The 4th Global Forum on Children Affected by HIV and AIDS, taking place in Dublin, has called for a package of social welfare services to tackle child poverty and assist households in developing countries affected by HIV and AIDS.

The forum, attended by 200 delegates from 42 countries, is co-hosted by Irish Aid, the Government’s overseas aid programme, and UNICEF.

The Forum will attempt to secure commitments for children affected by HIV and AIDS to realise their right to health, education and welfare. The provision of social services is key to ensuring that children living in households affected by HIV and AIDS are not forced to drop out of school to care for sick relatives or to engage in paid work when a breadwinner falls ill.

Cash transfers and other social welfare instruments may alleviate poverty, improve school attendance and nutritional intake, the Forum heard.  Delivering the key note speech, the Prime Minister of Ireland, Brian Cowen TD, re-affirmed the Government’s commitment to the world’s poorest children and said: “All the evidence points to broad social protection and welfare approaches as a means of mitigating the impact of HIV on children. Our own history of social policy and protection, with the introduction of pensions and allowances, demonstrates the importance of these instruments in responding to household and child poverty.”

The Executive Director of UNICEF, Ann M. Veneman joined the Taoiseach at the Forum.  Speaking about UNICEF’s work with children affected by HIV and AIDS, Veneman said: "For too long children have been the missing face of the aids pandemic. This conference, generously co-hosted by the Irish government, provides an important opportunity to discuss approaches for dealing with children impacted by HIV and AIDS.”

Singer and HIV/AIDS Campaigner Annie Lennox will also address the Forum. 

Additional Notes:
This is the fourth meeting of the Global Partners’ Forum, established to provide momentum in fulfilling global commitments for children affected by HIV and AIDS as enshrined in the Millennium Development Goals and the 2001 United Nations Declaration of Commitment on HIV and AIDS. The forum brings together leaders in Government, civil society and the United Nations to review progress, set priorities, and make commitments for children affected by HIV and AIDS. 

Ireland has made a high-level political commitment to the global HIV/AIDS pandemic. With over €100 million being spent annually on HIV and other communicable diseases, the Government is investing in programmes that are benefiting those most in need, with a particular emphasis on supporting children. Resources are channelled through a range of organisations working at global, regional, country and community levels.

About UNICEF:
UNICEF works on the ground in more than 150 developing and transitional countries to help children survive and thrive. The world’s largest provider of vaccines for poor countries, UNICEF works to advance the Millennium Development Goals by supporting child health and nutrition, quality basic education for all boys and girls, access to clean water and sanitation, and the protection of children from violence, exploitation and AIDS.

UNICEF 

If you live along the main highway linking Abidjan, Côte d'Ivoire's economic hub, with Lagos in Nigeria, it is almost impossible to ignore the many AIDS awareness messages along the route, travelled by 47 million people each year.

"A few years ago I would never have believed it was so easy to get tested [for HIV], since it's so difficult to talk about AIDS in our communities," said Madeleine Abboh, a hairdresser in Hillacondji, a town in Benin near the border with Togo.

Abboh was attending the 'Caravane pour la vie' (caravan for life), an annual travelling HIV/AIDS awareness campaign organised for the third successive year by the Abidjan-Lagos Corridor Project in the five countries - Côte d'Ivoire, Ghana, Togo, Benin and Nigeria - that the road goes through. She took advantage of the event to be tested for HIV, as 79,000 other people between 2005 and 2007 have also done.

This regional project, launched in 2003 by the World Bank and funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2007, has focused on often neglected border areas between countries and groups of people who depend on the 825km road and are particularly vulnerable to HIV: truck drivers, sex workers, security forces, traders and communities.

Around 800,000 people have been reached by the awareness campaign since the project began. According to an audit report at the end of 2007, more than 18 million condoms had been distributed.

Radio – a preferred form of media

All available means of communication were used to reach target groups: more than 5,900 radio and 50 television commercial spots were produced and broadcast on the project's partner stations, as well as programmes aimed at vulnerable groups.

"The programmes scared people," said Jean Discipline Adjomassokou, mass media officer of the Corridor Project. "In Hillacondji, sex workers abandoned their trade as they no longer had any clients, and brothel owners were forced to close down."

