Subject: UNAIDS in Central America
From: [email-masked]
Date: Sun, 12 Apr 1998 10:49:47 -0600 (CST)

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