Mexican sex workers want place at AIDS conference

A global AIDS conference that opens in Mexico City on Sunday is meant for people infected with HIV, but transsexual sex worker Elma Delea cannot get inside.She will be protesting on the fringes of the six-day biennial event.

"They (Mexican health authorities) said they had no money for everyone who wanted scholarships. We are very angry," said Elma Delea, as she stood at the junction of Calle de Alfredo Chavero and Calzada San Antonio Abad, a stretch of road where transsexuals wait all night to be picked up by customers in passing cars.

Her friends nodded, citing other explanations given by organizers, such as not being able to speak English.

Some 25,000 people are expected at the event, which draws scientists, international agencies, government officials, non-government organizations and the media.

But people most at risk of the disease, such as sex workers, homosexuals and intravenous drug users, are least visible. Most are poor and cannot afford registration fees.

"The conference is a place to exchange opinion but now, only those in power have a say," said Elvira Madrid, an activist working for the rights of sex workers in Mexico City.

At one point, passengers in a passing car hurled eggs at the group standing on a street corner, narrowly missing.

"This is common. One time, some men shot paintballs at us, and it hit my thigh," said Orchidia Montenegro, as her colleague Martha de Juarez nodded in agreement.

SHUNNED IN HOSPITALS

Those infected by HIV say they are shunned in hospitals.

"We are told to stand far away and open our mouths from three feet away," said another sex worker. "And when they do examinations, they use the same tools without disinfecting first."

The AIDS virus infects 33 million people globally, 1.7 million in Latin America. In Mexico, $23 million was spent on keeping blood safe in 2005 and $5 million on prevention and care among men who have sex with men, but less than $1 million on sex workers.

"Interestingly, although prostitutes are considered to be victims, they are also viewed as wanton, debauched and morally weak," reads a UNAIDS report on sex workers.

Delea, who had been hoping to speak at the conference, said it was important for society to acknowledge sex workers, starting with the police, who often detain prostitutes when they find them with condoms. This makes it harder for the workers to practice safe sex.

"We also want the government to reduce prices on HIV drugs, which are 13 times more expensive than in Brazil, Guatemala and Honduras," said Delea, who heads the sex worker group Angeles en Busqueda de la Libertad or Angels In Search of Freedom.

Prostitution is illegal in Mexico but widely tolerated everywhere from grimy street corners to swanky brothels. Police can easily be bribed to turn a blind eye to sex workers.

Delea's group wants to coach women on how they can protect themselves when customers refuse to use condoms.

"We have to be very creative when using condoms. We have to start looking at them as tools of eroticism instead of disease prevention," said transvestite sex worker Chrisna.

"We are able to put condoms on our customers with our mouths without them even knowing, so that they even think we have swallowed their semen. But we have it in a bag to go," she said with a laugh.

Grassroots networking at heart of AIDS meeting

With her immaculate face, cheekbones to die for and slim legs showcased by a slinky black microskirt, Dr. Safelove is unforgettable as a promoter of safe sex among teenage girls."I tell my girls, 'Girls, everyone needs to carry a condom. Take one and carry it in your back pocket. Always judge a penis by its cover'," says the doctor in a cut-glass English accent.

What makes Dr. Safelove especially memorable is that she's not even human -- she's a glove puppet, part of an unusual tactic to help sexual health in the era of AIDS.

The good doctor's voice belongs to a South African, Dina Kaplan, who works with a French-based group, Puppeteers without Borders, which trains teachers, nurses and sex educators in the skills of puppeteering.

In classrooms, hospitals and community centres, the hand puppets then come to life, conveying messages about sexuality, stigma, homophobia and other often-taboo issues to youngsters.

"Puppets can say so many things that adults find it difficult to say directly to young people. Puppets make people work together," said Kaplan.

Her voice is slightly hoarse because she has been making presentations all day, satisfying the massive interest in her organisation's booth in the "Global Village" of the International AIDS Conference here.

To the rest of the world, the biennial conference is a council of war, assessing the latest news about HIV drugs, the search for a vaccine, modes of infections and other big medical issues.

That part is indeed true. Less well known, though, is the conference's use as a platform for networking, especially in the "Global Village," a forum that exists only for the duration of the six-day gathering.

Housed this year in a massive tent in the centre of a racecourse, the Village is a carnival of noise and colour and skills-building, where AIDS activists from around the world swap experiences, tips and addresses.

Contact like this is like finding nuggets of gold, helping to hone knowledge and networks and overcome the isolation that may beset a campaigner living in a country where discrimination is rife.

"The response has been fabulous, overwhelming." said John Piermont Montilla at the booth of a Philippines organisation called Kabatang Gabay.

Montilla, forced into sex work as a young boy, set up the group in Iloilo City as an adult to provide shelter and therapy to youngsters aged seven to 17 who have been driven into prostitution.

Scraping his money together and helped by a donation, Montilla made a 35-hour trip to get to Mexico City.

"We've had people from around the world, from Africa, from Europe, from Fiji, coming up to us and asking us about how we work," he said.

