diagnosis for opportunistic diseases. He also mentioned the need to develop mathematical models to complement knowledge about the HIV epidemic; for example, software and spreadsheets that make it possible to evaluate the incidence and prevalence of HIV cases.




PAHO Strengthens Dialogue with Civil Society in CONCASIDA


A meeting was held with representatives from several nongovernmental organizations from the Central American countries within the framework of CONCASIDA in order to strengthen the dialogue with the civil society organizations involved in the HIV response in Central America, forge ties between PAHO and civil society, and listen to recommendations and suggestions from civil society for consideration during the biennial planning process.


At the meeting, participants learned about the PAHO new planning cycle, including both the new Biennial Plan (2008-2009) and the Regional HIV Plan, which represents a long-term commitment by the Organization and coincides with the Millennium Development Goals.


Civil society representatives stated that they look forward to ongoing support from PAHO for the processes that will permit the achievement of comprehensive universal access. Recommendations to PAHO included requests for technical support to the countries in areas such as patents, compulsory licenses, drug surveillance, and the NAFTA process, as well as coordination of the dialogue between civil society and government in each country.


The civil society participants included the Nimehuatzin Foundation and ASONVIHSIDA of Nicaragua, ICW Latina and Agua Buena of Costa Rica, the Central American Network of HIV+ People (REDCA+), Gente Buena, Oasis and Agua Buena of Guatemala, Grupo Génesis, and the Association of New Men and Women of Panama, and Equity House of Belize. Also present was UNAIDS’ Regional Director, César Nuñez.




Pos-CONCASIDA, Nicaragua Repeals Article that Penalized Same-Sex Relations


Fifteen years after approving it, and a few days alter the closing of the V CONCASIDA, the Nicaraguan National Assembly repealed Article 204, which penalized sexual relations between people of the same sex. This marks an important step to guarantee observance of the human rights in that country.


Article 204 had stated that “the crime of sodomy is committed when a person scandalously induces, promotes, advertises, or practices relations between people of the same sex.… That person will incur a penalty of one to three years in prison…”  Several international agencies supported the efforts of Nicaraguan society for the repeal of this article.




Third TAC Reviews Progress and Priorities


A review of progress in the implementation of the Regional HIV Plan, the results of the evaluation of the health sector response to HIV in the Dominican Republic, and establishment of priorities for PAHO’s cooperation for the next biennium were part of the work agenda of the third meeting of the HIV Technical Advisory Committee (TAC), held September 16 to 18 in Managua, Nicaragua.


The TAC meets every year, and its purpose is to advise the PAHO Secretariat on the identification of work priorities for HIV in the region, propose optimal strategies to ensure that these goals are met, and promote the support and understanding of these goals by the Member States, including governments, civil society, technical institutions, and private sector.


The TAC consists of ten members from civil society, academia, and international organizations. During the Third TAC Meeting, Marisela Padrón, former Minister of Labor and Social Security of Venezuela, officially joined the committee.


More information:




PAHO and Representatives from the Religious Sector to Cooperate


PAHO and representatives of several religious denominations held a one-day technical consultation at PAHO Headquarters in Washington, in which the two sectors had an opportunity to exchange information and cooperate for the purpose of strengthening the regional response to HIV.


The participants approved the creation of a working group, which will involve representatives of a broader number of religious groups, with the purpose of maintaining a communication system to share experiences and best practices, and monitoring the development of a plan of action that addresses of human resources education, research, dissemination of information, and increase of awareness and knowledge in both PAHO and the religious sector.


Representatives from the Catholic University of Chile, the Latin American and Caribbean Council for Religious Leaders, US-Brahma Kumaris, and the Caribbean RST, a professor of theology from Boston College, representatives from the HIV Office of the D.C. Government, and UNAIDS also participated in this meeting.




Suggested Readings:


Faith-Based Organizations: Contributions to HIV Prevention


Guía para Tratamiento Antirretrviral para Adultos y Adolescentes para Latinoamérica y el Caribe [Guidelines for Antiretroviral Treatment of Adults and Adolescents in Latin America and the Caribbean] Spanish only


PAHO Caribbean HIV/STI Plan for the Health Sector, 2007 to 2012


Análisis de Situación del VIH de la Subregión Andina 2003-2005, Plan Subregional Andino de VIH para el Sector Salud, 2007-2010. [Analysis of the HIV Situation in the Andean Subregion 2003–2005: Andean Subregional HIV Plan for the Health Sector, 2007–2010 Spanish only


Explorando las intersecciones entre Empoderamiento, VIH, y Violencia contra las Mujeres en Latinoamérica y el Caribe [Exploring the Intersections between Empowerment, HIV, and Violence against  Women in Latin America and the Caribbean] Spanish only


Estrategias Nacionales sobre VIH y violencia contra las Mujeres en América Latina y el Caribe: Un reto impostergable [National Strategies on HIV and Violence against Women in Latin America and the Caribbean: An Urgent Challenge] Spanish only


Conversando con Niza Picasso (ICW-México) sobre el VIH y la violencia contra las mujeres [A Conversation with Niza Picasso (ICW-Mexico) about HIV and Violence against Women]

Spanish Only




Most frequently used HIV Acronyms:




The purpose of this bulletin, produced by the FCH/AI Unit, is to share information

on the efforts of PAHO professionals involved in the response to HIV/STI.

It is not an official document of the Organization.


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