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第19回国際エイズ会議 参加報告書
 

特定非営利活動法人ぷれいす東京
大槻知子

 “Welcome to the United States,” said U.S. Secretary of State Hillary Clinton in one of the plenary sessions. The return of the International AIDS Conference to the United States after twenty-two years of absence, to some, seemed to mark a new chapter of the history of HIV/AIDS. In the middle of a presidential year, political motives, gestures, and spectrum pumped up the conference. President Barack Obama's 2009 decision to lift the U.S. travel ban on people living with HIV/AIDS was well-received. However, there are still people like sex workers and people who use drugs who are prohibited from entering the country and thus from participating in the conference. Small and large groups of people marched to protest against unfair treatment and mistaken policies. Yet, as Ms. Clinton put it, “What would an AIDS conference be without a little protesting?”

What was most impressive to me were actions taken by and for black Americans. Washington D.C., where the black population is high, reminds me of Martin Luther King’s “I Have A Dream Speech.” Today in the United States, black men who have sex with men (MSM) are the only population demographically increasing HIV incidence. Black people make up thirteen percent of the U.S. population yet account for about half the total number of people living with HIV/AIDS.1 I heard a number of messages to raise awareness of HIV/AIDS, to eradicate the stigma attached to it, and to improve sexual health directed specially to black communities.

Like the Vienna Declaration in the preceding conference in 2010 that gained more than twenty thousand endorsements up until today, delegates signed the Washington D.C. Declaration online and onsite at Walter E. Washington Convention Center. The Washington D.C. Declaration is a statement of commitments on HIV/ADIS response efforts including; ensuring evidence-based HIV prevention, treatment, and care with emphasis on the human rights, eliminating the stigma attached to HIV/AIDS, and ensuring universal access to anti-retroviral drug (ARV) and meaningful involvement of people and communities affected by HIV/AIDS.

The Vienna Declaration and its emphasis on human rights protection still clearly remain in my mind, and two years later, human rights are still at issue. In some countries and regions including the United States, living with HIV/AIDS itself can be a crime. Legal professionals who prosecuting people for HIV transmission do not necessarily get the latest information (e.g. due to the advancement of medicine, AIDS is no longer a death sentence), and they are irresponsible for it.1,2 It goes against the times of evidence-based and more and more stigmatizes HIV/AIDS.

Speakers repeated the lines like “beginning to end AIDS” and “getting to zero” highlighted the use of HIV treatment as prevention and pre-exposure prophylaxis (PrEP) as example. The advancement of technology as such sounds sweet and exciting, but at the same time, survivors living today should not be forgotten. It was a groundbreaking event to hold a session on HIV and aging two years ago at the conference. This year HIV and aging were dealt with in at least five sessions, and aging issues in Sub-Saharan Africa were also addressed. In addition, it must include aging of people living with HIV/AIDS as well as prevention for older people. While people living with HIV/AIDS have a longer life expectancy, we should take note of the fact that HIV/AIDS systematically diminishes people no matter what they have – health, wealth, housing, and all.4

Numerous affiliated events, some of them were open to public, took place around the city. Those events helped people in the city to be aware of it while the conference received little media coverage (partly because of movie theatre shooting in Colorado and the London 2012 Olympic Games). The International AIDS Society’s HIV and drug policy pre-conference was worth noting. Michel Kazatchkine, while showing video messages from injecting drug users (IDUs) who could not come to the United States, stressed the need for harm reduction. Nearly one-third of HIV infection worldwide is IDU-related, and countries and regions that have implemented harm reduction see the decline in HIV prevalence among IDUs. Drugs and HIV/AIDS (tuberculosis and hepatitides also) should be addressed together. Here again, stigma lies within systems: Only few drug users are given access to prevention of infectious diseases by health care providers. HIV-positive drug users with ART have an up to twelve times shortened life expectancy, according to him. He pointed out that the war on drugs has been a failure as increased drug supply and increased purification of drugs were seen; on the contrary, community safety decreased.5 Is the power of evidence weaker than ideology?

A staff member at a local NGO providing harm reduction programs told me that U.S. policies on harm reduction have gone back and forth. One of the official engagement tours to visit a local organization providing IDUs with care and support was canceled for lack of participation. It is pity that delegates had little interest in it.

