UNFPA Seminar

AUICK held the UNFPA Seminar jointly with the Tokyo Office of the United Nations Population Fund (UNFPA) at Kobe International House from 1:30 pm to 4:30pm, Thursday 30 June 2005. The seminar, subtitled "Sound Mind and Sound Body: Let us think and learn and have a wonderful adolescence," was organized as a forum of AUICK's First 2005 Workshop open to the public, and attended by 150 people.

Opening

The seminar was opened with a welcome address by Mr. Yoshikane Fujimoto, Executive Director of AUICK. He explained that the seminar was conducted with the objectives of raising awareness and understanding of issues relating to reproductive health and HIV/AIDS and informing the general public of other countries' experiences, challenges they face, and the initiatives they are taking with these concerns. Then, he introduced Ms. Kiyoko Ikegami, Director of UNFPA Tokyo Office, as a facilitator of the Seminar.

UNFPA Activity Reports

Ms. Kiyoko Ikegami invited three guests from UNFPA to provide general information on UNFPA's viewpoints and peer education activities against HIV/AIDS in Asia.

First, Dr. Farah Usmani, HIV/AIDS Advisor of UNFPA, presented a general overview of HIV/AIDS in Asia. She pointed out that Asia is home to 60% of the world's population and 20% of the cases of HIV/AIDS. She said HIV prevalence in Asia is high as a whole, but ranges from 0-5%. Due to the region's high population, however, even low prevalence translates into a high number of cases, and these number are quickly growing. There are several interlinked issues that underline Asia's vulnerability to HIV/AIDS, such as low knowledge about the disease, high migration and mobility within the region, high numbers of intravenous drug users, and proportionally high populations of young people. She explained that most countries in the region have a national plan and a national organization in place. There have been some successes, but overall there is generally insufficient coverage of programs and lack of impact. Priority areas have been set, which include the prevention of HIV among young people and women. She also stressed the combined need for global, regional and local initiatives together with multi-faceted collaboration and cooperation.

Second, Ms. Katia Lukicheva, a young peer activist for Kyrgyzstan, introduced her peer education activities on reproductive health and HIV/AIDS in her country. She explained that their peer education activities involve communication with young people to raise their awareness of the issues and understanding of how to protect themselves. She stressed that peer education was a friendly and highly effective means to get the message out.

Mr. Chen Zuo, leader of the peer educators of Renmin University in China, explained that in China until a few years ago people were very reluctant to discuss HIV/AIDS and other reproductive health issues, but now there are many NGOs there working in the field and also government support for related initiatives. Aiming to attract more people to participate in discussion of the issues, he has established a national youth network. He stressed that although young people need the support of adults and governments, youths must help themselves by themselves, as they are the future.

Reports from Ten Cities

The ten senior officials from ten Asian cities in charge of adolescent reproductive health and HIV/AIDS made brief reports on the history, current status, countermeasures, and challenges of HIV/AIDS in their respective cities and countries.

Dr. Salim Akhter Chowdhury from Chittagong, Baangladesh, reported: "The spread of HIV infection is rapidly increasing. Some highly positive HIV prevalence areas were considered as having great potential to make Bangladesh a HIV/AIDS prone country in the very near future. Almost half of the population is under 15 years of age, and risky behaviors, including high rates of unsafe injecting drug use, a thriving sex trade, and unsafe blood transfusion practices, are widespread."

Mr. Fan Kaimin from Weihai, China, reported: "In 1993 the first HIV/AIDS was found in Weihai. At present Weihai had nine HIV/AIDS patients. All of them were under control. Adolescents often do not know how serious the problem of HIV/AIDS is, how it is caused or what they can do to protect themselves. The other challenges are the floating population, which is increasing very fast, and the increase of risky sexual action."

Dr. Kandasamy Manivasan from Chennai, India, reported: "In 1986 the first case of HIV was identified in India. Chennai Corporation AIDS Prevention And Control Society (CAPACS) was established in 1998 to combat the spread of HIV/AIDS among the general population within Chennai City besides providing care and support facilities to the HIV/AIDS patients. The challenges for them are: (i) Bringing about behavioral changes in the high risk group and the general community, (ii) Empowerment and rehabilitation of marginalized groups such as commercial sex workers, homosexuals, and injecting drug users, (iii) Dealing with continuing migration trends, which lead to high-risk behavior and street children, (iv) Dealing with the high percentage of slum dwellers, (v) Provision of free anti-retroviral treatment to all those who have become infected, and (vi) Overcoming stigma and social discrimination."

