Global HIV/AIDS project E-bulletin

1st of December 2008 was the 20th anniversary of World AIDS Day, which is marked by significant progress in prevention and treatment over the past two decades, but highlights how much more still needs to be done by leaders at all levels to reach universal access to prevention, treatment, care and support by 2010. As of 2007, nearly all countries have national policies on HIV. However, despite these policies, most have not been fully implemented and many lack funding allocations.Despite HIV awareness now reaching nearly all areas of the globe, infection rates are still happening 2.7 times faster than the increase in number of people receiving treatment.

As a part of its HIV/AIDS campaign, ITF affiliates observed World AIDS Day in a befitting manner with a promise to unite and fight the pandemic to prevent new infections and provide necessary care and support to transport workers all over the globe. Some of the events that were organised by affiliates include:

Antigua and Barbuda Workers Union distributed condoms and awareness materials in their work places.

Centro de Capitanes de Ultramar y Officialis de la Marina Mercante of Argentina organized special session on HIV/AIDS for cadets in National Nautical College.

Australian Services Union distributed HIV/AIDS posters all around the country. Their national website put on stories on HIV/AIDS related issues.

Bahrain General Trade Union of Marine port distributed educational materials all around port area. They also distributed educational materials to management personnel of port authority.

In Brazil, the Confederaçao Nacional dos Trabalhadores em Transportes Terrestres (CNTTT) organised number of events in bus garages and parking places along two major truck routes. They also distributed condoms donated by the health authorities.

ITF affiliates in Cameron organised a symposium in collaboration with the employers and management. They distributed condoms in airport. They also organized VCT programme to promote testing.

Asociacion Nacional de Servidores Publicos del Instituto Nacional de Vias Anseinvias, from Colombia organized discussion session for workers and their families. They also made arrangements to show the ITF documentary, " Highway of Hope" at workplaces.

Ethiopian Transport and Communication Workers Trade Union Industrial Federation(TCWTUIF) organized number of activities in collaboration with Minstry of Health. They also organized plenary session on 5 years nutritional support strategy for people living with HIV/AIDS. They also organized education session for women network.

Grenada Seamen & Waterfront Workers Union participated in activities organised by the national HIV/AIDS programme. They also organized motorcades throughout city with awareness materials.

ITF affiliates in Guinea Conakry organized charity football match both for male and female workers and disseminate awareness materials during matches. They organized film show on HIV/AIDS and STIs. They distributed condoms at work places

In India 25 trade unions representing one and a half million members joined a campaign to hold rallies, exhibitions, awareness programmes and seminars, street plays, cultural shows, condom distributions and blood donation camps. The unions involved include the All India Railwaymen's Federation and the National Federation of Indian Railwaymen, National Union of Seafarers of India, Forward Seamen's Union of India, Tamil Nadu Road Transport Workers' HMS Federation, Indian National Transport Workers Federation, Adarsha Auto and Taxi Drivers Union, Aviation Industry Employees' Guild and the eleven affiliated unions of the All India Port & Dock Workers' Federation.

Kenya Long Distance Truck Driver and Allied Workers Union, organized a week long "Moonlight VCT" programme, which was organized in collaboration with Ministry of Transport. Moonlight VCT programme enable truckers to go for test at night when they take rest at parking lot. They also organized a procession involving truckers and sex workers.

Associacion Sindical de Sobrecargos de Aviacion de Mexico (ASSA) organised seminar in collaboration with civil aviation medical board. They organised sessions to show ITF documentary, "Highway of Hope". They also set up week long "Information booth" in collaboration with local NGOs to disseminate information and distribute education materials and condoms.

SINATRAT from Mozambique also met with their colleagues from Zimbabwe and South Africa and organised education session in border crossing between the neighbouring countries. They also organises sensitization meetings at work places to encourage workers to go for VCT.
Peer educators of Nepal Yatayat Mazdoor Sangh conducted education sessions thought out the country. They also put on posters and stickers at different workplaces.

New Zealand Road and Maritime Transport Union distributed campaign materials to all of its branches and organized discussion sessions.

Women's department of AMOSUP, ITF affiliate in Philippines produced comic books for HIV/AIDS education and awareness activities.

Road Transport union of ALUTUCP, Philippines started their HIV campaign during ITF road transport action week and distributed awareness materials in bus, truck and taxi parking lots. They also organized number of group education sessions.