Partner radio stations were encouraged to broadcast programmes as often as possible, so that the "target groups could have the opportunity to listen to them at any time of the day, depending on their jobs," Adjomassokou added.

Sometimes the results were immediate. A young motorist, who asked not to be named, said he was parked near the border between Benin and Nigeria one day, in the middle of having casual sex, when a radio programme started on which the presenters and guests were emphasising the importance of wearing a condom when having risky sex.

"I was ashamed and I couldn't carry on with the act, [I] lost my erection," he told IRIN/PlusNews. "A few days later I started having problems with my penis. When I went to the hospital, the doctor [told] me that it was gonorrhoea [a sexually transmitted infection].

"I knew I had been lucky, and that I could have caught HIV if my casual partner had had the virus. Since then I no longer have unprotected sex with casual partners," he said.
The Corridor Project originally covered eight areas, but now operates in 22 and has expanded its work to non-border areas. "Lots of people criticised us a few years ago because we limited our work to border regions," said Harvey de Hardt-Kaffils, the project's information, education and communications officer.

"They asked us to expand our range, which we've done, but it still isn't enough; we need to do more."

PlusNews 

Africans comprise up to 70 percent of all new heterosexual HIV cases in the United Kingdom each year, but they struggle to access prevention information and services, advocacy groups have said.

A 2007 report by the UK parliamentary office for science and technology found that of all ethnic groups, black Africans represented the largest number of new HIV diagnoses. "Almost 25,000 people born in sub-Saharan Africa were estimated to be living with HIV in the UK in 2006, a proportion 50 times that of whites," it noted.

Despite such figures, knowledge about how to prevent HIV remains low among this group, according to a recently released assessment of the HIV prevention needs of African people in England by research group, Sigma.

"Sixteen percent [of people surveyed] did not know it is possible to have HIV without knowing it, and a similar proportion did not know that someone with HIV is not obviously positive simply by looking at them."

The study, which surveyed more than 4,100 African men and women, found that 48 percent of Africans living in England had never been tested for HIV, yet more than one in 10 of the respondents wanted to test for HIV but did not know where to go, highlighting the need for more information about the availability of testing services.

Male respondents were more likely to have had more than one sexual partner in the last year than women, and one in eight men reported having had five or more partners in the last year. Bisexual and homosexual men had higher numbers of partners than exclusively heterosexual men, while bisexual men were least likely to know all the facts about AIDS.

Condom use among the respondents was inconsistent, with 25 percent of people who reported having had sex in the past year saying they had not used a condom, and fewer women than men reporting condom use. One in 10 respondents said they had definitely or probably had sex without a condom with someone who had a different HIV status to themselves in the last year.

An estimated 30 percent of those who did use condoms reported that it had broken or come off during intercourse, highlighting a need for more education on condom use. A quarter of respondents were unaware that condoms were freely available from clinics and other service providers.

The report recommended that "interventions to increase condom use should address confidence in negotiating their use, and should aim to increase the social acceptability of carrying and using them."

The researchers noted that access to health services was particularly difficult for illegal immigrants, who were often too afraid of being arrested and deported to seek medical help; many had fled conflicts in which they might have been subjected to sexual violence, or forced into sex work that could have made them vulnerable to HIV infection.

The African HIV Policy Network (AHPN), a UK-based coalition of NGOs that collaborated with Sigma in the research, has estimated that twice as many African women as men are diagnosed with HIV in the UK annually, mirroring the epidemic on the African continent, where HIV infections among women outstrip infections among men.

AHPN's recommendations for reducing the number of new HIV cases among Africans living in England included directing more public funding to prevention programmes targeted at this group, providing better sex education in schools with large numbers of African students, and making prevention interventions accessible and appropriate for African audiences.

IRIN

Bellissima, on bustling Gabon Street in the Ethiopian capital, Addis Ababa, could be just another upmarket café, except that each order comes with a packet of 'Sensation' condoms, and is served in 'Sensation' cups by staff wearing 'Sensation' T-shirts.

