Report - Sida Studi

Saturday 1 October 2005: Innovative Actions
8 Plenary session 3: Innovative actions: PLWHA
and access to treatment and care
matization. She argued that these policy developments need
to be predicated on an accurate assessment and acknowledgement
of the experiences of women and to be flexible
to their diversity. In relation to reaching the individual, Ms
Nunes mentioned the importance of addressing women’s
sense of self-efficacy, response efficacy, response costs and
bolstering their assertiveness skills.
She concluded her presentation with a call for action to
achieve the following:
• Better quality of life
• More autonomy
• More self-esteem
• More resilience
• A critical attitude
• Assertive negotiation skills
• Improved preventive behavioural skills
She suggested that this might be accomplished through
innovative action including:
• Self and social development
• Post-traumatic stress therapies
• Emotional freedom therapies
The chair thanked Ms Nunes for her presentation and
drew attention to the importance of developing prevention
activities which reach all people but acknowledged
the particular vulnerabilities of women, especially
migrant women. She introduced Mr Gonzalo Mazuela.
8.22 Innovative action in targeting men who have sex with
men, Mr Gonzalo Mazuela, Spain
Mr Mazuela began his presentation by asking us to consider
what is meant by innovation in HIV/AIDS prevention.
He presented slides of several Spanish condom promotion
posters, illustrating the differentiation of messages
for different target groups. He pointed out that while
this was somewhat innovative in terms of acknowledging
different behavioural risks associated with different target
groups, it lacked any deeper understanding of the factors
which might militate against people being able to convert
the message into action.
Turning to the specific issue of targeting men who have
sex with men (MSM), Mr Mazuela explained that, in his
experience, it is at least in part the nature of the cultural
context which affected the ability of MSM to recognise,
internalise and act in accordance with these messages
about safer sex. He pointed to the lowering of their selfesteem
through the association of homosexuality with
perversion, and suggested that campaigns simply extolling
condom use and which do not take this into account
are unlikely to be successful.
He elaborated this point turning to the issue of reaching
drug users, noting that some terms used in media campaigns
and interventions do not acknowledge the meanings
attached to concepts within the particular target
groups (for example, the positive connotations of ‘risk’ in
the context of masculinity).
In Mr Mazuela’s view, these examples illustrate that currently
media campaigns promoting safer sex are not sufficiently
empathetic or sensitive to the experiences of the
groups which they are targeting. They tend, more than
anything else, to address ‘risk’, which may not always be
present, but to exclude pleasure, which usually is. He
argued that it might be necessary, therefore, to reconfigure
publicity campaigns so that they acknowledge that
MSM may use drugs in order to boost their confidence
and self-esteem, and that sex itself may then be selfaffirming
for them. He added that in this context giving
and receiving sexual pleasure and the consequent boost
to self-esteem may override any concerns with risk of
exposure to HIV. He drew a comparison between risk
of HIV infection and other risk activities like sports in
which risk-taking is not always condemned but sometimes
celebrated.
In conclusion, Mr Mazuela argued that there is a need
to strengthen positive behaviour rather than stigmatise
negative behaviour through media campaigns and other
HIV/AIDS prevention interventions. He suggested that
this requires more careful and sensitive attunement with
the target group and the adoption of a less patronising
position on the part of HIV/AIDS prevention workers.
Ms Nyambe thanked Mr Mazuela for his presentation.
She noting that it served as a reminder that HIV/AIDS
prevention aimed at gay men demands work to challenge
homophobia. She then introduced Mr Julian Hows.
8.3 Short presentations by other panel members
8.31 PLWHA and access to treatment and care, Mr Julian
Hows, United Kingdom
Mr Hows gave a short presentation in which he argued
for action to challenge inequalities in relation to access to
HIV/AIDS treatment and care. He discussed the claims
made by UNAIDS and WHO that in 2005, PLWHA in
Western Europe had universal access to treatment and
care and half of all PLWHA in Eastern Europe had access
to treatment and care. Mr Hows held these claims to be
misleading, since universal access was defined here as
representing more the 80% of the population of HIV+
persons. He commented that it was his view that those
excluded for access to treatment and care would include
the most vulnerable and marginal groups of migrants,
19