South Africa Transport and Allied Workers Union(SATAWU) in collaboration with employers organized week long wellness programme to promote VCT and to enrol more members into ARV therapy.

Sri Lanka Flight Attendant Union organized education sessions for all of its members. They also put in ITF posters in airports.

ITF affiliates in Togo organized workshops to develop workplace policies. They organized large-scale awareness campaign at workplaces. Dock and Port workers Union organized special VCT session at port medical centre.

Ugandan Amalgamated Transport and General Workers Union (ATGWU) organized special exhibition at Uganda and Rwanda border which attracted large number of truckers and affiliated community members including sex workers.

International Association of Machinists and Aerospace Workers (IAMAW) of the USA distributed awareness materials at workplaces.

Trade Union of Railway Workers & Transport Constructors of Ukraine distributed information campaign materials including brochures, posters, and leaflets at workplaces. They also organized training programme for medical staff in protocols for diagnosis and treatment of opportunistic Diseases and VCT.

Zimbabwe Amalgamated Railway Workers Union participated in the programme organized by national trade union centre. They also organized education session for workers and distributed information materials.

 

HIV prevalence rate in Scotland is very low. According to government data 5530 HIV infections have been diagnosed in Scotland since the epidemic began in the early 1980s; at least 1562 (28%) are known to have died. But in recent years the number of new HIV positive cases are is increasing. The major factors contributing to the rise has been the increase in the numbers of previously infected individuals from high prevalence regions such as sub-Saharan Africa coming to Scotland, coupled with a substantial rise in number seeking out a diagnostic HIV test. The annual number of men who have sex with men (MSM) diagnosed with HIV has also seen a rise in recent years; this stems from a number of factors including increased HIV testing, particularly in the genitourinary medicine clinic setting, and continued transmission of HIV. The number of diagnoses among injecting drug users (IDUs) decreased following the introduction of harm reduction measures in the early 1990s and has remained relatively low since.

But according to a recent study conducted by the Dutch group Wolters Kluwer Health, more than one-third of HIV-positive men in Scotland's capital of Edinburgh are unaware of their status. HIV tests were conducted among 599 men at universities and gay bars throughout Edinburgh, and 33 men tested positive for HIV. Of these men, 12 were unaware that they were living with the virus. The study said, "A high proportion of the HIV-positive men were undiagnosed and not receiving benefits of clinical care." The study also said clinics should "proactively" offer testing to decrease the number of undiagnosed cases. The release of the study coincides with a new HIV awareness campaign conducted by NHS Lothian in partnership with the Edinburgh-based Gay Men's Health to warn people with multiple sexual partners and men who have sex with men against complacency regarding the virus.

The Russian Federation has the largest AIDS epidemic in Eastern Europe and Central Asia accounting for approximately 66 percent of the region's newly reported HIV cases in 2006. It is estimated that 1. 2% of adults are HIV-positive and more than 100 new cases of HIV are registered every day. The HIV/AIDS epidemic is increasingly threatening young people and combating the virus is now a high priority as young people between 15 and 29 years make up some 80% of infected persons with 43% of all newly registered HIV cases are women of childbearing age. At 107 tuberculosis (TB) cases per 100,000-population n 2006, Russia has a high rate of estimated TB incidence, according to World Health Organization (WHO). HIV-TB co-infection is also substantial, with an HIV prevalence of 3.8 percent among TB cases. High rates of co-infection complicate treatment and care for both diseases.

Vadim Pokrovsky, head of the government-funded Federal AIDS Centre recently said that the number of registered HIV cases in Russia is increasing by 10% annually despite increased federal funding for HIV/AIDS efforts. According to Pokrovsky, Russia's rising HIV prevalence likely stems from the government's focus on HIV/AIDS treatment instead of prevention. Pokrovsky estimates that more than one million people in Russia or almost 1% of the country's population of 142 million people are HIV-positive although Russia officially has registered only 470,000 HIV cases. According to experts, a large number of HIV-positive people in Russia are injection drug users. In addition, many people are unaware of HIV risk factors because of denial, insufficient information and social stigmas.
According to Pokrovsky, many regional governors in Russia "have simply refused to acknowledge the problem" of HIV/AIDS, while others have chosen to increase funding for the disease rather than promote awareness about the issue. According to him, HIV prevention funding is inadequate and is "the weakest point" in Russia's HIV/AIDS efforts. Due to recent financial crisis, the government has also reduced its budget for HIV/AIDS programme in the country.