"I wanted to link business with a message for sexually active people," Bellissima's owner, Hayat Ahmed, 26, told IRIN/PlusNews. "I am the brand ambassador for 'Sensation' condoms in Ethiopia, and I want to spread the message that condoms can protect you from HIV/AIDS."

Hayat, a former beauty queen, has been involved in HIV/AIDS campaigns since she was crowned Miss Ethiopia in 2003 and subsequently named an HIV/AIDS ambassador.

Her face adorns billboards and she regularly appears on Ethiopia's only television station promoting condom use. "When I walk down the road even children recognise me," she said. "But they do not call me Hayat; they call me 'Sensation'."

Modelled on 'condom bars' in Asia, Bellissima handed out six boxes of condoms, each containing 48 packets of three-in-a-pack, within two days of opening its doors.

The free condoms have elicited mixed reactions, with older patrons tending not to like the idea, while younger ones love it and sometimes ask for a second packet.

"We have had young people come in and ask 'Is it true that you actually give free condoms?' and when we say, 'yes', their faces brighten up and they quickly order," said one waiter. "But we have also had people who get shocked when we bring the bill with a condom, some saying we are promoting immorality."

Guests do not have to take the packs home when they leave the restaurant. "It is your choice to take it or leave it," Hayat said. "We also plan to set up condom vending machines in the toilets."

Her campaign is supported by social marketing groups such as the non-profit organisation, DKT-Ethiopia, which sold almost 60 million condoms in 2007 and also launched a coffee-flavoured version of Sensation condoms. Ethiopia is widely thought to be the birthplace of coffee and it is very popular.

Hayat intends to open more cafés in the capital and other towns, and continue promoting various anti-HIV strategies, including abstinence and faithfulness. She might even expand the 'condom bars' concept to other African countries.
"A lot of people in Ethiopia are ashamed of talking about or using condoms," said. "Yet some companies put condoms in their toilets and when you go to look, each day, the boxes are empty. I don't care if the condoms are used behind closed doors or in public – as long as many people use them."

Ethiopia's HIV prevalence is estimated at over two percent among sexually active people aged 15 to 49. A report by the Federal HIV/AIDS Prevention and Control Office in March noted that between 2000 and 2005, condom use among males increased from 30.3 percent to 51.9 percent, and among females from 13.4 percent to 23.6 percent.

According to Ethiopian government data, half the public sector institutions and 20 percent of private businesses have mainstreamed HIV/AIDS prevention in their operational policies.

However, Philopos Petros, head of the Ethiopian Civil Service College's HIV/AIDS management unit, noted that "There are still educated people exposed to HIV and dying of AIDS," and said greater awareness was necessary.

"One person cannot change the world, but I want to make a contribution," Hayat said. "I have a name and the will, and I will use that."

PlusNews

While researchers and advocates at the International AIDS Conference this week urged donors and governments to rapidly scale up male circumcision programmes, others raised concerns about what this would mean for women.

In March 2007, the World Health Organisation and UNAIDS issued recommendations that gave the green light to male circumcision as an HIV prevention strategy, after studies in Kisumu, Kenya and the township of Orange Farm in South Africa showed that it could reduce the risk of infection by up to 60 percent.

But the recommendations also stressed that not enough is known about whether male circumcision reduces sexual transmission of HIV from men to women, making the intervention "highly problematic" according to Marge Berer, editor of the London-based journal Reproductive Health Matters. "From a public health perspective, we are told that 60 percent protection [for circumcised men] is far better than nothing. But is male circumcision good enough for women?" she wondered.

A study of almost 3,000 men between the ages of 18 and 24 in Kenya, compared sexual function between circumcised and uncircumcised men, assessing sexual satisfaction over a two-year period. The researchers found that the circumcised group had no higher rates of sexual dysfunction than the uncircumcised men.

According to John Krieger of the University of Washington, Seattle the men that had been circumcised reported more sexual pleasure post-circumcision, and that they found condoms easier to use.
In addition, new results from a male circumcision initiative implemented by Population Services International in Zambia suggest that cultural resistance may not pose as serious a barrier as previously thought, and that it is possible to do the procedures safely and effectively in poor settings, using nurses and clinical officers.

