Meeting Report
Copenhagen, Denmark13 December 2004
MEETING REPORT
(F/W scheduled 13-14 June 2005, Turku, Finland)
BACKGROUND
A poll, held amongst health care professional association leaders at a conference of the World Health Professionals Alliance (WHPA) in May 2004, revealed that HIV/AIDS was not perceived as a highest priority area for action by health professionals. The World Health Report issued that same week identified HIV/AIDS as the number one global health priority. Concern regarding this discordance led to a 'wake-up call' from WHPA to all health professionals.
WHPA Press Release
Health Professionals Issue a Wake-up Call on AIDS
Geneva, Switzerland, 16 May 2004 - An urgent plea to all national governments and health professionals to stop procrastinating on the HIV/AIDS pandemic has been issued by the world's nursing, pharmacy and medical leaders.
Representatives of the three health professions, attending the historic first conference of the World Health Professions Alliance in Geneva today, unanimously passed a resolution urging governments to recognise the scale of the tragedy facing the world and to immediately commit the necessary funds to fight the pandemic ...
This scoping meeting was a direct result of this call. Based upon the outcomes of a focus group looking at ways of developing health competency in patients1, also held in Geneva, May 2004, the WHPA has been working with the World Health Communication Associates (WHCA) in exploring campaign concepts which could help facilitate health system information and communication capacity development. The HIV/AIDS Ask? & Act! - It's your health! campaign links these two streams. WHPA executives agreed to test the campaign concept on HIV/AIDS, with the aim of stimulating a broader demand for HIV/AIDS prevention and treatment information and strengthening the capacity of local health information mediators, eg health professionals, media, policy spokespeople, NGO advocates, and private sector advertisers, to respond effectively.
This scoping workshop was therefore convened to:
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Review current HIV/AIDS information activities of participating networks;
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Identify the strengths and weaknesses of current HIV/AIDS information initiatives in Central and Eastern Europe;
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Explore opportunities for and obstacles to cooperative campaigning; and
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Identify ways to strengthen each other's work and explore ways to link the proposed campaign entitled HIV/AIDS Ask? & Act! - It's your health! with ongoing initiatives and funding.
Participants represented a broad range of scientific, media, patient2, medical, nursing and pharmacist associations, funding, nongovernmental and intergovernmental agencies. Healthy City3 representatives from the Baltic Centre (Turku, Finland), Russia, Ukraine, Estonia and Latvia were present. The meeting was organized by WHCA with support from Johnson & Johnson and the World Health Organization Regional Office for Europe.
THE GROUND RULES
The group adopted Chatham House rules, a UK convention, which basically state that everything discussed can be made public but nothing can be attributed without permission. Secondly, the meeting acknowledged that the agenda was 'filled to bursting' (FTB) and that some discussions would need to be cut short, which could prove frustrating. Order would come from this chaos as discussions are to inform a longer process which would continue 'virtually', after this first meeting, with internet-based communications and support to local city-based HIV/AIDS communication projects. Thirdly, it was agreed to move quickly to solution discussions and not just concentrate on describing the problems. Finally, acknowledging the need for continuous connectivity in communications, mobile phones were put to silent but not turned off.
MORNING SESSION (09.30-12.45)
Introductions - Concerns/Interests
Participants introduced themselves in turn, stating their interest, concerns and hoped-for outcomes of the meeting. From this 'Tour de Table' it became apparent that participants:
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saw this as both an urgent and unique time for HIV/AIDS communication action, given the rapidly growing epidemic, new treatment possibilities, unprecedented international resources and continuing poor and inequitable uptake of prevention and treatments in Central & Eastern Europe;
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were interested in strengthening their capacities to make the case for HIV/AIDS investment (eg to municipal leaders, professional associations, Nordic Council, etc);
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were willing and interested in looking at the 'opportunities' for health system and civil society development that the epidemic posed and obstacles to progress;
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were willing to share their experiences and knowledge of how to work with different target groups in different information marketplaces;
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were keen to create partnerships and cooperation;
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were concerned about professional and political attitudes, stigmatization, discrimination, legal barriers, public perceptions, underdeveloped advocacy capacity, poor communication and duplication of efforts between groups working on different infectious threats (eg TB and HIV), and roles of various information mediators;
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were concerned about the effectiveness, particularly as it relates to communication, of current funding initiatives;
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were keen to learn more about the specific situation in different high risk areas of Central & Eastern Europe; and
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emphasised the need for concrete measures and practical steps.
