One-size does not fit all: Importance of all- inclusive HIV prevention HIV-Prevention:update on global and Finnish HIV situation and new preventive technologies Seminar in Parliament 24 October 2007

Hilkka Vuorenmaa Devlopment Cooperation Unit 2 HIV TRANSMISSION Sexual transmission Transmission through blood Mother-to-child transmission

Hilkka Vuorenmaa Devlopment Cooperation Unit 3 TO BE SUCCESSFUL AN HIV PREVENTION PROGRAMME MUST MAKE USE OF ALL APPROACHES KNOWN TO BE EFFECTIVE, RATHER THAN JUST IMPLEMENTING ONE OR A FEW SELECT ACTIONS IN ISOLATION

Hilkka Vuorenmaa Devlopment Cooperation Unit 4 Requirements for prevention of all forms of HIV transmission Comprehensive awareness of HIV and how it can be spread Provision of services and necessary prevention methods HIV counselling and testing Provision of antiretroviral treatment Protecting and promoting human rights

Hilkka Vuorenmaa Devlopment Cooperation Unit 5 Comprehensive sexuality education Provision of sufficient and reliable information Encourage abstinence Promotion of condom use Encourage fewer sexual partners Early identification and treatment of STIs Teaching sexual communication skills

Hilkka Vuorenmaa Devlopment Cooperation Unit 6 Obstacles Women and young people unable to negotiate condom use or abstinence Couples compelled to have unprotected sex to have children Condoms often associated with promiscuity and lack of trust Authorities restrict what subjects can be discussed in schools or in public campigns for moral and religious reasons Marginalisation of groups at high risk Lack of condoms and services

Hilkka Vuorenmaa Devlopment Cooperation Unit 7 Abstinence-only programmes Focus on abstaining from sex until marriage Religious and/or moral approach Strong opposition to same-sex relationships and abortions Encourage young people to refuse or avoid sex altogether Exclude any other information, which conflicts with this view Increases the risk of young people for pregnancy and STIs including HIV Ineffective and dangerous PEPFAR

Hilkka Vuorenmaa Devlopment Cooperation Unit 8 Male circumcision Strong evidence that male circumcision reduces HIV transmission from woman-to-man by 60 % Not known if affects likelihood of male-to-female or male-to-male transmission Research is still ongoing Needs to be considered as just one part of comprehensive HIV prevention package Sexual partners need to avoid false sense of security Other forms of protection needs to be used simultaneously

Hilkka Vuorenmaa Devlopment Cooperation Unit 9 Mother-to-child transmission Transmission Pregnancy, labour, delivery Breast feeding Prevention Testing Antiretroviral drugs Caeserean section Avoiding breast feeding Obstacles Lack of drugs and medical services Caeserean section impractical No resources to avoid breastfeeding Stigma

Hilkka Vuorenmaa Devlopment Cooperation Unit 10 Transmission through blood IV drug users Needle exchange programmes Necessary part of HIV prevention Transfusion of infected blood or blood products Screening all blood supplies Heat-treating blood products Restrictions to blood donations Medical procedures/other activities involving contact w. blood Sterilisation or disposal of equipment after each use Health care workers safety Practicing universal precautions

Hilkka Vuorenmaa Devlopment Cooperation Unit 11 Integrating SRHR with HIV prevention and treatment HIV and AIDS education programs restricted to factual info on HIV transmission and AIDS prevention Broader rh needs are rarely met SRHR programmes although broader usually do not include strategies for HIV and AIDS prevention, care or stigma Both address human sexuality, serve similar target groups, promote safe responsible sexual behaviour etc. Integration beneficial to both

Hilkka Vuorenmaa Devlopment Cooperation Unit 12 Policy measures Strong political leadership and commitment necessary All leaders in all sectors must speak out openly Protecting and promoting human rights Awareness raising, attitude change Legislating against any forms of stigma and discrimination Strategic planning based on good quality science Consideration of local society and culture All sectors of the population actively involved: employers, religious groups, NGOs, HIV positive people, young people

Hilkka Vuorenmaa Devlopment Cooperation Unit 13 THANK YOU!