Nearby, indigenous people from around Latin America gathered in a semi-circle for a workshop on the problems they face. Field workers from Taiwan, Hong Kong and China pooled their knowledge. An Arab activist manned a stand about homophobia in North Africa and the Middle East.

The Village is also a venue for art and solidarity. This year's exhibitions include enormous black-and white photos taken by people with HIV living in remote parts of Africa, as well as Mexican skeleton puppets and a quilt made by women from Southeast Asia, bearing messages of support from the other side of the world.

It also puts on fashion shows, rock concerts and unconventional theatre.

On Thursday, the eve of the six-day conference's close, an international team of sex workers are scheduled to perform an offbeat play called "Star Whores 2." The message: May the condoms be with you!

Gift cards key to new AIDS prevention strategy

Could the AIDS virus be stopped with gift cards? Desperate for a way to stop the escalating spread of HIV among young gay men, public health officials are looking to novel strategies, such as enlisting local gay opinion leaders to urge their peers to practice safe sex.Promising signs from such a project in North Carolina led the Centers for Disease Control and Prevention to begin rolling it out on a broader scale, to more than 200 community groups. The budget is $1.5 million over a two-year period.

The idea is to give gift coupons to popular, influential men in the gay community and encourage them to talk up condom use, regular HIV testing and other responsible actions.

It may sound frivolous, but little else has proven effective for the men most affected by the epidemic.

Last week, new figures showed still-rising HIV infections in gay and bisexual men, with about 53 percent of new cases in that group. Meanwhile, HIV rates among injection-drug users and heterosexuals is declining.

The CDC says it's also committed $5 million to a five-year social marketing campaign to promote HIV testing to young black gay and bisexual men, who have been diagnosed with HIV at especially high rates.

"The CDC is committed to ensuring that its resources are going to the populations hardest hit by the epidemic," said Richard Wolitski, acting director of the CDC's Division of HIV/AIDS Prevention.

The new approaches are an encouraging sign of help, but the funding behind them doesn't come close to raising prevention spending to the level most experts say it should be, said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors.

"It's a drop in the bucket," she said.

Scrutiny of U.S. prevention efforts increased after the CDC's release last weekend of new estimates of annual HIV infections. The CDC said the nation had roughly 56,300 new infections of the AIDS virus in 2006 — a dramatic increase from the 40,000 annual estimate used for the last dozen years.

The agency acknowledged it had been undercounting but said new testing technology offered a more accurate picture of trends in the U.S. epidemic. For example, the new report found infections are falling among heterosexuals and injection drug users, even as they continue to rise in men who have sex with men, especially among blacks.

Advocates have complained that prevention spending in general has been too low, and that what is spent is not targeted properly.

The CDC's HIV prevention budget has remained at roughly $700 million since 2001, while costs have risen. (That's about 3 percent of what the federal government spends on AIDS; much of the rest is on medicines, health care and research.)

Meanwhile, prevention programs that target gays and bisexuals are scattershot. Even in progressive cities, these efforts sometimes amount to little more than offers of testing and free condoms, some experts said.

Great attention was focused on the gay community when AIDS first hit the United States in the 1980s. But the epidemic gradually became perceived as a threat to the general population, and some political leaders have kept the focus away from gay men, said Leroy Blea, a Berkeley, Calif., health official who is past president of the National Association of County and City Health Officials.

"It's not a very easy population to fund," Blea said. "It's often more politically viable to fund programs for women and children and youth.

The CDC's Division of HIV/AIDS Prevention estimates that about 42 percent of its fiscal 2007 funding was targeted at gay and bisexual men. That translates to about $280 million.

But with 53 percent of new HIV infections occurring in men who have sex with men, that's not enough, some experts said.

"At a minimum, we need to be matching percentages to where the epidemic is," said David Holtgrave of Johns Hopkins University.

Prevention programs are largely funded at the state and local level, and funding has not quite kept up on those levels either.

In California, about 70 percent of HIV infections occur in men who have sex with men, but about 64 percent of the state health budget targeting HIV is focused on gay and bisexual males.

Some experts say it's been hard to find prevention efforts proven to work, and that's especially true for black and Hispanic gays.

Weaknesses in prevention became clear about five years ago in North Carolina, with an outbreak of HIV among male students at some historically black colleges.

The North Carolina Department of Health and Human Services tried a program that had been tested in white gay men in London.

With $1 million in funding from the CDC, North Carolina health officials went to gay nightclubs in Charlotte, Raleigh and Greensboro and recruited men who were well-liked and socially influential.

These opinion leaders were given four $25 gift cards, along with marketing materials, to talk up safe sex. A study of the effort, published in June in the American Journal of Public Health, indicated more men were practicing safe sex.

The research was based on repeated surveys over time of about 300 men. It found a 32 percent reduction in unprotected anal intercourse during 2005, and a 40 percent reduction in the average number of sexual partners.

The funding ran out and the program ended. And the surveys weren't backed up by HIV testing.

But CDC officials are impressed enough to package it, and are identifying other cities where it can be tried. The training of community activists in the strategy should start in a few months, Wolitski said.