Delegates heard that circumcision also lowers the risk of men getting the human papilloma virus (HPV) that causes genital warts, and trichomoniasis, another common sexually transmitted disease.

What about women?

"All I'm hearing [at the conference] is about what it will do for men, the sexual satisfaction of men...but what about the women? What is their involvement?" commented Siphiwe Hlope, a founder of Swazis for Positive Living (SWAPOL), an AIDS support organisation.

Nicolai Lohse a research officer at UNAIDS said mathematical modelling showed women would benefit from male circumcision as long as it did not result in condom use dropping by more than two-thirds. Women's risk of acquiring HIV would also be reduced if circumcision programmes led to fewer HIV-positive men in the population. The risk to women of HIV acquisition would decline by 2 percent if only 5 percent of men were circumcised, and by 20 percent if half the men in a population were circumcised.

While Berer told delegates on Thursday that the potential benefits of male circumcision were "too large a gamble" for women, many countries in Southern Africa are already in the process of developing national policies on the procedure.
"We have to support these programmes, I don't think we have a choice. But one would really argue that these programmes have a responsibility to women," Berer told IRIN/PlusNews.

She called for campaigns expanding male circumcision to involve couples and not to focus solely on men. Women health advocates also had a role to play in drafting national policies. "No one is going to pull out the red carpet for women's involvement in male circumcision ...it is up to women to stop being victims," Berer added.

PlusNews 

Experience has shown that it is possible to run successful paediatric HIV programmes in rural African settings, yet less than 10 percent of patients on life-prolonging antiretroviral (ARV) drugs are children, field officers of the international medical NGO, Médecins Sans Frontieres (MSF), have said.

"Studies show that without treatment, 50 percent of children with HIV will die within the first two years of their lives," Fernando Parreno, who has worked for MSF's ARV programme in Bulawayo, Zimbabwe's second city, said at the recent International AIDS Conference in Mexico City. "It is imperative that all children are diagnosed and started on treatment as early as possible after diagnosis, or too many children will continue to die."

Children in rural Africa are rarely taken to hospital for HIV testing and accurate testing facilities for children are few and far between, so they are often diagnosed too late to benefit from treatment programmes.

MSF has more than 10,000 paediatric patients in more than 50 projects in poor countries around the world. An analysis of all child patients under five who started taking ARVs in 2002 found that by January 2008, 79 percent were still on treatment.

"In Rwanda, where MSF has over 300 children on ARVs, we decided to increase testing by proposing to all patients that they bring their children in for testing," said Johan Van Griensven, of MSF's programme in Rwanda. "We faced reluctance from the nurses, who were uncomfortable disclosing the HIV status of children, and from parents, who feared a positive result and its implications."

Van Griensven said after training the nurses were better able to disclose a child's status to them in a sensitive and informative way. Parents whose children test positive are actively encouraged to disclose their children's status to them.

"We have developed child-adapted tools to talk to children about HIV in ways they can understand," he added. "But as kids get older their perceptions change, so it is important to keep supporting them as they grow into adolescence; support groups have been very helpful in enabling children to talk openly about their experiences."

Helen Huerga, who is with MSF Kenya, said it was crucial for the family to be involved in the child's treatment, so programmes encouraged parents to attend children's clinic days; she also noted that community support was crucial to follow-up.

Need for suitable ARVs

However, support at the community and health centre level was not being matched with the same commitment by large drug manufactures, according to Karen Day, a pharmacist from MSF's Campaign for Access to Essential Medicines.

"Although there are 13 ARV formulations specifically developed for children, they are not adapted for use in resource-poor settings. Most of them are liquid, and come as three, often unpalatable, separate drugs that are difficult for children to take; others are in powder form and need to be reconstituted. In many cases there may not be an adequate supply of clean water to do this," she said.

"What we need from the drug companies are small, scored – and therefore easy to halve – tablets that are chewable and stable at high temperature and high humidity," Day suggested. "They must also develop fixed-dose ARVs for children; so far, only one fixed-dose exists, and none for second-line treatment."

