2016 SCORA World AIDS Day Manual

The 2016 SCORA

WORLD AIDS DAY MANUAL

IFMSA Imprint Standing Committee Director Carlos Acosta - Brazil International Team Carles Pericas Escale - Spain Anthony Kerbage - Lebanon Afolabi Oluwatoyosi Tolulope - Nigeria Jenna Webber - Canada Anshruta Raodeo - India Elissa Abou Khalil - Lebanon Pepe Ferrer Arbaizar - Spain Publications Team Firas Yassine - Lebanon

The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains 130 National Member Organizations from 122 countries across six continents, representing a network of 1.3 million medical students.

IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future.

IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

Publisher International Federation of Medical Students’ Associations (IFMSA)

This is an IFMSA Publication

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Contents

Welcome Message Page 3

World AIDS Day Theme Page 4

HIV Testing Page 5

HIV-related Stigma & Discrimination Page 7

How Can We Help?

Page 9

Our Campaign Page 11

Suggested National & Local Activities

www.ifmsa.org

Page 13

Basic Information About HIV-related Topics Page 15 Online Resources Page 18

HIV/AIDS & Other STIs Program Page 18

Acronyms Page 20

Collaborators Page 20

Welcome Note Dear SCORA family,

Carlos Andrés Acosta Casas Director on Sexual & Reproductive Health incl. HIV/AIDS 2016-17

We are about to have one of our main celebrations soon!

This year, World AIDS Day will have a great working reference frame: the new developments that we’ve made in the past few months. The world has radically changed its strategy to end AIDS by 2030. Sounds promising, isn’t it?

But as future healthcare workers we are going to have to deal with the direct barriers that limit progress in this specific area. HIV is all about primary healthcare and this is the first point we want to raise with the campaign. It depends directly on community-based influences. This means that we need to place ourselves in a classroom without walls to understand the organic developments of HIV and use these in order to guide our patients to a healthy lifestyle. We have so much to do! It may seem overwhelming but we believe it is somehow reachable and absolutely crucial, especially when you discuss and expand the virus outside the medical nook and into social determination.

The second thing that we want to transmit is youth participation and key populations. These two overlap in many ways and create what we call overlaid stigma. We generally forget that people are not just one characteristic but rather a conjunction of features that are in kinetic movement. Therefore, we need to be always in movement with them. Lastly, I wanted to thank all Angel members of the SWG for their hard work and what is yet to come in the next weeks!

Let’s make this WAD great!

Warm Hugs,

Carlos

World AIDS Day Manual 2016

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World AIDS Day Theme

#Get Tested: on the Road to 90-90-90 Why? Some have called it “ambitious,” others have debated its “achievability,” but all agree on the necessity of ending AIDS globally by 2030. To-date, almost 40 million people have died from AIDS-related diseases worldwide[1]. This unfortunate statistic becomes even more dismal when one considers that these deaths could have been prevented with appropriate prophylaxis. All 40 million people died prematurely. It has been proven that people diagnosed with HIV and given appropriate antiretroviral therapy will have lifespans comparable to uninfected people[2]. Thus early detection, and sustained and appropriate antiviral treatment are vital to survival.

In 2010, there were a staggering 8,220 new infections per day worldwide[3]. In 2014, the new infection rate dropped to 5,500 per day[3]. Though progress has been made, it is too slow and not dramatic enough to make a significant and impactful difference. It has been projected that there will be as many as 2.5 million future adult HIV infections per year costing 1.5 billion USD per year; thus, the health and economic implications are disastrous and unsustainable[3].

To curb this trend, there have been several targets set over the last 13 years, with the latest one embraced by the Coordinating Board of the United Nations’ AIDS Program[1,2,4,5]. Using the momentum of prior campaigns, a new set of goals were implemented in December 2013 called “90-90-90.” A three-fold plan, 90-90-90 combats HIV and AIDS on the global level by using antiretroviral treatment as prevention. Its objectives are that by 2020: (1) 90% of people living with HIV will be diagnosed, (2) 90% of people who those diagnosed will receive antiretroviral therapy, and (3) 90% of those on antiretroviral therapy will be virally suppressed[2,5].

The arduous road to eliminating AIDS worldwide by 2030 can be traversed successfully with HIV testing; thus we propose this year’s World AIDS Day theme as 4

#GetTested.

There is undeniable power in knowing one’s HIV status.

The goal of reducing the morbidity, mortality, and transmissibility has been outlined by the Coordinating Board of the UNAIDS Program[1]. The major advantage of early diagnosis is early antiretroviral therapy initiation, thus increasing viral suppression and decreasing the HIV transmissibility, which has been scientifically proven to be key in the management of the “AIDS healthcare crisis[1].” Despite this optimism, 90-90-90 doesn’t come without scrutiny. Scholars are critical of the large scale implementation necessary for universal testing and treatment[4]. Encouraging more people to get tested requires novel ideas in overcoming accessibility an issue especially relevant amongst marginalized populations, and in underserved and rural areas of the globe[4]. Counselling is quintessential in drug therapy compliance and thus, the human resource burden necessary to support those recently diagnosed must also be considered. Additionally, as an offense to drug resistance, countries are encouraged to have at least three lines of drug therapy, but in poor countries this is hard to realize due to lack of resources or difficulties in accessing them[4].

