Sexual and reproductive rights are recognized around the world as human rights.
Every person living with HIV is entitled to these rights and they are necessary for the development and well-being of all people and the societies in which they live.

Table of Contents

SUMMARY................................................................................................................................................................1

BACKGROUND........................................................................................................................................................2
WHY MUST ACCESS TO AND UPTAKE OF HIV TESTING AND COUNSELLING (HTC) BE INCREASED?............................2
SCOPE AND PURPOSE.................................................................................................................................................3
TARGET AUDIENCE...................................................................................................................................................3

KEY PRINCIPLES AND CONSIDERATIONS......................................................................................................4
1. SCALING UP HTC IS A PUBLIC HEALTH AND HUMAN RIGHTS IMPERATIVE AND MUST BE LINKED TO BROADER EFFORTS TO ACHIEVE UNIVERSAL ACCESS TO COMPREHENSIVE, EVIDENCE-BASED HIV PREVENTION, TREATMENT, CARE AND SUPPORT...................................................................................................................................................4
2. EXPANDED HTC MUST BE TAILORED TO DIFFERENT SETTINGS, POPULATIONS AND CLIENT NEEDS........................5
3. EFFORTS TO INCREASE ACCESS TO AND UPTAKE OF HTC SHOULD INCLUDE IMPLEMENTATION OF PITC FOR SYMPTOMATIC PATIENTS AND THOSE WITH SUSPECTED PRIMARY HIV INFECTION, AND IN SELECTED HEALTH FACILITIES................................................................................................................................................................6
3.1 PITC for symptomatic patients and those with suspected primary HIV infection should be prioritized.........6
3.2 Consideration should be given to implementing PITC in selected health facilities........................................7
4. EFFORTS TO INCREASE ACCESS TO AND UPTAKE OF HTC MUST MEET THE NEEDS OF MOST-AT-RISK AND VULNERABLE POPULATIONS AND EXPAND BEYOND HEALTH CARE SETTINGS.............................................................8
4.1 Meeting the needs of most-at-risk and vulnerable populations.......................................................................8
4.2 Meeting the needs of prisoners, detainees and people in other closed settings..............................................9
5. RAPID HIV TESTS SHOULD BE USED, WHERE APPROPRIATE, TO SUPPORT EFFORTS TO INCREASE ACCESS TO AND UPTAKE OF HTC.......................................................................................................................................................9
6. HIV TESTING MUST ALWAYS BE DONE WITH INFORMED CONSENT, ADEQUATE PRE-TEST INFORMATION OR COUNSELLING, POST-TEST COUNSELLING, PROTECTION OF CONFIDENTIALITY AND REFERRAL TO SERVICES...........10
6.1. Informed consent and pre-test information or counselling..........................................................................10
6.2 Post-test counselling....................................................................................................................................11
6.3 Ensuring confidentiality, privacy and security of data..................................................................................11
6.4. Ensuring referral to services.......................................................................................................................11
7. TESTING POLICIES AND PRACTICES SHOULD BE REVIEWED TO ELIMINATE ANY NON-VOLUNTARY FORMS OF HIV TESTING..................................................................................................................................................................12
8. EFFORTS TO INCREASE ACCESS TO AND UPTAKE OF HTC MUST BE ACCOMPANIED BY EQUAL EFFORTS TO ENSURE SUPPORTIVE SOCIAL, POLICY AND LEGAL FRAMEWORKS TO MAXIMIZE BENEFIT AND MINIMIZE HARM TO THOSE TESTED....................................................................................................................................................................12
9. CONSULTATIONS SHOULD BE UNDERTAKEN TO FORMULATE PLANS FOR EXPANDED HTC..................................13
10. HTC MUST BE CAREFULLY MONITORED AND EVALUATED.................................................................................14

RECOMMENDATIONS.........................................................................................................................................15

REFERENCES.........................................................................................................................................................19