She said there was a need to reach children earlier with treatment in order to improve their chances of survival. New guidelines by the UN World Health Organisation recommend that children under 12 months be diagnosed as early as six weeks and be started on treatment immediately, regardless of CD-4 count (which measures the strength of the immune system) or clinical signs.

PlusNews 

Petrol tankers parked nose-to-tail line the five-kilometre stretch of road from the southern Nigerian town of Eleme to its refinery, waiting to fuel up and begin their long journey home.

If the trip runs smoothly, a tanker leaving the big cities of the north at dawn should arrive at Eleme, in the troubled oil-rich delta region, by early evening. The following day the fuel company's representative fights to get a "ticket" for the driver, authorising the consignment. With the allotted load on board, the gear-grinding exhaust-belching trucks nudge their way out of the depot and into the traffic.

But because things do not usually go to plan, there is a thriving roadside service industry taking care of stalled truckers, refinery workers, fuel dealers and anybody else looking for accommodation, banks, butchers, bars, mechanics, places of worship, restaurants, laundry services, film halls, cell phone kiosks – and sex.

More than 100 women from all over Nigeria work out of the tiny wooden shacks at the heart of the community. They pay N300 (US$2) a day for their rooms - not much bigger than the space taken by a single mattress, without electricity or running water - and charge a minimum of N300 for sex.

Eleme, on the southern rim of Rivers State, one of the four core delta states, is one of the largest of a string of eight truck stops along the 800km route into the north where commercial sex is available.

Rivers has an HIV prevalence rate of 5.4 percent, above the national average of 4.4 percent, but not the worst result in the country; that position is held by the state of Benue, in central Nigeria, with an infection rate of 10 percent.

Rivers, however, is at the centre of delta militancy, in which armed young men have proved themselves willing and able to take on the armed forces of the federal government to press their demands for a fairer sharing of Nigeria's wealth, almost exclusively derived from the oil and gas of the region.

AIDS and insecurity

Dr C. Okeh, head of the State Action Committee on HIV/AIDS in Rivers, worries that the unrest will have an impact on the fight against the virus. At the very least, "a crisis situation means that you don't have time to listen to [AIDS] messages – you're thinking of your immediate survival," he told IRIN/PlusNews.

Queen Henry is the peer educator for the sex workers in Eleme, part of a community-based organisation supported by the Society for Family Health, Nigeria's largest AIDS service provider. For her, the most pressing concern is the insecurity in the area.

Soldiers based at the nearby river jetty, where cargo ships take on fuel pumped from the refinery through a bundle of pipes, each the width of a man's waist, have decreed an unofficial 9 p.m. curfew on the sex trade. Enforcing it has meant regular raids on the shacks, kicking out customers and beating women not inside their rooms.

But the AIDS message is sinking in, condoms are cheap and available, and the sex workers are organised. Henry has no doubt that all the women she reaches know in theory the importance of protection. "But the problem is you're not in the room with the girls when they are alone with a customer," she explained. "If eager for money, you do it [without a condom]; if you want to protect your life, you don't," was her matter-of-fact assessment.
That triggered a mini-debate among the women gathered outside her small kiosk, where she sells tonics and douches. "Two thousand naira [roughly US$17, what some women charge for sex without a condom] cannot cure the sickness inside my body [as a result of HIV]. I have seen money [had a lot of it]; I'm too young to die. It's not because of [greed that] I'll go and mess up my life," said Patience Orkah, wearing black hot-pants and a lot of make-up.

All the women agreed, except Charity Ekiti. "All I know is I [get the] money, I f***," she chipped in. "If I [don't die as a result of AIDS], I still go die. I only know God [won't] let that happen." Loud and outrageous, it was hard to tell if she was serious. But what she made clear was that she did not bother using condoms with her boyfriend: "It's not sweet like that."

Why condoms are still an issue is because of men like Umoru, 36, who has a wife in the north but works from Eleme as a tanker driver hauling fuel to the southern cities. He visits his wife every three months or so, and in the interim – "just two or three times" - calls on sex workers and offers double the normal rate not to use a rubber. "They tell me [to wear one] but I no fit do am [I can't do it] with condom."

He said some of the women would refuse bareback sex, "even if you give them one million naira". But he knows some who are less fastidious, and they are his regular partners. "I fear [but everything that happens] is through God" was how he rationalised the risk.