Presentations/Discussions
During the morning session, 'perspective' presentations were given. All presentations were followed by discussions in which participants were asked to come forward with solutions and examples of good practice rather than just focusing on the problems and challenges. Comments are summarized here under the following topic headings:
1. HIV/AIDS in Eastern Europe Update
2. Barriers to treatment uptake
3. Addressing barriers to care
4. Sustaining Action
1. HIV/AIDS in Eastern Europe Update4
An overview of the epidemic in Europe, with a specific focus on the estimated prevalence in the Baltic States and Central and Eastern Europe, was presented. Emphasized was the fact that HIV/AIDS is no longer occurring in the EU's backyard, but in the EU's front yard!
The situation in Western and Central Europe can be summarised as follows:
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Transmission is mainly sexual
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25-75% of all cases are among men having sex with men
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Up to 75% of all heterosexual cases are among immigrants from high-prevalence countries
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Women are >50% of all heterosexual cases
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Vulnerable Groups: men having sex with men & immigrants, especially immigrant women
The situation in Eastern Europe on the other hand shows a different picture:
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Transmission is mainly IDU related
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75-85% of all cases are males
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Up to 30% of infected females are IDU and 50% are partners of IDU
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30-70% of all HIV infections are among younger than 25 years
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Vulnerable Groups: IDU, migrants, ethnic minorities, sex workers
Access to treatment also seems to be a tale of two worlds: there are enormous differences in the access to HAART (Highly active anti-retroviral treatment) - with high access in Western Europe against (very) low access in Central and Eastern Europe.
European Aids Treatment Group (EATG) – Case study : Estonia5
* 4,312 HIV cases (population 1.4m). Estimated 1.1% of the population is HIV positive.
* 1/3 deaths last year were caused by AIDS.
* Access to HIV care: only if patient is drug free (80% of HIV+ are drug users). Exclusion is extended to users in methadone maintenance.
* Treatment is not free, so most cannot afford it.
* All treatment is financed by the Global Fund. When the contract is finished it is not sure that the government will continue financing.
* Estimated 5,000 in need of health care but no services, hospital beds, or money.
* ARV therapy: less than 100 people. Provided by the government.
* There are 4,300 positive persons, but only three physicians dealing with HIV, in two HIV centres.
* Cost of therapy per person per year: 3,300 euro.
* HIV testing is not anonymous.
2. Communication/Information Obstacles to Initiatives
2.1 Frames
In many cases, in spite of the availability of and resources for treatment, it is not taken up due to prejudice, misinformation, unwillingness to take up treatment, stigma and discrimination. In other words, access is not only a matter of resources or money but also a matter of how it is perceived and 'framed'6 by providers and patients and people in general. How HIV/AIDS and HIV/AIDS patients are perceived will need to be changed if treatment uptake is to be successful. There is a need to move away from frames which deny care to IDU based on "if you play, you pay" or "if that's your choice, well good luck" or "choose drugs and die" frames to ones which will engage relevant players more positively and effectively - such as the right to treatment, the need for harm reduction, the relationship to social and economic development, the opportunity to transform health systems and the need to protect the general population. Ways need to be found to make services more patient-friendly and appropriate.
2.2 Stigma and Discrimination
One of the main barriers to treatment uptake is stigma and discrimination. People in need of testing and treatment may not come forward because of the stigma attached to HIV/AIDS. In many people's minds, getting infected with HIV/AIDS is the result of either 'stupidity' (drug use, unsafe sex) or socially unacceptable behaviour (promiscuity, men having sex with men, prostitution). This is a major barrier which also stands in the way of effective NGO work. In addition, it needs to be kept in mind that for some behaviours (such as drug use) there is a risk of legal prosecution, which makes it difficult for people to come forward.
2.3 Lack of Information (confidentiality issues)
Many people with HIV/AIDS are misinformed or not informed at all about testing and treatment, for instance in relation to confidentiality aspects. A fear of being exposed might well stand in the way of people coming forward. Also, there might be worries about the testing process, cost and availability, or simply not having the information on where to go.