ÍNDICE
AGRADECIMENTOS
ÍNDICE
CONTEXTO E QUESTÕES
Princípios
RECOMENDAÇÕES
Conhecer, entender e responder aos específicos e variados efeitos da epidemia de HIV/VIH em mulheres e meninas
Traduzir compromissos políticos em ações intensificadas que atendam aos direitos e necessidades de mulheres e meninas no contexto do HIV/VIH
Um ambiente que favoreça o cumprimento dos direitos humanos de mulheres e meninas e seu empoderamento, no contexto do  HIV/VIH
PRESTAÇÃO DE CONTAS E PRÓXIMOS PASSOS
Prestação de contas e Relatórios para o Plano Operacional
Próximos passos
PARTICIPANTES
ANEXO
Força Tarefa Global sobre Mulheres, Meninas, Igualdade de Gênero e HIV/VIH
Aceleração da ação global para mulheres e meninas no contexto da Sida/SIDA
1. Fortalecimento da orientação e do apoio estratégico aos parceiros nacionais para “conhecerem suas epidemias e a resposta”, no intuito de atender com eficácia as necessidades de mulheres e meninas
2. Assistência aos países para garantir que as estratégias de HIV/VIH e desenvolvimento, os planos operacionais, os sistemas de monitoramento e avaliação e orçamentos nacionais associados atendam as necessidades e direitos de mulheres e meninas no âmbito do HIV/VIH
3. Advocacy, fortalecimento da capacidade e mobilização de recursos para fornecer um conjunto abrangente de medidas para tratar das necessidades e direitos de mulheres e meninas no contexto do HIV/VIH
Um processo com prazo reduzido para resultados
Recomendações para uma mudança positiva
Eventos-chave no processo da Força Tarefa Global

PREFÁCIO
INTRODUÇÃO
PRINCÍPIOS BÁSICOS
Excelência científica e integridade ética
Respeito
Clareza de papéis e responsabilidades
Responsabilidade compartilhada
Gestão participativa
Autonomia
Mais transparência
Normas de prevenção
Acesso a atenção à saúde
Construindo a base de conhecimentos sobre pesquisas
PARTE I
QUESTÕES E ATIVIDADES ESSENCIAIS
Pesquisa formativa com a comunidade
Elaboração do protocolo
Conselhos institucionais de supervisão, comitês de ética
em pesquisa e outros mecanismos reguladores
Política de cobertura de danos relacionados à pesquisa
Plano de envolvimento, educação, e participação da
comunidade
Plano de comunicação
Plano de monitoramento e gestão de eventualidades
Mecanismos consultivos comunitáriosPARTE II
BOAS PRÁTICAS DE PARTICIPAÇÃO E O CICLO DE
VIDA DA PESQUISA
Preparação local de pesquisa
Início do estudo
Realização do estudo
Encerramento do estudo
Análise, validação, divulgação e publicação dos dados
Manutenção dos centros de pesquisa no período
intermediário entre os ensaios clínicos
Acesso futuro a tecnologias de prevenção do HIV
Conclusão
Referências

In this issue, we cover male circumcision
(does circumcising HIV-infected men reduce transmission to women?; does sex in the wound
healing period increase HIV acquisition risk for HIV-negative men?), programme evaluation:
equity (Malawi leads the way in equity policy and analysis; how sex and income affect survival
and retention in Nyanga’s antiretroviral treatment programme near Cape Town), injectingdrug
users (good news on harm reduction in the USA), paediatric outcomes (non-infected
kids exposed to antiretroviral drugs in pregnancy do not have intrauterine growth
retardation; how many kids starting antiretroviral therapy get immune reconstitution
inflammatory syndrome (IRIS)?

 SEE THE NEWSLETTER HERE

About Financing Global Health 2009

An overwhelming majority of the global burden of disease lies in low- and middle-income countries. In contrast, these countries account for a minor share of total global health spending. Given this discrepancy, it is not surprising that improving health in developing countries and mobilizing more resources to achieve that end have emerged as urgent development priorities. The first is reflected in the Millennium Development Goals, three out of eight of which pertain to health. The second is evidenced by the unprecedented rise in development assistance for health and the emergence of several new global health financing institutions in recent years. Objective, comparable, and comprehensive information on public and private resources for global health is needed for improving the quality of policymaking and planning at all levels. It is also an essential ingredient for the effective monitoring and evaluation of global health initiatives and national health programs. The Organisation for Economic Co-operation and Development (OECD) routinely produces data on national health accounts which reflect public and private health expenditure for its member states.

