From: rastern@sol.racsa.co.cr Date: Sun, 12 Apr 1998 10:49:47 -0600 (CST) Subject: UNAIDS in Central America 7 April, 1998 Mr. Louis Loures Team Leader: Latin America and the Carribean Country Support UNAIDS Geneva Fax # 4122-791-4187 Dear Mr. Loures: Thank you for your fax of April 3 responding to the issues we had raised in our fax to Peter Piot of March 23. We are writing with regard to the position called "Inter Country Programme Advisor," mentioned in point #1 of your fax to us. We would like to offer either one of ourselves as potential candidates for the position, and we would ask that you would consider this as a formal application, and also make sure that any other necessary application materials are sent to us as soon as possible. Although we haven't seen a job description as such we would see some of the following as priorities for the person or persons assigned to the position in Guatemala. SOME REGION WIDE PRIORITIES 1) To immediately attempt to hold a regional meeting of government health care officials, representatives from NGO's and pharmaceutical companies to look realistically at a plan to provide the best possible medical attention for people living with AIDS. We would ask for participation by one Senior level health care offical from each country, at least three NGO representatives from each country, at least two people Living with AIDS from each country, and one Senior level representative from each of the major pharmaceutical companies. We would also ask for participation from experts in the field of health care policy, and economics as well. 2) To immediately plan a series of meetings in each country with representatives from NGO's working in both prevention as well as attention to patients. Some of the areas that we would focus on in these meetings would be: a) the importance of including HIV+ people at as many levels as possible in areas of human rights, prevention and access to medical treatment, in NGO's as employees, administrators and Board members. Obviously it is important to be sensitive to the fact that this kind of transition takes time to accomplish. b) to review the strategies of prevention in each country taking into account cultural and social factors influencing the spread of AIDS in these countries. This would result in a document for each country somewhat similar to your "strategic planning," document but it would be much more country and culturally specific. 3) Funds should be used to create a region wide week long workshop for People Living with AIDS with a minimum of five representatives from each Central American country, from diverse sectors, nominated by NGO's as well as government sources, during which in depth workshops would be held in the areas of a) human rights law and empowerment for People Living with AIDS b) advocacy strategies c) recent advances in medical attention d) strategies for encouraging participation of minorities such as women, homosexuals, etc. e) strategies for dealing with media, writing press releases,etc. The basic goal of this workshop is to train potential leaders for the HIV affected community to be able to return to their countries and participate effectively in advocacy actions, community organization, and prevention efforts. We believe that the visibility of People Living with AIDS is an important tool in prevention that can help to change the course of the epidemic in Central America. 4) Publish a monthly bulletin for the region to be distributed to NGO's, individuals and government health care officials by mail or by internet focussing on the following: a) individual personal experiences of people living with AIDS in Central America b) news from NGO's that work in AIDS in the region c) news of general interest from the region about changes in the areas of human rights and access to treatment for people with AIDS. d) news about creative and innovative approaches to prevention in different sectors of the population e) news for women about women's issues that would be related to prevention and human rights issues. f) news for gays and other sexual minorities related to human rights, medical attention and prevention strategies. g) news for sex workers related to human rights, medical attention, and prevention strategies. h) news directed at youth leaders and school personnel. It is important to mention that the methodology used for distribution of this bulletin is as important as the contents. In many cases important news about AIDS in our region only reaches the desk of the already empowered NGO directors, their assistants and those very few persons who have access to internet. We would endeavor to make this Bulletin available in the community whereever our target population is likely to be able to receive it, i.e. bus stops, bars, brothels, community meeting places, schools, universities, etc. We would consult with knowledgeable people in each country to see how an effective distribution might best be accomplished. 5) In each country we would see it as imperative to hold a series of "open houses" for various influential sectors such as government, medical, religious, business, education, and NGO: These open houses would convene leaders is each of the above areas and focus on visibilizing the epidemic and raising the conciousness of these leaders about AIDS and providing them with recommendations for issues that they could begin to address in their respective spheres of influence. FUNDING PROCESS CLARIFICATION We would, taking into account realistic budgetary limits, endeavor to make available to all NGO's, grass roots organizations, etc, concrete procedures for presenting innovative proposals for funding and we would give priority where appropriate to those proposals which include the participation of People Living with AIDS as executors of the program. We also feel it would be important to make public all information about salaries and budgets of UNAIDS in the central American region, for anyone who requestedd it. PREVENTION PRIORITIES With respect to prevention, there are four main avenues that should be given priority and all of these are interrelated: 1) one of the main focusses of prevention in the Central American Region, should be in schools, both primary and secondary, because of the fact that a high percentage (although not all) of young people can be reached in the schools. There needs to be a comprehensive program with written as well as audio-visual materials available to public and private school systems and there need to be trained counselors or teachers available to implement this program. A region wide meeting of Education Ministry leaders to address this problem would be important. If the Education officials were in agreement it would be important to begin to seek the most practical method of training the appropriate personnel in each country. There are cultural and religious issues and obstacles to an effective school based prevention program that must be resolved, but as the epidemic has widened perhaps religiously based objections will be somewhat less than before and the issues related to an effective school based prevention program could be addressed. 