Issue
December  1999

Parliamentarians’ efforts at constituency level will make a difference.
- H.E. Wanmuhamadnoor Matha, Hon. Speaker of the Parliament of Thailand

At the Opening Session of the Inter-Country Meeting on HIV/AIDS and STDs Prof. Dr. Prasop Ratanakorn presenting a momento to H.E. Wanmuhamadnoor Matha, Hon. Speaker of the Parliament of Thailand

H. E. Wanmuhamadnoor Matha, Honorable Speaker of the Parliament of Thailand opened the Inter-Country Meeting of Parliamentarians and Specialists on HIV/AIDS and STDs in East and South-East Asia, held on 12, 13 and 14 November 1999 in Bangkok, Thailand. Parliamentarians from over 11 countries attended this most important Meeting, which was organized by AFPPD in cooperation with UNAIDS and UNFPA. The countries included Cambodia, China, Indonesia, Republic of Korea, Lao PDR, Malaysia, Mongolia, Paupa New Guinea, Philippines, Thailand and Vietnam.

H. E. Wanmuhamadnoor Matha stated in the Opening Session that: Discrimination against individuals with HIV--a violation of human rights--takes many forms, from losing one’s job to being chased out of one’s home or even beaten and murdered. Discrimination and stigmatization also affect communities, hampering HIV prevention by driving the problem underground and blocking access to much needed services. People with HIV who fear disclosure are reluctant or unable to access help-including health care for themselves and the information and tools needed for preventing transmission to others.

While medical therapy and nursing care are desperately needed for people with HIV wherever they live, other forms of support are equally vital. These include emotional support for infected individuals and their families, and social measures to alleviate the economic and other impacts of AIDS on families, and households.

Thailand has also faced this problem but thanks to the systematic campaigns and joint efforts of all agencies concerned and leadership. UNAIDS reported that "it is turning around a runaway epidemic". In just five years, risk behavior decreased significantly and the rate of new HIV infection among young men fell dramatically. The broad-based response to HIV/AIDS in Thailand has involved joint efforts, resource contribution and action by all departments concerned, such as NGOs, businesses, schools communities and self-help groups of people with HIV.

He concluded by saying that the Parliamentarians involvement is a good beginning as they are directly in touch with people. Their efforts at the constituency level will make a major difference. They can also work with Ministries wherever need they can affect the policy and legislative changes.

Lead communities toward better living
-H.E. Korn Dabbaransi

H.E. Korn Dabbaransi, Deputy Prime Minister of Thailand and Minister of Public Health, in his Keynote Address spoke concerning the possible national responses to HIV/AIDS. His address stressed the parliamentarians role to furnish HIV/AIDS control programs. He emphasized three aspects:

Dealing with health problems relating with individual behaviors, in general, legislative methods follow knowledge, attitude, and behavioral interventions. However, legislative ways are usually the most powerful tools to wipe out hard core groups and maintain societal order. Sometimes, legislation can activate societal concerns, can demonstrate solid policy, and allows effective resource allocation. It is obvious that the unique roles of parliamentarians are applicable from the initiation, in the middle, and at the near end of specific HIV/AIDS projects. However, when compared with other communicable diseases, HIV is associated with social stigmatization and discrimination. Furthermore, risk behaviors for HIV infection are mostly illegal. Identification of infected people is usually associated with illegal behaviors such as drug use or at least unfavorable personal behaviors such as sexual promiscuity. Legislative methods often drive people underground and destroy their coordination. Concerning these limitations, legislative method is most efficient when it is used in coordination with social measures.

Knowledge dissemination, behavioral intervention to decease risk behaviours and social discrimination are the universal role that is essential for every community leaders. Parliamentarians are leaders by status. Their roles are to lead the communities towards better living and a better quality of life. The complexity of the HIV/AIDS epidemic and its association with social-cultural determinants, entitle us to both build barriers for people who are at risk, preventing them from involvement in risk activities, and tear down barriers between known infected and uninfected people in the aspect of social discrimination. Parliamentarians, as community representatives and community leaders, have great opportunities to bring light to their people for clear understanding of these complex issues.

By day to day interfacing with many stake holders in our societies, parliamentarians have great chance to bring people who have been working on similar areas to work together. Reducing duplicated activities does not only save resources but also increase efficiency. At greater extent, parliamentarians can be coordinating nodes for their local and national authorities.