Dr. Esty Martiana Rachmie from Surabaya, Indonesia, reported: "In 1996 five HIV positive cases were firstly found in Surabaya. Each year the number of cases found increased remarkably. By 2004 there were 323 HIV/AIDS cases found in total. The challenges are (i) To reduce stigma and discrimination of HIV/AIDS among government officials, religious leaders and PLWH, (ii) To promote safe sex and condom usage, (ii) To provide support and care for HIV/AIDS patients, and (iv) To conduct operation research for improving intervention against the spread of HIV/AIDS."

Mr. Mohamad Zainudin Idris of Kuantan, Malaysia, reported: "National efforts to combat the epidemic of HIV/AIDS have been initiated since 1985. The first case of HIV was detected in 1986, and in 1997 systematic HIV/AIDS surveillance system has started, and up to now there are about 65,000 HIV careers and 7,000 AIDS careers. While in Kuantan, 297 cases of HIV and 66 cases of AIDS were detected in 2004. For the purpose of improving adolescence sexual and reproductive health, certain measures are formulated and implemented by Kuantan Municipal Government, with cooperation of other agencies or NGOs. For example, special program including exhibition on such issues as sexual abuse, idea of contraception are conducted in every school under National Population and Family Planning Development Board."

Dr. Aslam Pervaiz from Faisalabad, Pakistan, reported: "According to the Government of Pakistan, there were 1,998 cases of HIV/AIDS reported in 2002. Based on the WHO estimate of people living with HIV/AIDS, deaths related to HIV/AIDS would have been approximately 3,500 in 2002. No authentic data is available at national and city levels, except at one diagnostic facility at Allied Hospital Faisalabad. So far, four cases of HIV/AIDS positive have been identified by the private sector of the Faisalabad District. Pakistan is currently classified by WHO/UNAIDS definitions as a low prevalence but high-risk country for the spread of HIV infection due to a number of varied factors, including low literacy rate, high prevalence of sexually transmitted infections, limited safety in blood transfusions, increasing numbers of injecting drug users, use of contaminated needles, high injection use rate, and its highly mobile refugee population."

Dr. Nilda Ticar Montoya from Olongapo, Philippines, reported: "Out of 74,341 HIV tests done from 1985 to 1990, 44 were identified positive. There was a total of 49 HIV cases in 1992. Seven years after the pull out of the US armed forces, twelve additional cases were identified bringing the total cases to 61. Several organizations such as the I CARE Fellowship, Youth with a Mission, Precious Jewel Foundation and the Reach-UP Project of the City Government, provide material and spiritual as well as educational support to the children of PWHIVs."

Ms. Wallapa Prangthawat from Khon Kaen, Thailand, reported: "In Khon Kaen HIV/AIDS was first identified in 1988. The number of AIDS cases and deaths due to AIDS reported from 1988 to May 2005 are 5,599 and 1,036 respectively. A behavioral surveillance conducted annually in June-July, shows that the percentage of the 11th grade students who had sexual intercourse was 24.5% of males and 6.4% of females. During their first sex, only 29.5% of male students and 48.6% of female students used the condom. The result of Mother to Child HIV Transmission Prevention Program in 2005 showed that out of the coverage of 97.8% of the ANC attendees (18,605 cases), the prevalence rate of infected mothers was 0.8% (148 cases), and the percentage of ARV received was 88.8% of HIV infected mothers (131 cases) and 99.3% of their infants (149 cases). The cumulative number of children under 15 years old living with HIV/AIDS in 2005 was 420 cases. It is a serious health threat which has spread from the earlier known high risk groups to other vulnerable population such as married women, their infants and youth."