Chinenye Imoh sits at a table under an umbrella all day, handing out information pamphlets to truckers for the Arewa Society Against HIV/AIDS, a community-based organisation. She has heard all the excuses before, especially by drivers from the more conservative Muslim north, where discussion about sex is less open, literacy is low, and girls often quit school and marry early.

"Some say people [in the past also became] emaciated and died. Others say, 'no sickness wey no get medicine' [every ailment has a cure] ... but we're trying," was her upbeat message.

PlusNews 

The risk of an HIV-positive mother infecting her child through breastfeeding can be significantly reduced by antiretroviral treatment (ART), say health officials in Kenya.

"HIV-positive mothers on ART lower the risk of transmission through breastfeeding from 20 [percent] to five percent," said Linda Beyer, an official in charge of Nutrition and HIV/AIDS at the UN Children's Fund (UNICEF).

In developing countries the nutritional and other health benefits of breastfeeding over formula feeding have generally been thought to outweigh the risks of HIV infection. Recent clinical trials have found that putting nursing HIV-positive mothers on ART can suppress viral load and minimise the chances of transmission.

"Breastfeeding for the first six months of a child's life reduces up to 13 percent of under-five deaths," Beyer said at the start of World Breastfeeding Week on 1 August.

According to the World Health Organisation, every year 10 million children younger than five die worldwide, often as a result of malnutrition.

Beyer said that promoting breastfeeding was vital to achieving the Millennium Development Goal of a two-thirds reduction in childhood mortality rates by 2015.

Terry Wefwafwa, an official in Kenya's ministry of health, said her department was already providing ART to breastfeeding HIV-positive mothers through its prevention of mother-to-child transmission [PMTCT] programme. "They are available at all health facilities for the women at no cost," she told IRIN/PlusNews.

HIV-positive mothers should stop breastfeeding their babies after six months and introduce other foods, Wefwafwa said. She also warned that there was a risk of infection if other foods and liquids were mixed with breast milk before the baby was six months old.

The world breast week campaign will be used as a platform to sensitise the public to the importance of breastfeeding.

PlusNews

Steadily increasing prices could lead to a lack of affordable and nourishing food, endangering the lives of people living with HIV in the developing world, experts have said.

"As prices continue to rise, people will start to buy cheaper, less nutritious food and may begin to skip meals – in Lesotho we are already seeing people skipping meals because they can't afford food," Alan Whiteside, an economist with South Africa's University of KwaZulu-Natal, told a press conference at the International AIDS Conference in Mexico on Thursday.

"For people living with HIV, who require more nutrition than healthy people, this will have terrible consequences."

Rising oil prices, the impact of climate change and the loss of agricultural land to biofuel production have all contributed to the current crisis affecting people in the developing world, most of whom rely on agriculture for their livelihood.

"The effects of climate change have made food production less secure, droughts longer, and when the rains come they are heavier and damage crops," Whiteside explained.

He noted that HIV-positive people on antiretroviral (ARV) medication, who skipped doses because they did not have food to take with their medication, risked developing drug resistance, which could lead to treatment failure.
A likely increase in mobility as people leave their homes to search for food and an income also had the potential to disrupt treatment, said Martin Bloem, head of HIV/AIDS and nutrition at the United Nations World Food Programme (WFP). Increased mobility has been associated with increased HIV risk, as men and women leave their marital home for long periods.

Food shortages may also lead to women and girls resorting to transactional sex, another factor that increases the risk of HIV infection.

A way out of poverty

Robin Jackson, a UNAIDS special advisor on food and nutrition, said providing daily food packages containing corn soy blend, maize-meal, beans and sugar was relatively inexpensive: about US$0.70 for an adult and $0.31 for a child.

But a combination of high food prices and funding shortfalls meant the WFP had been forced to reduce the number of people it was supporting around the world at a time when the need was increasing. "In the past, only the poorest 10 percent of the population has generally needed assistance, but that figure is rising along with food prices," Bloem said.