HIV prevalence rate in some Latin American countries including Paraguay is still low but no country in the region has experienced a significant drop in HIV prevalence. It was estimated that approximately20000 people were living with HIV/AIDS in Paraguay at the end of 2007

HIV/AIDS in Latin America is sometimes referred to as a ‘hidden' crisis: awareness is low, surveillance of those affected is sometimes unreliable and stigma has stopped people from conducting open and frank debate about the problem. Also HIV prevention efforts in the region are small-scale, slow, and largely dependent upon non-governmental organisations and international programmes. This is partly due to poverty and a shortage of resources throughout the region, but lack of political leadership and will has also played a role.

In almost every Latin American country, the highest levels of HIV infection are found amongst Men who have sex with men (MSM). This problem is largely hidden, since homophobia and ‘machismo' culture are common throughout the region and sex between men is highly stigmatised. The extent of HIV infection among MSM is downplayed in many countries, and prevention campaigns often neglect this group. Migration also occurs on a large scale throughout Latin America. Several factors may put migrants in this region at a high risk of HIV infection: poverty, violence, few available health services, increased risk-taking, rape, loneliness, and contact with large numbers of sex workers.

HIV/AIDS is increasingly becoming an important cross cutting issue for ITF affiliates in all regions. Recently during road transport action week, the Unión de Sindicatos de Trabajadores de Transporte (USTT) organised number of activities to highlight the importance of dealing with HIV/AIDS at the work place. The have organized a seminar on HIV and also distributed information materials to members and community people.

At the end of 2007, an estimated 230,000 people were living with HIV and AIDS in the Caribbean. In two countries in this region - the Bahamas and Haiti - more than 2% of the adult population are living with HIV. Higher prevalence rates are found

only in sub-Saharan Africa, making the Caribbean the second-most affected region in the world. Haiti is the Caribbean country most affected by HIV/AIDS. The epidemic is generalized and fuelled by endemic poverty and high illiteracy rates. By the end of 2007, the national HIV prevalence among adults ages 15 to 49 was 2.2 percent. In Haiti, HIV is primarily transmitted through heterosexual contact, followed by mother-to-child transmission. Half of the people living with HIV/AIDS are women. AIDS is also now one of the leading causes of death in Haiti, an estimated 7,500 lives are lost each year to AIDS and thousands of children have been orphaned by the epidemic. According to the UNICEF, Haiti also has one of the highest rates of infant and maternal mortality in the Western hemisphere.

As more than 60% of Haitians live below the poverty line of less than $2 per day, many HIV-positive people in Haiti now face challenges in adhering to their antiretroviral drug regimens because of a lack of food throughout the country. Antiretrovirals are more effective and cause fewer side effects when taken with food, and proper nutrition helps delay the progression of HIV. However, rising food prices, high poverty rates, a troubled agricultural sector and recent hurricanes have exacerbated existing food shortages and created challenges for HIV-positive people seeking treatment. The country's National Food Security Council reports that an estimated 2.7 million of the country's population of 9.2 million faced food shortages before the hurricanes this year, and an additional 800,000 people faced food shortages following the storms.

Although Cambodia has one of the highest HIV/AIDS infection rate in Asia, the impoverished nation is making major inroads in its war against the epidemic. The country provides evidence that well-focused and sustained prevention efforts can help reverse an HIV epidemic. Nationally, HIV prevalence has fallen to an estimated 0.9% among the adult (15-49 years) population in 2006, down from the revised estimates of 1.2% in 2003 and the peak of 2% in 1998. At the heart of the success is the government's decision to order all brothels, which are legal in Cambodia, to require sex workers who have the nation's highest HIV/AIDS prevalence rate -- more than 40 percent, according to UNAIDS to insist on the use of condoms. The most common method of transmission of HIV in Cambodia is through males who have unprotected sex with sex workers and then bring it home to their wives, who in turn pass it to their newborn children during childbirth.

As Cambodia's commercial sex industry increasingly moves away from brothels and into businesses such as karaoke bars and beer gardens, the country's National AIDS Authority (NAA) is calling on private businesses to address unsafe sex practices in the industry. According to NAA Secretary-General Teng Kunthy, "the change of behaviours is a new challenge, as high-risk behaviours become associated with beer promotion and mobile work and focus should be placed on ensuring that private businesses provide sex education and are more integrated into health services."