2.4 Skills and Attitude of Health Professionals
Stigma not only affects people with HIV/AIDS, but is relevant to health professionals as well. The closer health professionals work with people with HIV/AIDS, the more stigma seems to exist. Toolkits for working with HIV/AIDS exist for nurses, but these have been designed without the input of patients. This needs to be changed. (Continuing) education for health professionals in this domain is crucial, not least in the area of communication skills. This is often lacking, while communication in building relationships with patients is crucial in order to facilitate access to testing and treatment and the provision of other forms of support.
Unethical behaviour of health professionals was also cited in relation to violating confidentiality and unequal standards of human rights regarding free and anonymous counselling and testing, access to harm reducing interventions (sexual and IDU) and free and voluntary inclusion in clinical trials.
2.5 Infrastructure Weaknesses
Low healthcare budgets and poorly developed infrastructures result in difficulties with coverage and treatment due to geographical location of treatment centres and general poor management.
2.6 Single Disease/Sector Focus
Since HIV/AIDS is often compounded by other illnesses and should therefore be considered a multidisciplinary and multi-pathology disease, cooperation between the various disciplines is essential. However, there seems to be a dramatic lack of interconnection between different parts of the health services when multiple illnesses are occurring. Cooperation between the various parts of, and stakeholders in, the health (and policy) system remains difficult, and is often related to historical factors. This wasteful/duplicative approach to different diagnostic entities is reinforced by donor focus on single diseases.
2.7 Denial
It is clear that denial of the possibility of being infected plays a major role in accessing testing and treatment, even if a person possesses the appropriate information and is aware of the availability.
2.8 Open Society Issues
"Where AIDS decision making is not open the circle of those who are able to provide insights and information is reduced, leading to less informed policy. On the other hand, where political process allows for the participation of civil society, where media can speak out about HIV/AIDS issues, where individuals have rights to freedom of speech, freedom of association and freedom of movement protected by law, then positive policy environments for successful responses to HIV/AIDS can follow." (Stiglitz, J quoted in PANOS 2003) Concerns were raised about the lack of political commitment, independent media, continuing difficulties with NGO formation, competencies and sustainability.
2.9 Corruption
The level of resources has never been so high. Yet, not all money intended for combating HIV/AIDS and improving access to treatment actually ends up where it was originally intended to go. Corruption is a serious problem. Better monitoring on what funding gets spent on is clearly needed. Additionally, large price differentials between east and west are leading to supply chain problems of counterfeit drugs, thefts and substitutions.
3. Addressing Barriers to Treatment Uptake
3.1 Healthy City Settings7
The need for local policy environments that can openly address the problem of HIV/AIDS, provide leadership, accommodate civil society action, and be responsive and accountable to the communities most affected is a key recommendation of the PANOS (2003) report. Established Healthy City settings seem to fit this call well. Key principles of Healthy Cities include commitment to health for all, joint action between sectors, active community participation, innovation, healthy public policy and international solidarity. The overall goal is to implement four areas of action, ie:
* addressing the determinants of health and the principles of health for all
* integrating and promoting European and global public health priorities
* putting health on the social and political agendas of cities
* promoting good governance and partnership-based planning for health
The Baltic Region Healthy Cities Association was founded in Turku as a WHO Collaborating Centre in 1998 to co-ordinate and promote the goals of the Healthy Cities operations in the Baltic Sea Region. The centre is looking at ways it may provide "the structured setting where cultural and ideological contest or negotiation takes place" (PANOS, 2003). While HIV/AIDS is not now a Healthy City priority, the Centre is exploring plans to coordinate the Ask? & Act! campaign in high-risk Baltic Healthy Cities.
3.2 Networking Networks
The World Health Professions Alliance (and its constituent members FIP, ICN, and WMA) is looking at ways to facilitate its member national associations to assume more leadership roles in HIV/AIDS initiatives. Links between these networks and Healthy Cities, EATG, industry, media, IGOs and funders, etc, is the focus of this meeting.
3.3 Involving People Living with HIV/AIDS (PLWHA) at all Levels of Action and Decision-Making
Organisations representing people with HIV/AIDS need to become official partners in the discussion and have a seat at the (policy and health systems) table if effective change is to be brought about. People with HIV/AIDS acting as advocates and informers and representative NGOs taking visible action are needed to break down stigma, for instance as participants in ethics committees. Their presence (putting a face to the disease), experience and information might help clear many misconceptions and facilitate a more effective approach.