1. Since 1998, the World Health Organization (WHO) has been committed to expanding national health accounts to developing countries.
2. While these are important efforts, there are major gaps in both the methods for measuring health expenditures and the available data. To help fill these gaps, IHME is tracking three major components of financial resource inputs for health:

Development assistance for health: Donor contributions are an important source of revenue for health systems in many low- and middle-income countries. Monitoring the volume of external aid and understanding its nature and composition is of vital importance to the global health community.
IHME’s research in this area focuses on generating valid, reliable, and comparable estimates of development assistance for health on an annual basis from
1990 onwards, and undertaking targeted research into its composition and effectiveness. The central questions this research seeks to address are: Who is giving what, how, to whom, and to what end? Does the distribution of global health resources across different disease areas, types of interventions, and
geographical areas reflect current global health priorities? Are information systems for tracking aid transparent, and how may they be improved and standardized?
• Government health expenditure: Measuring how much governments in low- and middle-income countries spend on the health sector, both from domestic revenue and from funds received from external sources, is essential for understanding the performance of health systems in these countries. IHME’s work in this area focuses on both generating the most up-to-date and valid time-series data on government health expenditure and undertaking research into the links between development assistance and national health expenditure. By how much does a dollar in external aid increase government health expenditure in different recipient countries?
Does foreign aid for health lead governments to reallocate their domestic funds to other sectors? These questions lie at the heart of this research area.

• Private health expenditure: Out-of-pocket payments by households for medical services constitute a large share of total health expenditure in most developing countries. These payments can often be catastrophic and can drive households into poverty. As developing countries enact policy reforms to alleviate the economic burden of accessing health care through different kinds of health system reforms, it is essential that we have accurate and comparable estimates of private health expenditures across countries and over time. IHME’s work in this area will focus on validating existing methods, systematically analyzing all available data on private spending in low- and middle-income countries, and developing new tools for tracking private health expenditure.

IHME is launching an annual report on global health financing to present results from these three research streams and to make information about health spending widely available. This annual report will provide valid and consistent time-series data for tracking global health resources and in-depth analyses of timely and relevant research questions in all three areas described above. Disseminating our research findings to the widest audience possible will contribute to evidence-based policymaking, advocacy, and action.
We also hope the reports will foster constructive debate and dialogue about the substantive research questions, the analytical methods, and the findings.
We foresee this dialogue opening new avenues for consultation and collaboration, which will in turn serve to improve and strengthen the evidence base in the long run.

In Financing Global Health 2009 we showcase our research on development assistance for health. The key results and methods presented in this report have been published in a research paper in The Lancet.30 Government health spending and private health spending will be the focus of the reports in years two and three, respectively. In subsequent years, the Financing Global Health report will present annual updates and new research findings in all three areas, as well as in-depth analyses on special topics of interest in the area of resource inputs for health.

The HIV/AIDS and Human Rights in Southern Africa 2009 Report was launched by Mark Heywood, director of the AIDS Law Project and Deputy Chairperson of SANAC on 1 April 2009 at the 4th SA AIDS Conference in Durban, South Africa.

SEE THE REPORT HERE

Dicas sexuais

A Associação ILGA Portugal* lança colecção de cinco postais visando aumentar a confiança de HSHs (homens que têm relações sexuais com outros homens) em relação ao sexo e dando dicas para o tornar melhor e mais seguro. A par de dicas sexuais, cada postal aborda um dos seguintes temas:
1. Penetração – aborda-se o uso de brinquedos sexuais, bem como o risco de lesões na membrana anal que podem facilitar a transmissão do VIH/sida e outras ISTs (infecções sexualmente transmissíveis);
2. Posições – propõe-se que se tenha preservativos sempre à mão, hábito este essencial à prática consistente de sexo protegido;
3. Sexo oral – recomenda-se evitar a prática de sexo oral a seguir à lavagem dos dentes e o contacto com esperma durante o sexo oral;
4. Cock rings – discute-se a disfunção eréctil e algumas das suas causas e relembra-se que o uso de cock rings facilita a erecção, fundamental para a utilização correcta do preservativo;
5. Massagens – aconselha-se a massagem como uma oportunidade para discutir expectativas e termos do sexo que se pretende praticar e relembra-se que os lubrificantes à base de óleo podem danificar e provocar o rompimento dos preservativos.

Estes postais, disponíveis on line em
www.ilga-portugal.pt/pdfs/dicassexuais.pdf
serão distribuídos em locais de entretenimento frequentados por HSHs já que nestes locais se propiciam contactos conducentes a relações sexuais. Ao disponibilizar este material informativo em tais locais, visamos fomentar a prática consistente de sexo protegido e, ao fazê-lo, contribuimos para diminuir os casos de transmissão ou contracção do VIH/sida ou de outras ISTs.