South Central Railway Employees' Sangh of India (NFIR) organizes HIV/AIDS awareness programme for unorganized railway licensed porters

The extent of the AIDS epidemic in India was dramatically scaled down last year when new, more reliable government figures revealed less than half the number of infections previously suggested by UN estimates. Still it is estimated that about 2.45 million Indians are living with HIV (1.75 - 3.15 million) with an adult prevalence rate of 0.41%. But the spread of HIV in India has been diverse, with much of India having a low rate of infection and the epidemic being most extreme in the southern half of the country and in the far north-east. The highest HIV prevalence rates are found in Maharashtra, Andhra Pradesh and Karnataka in the south; and Manipur, Mizoram and Nagaland in the north-east. Four southern states (Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka) account for around 63% of all people living with HIV in India.

The Indian epidemic continues to be concentrated in populations with high risk behaviour characterized by unprotected paid sex, anal sex, and injecting drug use with contaminated injecting equipment. Several high-risk groups have high HIV prevalence, and sexual networks are wide and inter-linking. According to India's National AIDS Control Organization (NACO), the bulk of HIV infections in India occur during unprotected heterosexual intercourse. Consequently, and as the epidemic has matured, women account for a growing proportion of people living with HIV (38 percent in 2005), especially in rural areas. The low rate of multiple partner concurrent sexual relationships among the wider community seem to have, so far, protected the larger body of people with 99 percent of the adult Indian population being HIV negative. However, although overall prevalence remains low, even relatively minor increases in HIV infection rates in a country of more than one billion people could translate into large numbers of people becoming infected.

South Central Railway Employees' Sangh (NFIR), India organized a HIV/AIDS education programme for unorganized railway licensed porters. Many of these porters are migrant workers coming from other states and are vulnerable to HIV/AIDS. In addition to this, the union regularly conducts education sessions at work places for different cadres of railway workers.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioural change and increased access to ART. An estimated 1.4 million adults in Kenya are infected with HIV and currently 213,000 patients are on treatment with a monthly increase of 5,000 new patients. National adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 7 percent in 2007. Women face a considerably higher risk of HIV infection than men, and also experience a shorter life expectancy due to HIV/AIDS.

Kenya dockworkers' union in collaboration with the Kenya port authority recently organised a workshop on "Gender equality and HIV/AIDS" in Lamu island. Lamu is a small island with a population of about 100,000 and most of them are Muslims. This is the first time, the union has organised such a workshop in the area so there was lots of enthusiasm from members and management. The workshop discussed about the issues related to sexuality, factors contributing to spread of HIV/AIDS, importance of women's empowerment in preventing infections, dealing with HIV/AIDS at the workplace including fighting stigma and discrimination.

In Lebanon sexuality is governed by strict norms influenced by religious rules, and illicit drug-use is legally and socially rejected. Little is known about the behaviours and attitudes of the populations engaged in sexual and drug use practices that are irreconcilable with existing norms and regulations; namely, the populations of female sex workers, men who have sex with men and intravenous drug users. According to the UNAIDS estimate, around 3000 people are living with HIV in Lebanon.

Recently a conference was organized by the United Nations Development Program and the Public Health Ministry for religious leaders in the country to raise awareness about HIV/AIDS issues. The main objective of the conference was to acquaint participants with the Cairo Declaration of religious leaders in the Arab region in response to HIV/AIDS, which was signed in 2004 by 80 religious leaders from 19 Arab countries. The workshop also discussed the Tripoli Declaration, which was endorsed by 80 female religious leaders who said they would focus on the rights of women and children in relation to HIV/AIDS

During the conference, UNDP Resident Representative Martha Ruedas said, "Until now, the Arab world had not addressed the issue of HIV/AIDS with enough energy because people were too scared or not sufficiently informed to discuss the disease." Accoring to Mostafa Mahmoud al-Nakib, national AIDS program manager at the health ministry, " attitudes in Lebanon need to shift away from the belief that HIV/AIDS affects only sex workers or others who engage in high-risk sex. Statistics proved that this disease affects everyone; it does not discriminate against age, gender, religion or nationality."