Also, it could be useful to look at organisations active in other disease areas fraught with stigma, such as mental health. Their experience and ideas in combating stigma and discrimination could be useful as models for combating the stigma related to HIV/AIDS.
Some specific initiatives raised at meeting addressing these issues include:
* EATG activities include: training (Warsaw - 1999, Budapest - 2000, St Petersburg - 2000, Moscow - 2001, Lubljana - 2002); information (COPE); advocacy and policy support building on EU "Vilnius" agreements; networking (ARTEU); support to local protest events; press coverage; and increasing awareness among health workers.
* A UK scheme8 where people with HIV/AIDS act as voluntary advocates between people with HIV/AIDS and treatment clinics. These clinics are obliged to consult the HIV/AIDS advocate and this consultation can influence decisions.
* Also, a 'speakers bureau' has been set up in the UK, which consists of volunteers (people with HIV/AIDS) who receive media training and training in public speaking. Their task is to support the education of the general public by means of structured presentations in schools and youth clubs, etc. This activity helps to put a face to HIV/AIDS, dispelling myths and contributing to de-stigmatisation of the disease and those infected.
3.4 Strengthening NGO-Civil Society Involvement
EATG activities are listed above.
The Global Fund is currently making active efforts to stimulate the involvement of NGOs in their funded projects by making this involvement mandatory in the application and implementation guidelines. In each country, funding applications are coordinated through the Country Coordinating Mechanism, which is designed to include broad representation from governments, NGOs, civil society, multilateral and bilateral agencies and the private sector.
In Estonia, for example, "the level of civil society involvement in implementation is high, with approximately 50% of overall budget allocated to NGOs. Five NGOs play a dominant role; all of them operational before the Global Fund contribution and are now scaling up their interventions." (Global Fund, 2004)
3.5 Professional Education
FIP/WHO training modules for health professionals9: These materials, described below, were thought to be easily adaptable for use by various professions. The FIP website also identifies "Stigma" training programme listed below.
FIP/WHO Training Modules in HIV/AIDS : http://www.fip.org/
Training materials were prepared through collaboration between FIP and WHO on the "Pharmacists as a Key for Prevention and as Providers of Pharmaceutical Care for People Living with HIV" project. These training materials target a variety of audiences with the aim to promote prevention, improve safe sexual behaviour, promote risk reduction, improve proper treatment and provide pharmaceutical care in the community.
Three modules have been prepared and are available here in draft form, including:
* a module that highlights the pharmacist's roles in preventing the transmission of HIV/AIDS PDF 1050KB;
* a module that addresses the roles of the pharmacist with regard to the safe and effective use of antiretroviral therapies, HIV opportunistic infection drugs and palliative care PDF 4700KB;
* a module that specifically focuses on the roles of the pharmacist in HIV/AIDS prevention among illicit IV drug users PDF 1350KB.
The materials produced are being reviewed and will be field tested and approved by the participating organisations before full dissemination and implementation worldwide. Your comments on these documents are appreciated and can be sent to hivaids@fip.org.
Reducing Stigma and Discrimination Related to HIV and AIDS: Training for Health Care Workers (Engender health)is a two-volume curriculum offering a unique training opportunity for health workers in countries hardest hit by the AIDS pandemic. The training course guides health workers through an investigation of the root causes of stigma and discrimination while helping them to understand their own attitudes about HIV, AIDS, and individuals affected by these conditions and how these attitudes might affect the care they offer. Click here to view or download the participant's handbook (PDF, 1,951 KB) or trainer's manual (PDF, 840 KB).
3.6 EU Initiatives
A process to harmonise health education curricula has been set in motion at EU level, and HIV/AIDS will need to be part of this. However, this will take time. Health professionals can also be 'educated' by being part of alliances and partnerships, having the opportunity to learn from other stakeholders and from people with HIV/AIDS themselves.
There is a new EU-funded project involving 10 IPPF (International Federation of Planned Parenthood) federations, which will run a series of action projects over the next three years with the aim to formulate concrete recommendations for policy makers. For more information contact jla@euro.who.int.