Trata-se da segunda de duas colecções de postais dirigidos a HSHs no âmbito de projecto com o apoio financeiro da Coordenação para Infecção VIH/sida (CNIVS) - Alto Comissariado da Saúde (www.sida.pt). Esta nova colecção de postais complementa a série “Pensa duas vezes” (www.ilgaportugal.pt/pdfs/pensaduasvezes.pdf) que combate pensamentos e crenças (que podem colocar os HSHs em risco de transmitir ou contrair o VIH/sida) e promove a prática consistente de sexo protegido.

Esta colecção de postais resultou da tradução e adaptação da campanha “Sex Tips for Boys”, originalmente concebida pela Gay Men Fighting AIDS (www.gmfa.org.uk), com autorização desta associação inglesa. Há que referir ainda o apoio da Relevo Branco (www.relevobranco.pt) e a adaptação gráfica de Vera Luís (www.veraluis.com).

Contamos com o seu meio de comunicação social para a divulgação desta brochura,

O Coordenador do “Grupo de Trabalho de Prevenção do VIH/sida e outras ISTs” da Associação ILGA Portugal, Prof. Doutor Manuel Cabral Morais (927 941 249, prevencao@ilga-portugal.pt)
O Consultor Técnico da campanha, Dr. Pedro Correia (964 228 898, sap@ilga-portugal.pt)

*Associação ILGA Portugal (Intervenção Lésbica, Gay, Bissexual e Transgénero) — Promovendo a saúde sexual e a luta pelos direitos de lésbicas, gays, bissexuais e transgéneros desde 1995.
Instituição Particular de Solidariedade Social (Diário da República, 2ª série - Nº 105 - 2 de Junho de 2008; registo no Livro nº 11 das Associações de Solidariedade Social e considerado efectuado em 21 de Janeiro de 1998).

Associação ILGA PORTUGAL
Email: ilga-portugal@ilga.org
http://www.ilga-portugal.pt/

Pedimos desculpa se receber eventuais duplicações deste e-mail.

Visite-nos no Centro LGBT
Rua de S. Lázaro, 88
1150-333 Lisboa
Metro: Martim Moniz
Autocarro: 790
Telefone: 218 873 918 | 969 367 005
Fax: 218 873 922

Youth Leadership: recommendations for sustainability

Fact-sheet de rede de associações jovens

A Unidade de DST do Instituto de Higiene e Medicina Tropical (IHMT) e a Associação ILGA Portugal - Intervenção Lésbica, Gay, Bissexual e Transgénero, lançaram uma de prevenção e rastreio do Linfogranuloma Venéreo (LGV) que inclui aquele que é o primeiro desdobrável em Português sobre esta infecção sexualmente transmissível.

CONTENTS:
Introduction
Background and general questions
Additional info
Protecting and ensuring the mothers health
Transmission
Planning your pregnancy
The Swiss Statement
Prenatal care and HIV treatment
HIV drugs during pregnancy
Resistance, monitoring and other tests
OI prevention and treatment during pregnancy
Vaccine use while pregnant
Treating recurrent genital herpes during pregnancy
HIV and hepatitis coinfection
HIV and TB coinfection
HIV drugs and the baby’s health
Choices for delivery and use of C-section
After the baby is born
Feeding your baby: Risks and options
Tips from the i-Base guides
Test and treatment records and notes pages
Adherence support charts

CONTENTS:
HIV and anti-HIV drugs
Types of antiretrovirals drugs
Where antiretrovirals block HIV
Nucleoside/nucleotide analogue reverse transcriptase inhibitors (NRTIs NtRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)
Fusion and entry inhibitors
Integrase inhibitors
Summary
Glossary

CONTENTS:
Summary
Introduction
Changes to the September 2008 edition
Resistance, cross-resistance and adherence
What, why, how...
What to do about a rising viral load?
Why a combination can fail?
Important monitoring tests
Choices for your next combination
Other treatment strategies
Changing treatment to avoid side effects
Expanded access and experimental drugs
Pages to record your treatment history
Further information
Glossary

CONTENTS:
General nutritional advice
Your diet and anti-HIV drugs
Eating and avoiding weight loss
Diarrhoea
Summary

CONTENTS:
What is resistance?
Reducing the risk of resistance
Cross-resistance
Infection with drug resistant HIV
Resistance tests
Summary
Glossary

CONTENTS:
Introduction
What, when, why & other questions...
You and your doctor
Adherence: why it is so important
Resistance
Which drugs, which combination?
Adherence diary
Record your treatment history