Prof. Dr. Prasop Ratanakorn, Secretary General of AFPPD, in his welcome remarks stated the need to systematically educate and inform parliamentarians on a wider scale. He explained, once parliamentarians are convinced about various related issues of HIV/AIDS, then it will be easier for them to work at the grass-root level to dispel doubts on any public mind and will help in removing the stigma attached to this epidemic.

An important issue that needs to be taken into consideration is the availability of medicines. We now have medicines available that can prolong the lives of individuals with HIV/AIDS. However, these medicines are so costly that the poor and the government in our region cannot afford them. Thus we must do something about it. Pharmaceutical companies should not play with the lives of people for the sake of money. They should realize their social role.

Parliamentarians could also help in developing new policies and legislation, and most importantly the mobilization of resources. He concluded that the idea of this meeting is for parliamentarians and specialists from participating countries to not only work here, but also to continue to process at the National Level.

Ms. Junsuda Suwunjundee, Country Represen-tative of the Asia-Pacific Network of People Living with HIV/AIDS, in her emotional speech at the Opening Session urged parliamen-tarians to make sure that people living with HIV/AIDS are not discriminated and are given proper medical care. Medicines are costly and unaffordable. Therefore, it is the responsibility of the representatives of people to ensure that those in need have access to these medicines.

Parliamentarians critical role in the mobilization of political will and resources
- Ms. Imelda Henkin urges parliamentarians to work for HIV/AIDS prevention 

Ms. Imelda Henkin, Director of the Asia and the Pacific Division, UNFPA New York, in her address introduced the key issues that were involved in the Meeting.

She told the audience that according to new estimates from UNAIDS and WHO, the number of people living with HIV has grown to 33.4 million, 10% more than just one year ago. The epidemic has not been overcome anywhere. Virtually every country in the world has seen new infections in 1998 and the epidemic is frankly out of control in many places. More than 95% of all HIV infected people now live in the developing world, which has likewise experienced 95% of all deaths to date from AIDS. These deaths have occurred largely among young adults who would normally be in their peak productive and reproductive years. Increasingly, the spotlight is on the spread of HIV through the Asian continent, especially in South and East Asia. While rates remain low relative to some other regions, well over 7 million Asians are already infected and HIV is clearly beginning to spread in earnest through the vast populations of India and China.

Dr. Nafis Sadik, the Executive Director of UNFPA, addressed the Sixth General Assembly of the Asian Forum of Parliamentarians on Population and Development in Japan. Whilst underscoring the remarkable success of Asian Countries in implementing the Cairo Consensus on Population, she mentioned the United Nations General Assembly Special Session on Population and Development held last summer that called for action and new benchmarks in key areas including the prevention of HIV/AIDS. The special session urged countries to "reduce vulnerability to HIV/AIDS infection where at least 90 percent of young men and women aged 15 to 24 years have access by 2005 to preventive methods such as male and female condoms, voluntary testing, counselling and follow-up. This goal should increase to 95 percent by 2010. HIV infection rates in persons 15 to 24 years of age should be reduced by 25 percent in the most affected countries by 2005 and by 25 percent globally by 2010."

In this context, Dr. Sadik emphasized the need for Governments to renew efforts and place firm commitment on resource mobilisation for implementing the initiatives encompassed within the ICPD Programme of Action. She likewise underscored the unique position of parliamentarians as the "crucial link between the people and the government" where "they play a critical role in mobilising the political will and resources to master these global challenges."

As the epidemic spreads and its dire effects are becoming increasingly visible, there is the need for a greatly expanded response. The Joint United Nations Programme on HIV/AIDS (UNAIDS) is an innovative joint venture of the United Nations family. UNAIDS brings together the efforts and resources of seven UN system organizations to help the world prevent new HIV infections, care for those already infected, and mitigate the impact of the epidemic. Its aim is to help mount and support an expanded response - one that engages the efforts of many sectors and partners from government and civil society.

