March 2001
Reported by Ida-Eline Engh,
Population Programme Service (SDWP)
FAO Women and Population Division
The main aim of Forum 2000 was to encourage discussion and exchanges of experiences and knowledge among those directly or indirectly involved in control and prevention of the HIV/AIDS and STD epidemic. Attendance included representatives of public and private organisations, civil society institutions, networks, national and international co-operation agencies and academic institutions. FORUM 2000 activities were directed towards suggesting integrated strategic action lines for a global response to HIV/AIDS and STDs. The event represented an opportunity for sharing doubts and difficulties concerning the development of scientific research, prevention, care and community action, as well as to act as a stimulus to establishing contacts, useful links and co-operation among all participants. FORUM 2000 was organised by the various national STD and AIDS programmes in Latin America and the Caribbean and by non-governmental and community institutions, multi- and bi-lateral international cooperation organisations, research and academic institutions.
The conference provided panels, round tables and workshops on a variety of issues related to HIV/AIDS and other STDs. It was interesting to observe the difference in focus as compared to the African society, FAO's priority, regarding the impact of HIV/AIDS on rural development and food security. In the Latin American and Caribbean context, the geographical focus was on urban areas, and main topics included prevention strategies; sexual behaviour and gender identities; health care, treatment and civil rights of people living with HIV/AIDS. However, many sessions reflected a wider developmental perspective and might also be applied in a rural context. The following appeared, in my view, as issues of special interest to FAO activities on HIV/AIDS:
Conceptual framework for HIV/AIDS prevention based on multidisciplinarity. Rodrigo Vera (FAO Adviser, UNFPA/CST, Mexico) discussed conceptual models which could serve as foundations for preventive activities. He stressed the importance of understanding why people expose themselves to risk, such as lack of knowledge and ability to make decisions; vulnerability to risk factors; and socio-cultural and contextual factors. Poverty and lack of opportunities, as well as low self-esteem and lack of life project all increase vulnerability to HIV/AIDS. Empowerment is required if campaigns to promote prevention among poor people are to succeed. In the same session, Richard Parker (Brazil) and Carlos Cáceres (Peru) discussed changes of paradigms and new concepts of the construction of sexuality. The session provided clarifications on the limitations of different paradigms of sexuality: 1) the biomedical and rational approach, based on a cost-benefit theory, with the view that sexuality is universally accepted and irreversible and e.g. homosexuality is "something different"; 2) the cultural approach; focusing on cultural diversity and sexuality as dependent of contextual factors; and 3) the structural and political approach, focusing on human rights and lack of access to resources.
Poverty and vulnerability to HIV/AIDS and STD: Jeffrey Stanton (UNAIDS) advocated education and empowerment of highly vulnerable population groups, and stressed the importance of building alliances and mediating between conflicting interests in society in order to ensure equitable access to services. Vulnerability to HIV/AIDS depends on 1) personal factors, such as sexual history, knowledge about protection and treatment; 2) institutional and political factors, such as accessibility of services; and 3) social factors, as cultural norms, social practices and marginalisation. José Ricardo Ayres (Brazil) discussed HIV/AIDS in relation to poverty and stressed that poverty is a complex factor which is not explanatory per se, as it relates to a variety of other factors as gender and age. Vulnerability may also be related to ethnicity and social exclusion with no explicit relation to development. The importance of ethnicity and race was also stressed. In Latin America and the Caribbean the situation of black people, their vulnerability and access to services have to be considered in the context of HIV/AIDS (ref. Ernesto Guerrero, Dominican Republic).
Religion and AIDS and the role of churches: A panel discussion on the role of the church consisted of three persons representing the Catholic Church, the Protestant Church, and Judaism. HIV/AIDS and sexuality in the Latin American and Caribbean context are, to a great extent (however, with regional varieties) associated with taboos and immorality. One of the panelists expressed the view that in many societies and countries where religion has a strong position, human behaviour reflects the behaviour of the church. In the panelist's view, the Church's exclusion of sexual minorities or people living with HIV/AIDS reflects a lack of concepts related to human respect and dignity. Furthermore, it was stressed that the Church has an important role to play both in prevention and care, especially in communities where there is a lack of access to public health services or NGOs. However, it must be stated that these three panelists participated as individuals and did not represent any official view, neither of their country nor their religious community.
The HIV/AIDS epidemic in Latin America and Africa compared: The differences in the HIV/AIDS situation in Latin America and the Caribbean as compared to the African context were discussed with the following conclusions: The situation in Latin America differs from that of Africa in terms of 1) absolute numbers: the former region has 1 million people living with AIDS, whereas the latter has 21 million; 2) national income and poverty levels: Africa's total GDP is only a percentage of the Latin American economy, which also reflects the vulnerability of poor populations, and the fact that the highest prevalence rates are to be found in the poorest countries; 3) gender differences: In most Latin American countries the majority of people living with HIV/AIDS is male, while in many African countries the majority is female. However, a feminisation of the epidemic has been observed in some Latin American countries (ref. José Izazola, SIDALAC).
A key theme of the Forum 2000 in Rio was South-South cooperation as an integral part of an effective AIDS response. South-South cooperation is a strategy which recognises that partners sharing knowledge and experiences and acting together become more powerful and effective. Nowhere is this demonstrated more clearly than in the emerging influence of South-to-South cooperation as a strategy to jointly bring down the prices of AIDS drugs. Dr Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), pointed to significant successes achieved by some Latin American and Caribbean countries, particularly Brazil, in broadening access to care and treatment. It was thanks to the strong political commitment and social mobilisation on the issue that Brazil has achieved such important progress. He added that it was also unacceptable that drugs should be beyond the reach of some people or countries. "We cannot tolerate a world where some regions have access to life-saving treatments and others are excluded, or societies where some classes of the population have comprehensive care but others have no chance of access." It was also stated that inequality and social exclusion are at least as much drivers of uneven health outcomes as absolute poverty, and that social injustices and the gap between rich and poor may be more important than just the level of poverty.
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