As the largest country in East Africa, Tanzania bears a large share of the global epidemic. According to UNAIDS/WHO estimates for 2007 HIV prevalence in mainland Tanzania was 6.2%, which reveals a positive trend from 7% HIV prevalence recorded in 2001. At the end of 2007 there were 1.4 million people living with HIV, which includes 140,000 children aged 0-14. Mainland Tanzania has a generalized HIV epidemic and the primary mechanism for HIV transmission in the country is unprotected heterosexual sex, which constitutes about 80% of all new infections.

To raise public awareness about issues surrounding multiple concurrent sex partners in an effort to curb the spread of HIV/AIDS, the Femina Health Information Project has launched a campaign in Tanzania. The campaign, called One Love, was formed in response to the high rates of HIV/AIDS in Eastern and Southern Africa and also includes nine Southern African Development Community countries, including Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. A recent study carried out by Femina HIP and

the University of Dar-es-Salaam showed that multiple concurrent partnerships, the practice of having more than one partner at the same time is common among men and women in Tanzania. The One Love campaign will be localized and adapted to fit the social and cultural environment of the country and is endorsed by the Tanzania Commission for AIDS.

Stigma and the resulting actual or feared discrimination associated with HIV and Sexually Transmitted infections (STIs) have proven to be the most difficult obstacles to effective HIV prevention. Stigma and discrimination reduces the effectiveness of our prevention efforts and createS an ideal climate for its further growth. HIV related stigma arises mostly from fear and lack of awareness and knowledge about the disease and/or hostility and existing prejudices about the groups most affected by it. All these factors make the vulnerable people even more vulnerable to HIV infection. Stigma prevents many people from negotiating safer sex, taking test for HIV and other STIs, disclosing their status to their partners or seeking treatment. A number of surveys conducted by ITF affiliates show that more than half of the drivers interviewed mentioned that they do not seek treatment for STIs because they might face stigma and discrimination. And for this reason they were also not interested to take tests for HIV and other STIs.

Guyana Clerical and Commercial Workers Union has recently launched a campaign against stigma and discrimination in collaboration with the Guyana Ministry of Health. They have organised A number of workshops and training programmes for both workers and management personnel. The objective of this campaign is to fight fear, ignorance and injustice with the main theme "Stand up for people living with HIV/AIDS, speak out against stigma and discrimination." They have put a number of billboards in the city and around workplaces to convey the message of nondiscrimination. They have also organised voluntary counselling and testing (VCT) programme for members so that they can know their status.

A mining boom in the Australian states of Western Australia and Queensland is contributing to an increase in the number of new HIV cases in the region, particularly among heterosexual men, Reuters reports. According to Reuters, a "large number" of new cases are among heterosexual men in the region who take vacations in Asia. There were 1,051 new cases in 2007 -- a 5% increase from 998 new cases recorded in 2006 and a 50% increase from 718 new cases recorded in 1999 -- according to a report by the National Centre in HIV Epidemiology and Clinical Research. Don Baxter, executive director of the Australian Federation of AIDS Organisations, said there has been a 68% increase in HIV cases contracted overseas by heterosexual West Australian men between 2002 and 2004, and 2005 and 2007. Baxter said that the group has found the "emergence over the past three years of pockets of heterosexual men who are becoming infected" in the "resourcerich states, adding that a "common factor seems to have been them taking holidays in Papua New Guinea ... and Thailand and Cambodia or some other Southeast Asian country". He also added that "relentless increases show our current investments in HIV programs are just not sufficient to reverse the rate of HIV infections in Australia; we're still heading in the wrong direction".

Darren Russell, director of the Cairns Sexual Health Service, said, "We're seeing something new with these older, heterosexual, Australian-based men with high disposable incomes putting themselves at incredible risk with unprotected sex, often after entertaining and drinking." Darren Russell added, "This cluster could just be the beginning of a very large outbreak. It indicates the HIV epidemic in Papua New Guinea is becoming more generalized, which puts these men at greater risk, and in that climate the numbers will only rise."

Although less than 1 percent of Nepal's adult population is estimated to be HIVpositive, according to UNAIDS, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), injecting drug users (IDUs), men who have sex with men (MSM), and migrants. Since Nepal's first cases of HIV/AIDS were reported in 1988, the disease has primarily been transmitted by injecting drug use and unprotected sex. Available data indicate that there was a sharp increase in the number of new infections starting in 1996, coinciding with the outbreak of civil unrest. However, the incidence appears to be levelling off with recent evidence of reduced prevalence and lower overall numbers. As of December 2007, the Government of Nepal reported 1,610 cases of AIDS and 10,546 HIV infections. UNAIDS estimates from 2007 indicate that approximately 75,000 people in Nepal are HIV-positive, including all age groups.