Aware that prevention and treatment of STDs, including HIV/AIDS, are an integral part of reproductive health care, UNFPA supports STDs/HIV/AIDS pre-vention activities in line with national policies and programmes. With the establishment of UNAIDS, UNFPA is working with its UN counterparts at the country level through the theme group mechanism to strengthen and effectively co-ordinate the support for the development and implementation of programmes, UNFPA support for STDs/HIV/AIDS prevention has been on: education and information activities for adolescents and adults; equipment and supplies including condoms at the primary health care level; training of reproductive health (RH) service providers; and research on the integration of HIV preventive education into RH programmes and sociodemographic consequences of the epidemic.

In the overall effort to deal with the HIV/AIDS crisis, the parliamentarians have a crucial role to play. Effective and just policies to reduce the spread of AIDS must be based upon a thorough knowledge of issues that will influence legislations and design of programmes. Key to an appropriate legislative response are adequate information, education and services. Thus, a fully expanded policy response to STDs/HIV/AIDS requires a combination of risk reduction and contextual interventions through laws, policies and practices aimed at promoting responsible behaviour and, in the long term, at increasing access of those infected to appropriate health care services.

Dr. Wiwat Rojanapithayakorn, Team Leader, UNAIDS Asia-Pacific Intercountry Team, speaking at the Opening Session, pointed out that the very purpose of this meeting is to call upon parliamentarians representing 11 different countries in this region as a group and as individuals to help expand the response to HIV/AIDS and STDs. The spread of HIV/AIDS and STDs will never be stopped by the medical or public health community operating alone. We need to work together and each of us must provide our own unique strengths and political powers into the process of reducing the spread of HIV/AIDS.

We have learned that effective action requires political support, expressing clear policies and allocation of the resources.

An effective government response comes most of all from the political will to do the best for its people: Political will ensure that adequate budgets are directed at effective prevention programmes; Political will ensures that people living with HIV/AIDS will not suffer needlessly from stigma and discrimination; and Political will ensures that all sectors of society will play their part in fighting the businesses, religious bodies, schools and government departments. He concluded that without political will, the best policies will never be effective .

The First TeleFood Medal presented to the King of Thailand

Bangkok – On Wednesday, 8 December 1999, the First TeleFood Medal was conferred on His Majesty King Bhumibol Adulyadej (King Rama IX) of Thailand on the auspicious occasion of HM the King’s 6th cycle birthday anniversary, and in recognition of his valuable support to food security and of his country’s contributions to TeleFood, the 3rd largest in the world in 1997. The Medal was presented by Dr. Jacques Diouf, the Director General of Food and Agriculture Organization of the United Nations (FAO), at the Chakri Throne Hall.

FAO is aware of His Majesty the King’s perseverance and his benevolence for the Thai people in developing agriculture and building food security to improve the welfare of the farming households. His Majesty has initiated various important agricultural development projects, in particular those involving the self-sufficiency economy and the New Theory on Agriculture, widely recognized both inside and outside Thailand.

To cerebrate this most auspicious occasion, AFPPD would like to take this opportunity to acknowledge the immense work that His Majesty has done for Thailand, Thai people and mankind.

Dr. Ghazi Farooq, Director of the UNFPA Country Support Team for East and South-East Asia, in his presentation on HIV/AIDS and STDs: Causes, Consequences and Preventive Programmes, outlined a group of strategies that parliamentarians can utilize to encourage and support STDs/HIV/AIDS prevention. He suggested that parliamentarians need to encourage and support:

1) Increased political commitment to effective HIV/AIDS preventive strategies and programmes.

2) Comprehensive STDs/HIV/AIDS preventive programmes as it is proven that they work and are cost-effective invest-ments (returning millions of dollars in health care savings, production and income).

3) Government to allocate substantial national resources for HIV/AIDS prevention and care programmes.

4) Government to develop, in partnership with communities, NGOs, research institutes and other organizations, national policies to guide and facilitate all STDs/HIV/AIDS prevention activities in the country.

5) The participation of individuals infected with HIV and communities affected by the epidemic in the design and implementation of programmes, as this is critical to an effective, humane and ethical response.

6) Government to review and revise laws, policies and protocols to ensure that they uphold human rights and do not deter men or women, including youth, to take protective action against HIV/AIDS transmission.

7) A non-judgmental approach that promotes equality within couples, families and communities as the key aspect of successful HIV prevention.