Dr. Kim Anh Thi Doan Vo from Danang, Vietnam, reported: "In April 1993 the first HIV case was found in Danang. Up to 31 May 2005 there have been 253 AIDS patients. The 6/6 districts and 45/47 communes have people living with HIV. City's central area has a higher rate than other areas. The number of young affected people under 29 years old increased year after year - 57% in 2001, 60% in 2002, 72% in 2003, and 73% in 2004. Migration is a big problem in Danang. The rate of migrants with HIV is relatively high accounting for nearly 40% of the found cases. The management of the affected people is very difficult, and the risk of AIDS spreading over the community is relatively high. To prevent the spread of this epidemic, the City People's Committee issued the Decision No. 161/2004/QD-UB dated 28 September 2004 on the issuance of the Action Plan on HIV/AIDS Prevention for the period 2005-2010. More than 30 branches and mass organizations involved in the activities such as behavior change, counseling, capacity development in management and monitoring, and mobilization of the community."

Dr. Chika Shirai from Kobe, Japan, reported: "On 17 January 1987, Japan's first female AIDS patient was reported in Kobe. This news encouraged 6,000 people to be tested for HIV antibodies and more than 10,000 people to use the HIV infection consultation service annually. In 1993 and 1994, a range of AIDS-related programs were conducted by public health centers throughout Kobe City, including seminars, production of educational videos, lectures by HIV-positive people, photo exhibitions and symposia. Because of some financial difficulties due to the great earthquake, the AIDS prevention efforts by the Kobe City Government are currently focused only on HIV antibody testing and counseling services. Annually about 1,400 people are tested for HIV. Since 1989, over 80 HIV-positive cases have been reported in Kobe, where only a limited number of hospitals are capable of providing AIDS treatment."

Discussion

Q: What is the relation between policies on sexually transmitted diseases (STDs) including HIV/AIDS and poverty reduction?

1. - Data shows that approximately 80% of HIV/AIDS cases are spread through sexual interaction. The poor are a particularly vulnerable group due to lack of knowledge about the disease and how to protect themselves. We at the UNFPA are making efforts to take a multi-faceted approach in the formulation of our programs to appropriately address the interconnected nature of the problems. (Ms. Kiyoko Ikegami)
   - There is indeed a close link between poverty and susceptibility. People who live in slums are particularly vulnerable. A multi-dimensional approach is required, one that not only increases awareness and knowledge, but one that actually leads to behavioral change. (Dr. Kandasamy Manivasan)
   - We should keep in mind that in 2000, leaders of 180 countries agreed on the Millennium Development Goals, under which the eradication of poverty and combating HIV/AIDS are top priorities. The poor usually have low access to knowledge and facilities, so they easily become victims. Commitment is one of the prime requirements needed to realize these goals. (Dr. Haryono Suyono)

Q: Why did you chose to become involved in peer education and what kind of training is needed?

1. - I studied cultural communication at university and this is a practical way to use what I have learned. I also like to serve as a resource base to others and provide them with the knowledge they need. Most importantly, I believe that peer education, especially young people teaching young people, is a very effective approach. As for training, I studied reproductive health, and as a UNFPA representative, I have taken a certified program and receive ongoing training. (Ms. Katia Lukicheva)

Q: I feel there is lack of knowledge among young people in Japan about global issues such as child labor, war and HIV/AIDS. How can we convey the message to young people?

1. - It is important to talk about HIV/AIDS because it is a social problem not a personal problem. You could encourage discussions in schools, for example, by organizing events or organizing competitions between schools for the most successful event. (Ms. Katia Lukicheva)
   - Peer education is a good approach. You can also use the arts as a medium, for example, by holding photo contests or video contests. (Mr. Chen Zuo)
   - In Vietnam, HIV/AIDS issues are taught in secondary schools. For children not in school, meetings and competitions are organized. The mass media should also allocate time to inform people on these issues. (Dr. Kim Anh Thi Doan Vo)
   - In addition to individual efforts, you could try tapping into resources and funding available through development agencies to pursue an issue that you feel strongly about.

Q: I hear about Japanese men who go to Southeast Asia to have sex with prostitutes and then come back to Japan infected with HIV/AIDS. I am angry that Southeast Asian countries allow this to happen. What are they doing about this problem?

1. - I think most people would agree that the "sex tourists" are the ones to blame for this, not the prostitutes. However, this question raises the issue of misconceptions about the disease and the inappropriate placement of blame on its vulnerable victims such as sex workers. We have to address the behavior, not just criticize. (Dr. Farah Usmani)
   - We have many so-called sex tourists in Vietnam. We carry out campaigns among the sex workers to promote condom use and we give advice and warning to the Japanese men and other tourists regarding the risks. (Dr. Kim Anh Thi Doan Vo)

Q: What are the best means to promote use of condoms? Does promoting condoms mean we support pre-marital sex and promiscuity?