The migrant people are one of the most vulnerable groups of people to STI/HIV infection in Nepal. Independent estimates reveal that the number of periodic migrants is higher than it is recorded in official statistics. About 800,000 people cross the southern border as seasonal migrant labourers to India every year and approximately 350,000 labourers migrate from one part of the country to another for wage earning (MEH and REGHED, 2000). Most of these migrants do not have access to information, condoms, supportive services which enable them to have safer sex. They are likely to take the virus back to their wives who could transmit it to their babies and at the same time work as HIV/AIDS bridging populations.

Nepal's National Centre for AIDS and STD Control, the country's HIV/AIDS and STD Control Board and the Nepal Red Cross Society (NCRS) recently hosted a Condom Day to encourage condom use, especially among young people and other vulnerable groups, to reduce the spread of HIV and other sexually transmitted infections. NRCS has distributed 10.34 million condoms at subsidized prices through 1,700 outlets.

incorporates HIV/AIDS education in its occupational health and safety training

Botswana is among the countries hardest hit by AIDS. In 2007 there were an estimated 300,000 people living with HIV. This, in a country with a total population below two million, gives Botswana an adult HIV prevalence rate of 23.9%, one of the highest in the world. Life expectancy at birth fell from 65 years in 1990-1995 to less than 40 years in 2000-2005, a figure about 28 years lower than it would have been without AIDS. An estimated 95,000 children have lost at least one parent to the epidemic. HIV/AIDS threatens the many developmental gains Botswana has achieved since its independence in 1966, including economic growth, political stability, a rise in life expectancy, and the establishment of functioning public educational and health care systems. At the household level, families face increasing health expenditures to meet the needs of family members with HIV/AIDS. At the same time, they are experiencing loss of income as productive family members become sick and die. Botswana's workforce is being depleted as many productive adults develop AIDS and are no longer able to work. Between 1999 and 2005, Botswana lost approximately 17 percent of its health care workforce due to AIDS. And the number of transport workers died of HIV/AIDS has also increased significantly.

But with strong leadership and commitment from the government and international organizations, the epidemic scenario has started changing. Recent data from the Ministry of Health in Botswana shows a drop in HIV prevalence among pregnant 15 - 19-year-olds (from 25% in 2001 to 18% in 2006), which suggests that the rate of new infections could be slowing.

The rate of turnover due to HIV/AIDS and retrenchments has been a critical concern for BRAWU. Recently they launched a capacity building project for its leaders and members. They have also decided to incorporate HIV/AIDS education in occupation health and safety training to make sure that every member is educated. They are also promoting VCT to encourage members to know their HIV status as majority of HIV infected workers do not know their status.

A text messaging programme using mobile phone technology has been introduced in western Uganda to increase awareness of and knowledge about HIV/AIDS. The AIDS Information Center (AIC)in Uganda and Celtel, a local mobile phone network, have partnered with Text to Change (TTC), a nongovernmental organization that uses a bulk short message service platform for HIV/AIDS education. The number of mobile phone users in Uganda is expected to reach six million by the end of 2008, according to the Ugandan Communications Commission. A 2006 Uganda Demographic and Health Survey showed that up to 50% of people in urban areas have mobile phones, compared with 10% in rural areas. According to DHS, about 30% of women and 40% of men in Uganda have comprehensive knowledge of HIV/AIDS, even though almost everyone in the country has heard of the disease.

The programme also encouraged people to go for HIV testing. According to Robert Natlaka, AIC's representative, requests for HIV testing at AIC's central facility in the Mbarara district of south-western Uganda increased by 100% over the six-week period of the trial program. Natlaka said that approximately 225 participants went to the Mbarara centre for testing and that others went to AIC partners throughout the district.

In the next year, TTC plans to expand the programme into other districts of Uganda.

There is now compelling epidemiological evidence from over 40 studies which shows that male circumcision provides significant protection against HIV infection; circumcised males are two to eight times less likely to become infected with HIV. Furthermore, circumcision also protects against other sexually transmitted infections, such as syphilis and gonorrhoea and since people who have a sexually transmitted infection are two to five times more likely to become infected with HIV circumcision may be even more protective. Currently around 30 percent of men in the world are circumcised and there is lower prevalence of HIV infection in countries where those men reside. HIV infection is lower in African countries where more men are circumcised.