8) The diversity of HIV/AIDS responses that emerge at national and local level by NGOs and community organizations and respect their autonomy of action.

9) Government’s responsibility for ensuring universal access to an essential package of complementary approaches that prevent the sexual, drug-related and bloodborne transmission of HIVAIDS infection and the other STDs (including multiple options and technologies for protective sexual behaviour). One hundred percent of individuals should have access, at a minimum, to preventive information, condoms and effective STD care.

10) The empowerment of girls and women and the promotion of gender equality. Due to economic dependence and social subordination, many girls and women are unable to negotiate safer sex or to refuse unwanted sex, which makes them more vulnerable to STDs/HIV infection.

11) The elimination of all legal and policy barriers to nation-wide condom promotion.

12) Multisectoral and community partnerships which are necessary to reduce the spread of STDs/HIV.

13) The government’s responsibility for ensuring safe blood supply and products.

14) The people hardest hit by the epidemic as they already face other health, social and economic problems. HIV prevention strategies therefore need to address poverty, violence against and the exploitation of women and children, and need to emphasise the human rights of ethnic minorities, refugees, migrants, drug users, sex workers and the poor.

15) The revision of laws and policies at all levels to ensure equal protection of persons living with AIDS regarding access to health care, employment, education, travel, housing, and social welfare, without discrimination on the basis of sexual orientation or marital status.

Dr. Gilles Poumerol, Regional Adviser in Sexually Transmitted Diseases and AIDS, WPRO/WHO, Manila, spoke on HIV/AIDS Epidemiology in Asia/Pacific. He said that while the HIV epidemic started in the Western countries, Australia, New Zealand and the African continent at the beginning of the 80’s, no country in Asia had experienced a major epidemic until the late 80’s. By the beginning of the 90’s, however, a number of countries, led by Thailand, observed an increasing number of infections, and by 1998, the epidemic is well established across the continent.

Many countries have low reporting rates for HIV and AIDS. This is due to limited capacity for diagnosis, weakness of the reporting system of confidentiality issues. The rate of reporting for HIV and AIDS is estimated to be lower than 20% in many countries in Asia. Therefore, we have to rely on estimates. Estimates are based on the analysis of sentinel surveillance for HIV infection.

Risk exposure category are evolving with time. In the Western Pacific region, the main risk exposure category of HIV/AIDS cases reported was essentially homosexual contact ten years ago. It became IVDU in the beginning of  the 90’s and is now increasingly heterosexual trans-mission -- reaching 33% in 1998. The same pattern has been observed in Thailand, India, Myanmar and China.

Behavioral surveillance in selected countries has been extremely instructive in understanding some determinants of the epidemic. The average HIV prevalence rate in the general population appears to be closely linked to the use of sex workers made by young people. These data probably explain why the epidemic did not expand rapidly in the Philippines and in Indonesia. Clearly, IVDUs, sex workers and clients are playing a major role in the diffusion of the HIV infection in Asia and all efforts should be directed to these groups to prevent larger spread to the general population. If sex workers are a groups at risk of infection, we should not forget that their clients are also at risk. These are often the individuals attending STD clinics. Commonly, the most vulnerable people are mobile men.

Many countries in Asia have initiated intensive prevention programmes. One of the main indicator showing the impact of these programmes is the increasing usage of condom observed among sex workers, clients and young sexually active adults in general. The most impressive example is Thailand, where behavioural surveillance combined to serological surveillance has helped to define risk behaviours, population at risk, design intervention programmes and monitor the impact.

Awareness and Advocacy for Effective Responses to HIV/AIDS and STDs was the topic of a panel discussion shared by Ms. Luwalhati R. Antonino, MP from the Philippines, Dr. Surya Chandra Surapaty, MP from Indonesia, and Mme. Xu Jing, MP from China.

Ms. Antonino from the Philip-pines said that parliamentarians can increase awareness of and support for HIV/AIDS among peers as well as look out for "turning points". Controversial and explosive news that would call the attention of key influential persons, for example, presenting a case through media that will catch the attention of parliamentarians. She pointed out that parliamentarians can also prioritize key issues and messages on HIV/AIDS in each country to disseminate to parliamentarians through the com-pilation of relevant national and local data, and tested preventive approaches. Culture-specific media modalities are effective ways of creating awareness. They can request for special "privilege hour" for presentation in the Parliament on a particular subject, such as related to key issues dealing with HIV/AIDS, and should request government of their countries to set aside a big sum of fund to activate the above in a more positive manner.