1. - Unfortunately many people believe that promoting condoms is promoting promiscuity. We use evidence-based advocacy in such cases, because evidence shows that use of condoms prevents the spread HIV/AIDS. Promoting condoms is difficult in the face of conservative and religious elements, but we are working with religious leaders and making progress. A multi-layered comprehensive program is required for effective results, and we also have to adapt the practices to the local context. (Dr. Farah Usmani)
   - We should keep in mind that the sex workers do not always have the choice to use a condom, as clients may refuse, and they are the ones in control. (Dr. Haryono Suyono)

Closing Remarks

Dr. Hirofumi Ando, President of AUICK, summarized some of the main points raised in the presentations and discussions as follows:

1. HIV/AIDS is a global issue that has no boundaries, especially in light of increased migration and mobilization worldwide. Its center is shifting from Africa to Asia, and no country is isolated from the problem or immune to its effects.
2. Groups particularly vulnerable to the disease are the poor, especially the young, commercial sex workers and intravenous drug users.
3. We need political commitment for effective policies and programs, but each of us must also be "politically committed."
4. The stigma and discrimination associated with HIV/AIDS is a problem that we can all play a role in improving. We have to help ourselves to help others, which of course applies to all aspects of HIV/AIDS and many other issues. Peer counseling is a prime example of such initiatives, and of the passionate dedication of young people that is sure to achieve timely results.

Dr. Ando closed the seminar by thanking the organizers of the forum, UNFPA Tokyo Office and AUICK, as well as Ms. Ikegami for her excellent chairpersonship and all the panelists and participants for making this event a success.

Participants

1. UNFPA Personnel
Dr. Farah Usmani
Advisor, HIV/AIDS & Reproductive Health, UNFPA / UNFPA CST for South and West Asian Kathmandu
Ms. Kiyoko Ikegami
Director, UNFPA Tokyo Office

2. Peer Education Activists
Ms. Katia Lukicheva
Y-PEER Focul Point for Kyrgystan
Mr. Chen Zuo
Leader of Peer Educators of Renmin University, China

3. City Officials
Dr. Salim Akhter Chowdhury
Health Officer, Chittagong City Corporation, Bangladesh
Mr. Fan Kaimin
Assistant to the Director General of Health Bureau, Disease Control Section, Weihai Municipality Health Bureau, China
Dr. Kandasamy Manivasan
Joint Commissioner (Health) & Project Director, Health & District Family Welfare Bureau/Chennai Corporation AIDS Prevention and Control Society, Corporation of Chennai, India
Dr. Esty Martiana Rachmie
Head, Coordinating Board of Municipal Family Planning, Surabaya City, Indonesia
Mr. Mohamad Zainudin Idris
Director, Health and Cleanliness Control Department, Kuantan Municipal Council, Malaysia
Dr. Aslam Pervaiz
Deputy Director, Solid Waste Management, Thesil Municipal Administration, Faisalabad, Pakistan
Dr. Nilda Ticar Montoya
Rural Health Physician, Social Hygiene Clinic, City Heath Department, Olongapo Medical Society, Olongapo City, Philippines
Ms. Wallapa Prangthawat
Public Health Technical Officer, Technical Supporting Section, Khon Kaen Provincial Health Office, Thailand
Dr. Kim Anh Thi Doan Vo
Vice Director, Department of Health, Danang People's Committee, Vietnam
Ms. Hong Thi Bui
Program Assistant, UNFPA Vietnam (Dr. Kim's interpreter)
Dr. Chika Shirai
Manager, Public Health and Welfare Department, Hyogo Ward, Kobe City Government, Japan

4. AUICK
Dr. Haryono Suyono
Member of AUICK International Advisory Committee / Former Coordinating Minister for Social Welfare and Poverty Alleviation
Dr. Hirofumi Ando
President of AUICK
Mr. Yoshikane Fujimoto
Executive Director of AUICK
Mr. Nobuyuki Morimoto
Deputy Executive Director of AUICK