The most dramatic evidence of the protective effect of circumcision comes from a study of couples in Uganda who had discordant HIV status; in this study the women was HIV positive and her male partner was not. No new infections occurred among any of the 50 circumcised men over 30 months, whereas 40 of 137 uncircumcised men became infected during this time. Both groups had been given free access to HIV testing, intensive instruction about preventing infection, and free condoms (which were continuously available), but 89% of the men never used condoms, and condom use did not seem to influence the rate of transmission of HIV.

Compared with the dry external skin surface, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein), a higher density of target cells for HIV infection, and is more susceptible to HIV infection than other penile tissue in laboratory studies. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans ***** may be conducive to viral survival. Finally, the higher rates of sexually transmitted genital ulcerative disease, such as syphilis, observed in uncircumcised men may also increase susceptibility to HIV infection.

There are challenges to MC as a prevention tool. Within the first few weeks of actual circumcision, men become more at risk for contracting HIV. Even with circumcision, HIV infection can still occur. Other challenges include concerns over the false belief that male circumcision is a "magic bullet" that will prevent HIV infection completely. Issues related to sexual satisfaction, cultural and behavioural dynamics and on broader perspective gender equity also need to be addressed. A study conducted in rural Kenya documented successful opportunities to provide HIV prevention, sexual and reproductive health, and gender messages to young at risk males about to undergo traditional\tribal circumcision. The effects of male circumcision on sexual function and pleasure emerged as an important question and a case control conducted among 2,784 participants study indicated no difference in sexual function and pleasure. There are also cultural and religious factors to consider, like in some regions practice of male circumcision are seen as the "Islamization" of their culture.

As a whole, male circumcision should not be seen as a complete answer as none of the prevention methods are 100 percent safe," she said. Male circumcision always needs to be considered as part of a comprehensive HIV prevention package, which includes the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; and the provision of male and female condoms and promotion of their correct and consistent use. Counselling of men and their sexual partners is necessary to prevent them from developing a false sense of security and engaging in high-risk behaviours that could undermine the partial protection provided by male circumcision. Furthermore, male circumcision service provision was seen, as a major opportunity to address the frequently neglected sexual health needs of men.

ITF affiliate in Chile working with HIV positive home

HIV/AIDS in Latin America is sometimes referred to as a 'hidden' crisis: awareness is low, governments have been relatively inactive, surveillance of those affected is sometimes unreliable and stigma has stopped people from conducting open and frank debate about the problem. This is not just an issue within Latin America though - the international community has also overlooked the region. In the face of a more severe situation in Africa, rapidly rising infection rates in Asia and higher profile epidemics in richer parts of the world, Latin America has often been neglected.

Although HIV prevalence in Latin American countries is relatively low compared to the rates found in many parts of Africa, the number of people affected is still substantial. What is more, the situation is likely to get worse in many Latin American countries. No country in the region has experienced a significant drop in HIV prevalence, and it is projected that the total number of people living with HIV in Latin America will increase in coming years. In the Andean countries (Bolivia, Peru, and Chile) HIV-infection rates among men who have sex with men has been found to be as high as 24%.

The first AIDS case in Chile was reported in 1984. In 1990, the Chilean government created the National AIDS Commission (or CONASIDA, the Spanish acronym) to respond to the epidemic. CONASIDA has implemented a series of programs including, among others, sentinel surveillance in different centres mainly treating female and transvestite sex workers.

The ITF affiliates in Chile has been implementing awareness programmes for their members for quite sometime. They also provide support to HIV positive workers. Federacion de Sindicatos de Trabajadores Portuarios del Puerto de Iquique, the port workers' union in Lquique is also working with "Welcome HIV House", a hospice which offers assistance to HIV positive persons so that port workers can get the necessary care and support.

Caribbean nations will establish national HIV/AIDS workplace policies as soon as a regional policy modelled after International Labour Organization guidelines is ready, the Jamaica Observer reports. According to Carl Browne, director of the Pan Caribbean Partnership Against HIV/AIDS who spoke at the XVII International AIDS Conference earlier this month, the organization will work with individual countries to implement national workplace policies tailored to specific needs with the goal of benefiting employees and their families. The policies will include support services and education programs, and a toolkit with relevant videos will be available for countries to provide to businesses.