Incidentally, it might not be directly comparable to our research on adherence to ART among people living with HIV/AIDS in Japan, yet I found one African research on community-based support interesting. The research shows that community-based support increases the likelihood that people living with HIV/AIDS will be retained in ARV (where less than a third of people who start treatment would stay). With the adherence support in their community, people living with HIV/AIDS more likely to overcome stigma, anxiety, and other possible obstacles that make them drop out of treatment.6

Having said that, I am aware that there is no easy way to eliminate stigma and discrimination. During my stay in the United States, upon showing my photo identification – passport with registered domicile Fukushima, one person paused for a moment, and other person directly asked, “How close is your home to the nuclear plant?” The earthquake occurred last year affected HIV/AIDS response in Japan nationwide, too. I come to connect HIV/AIDS with many other things happening in the world. The situation changes from moment to moment, and so does people’s understanding of the seriousness of the situation. Continuity — continued efforts and co-mobilization of these efforts on HIV/AIDS response and issues surrounding it would be a key.

Finally I would like to thank Japan Foundation for AIDS Prevention for the opportunity to attend the conference. It helps to enrich my community work on HIV/AIDS.
  1. Pettifor, A. Track C Rapporteur Report. Nineteenth International AIDS Conference, Washington, D.C., July 27, 2012.
  2. Lax-Vanek, J. The impact of HIV/AIDS criminalization on awareness, prevention and stigma in the: a qualitative analysis of stakeholders' perspectives in Ontario, Canada. Nineteenth International AIDS Conference, Washington, D.C., July 25, 2012.
  3. Hoppe, T. Punishing HIV: how Michigan trial courts frame criminal HIV disclosure cases. Nineteenth International AIDS Conference, Washington, D.C., July 25, 2012.
  4. Currier, J. Intersection of Non-Communicable Diseases and Ageing in HIV. Nineteenth International AIDS Conference, Washington, D.C., July 27, 2012.
  5. Kazatchkine, M. Opening remarks. The Twin Epidemics of HIV and Drug Use: Innovative Strategies for Healthy Communities, Washington D.C., July 20, 2012.
  6. Fatti, G. et al. Community-based adherence support associated with improved virological suppression in adults receiving antiretroviral treatment: five-year outcomes from a multicentre cohort study in South Africa. Nineteenth International AIDS Conference, Washington, D.C., July 25, 2012.
 大統領選挙の年にアメリカの政治の中枢ワシントンDCで開催された第19回国際エイズ会議は、政治的にショーアップされることが必然であったかのようであった。アメリカでの22年振りの開催に対する祝賀ムードや、予防としての治療、抗HIV薬の曝露前投与などの昨今のHIV/AIDSを取り巻く動向を紹介し発せられる“Beginning to End AIDS”“Getting to Zero”といったキャッチフレーズに彩られ、本会議はHIV/AIDS対策のひとつのターニング・ポイントとして位置づけられようとしていたように見えた。
 2年前の会議に続く参加だったので、いくつかのテーマが、当時と比較し、現在はどのように扱われているかという視点で興味深い点がいくつかあった。例えば、前回の会議では「恵まれた先進工業国ならではの問題」という批判さえあったHIV陽性者のエイジングのテーマが、今回の会議ではいわゆる開発途上国でもすでに起こっていることが前提に取り上げられていたのが印象的であった。一方、薬物使用/依存者へのハーム・リダクションを含めたケアの提供や、HIV/AIDSの犯罪化などの問題は、一進一退を繰り返しているように見えた。
 海外の国や地域(とりわけ“開発途上国”)で行われているHIV/AIDSの取り組みについて、日本とは前提条件が異なるといっていなすのは簡単である。しかし、震災後の日本でさまざまな社会問題とHIV/AIDSを結びつけて考えさせられることが多くなり、また地球の裏側で起こっている物事をより身近に感じるようになった自分に、今回の会議で気づかされることとなった。今回新たに得た見識や経験を自らの活動分野、とりわけ厚生労働科学研究費補助金エイズ対策研究事業「地域においてHIV陽性者等のメンタルヘルスを支援する研究」での薬物使用/依存に関わる研究や地域の相談・支援機関についての調査、および日本エイズ学会学術集会「HIV陽性者参加支援スカラシップ」をはじめとするプログラム運営を通じて関係者と共有・還元しつつ、さらに取り組みを続けていきたいと考える。
 最後に、今回の会議参加の貴重な機会を与えてくださった公益財団法人エイズ予防財団に感謝します。ありがとうございました。