3.7 Russian Language Materials
The Russian language HIV/AIDS Information Resources Network, an initiative of the EurasiaHealth AIDS Knowledge Network (www.eurasiahealth.org/aids/) and the HIVInfoRUS@mail.aiha.com, a forum for individuals and organizations interested or involved in the development of Russian language HIV/AIDS materials, is coordinated by American International Health Alliance (AIHA). These resources are developed with consensus panels made up of experts from the Region, to ensure that the content is appropriate and translations accurate.
3.8 Building Cooperative Partnerships Involving all Stakeholders
The need for partnerships, coalitions and alliances was a recurring theme in the discussion. The situation can be much better addressed in cooperation with all stakeholders, avoiding fragmentation and waste of resources, enabling the presentation of a stronger case to policy makers and raising HIV/AIDS awareness of the general public. Especially in high-stigma environments where PLHA and IDU are particularly vulnerable, visible courageous leadership and support from credible trustworthy sources such as health professionals, industry and municipal governments can help to reshape/reframe the environments.
3.8.1 Industry as partner10
Industry can add short and long-term value in several ways:
* Firstly, through facilitating involvement of all stakeholders, data collection, review and analysis of epidemiological data and dialogue regarding prevention and treatment needs and options.
* Secondly, through research, innovation and development of prevention and treatment options.
* Thirdly, through continued involvement in monitoring and evaluation of outcomes.
All activities need to be based on sound science and evidence, ethical and transparent objectives, with local stakeholder engagement.
3.8.2 Linking different parts of health sector and multiple sectors
The Global Fund now enables 'combined grants', which enable cooperation between different (parts of health and other) sectors.
3.9 Making the Case for Policy Makers
Policy makers are an important target group. While health professionals and patients clearly are the crucial stakeholders, it is the policy makers who take the important decisions relating to resources and systems; they determine the (health and social) priorities. It is therefore imperative to involve the policy makers, and to incorporate them in activities rather than simply inform them. Policy makers should be made part of the process to fight the disease, ensuring they see a role for themselves in making a difference.
An effective example11 of an activity to spur policy makers into action was a meeting where HIV/AIDS infected nurses (through needlesticks) made the case for action to policy makers. This putting a face on the issue for policy makers yielded quick results!
When making the case to policy makers, simple and understandable messages need to be used. The focus should be on the broader (social) aspects of the disease rather than on the medical/ physical side only.
3.10 Increasing Demand for Information through the Media
The demand for information relating to HIV/AIDS needs to be increased. The general public's interest can be raised by the development of tailored communication projects. Effective examples in this area were given, such as a South African 'soap opera' approach (Soul City): a TV series which is accompanied by a variety of services and follow-up (information and support) activities.
The credibility of messages is an issue as well: the messages sent out about HIV/AIDS (as well as the messenger(s)) will need to be trusted. Credibility can be enhanced by building stakeholder alliances, where certain perspectives can be combined and one-sidedness avoided.
It is clear that the role of the media is crucial. The media have a clear role to play in dispelling myths, and de-stigmatisation. However, sensationalism and misrepresentation are the reality more often than not.
Examples of positive media activities in Russia and St. Petersburg were presented. Russia has the fastest increase in the number of HIV/AIDS cases, with access to ART being very low. Corruption is rampant: the cost of treatment calculated at 10.000 euro per individual per year, and this unrealistically high cost seems to stem from deals made between officials. Internews12 (a leading Russian news agency) produced a film, which addressed common prejudice against HIV/AIDS. This was broadcast from 250 Russian television stations on World AIDS Day 2004.
In St Petersburg,13 activities have been launched to address the rising number of women with HIV/AIDS and a magazine was produced, specifically dedicated to information on HIV/AIDS (3000 copies). The target audience consisted of health professionals, young people and patients.
Concerns were raised about the safety of journalists who investigate the root causes of HIV/AIDS and criticise public entities. Active involvement of IGOs and NGOs was seen as a way to help protect these journalists. Creative weaving of themes into various popular formats was identified as another approach.
4. Sustaining Action
The need to address both a short-term (urgent) and longer-term (sustainable) agenda was pointed out. Panos, in reviewing 20 years of HIV/AIDS communication experience, calls for a shift from message to voice, emphasising lessons learned from successful HIV/AIDS communication initiatives which addressed the need for local leadership, empowerment and ownership. Concerns were raised about the short-term outputs required by funding agencies. Some issues (such as improving access to testing and treatment) should be addressed immediately, while others, such as attitude change and the development of civil society leadership, will take a (much) longer time. The challenge is how to combine the development and implementation of both agendas simultaneously.