In addition, countries will be required to report by June of each year so that a consolidated report can be prepared for an annual regional meeting in October, Browne said. He added, "At the end, we want each country to send a report of the number of enterprises they have reached in order for us to develop a database."

The article also examined efforts to address HIV/AIDS in the workplace in Jamaica. According to the Gleaner, the tourism sector's HIV/AIDS policy has "reaped great success" in the country. Last year, 600 people in the sector received HIV tests, and 400 so far this year have been tested.

"In terms of programs, Jamaica has gone very far ahead as they not only have a workplace policy, but have also developed material from which we are borrowing to share with other countries," Browne said. He added that Jamaica's success is because of the involvement of a number of government ministries and the private sector.

Although the Philippines is considered a low-prevalence country, with less than 0.1% of the population testing positive for HIV, the number of HIV-positive people continues to grow. Directorate of Health (DOH) data indicates that the number of recorded HIV/AIDS cases rose to an average of 29 per month in 2007, up from 20 cases monthly in past years. Estimates place the number of HIV/AIDS cases recorded between 1984 and 2007 at 3,061. But since 1984, when the Philippines' first case of HIV was reported, approximately one-third of diagnosed HIV/AIDS cases have occurred among returning migrants. However, because HIV testing for these workers is mandatory in most host countries, this number may be disproportionately high.

According to DOH, the spread of the disease primarily is through sexual transmission, and condom use among the most at-risk population is below target. A health department report on HIV/AIDS in the Philippines found that 48% of female commercial sex workers, 27% of injection drug users, and 49% of men who have sex with men and people with multiple sex partners reported using a condom. The report called for a focus on "prevention activities geared towards vulnerable populations," as well as a "scaled up response for making available affordable treatments and control."

Despite opposition from the Roman Catholic Church, the Philippine Department of Health will support the use of condoms to prevent the spread of HIV/AIDS in addition to encouraging education on the topic and promoting measures to guard against sexually transmitted infections. Health Undersecretary Mario Villaverde at the second Asia Pacific Regional Meeting on universal access to HIV prevention in Manila, Philippines, said, "The use of condoms to prevent the spread of HIV/AIDS is different from their use for birth control," adding, "The church's position is detrimental to public health". According to Villaverde, "We cannot really prevent people, regardless of their religious belief, from engaging in high-risk behaviour, and so we must educate them and we must provide some preventive and control measures for them."

"Universal action now" was the theme of the 2008 International AIDS conference. As more than 7000 new infections occur every day and as the rate of infection still increases in many countries, over 24,000 participants from 194 countries gathered in Mexico city for the XVII International AIDS Conference on 3-8, 2008 to discuss and share policy issues regarding universal access to HIV/AIDS prevention, treatment, care and support.

Some 40 trade unionists representing the International Trade Union Confederation and the Global Union Federations from 20 countries took part in the conference and made a significant contribution to the debate and emphasized the role of workplace-based action in combating HIV/AIDS, engaged with international institutions, NGOs and community-based organisations in policy dialogue and explored possibilities of close collaboration with them.

The world of work emerged as a major theme at the conference. The Conference highlighted the impact of AIDS on the productive population of some of the world's most vulnerable economies, as well as the need for successful mobilization of the workplace as an entry point for AIDS responses. It also set the stage for discussions on the development of a new international Labour standard on HIV/AIDS, currently in Preparation for approval at the International Labour Conference in 2010.

One of the main attractions of the conference was the "Global Village" which provided a space to share knowledge and skills, build coalitions, and promote interactive learning among communities living with and affected by HIV/AIDS, policymakers, researchers and other stakeholder groups. The Global Unions HIV programme had a stall in the village. A large quantity of HIV/AIDS materials including the ITF's Agenda magazine, documentary, posters, leaflets and T-shirts were distributed from the stall. The national centre in Mexico gave us 50,000 condoms for distribution during the conference and all of those were gone in 2 days.

"Global Voice", the official conference newsletter published an article on HIV and workplace issues. According to the article " Living with HIV does not disable people from working, but related stigmas do affect the environment. Three local experiences (ITF, EI and ITGLWF) which show the implications of AIDS in the working place were highlighted." Conference Newsletter (PDF)