Dr. Surapaty from Indonesia spoke about the situation in his country, and mentioned that awareness and understanding of HIV/AIDS and how it is transmitted are parti-cularly low in the rural areas. There is reliance on less credible sources. Misconceptions and myths about HIV/AIDS and its transmission are widespread. There is limited access to correct information on prevention and care, resulting in prejudice and discrimination.

Mme. Xu Jing from China said that parliamentarians are well-placed to motivate public as well as to help create the environment where HIV/AID infected people are not discriminated. Parliamentarians can also ensure that proper treatment is available for those in need.

Dr. Ying-Ru Lo, Medical Officer - HIV/AIDS and STDs, WHO, Thailand, explained the need for parliamentarians to see that care and support were extended to the HIV/AIDS inflicted. She explained that the rapid increase in the number of AIDS cases in adults in some countries, as for example in India, Thailand, Myanmar and Cambodia, creates a heavy burden in terms of care, both for the families of AIDS patients and for health systems. Many researchers fear that even in areas where the HIV infection levels are not yet very high, the epidemic will eventually appear. Prevention and care need continuous strengthening in facing existing and future problems with HIVAIDS.

The predominant mode of transmission of HIV and STIs is sexual. Other routes -of transmission for both include blood, blood products, donated organs or tissue and vertical transmission from an infected mother to her fetus or newborn infant. Many of the measures for preventing sexual transmission of HIV and STIs are the same, as are the target groups for these interventions. Clinical services for STIs are important points of contact with persons at high risk of both AIDS and STIs, not only for diagnosis and treatment but also for education and counselling. Trends in STI incidence and prevalence can be useful early indicators of changes in sexual behaviour and are easier to monitor than trends in HIV seroprevalence or incidence.

On account of these proven relationships between conventional STIs and HIV, WHO and UNAIDS have designated the control of STIs as one of the priority interventions for the prevention of HIV transmission.

Dr. Wiwat Rojanapithayakorn, Team Leader of the UNAIDS Asia-Pacific Intercountry Team, in his talk on HIV/AIDS and STDs: Policies, Legislation and Human Rights, made a plea for the careful monitoring of human rights in respect to the epidemic. He spoke about how HIV/AIDS continues to spread throughout the world at an alarming rate. A cumulative total of 47 million people have contracted HIV since the pandemic began, and some 14 million people have died of AIDS, leaving more than 33 million living with the virus by the end of 1998. Last year alone, there were nearly 6 million new infections, which means that every minute of every day 11 people contracted the virus.

In the wake of this epidemic comes the widespread abuse of human rights and fundamental freedoms. In all parts of the world, many people with HIV/AIDS suffer discrimination, intolerance and prejudice. Yet the product of 50 years of international human rights machinery and 15 years of practical experiences in responding to HIV/AIDS in countries throughout the world teaches us one very clear lesson: The protection of human rights is essential to safeguard human dignity in the context of HIV/AIDS, and to ensure an effective public health and social responses to HIV/AIDS. An effective response requires the implementation of all human rights, civil and political, economic, social and cultural, and fundamental freedoms of all people, in accordance with existing international human rights standards.

It is increasingly clear that public health interests do not conflict with human rights. On the contrary, it is widely recognized that when human rights are protected, fewer people become infected and those living with HIV/AIDS and their families can better cope with HIV/AIDS. A rights-based, effective response to the epidemic of HIV/AIDS and STDs involves establishing appropriate governmental institutional responsibilities, implementing law reform and support services, and promoting a supportive environment for groups vulnerable to HIV/AIDS and STDs and for those living with HIV/AIDS.