AFTERNOON SESSION
In the afternoon, participants were divided into four working groups to brainstorm ideas regarding the launching of an HIV/AIDS Ask? & Act! - It's your health! campaign in Russia, Ukraine, Estonia and Latvia. After a brief introduction regarding the reality of HIV information activities in the cities of focus, participants were asked to fill in a matrix (see Annex) identifying specific actions different stakeholders might usefully take to address obstacles and move the information, prevention, and treatment agenda forward.
Summary of Stakeholder Action Suggestions to Increase Demand for Information
PLWHA:
Counselling, peer education, condom distribution, information dissemination (Latvia).
Harm reduction, anonymous testing, treatment possibilities (Estonia).
Targeted NGO action to 20-29 year olds (Kiev, Ukraine).
Too early (Russian cities).
Health Professionals:
Identify spokespeople for media and advocacy, use their credibility/public trust and large numbers in different settings, promote behaviours (like confidentiality) (Russian Cities).
Continuing education (Kiev).
CME, outreach of experts, involve more physicians (not just specialists) in treatment and care, distribution of medication information (Estonia).
Develop interpersonal communication skills, hold conference for doctors, nurses and pharmacists, information displays (Latvia).
Healthy City Municipalities:
Put HIV/AIDS on local political agendas (Russia).
Convene health commissions, meetings, workshops to raise awareness (Kiev).
Distribute free condoms (Latvia).
Health Professional Students:
Voluntary work (Latvia).
Peer education (Kiev).
Speaking out, demonstrating, inform workforce (Russian cities).
Pharmaceutical industry:
Lobby governments on economic and social consequences of HIV/AIDS, pressure for subsidized medicines (Russian cities).
Policy and pricing issues (Kiev).
Provide leadership (Estonia).
Media:
Gather good evidence, involve famous people, 'edutainment', web sites (Kiev).
Give HIV a face, address cultural/linguistic/language issues, target specific groups (like sex workers) (Estonia).
Media training (Latvia).
Produce and create popular talk show programming, develop quality collateral materials, raise HIV/AIDS awareness by emphasizing the sex, drugs and death angles (Russian Cities).
IGOs:
Provide models for strategy and policy, provide credible up-to-date information (Russian Cities).
Capacity building of organisations and professionals (Kiev).
Global Fund:
Involve media in CCM, make plans known broadly in country, publish results (Kiev).
Better auditing (Estonia).
More broadly publicise information about money already committed (Russian Cities).
International NGOs:
Campaign on access to therapy and costs of medicines (Russian cities).
Share information and resources widely (Kiev).
Next Steps:
1. Draft report will be circulated before end of year
2. Final report to be distributed end January 2005
3. Virtual network to communicate via email
4. WHCA interactive campaign website to be launched early 2005
5. WHPA executives to review meeting findings, January 2005
6. Communication audits in proposed city projects to be completed first quarter 2005
7. Model projects, building on audits, to be developed by Healthy City partners (with coordination by WHCA and the Baltic Centre) and submitted for funding in first quarter 2005
8. Selected projects to be launched April/May 2005
Relevant reports cited and distributed
Panos, 2003. Missing the Message? 20 years of learning from HIV/AIDS. www.panos.org.uk
The Global Fund, 2004. Annual report 2003. www.theglobalfund.org
UNAIDS, 2004. AIDS Epidemic Update – Eastern and Central Europe (Chapter 6). www.unaids.org/wad2004/report.htm
UNDP, 2004. Reversing the Epidemic: Facts and Policy Options. HIV/AIDS in Central and Eastern Europe and the CIS. www.undp.org/hiv
WHO, 2004. HIV/AIDS Update. www.euro.who.int
ANNEX
1. Russian Cities Group (example)
Stakeholder groups
Action to increase demand for information
Communication capacity needs
Obstacles
Opportunities
People living with HIV/AIDS
Group felt it was too early in the PLWHA development process for this group to be able to take effective action in stimulating demand for information.
The tremendous stigma towards PLWHA.