CONTENTS:
What is a clinical trial?
What sort of trials are carried out in HIV infection?
What types of trials might I be asked to join?
The different methods of comparing treatments
The preparation for a trial Informed consent
How to join a trial
Reasons for and against joining a trial
Questions to ask if you are thinking of joining a trial
Thinking it over
Rights and responsabilities
Summary
Glossary

CONTENTS:
Section 1: General information
Section 2: Individual side effects
General side effects
Progressive and acute side effects
Section 3: Further information

CONTENTS:
BHIVA HIV treatment guidelines
What is HIV therapy?
When should anti-HIV therapy be started?
What to start therapy with
When to change therapy
Taking your treatment
Summary
Glossary

CONTENTS:
What is tuberculosis
TB - the basics
TB's interaction with HIV
Symptoms
Diagnosing TB
Preventing TB
Treating TB
Drug-resistant TB
Immune reconstitution syndrome
Summary
Glossary

CONTENTS:
CD4 counts
Viral load
Why do I need to know my viral load and CD4 count?
Undetectable viral load
Viral load and drugs resistance
Viral load and HIV transmission
How often should I have mu viral load tested?
Summary
Glossary

CONTENTS:
The liver
Vaccinations
Hepatitis B
Hepatitis C
Liver transplants
Hepatitis A
Complementary therapies
Treatment networks
Further information
Summary
Glossary

CONTENTS:
Introduction
First questions
HCV transmission: how HCV is caught and passed on
Natural history of HCV
Issues affecting specific individuals
Acute HCV infection: new HCV infections in HIV-positive gay men
Long-term coinfection: long term HCV infection from blood products or by injection drug use
Testing and monitoring
HCV treatment and management of HCV infection
Side effects and management strategies
Deciding whether to treat HCV
Research into new HCV drugs
Living with co-infection: reducing stress and other lifestyle factors
Other viral hepatitis infections
Controversial aspects of HCV transmission, monitoring, care and treatment
HIV and HCV: Similarities and Differences
Glossary
Further information – web links and resources

CONTENTS:
What is adherence?
Why is taking your medication properly so important?
How many doses of my medication do I need to take?
Helping you to adhere
You and your medication
Your healthcare team and adherence support
Your medication and adherence
Pregnant women and children
Adherence tips
Summary
Glossary

CONTENTS:
Part one: HIV, sex and me
What sort of problems?
Dealing with sexual problems
HIV, sex and the law
Part two: HIV and sexual health
Anal and vaginal sex
Oral sex
Condoms
Use of anti-HIV drugs to prevent infection with HIV
Sexual health check-ups
Sexually transmitted infections
Undetectable viral load and infectiouness
Reinfection
Pregnancy
Summary
Glossary

CONTENTS:
HIV and women
HIV and women's health
Monitoring HIV in women
HIV & your body
Mother-to-baby transmission of HIV
Preganancy and conception
Anti-HIV treatment in women
Specialist support
Summary
Glossary

CONTENTS:
Mental health is an issue for people with HIV
HIV- related mental disorders
Depression, anxiety and emotional distress
Mental health problems as a side-effect of anti-HIV and other medicines
Looking after your mental health
Where to go for mental health advice and support
Summary
Glossary

CONTENTS:
What is lipodystrophy?
Who will develop body fat changes?
Do particular drugs cause body fat changes?
Should I be worried about body fat changes?
Preventing and treating body fat changes
Treating fat gain
Exercise and body fat changes
How does exercise affect the different body fat changes?
HIV, HIV treatment and changes in your metabolism
Heart disease and anti-HIV drugs
Treatment for metabolic changes
Stopping smoking
Lipid lowering drugs
Drugs to normalise or control glucose and insulin
Summary
Glossary

CONTENTS:
Part 1: Mother-to-baby transmission of HIV
Treatment
Delivery
Breastfeeding
HIV testing in babies
Part 2: HIV infection and children
Monitoring HIV in children
Anti-HIV treatment in babies and children
Side-effects
Table - Anti-HIV drugs available for the treatment of HIV-positive children
Living with HIV
Summary
Glossary

CONTENTS:
Introduction to this guide
What, why, when & other questions..
You and your doctor
Adherence: why it is so important
Adherence chart
Which combinations are best?
What about side effects?
Resistance
Which drugs and combinations
Drugs and doses