In the context of HIV/AIDS, international human rights norms and pragmatic public health goals require States to consider measures that may be considered controversial, particularly regarding the status of women and children, sex workers, injecting drug users, and men having sex with men. The Vienna Declaration and Programme of Action, adopted at the World Conference on Human Rights in June 1993, affirmed that all human rights are universal, indivisible, interdependent and interrelated. While the significance of national and regional particularities and various historical, cultural and religious backgrounds must be home in mind, States have the duty, regardless of their political, economic and cultural systems, to promote and protect universal human rights standards and fundamental freedoms

Partnership with private sector
- Dr. Anthony Pramualratana

Dr. Anthony Pramualratana, Executive Director of the Thailand Business Coalition on AIDS, spoke about NGO’s response to HIV/AIDS. He sited examples of Business Houses around Asia cooperating to prevent the stigma of HIV/AIDS at the workplace. He said that special groups had now been setup in several countries to help business and industrial houses to deal with the HIV/AIDS situation which includes education/training, a non-discriminatory approach, no compulsary testing, assistance to staff living with HIV/AIDS and to support the continuation of life insurance.

Dr. Pramualratana explained the goals of his organization: To promote a society where people with HIV/AIDS and their families can live normal lives, free from discrimination and undue physical and mental suffering: where their human rights are protected and they receive the necessary welfare and social support needed to maintain their livelihoods and their dignity as individuals and families.

To strenghten and extend the network and capacity of NGOs working on HIV/AIDS and PHA groups in promoting and supporting a society that is understanding, accepting and suppor-tive toward people with HIV/AIDS and their families.

Dr. Lee-Nah Hsu, Manager of the South East Asia HIV and Development Project, UNDP, Bangkok, spoke at length on the subject of "Governance and HIV/AIDS." She stated that a good gover-nance system consists of full participation of constituents, rule of law, transparency, responsiveness to the constituents, consen-sus building, equity, effectiveness, accoun-tability and vision.

She pointed out how the rule of law relates to HIV/AIDS. By rule of law one does not only mean the adoption of laws, bills and regulations but also ensuring that your constituents are aware of their rights and how to improve their situation within the existing legal frame-work. This would mean reducing all forms of discrimination, especially against women or minorities while also encouraging legal literacy. Such em-powerment of women would contribute significantly to re-ducing abuses, traf-ficking and other forms of mistreatment in which HIV can flourish.

Among the components of good governance, responsiveness to the stakeholders’ and constituents’ needs and wishes is a crucial dimension of a parliamentarian’s function. Such responsiveness is related to the flow of information inside your constituencies and to the strategic vision you develop for their future with their participation.

Ms. Prudence Borthwick, Assistant Project Officer, UNICEF, presented a paper written by Dr. Rudolf Knippenberg, Regional Adviser-Health and Nutrition, East Asia and Pacific Regional Office, UNICEF, Bangkok, entitiled, "Young People Living in a World with HIV/AIDS." In it, he described the situation facing the young as they try to cope with the disease. Every time you see a sentinel surveillance figure which includes the number of pregnant women affected in your country, please remember that that means in 3 months or six months time there will be another child affected by HlV/AIDS in that woman’s family and community. Another family, another community will be facing the prospect of caring for an orphaned child or an infected child. Of course it’s not just pregnant women who get HIV. And its not just infants and small children who are orphaned. Many women who contract HIV have older children, whose futures are also threatened with the toll taken on family finances and resources by illness and death.

In addition, infants and small children who are orphaned grow. When they are little, in some ways, their physical care is perhaps more easily taken care of by elderly relatives than their emotional and social development as adolescents. Such children and youth are often left with few financial resources, limited care and attention from elderly relatives and the traumatic legacy of death and illness. They have the additional burden of discrimination and stigma. Preliminary research in Thailand suggests that AIDS orphans have more behaviour problems than other orphans.

Asian Parliamentarians discuss waste management
- APPCED Conference in Thailand

Chiengmai – An Asian-Pacific Parliamentarians Conference on Environment and Development was held in Chiengmai on 20 to 23 November 1999 with the theme on "Waste Disposal", and was organized by APPCED (Korea) in cooperation with the National Parliament of Thailand.

Papers were presented by experts on various aspects of waste management, and attending countries provided information on waste management programme. Dr Sang-Mok Suh, Chairman of AFPPD Korea Committee, was the chairman of the conference.It was also addressed by H.E. Wanmuhamadnoor Matha, Hon Speaker of the House of Representatives, Thailand, and Mr. Meechai Ruchupan, President of the Senate of the Parliament of Thailand. Mr. Shiv Khare, Executive Director of AFPPD, represented the Asian Forum.