Would make a significant impact eventually when better organized and with proper spokespersons.
Doctors, Nurses, Pharmacists
Health professionals - acting as individual professions and collaboratively - could identify spokespersons that could participate effectively in media and advocacy campaigns. Their credibility and public trust would raise the profile of the HIV/AIDS situation in a credible way and stimulate demand for more information from citizens and local policy makers.
Health professionals represent an important opportunity to inform and stimulate demand for information from the public directly. Their large numbers, public trust and presence in all settings (communities, schools, workplace, clinics, pharmacies, prisons, etc) make them a powerful potential sales force. The appropriate training of health professional representatives in HIV/AIDS and communications skills, as well as access to collateral materials to use in interacting with the public could create a significant demand for information.
Media/speaker training.
Continuing education materials.
Collateral materials/tools such as posters for offices and pharmacies, public-friendly information leaflets.
Current beliefs and practices (ie that it is the correct and ethical thing to do to disclose HIV status to the entourage of HIV+ person, rather than maintain confidentiality).
Time.
Fear of political backlash.
A significant opportunity to engage and mobilise the key players in the health system and thereby to strengthen the system.
Opportunity to foster collaboration and coordinated activity among the health professionals.
Healthy City Municipalities
Put HIV/AIDS on the agenda cutting across all health and social development issues.
Model strategic plans and access to broad range of information in Russian.
Availability of reliable and up-to-date information and policy tools in the Russian language.
Could be the cross-cutting driver of an effective information campaign and related policy development.
Health Professional Students
Speaking out/demonstrating on the HIV/AIDS issue.
Pressure/inform the HPs in the workforce on the topic.
Willingness.
Pharmaceutical Industry
Work to enhance government understanding of the importance and economic and social costs/consequences of the HIV/AIDS.
Pressure for subsidization of medicines.
Engage government - break the political inertia.
Media
Produce/create/populate talk show format programming on the theme of HIV/AIDS.
Develop quality collateral materials - PSAs, films.
Media credibility is very low - either state mouthpieces or very low quality or so commercially oriented they would be difficult to engage.
Could stimulate a very broad increase in demand for information.
Significant impact on stigma reduction.
Could strengthen the credibility and scope of the media in society.
Provision of quality programming related to HIV/AIDS can assist them in filling the many hours of programming they need to fill.
IGOs
Provide models for strategy and policy.
Provide credible up-to-date information.
Could provide a good network for exchange of resources and opportunities.
Global Fund
Broadly publicise in Russia information about the funding that has already been committed.
Sponsor some of the above activity.
International NGOs
Campaign on access to therapy and costs of medicines.
1 'Health competent' patients were identified as being more independent, better able to co-manage their health and healthcare, cost less to health systems and are more likely to actively engage in shaping effective health policies.
2 'Patient' versus 'people with ...'. The term 'patient' is not ideal, in that it carries "a lot of perceptual baggage". Many feel that it implies a rather passive un-empowered role. It is, however, a useful and well understood term that can be applied to anyone interfacing with the various aspects of health and health care systems, including preventative, curative, rehabilitative and palliative services. On an individual level everyone is a person, on a systems level it was felt convenient and appropriate to talk about patients and patient groups.
3 Healthy Cities engages local governments in health development, through a process of political commitment, institutional changes and capacity building and partnership-based plans and concrete actions. The WHO Healthy Cities network includes over 40 members and these cities coordinate national networks which include over 1300 cities in Europe.
4 Srdan Matic (WHO)
5 Lital Hollander
6 'Framing' relates to the 'spin', the way perceptions related to an issue are managed/manipulated. Frames create the context within which policy debate takes place. Simply put, if you get people asking the wrong questions the answers do not matter. For example, marketing people hired by the tobacco industry have been very successful in framing tobacco issues around freedom, autonomy and choice as opposed to public health. Key to the success of the Framework Convention on Tobacco Control was the ability of public health advocates to reframe the issue around public health concerns, eg "Tobacco Kills Don't be Duped".
7 Heini Parkkunen (Baltic Region Healthy Cities Association)
8 Rod Watson
9 Ida Gustafsen
10 Comments from Scott Ratzan
11 Comment from Paul de Raeve
12 Comments from Ella Tukhareli and Gillian McCormack
13 Comments from Lidia Simbirtseva