2) a second issue with relation to prevention is the visibilization of the epidemic in the popular press, (TV, radio and print media,) with an accurate and complete coverage. For this we would recommend a region wide workshop to train journalists in the area of AIDS and also to seek a committment from the communication media to publish more and better information about AIDS, not just sensationalistic material that is of little real value. In Costa Rica in the past year, we sent press releases which resulted in the publication of more than 40 articles, as well as numerous TV and radio interviews and we feel that this has had important impact on prevention as well as treatment. 3) There is the obvious need to continue to reinforce and strengthen NGO's that carry out programs of prevention with specific minority populations such as women, sexual minorities, and sex workers. It would be important to attempt to have a region wide summit of NGO's to facilitate a better sharing of similarities and differences of programatic approaches as well to attempt to dialogue about these approaches and to strengthen communication between these groups. Obviously representatives from these NGO's must participate in the workshops and open houses that we have described in previous points. 4) There is a need to address the problem of children who do not attend school. In most of the Central American countries there are significantly large numbers of children who leave home at an early age and are at risk for sexual abuse, and/or prostitution. It is necessary to support the NGO's that work with these children, and include them in prevention planning. FUNDAMENTAL PRINCIPALS FOR QUALITY REPRESENTATION In General we feel that the role for regional representative(s) must take into account the following issues which we feel are critical: a) the recognition that People Living with AIDS themselves, because of the terrible discrimination they have suffered are extremely reluctant to get involved, to sign complaints etc. It is very delicate process requiring incredible patience to work with victims of discrimination in a machista, vertical, culture. The "visibilization" of People Living with AIDS will be extremely important in prevention efforts b) the need to draw attention in the media, on a national as well as international level, to the discrimination and abuse which occurs in our region, as well as helping the media to play a more important part in prevention efforts. c) to look for empowered leaders from the target group of people with AIDS who can begin to assume a role of leadership and importance in drawing attention to the problems of their own group and to serve as models for others members of the target population. d) to support the empowerment of smaller and less well developed NGO's in the region by providing support and recognition for them whenever possible. To recognize that to a certain extent, even in the world of those who work with the AIDS affected community, there may be imbalances of power that need to be addressed and worked through. e) it is important that UNAIDS analyze and remediate the situation that has occurred in the past few years where the impact of UNAIDS programs in Central America has been minimal. The representatives must be persons who have lived through and been part of the response to the epidemic in central America and who are dynamic and energetic and creative in their approaches. We also worry that a very high salary for this position may tend to lend itself to have representatives that move in "elite" circles. The elitism of professional classes in our region is a problem in that these often very knowledgeable and qualified persons are simply out of touch with what happens at a "grass roots" level. We have heard a "rumor" that the advertised salary for the Inter Country Program Advisor is over $50,000 per year. We feel that a salary of $15,000-18,000 per year (which is equal to what most Agency Directors receive) is sufficient to attract qualified professionals from the region who would do a good job, and that this kind of budgeting could actually allow for Regional Commission of five or six Representatives instead of just one or two. e) to understand as completely as possible the nuances of the local culture and its impact on human rights, on the resolution of conflicts, and on the victims themselves. In Costa Rica, for example, this has involved a thorough understanding of several elements including: --the nature of the machista, heterosexist culture and its impact on sexual minorities and women who live with the AIDS virus. --the understanding of how cumbersome bureacratic procedures are used to discourage and confuse people with AIDS and their advocates. --to understand how government officials on the one hand can be innovative and progressive, if they understand the importance of being so, yet on the other hand they are responsive to a great variety of social forces and influences, some of which impede their being progressive. --the impact in Costa Rica on a person living with AIDS if family, or employers discover their HIV status. --the basically non-confrontational nature of Costa Rican culture where it is viewed as inappropriate to publicly engage in a dispute. This ultimately works against People with AIDS because they have a great deal of trouble expressing feelings of anger and frustration. --to understand the importance of patience, and persistence in denouncing human rights violations in a culture where these issues may not be seen as important. To continually reinforce and support People with AIDS in recognizing that changes happen very slowly but that it is important to persist, and to continue to denounce and call attention to these situations even when it appears that nobody is listening. -- to recognize the importance of involving the medical community, where possible, in taking initiative to advocate for better attention to patients and also for more honest and effective efforts at prevention. OUR REQUEST TO YOU We ask that you make available to both of us as soon as possible any additional application materials that would be necessary to complete the application process. Please also indicate to us to whom we should direct our Curriculum Vitae, letters of recomendation, and published articles related to AIDS in this region. You had made reference in your fax to a "selection committee composed of representatives of the Co-Sponsoring Agencies." Could you please provide us with the appropriate means to contact the selection committee. Because we feel that issues to be discussed regarding the appointment of the Inter Country Programme Adviser should be placed in the public forum, we will distribute this letter to other interested parties in our region. We would also appreciate if you could confirm that you have received this fax. Sincerely (signed) Richard Stern Apartado 366-2200 Coronado, Costa Rica Tel/Fax 506-234-2411 (signed) Guillermo Murillo Apartado 43-1300 Hatillo, Costa Rica Tel: 506-433-8522 Fax. 506-234-2411 cc. Central American NGO's Peter Piot, Director, UNAIDS Dr. Merlin Fernandez, UN Theme Group, San Jose