Several speakers noted that donors had not done enough to incorporate food support into their HIV programmes. "Putting people on treatment without ensuring that they have enough to eat is like sending your kids to school without any books," said Jackson. "With high food prices here to stay for the foreseeable future, it is critical to supplement HIV and TB programmes with a nutritional component."

Besides food aid, speakers also called for more programmes to provide livelihood support for agricultural production in the form of direct cash transfers or micro-financing.
"In some cases, such as school feeding and feeding people on ARVs, provision of food packages is the ideal solution," Whiteside said. "But where local markets are able to provide a nutritious diet, cash transfers may be the best way forward."

Supporting families engaged in agriculture has the dual benefit of increasing food production and raising nutrition and income levels.

A cash transfer scheme for poor families in Mexico, started by the International Food Policy Research Institute, has brought a 15 percent increase in the number of girls attending secondary school and a 12 percent drop in illnesses among children under five.

PlusNews  

In an attempt to stem the spread of the virus, African countries are increasingly passing legislation that criminalises HIV exposure and transmission. But these laws could do more harm than good, delegates attending the International AIDS Conference in Mexico, heard on Wednesday.

"Africa has burst into this whole frenetic spasm of criminalising HIV," said South African Justice, Edwin Cameron.

Laws that make HIV transmission an offence are nothing new in the developed world. In Switzerland, a man was sent to jail this year for infecting his girlfriend with HIV, even though he was unaware of his HIV status and a Texas court recently sentenced a man living with HIV to 35 years in prison for spitting on a police officer, although the chances the officer was exposed to the virus were virtually zero.

Now African governments - particularly in West Africa - are jumping on the bandwagon.

Four years ago, participants from 18 countries met at a regional workshop in N'djamena, Chad, to adopt a model law on HIV/AIDS for West and Central Africa. But the law that they came up with was far from "model", in fact Cameron described some of its provisions as "frankly terrifying".

According to Richard Pearshouse, director of research and policy at the Canadian HIV/AIDS Legal Network, the model law's broad definition of wilful transmission could be used to prosecute HIV-positive women for transmitting the virus to their babies during pregnancy.

The law also makes provision for compulsory HIV testing for accused rapists and for the settling of marital disputes; empowers healthcare workers to disclose a patient's HIV status to their spouse or sexual partner; and requires people with HIV to tell their partners as soon as possible or within six weeks of learning their diagnosis.

Worryingly, at least seven countries in West and Central Africa have already used the model as the basis for their national HIV legislation, while at least six others are in the process of developing similar laws.

Some countries have chosen to adopt the "model" law word for word, while others have attempted to simplify it, making the legislation "profoundly human rights unfriendly and human rights regressive", according to Pearshouse.

Southern Africa, where the burden of HIV is the highest, has a mix of effective and ineffective HIV laws, but very few countries have so far introduced legislation that criminalises HIV transmission.

However, Michaela Clayton, executive director of the AIDS and Rights Alliance of Southern Africa, told delegates that in Malawi, a bill with very broad provisions for criminalising transmission, including from mother-to-child, is currently being debated. If found guilty under the proposed law, an HIV-positive person could face imprisonment of up to 14 years. Mozambique is considering passing similar legislation.

"Bad laws can spread the virus"

Speakers agreed that the intentional and malevolent infection of another person is a criminal offence, but warned about the difficulty of drawing a line between criminal and non-criminal transmission.

Julian Hows, from the Global Network of People living with HIV/AIDS, urged delegates to consider the effect of criminalisation laws on HIV-positive people. He said they created "fear and confusion" and made people living with the virus feel like criminals.

"Criminal law is simply the wrong framework for dealing with HIV transmission," Cameron commented. "Everywhere it has been tried, it has been counterproductive and applied unjustly."

Instead of preventing HIV, criminalisation fuels stigma and discourages people from getting tested, disclosing their status to partners or accessing treatment.

Criminalisation is often positioned as a way of protecting women, but Clayton pointed out that because women test for HIV in greater numbers than men, it is women who were more likely to be arrested and prosecuted. She also warned that the laws would create mistrust between people living with HIV and health care providers.

"Just like faulty condoms or unsafe medical supplies, bad laws can spread the virus," Cameron said.

PlusNews