If successful by 2020, 73% of all people living with HIV globally will be virally suppressed. With viral suppression, the AIDS epidemic could be over by 2030 worldwide which would be a phenomenal feat. #GetTested!

1. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. First ed. Joint United Nations Program on HIV/AIDS (UNAIDS).; 2014 [cited 5 November 2016]. Available from: http://www.unaids.org/sites/default/files/ media_asset/90-90-90_en_0.pdf 2. Dr. Julio Montaner speaking on 90–90–90: A treatment target to help end AIDS. British Columbia Centre for Excellence in HIV/AIDS; 2015.

3. Ambassador Deborah Birx speaks on moving the 90/90/90 objectives into implementation. British Columbia Centre for Excellence in HIV/AIDS; 2015.

4. Gray G. HIV, AIDS and 90-90-90: What is it and why does it matter?

The Conversation. 2016 [cited 5 November 2016]. Available from: http:// theconversation.com/hiv-aids-and-90-90-90-what-is-it-and-why-does-itmatter-62136 5. Global HIV targets | AVERT. Avert.org. 2016 [cited 6 November 2016].

Available from: http://www.avert.org/global-hiv-targets

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HIV Testing What is HIV Testing?

HIV testing is the only way to know whether you are living with HIV. It refers to analysis of a sample of bodily fluid (typically blood) for antibodies to HIV and/or viral components. According to UNAIDS and WHO, testing must be confidential, provide the correct test results, occur only with the client’s informed voluntary consent and be accompanied by counselling about the results and connection to prevention, care and appropriate treatment[1]. There are three major modalities of HIV testing: client-initiated, which constitutes the bulk of global HIV testing, provider-initiated and self-testing[1].

Importance of HIV Testing

Globally, only 54% of people living with HIV are aware of their HIV status.2 Improving testing rates is crucial to achieving the 90-90-90 goals, as HIV testing is the first step on the pathway to effective treatment and prevention[1]. A significant percentage of new HIV infections can be traced to individuals unaware of their HIV status and awareness is key for initiating preventative measures and treatment [3].

Antiretroviral treatment leads to lower viral loads, therefore initiation of successful treatment is crucial for prevention [1,3]. Testing also empowers individuals living with HIV by allowing them to seek out treatment and support, and take action in protecting their health.

Barriers to HIV Testing

In any discussion of testing, it is crucial to understand and address how stigma and discrimination create barriers to client-initiated HIV testing. Fears of a positive result and mandatory disclosure, accessibility barriers to testing sites, stigmatizing behavior by health care workers, lack of treatment availability or knowledge about treatment effect can all reduce HIV testing rates [1,3].

Types of HIV Tests

There are multiple available options for HIV tests[1].

Decisions regarding modality choices can be made using the WHO Guidelines and/or testing algorithms at the national level[1].The WHO recommends that World AIDS Day Manual 2016

an HIV-positive diagnosis should be made using two sequential reactive tests in high-prevalence settings (>5% prevalence) and three sequential reactive tests in low-prevalence settings (<5%)[1]. A combination of testing modalities may be used based on cost, accessibility, availability, location of the test (clinic vs. community) and window period (duration of time between HIV infection and appearance of a positive result on a given test). All individuals with a positive result should receive comprehensive post-test counselling and connection to treatment services, and all individuals with a negative result should receive health information about prevention[1]. According to the WHO, routine HIV testing should be offered to all clients of all ages in all clinical settings in generalized epidemic settings and in lowerlevel or concentrated epidemic settings, as well as to all clients who present with symptoms or elevated risk for HIV infection[1]. Community-based testing services may also be offered (e.g. mobile outreach campaigns) to access harder-to-reach populations or first-time testers[1].

Priority populations for testing include adolescents, pregnant women through a provider-initiated approach, men, partners of people living with HIV, MSM, people who inject drugs and commercial sex workers and other vulnerable populations (e.g. migrant workers, refugees and people with limited access to health care)[1].

Rapid Test Rapid (point-of-care) tests allow individuals to be both tested for HIV and given their results within the same visit. Rapid tests can provide results in less than half an hour, eliminating the need for a subsequent clinic visit for clients to receive their results, decreasing anxiety during wait-times and allowing for results counselling to occur within the same visit[4]. Evidence suggest that rapid tests are effective in targeting first-time testers, traditionally hard-to-reach populations and people unaware of their HIV status, and ultimately improve overall rates of HIV testing[5].

Rapid tests are screening tests and not diagnostic, and therefore a positive rapid test, which is referred to as a preliminary positive or reactive result, should be followed by a laboratory-based test (e.g. Western Blot) to confirm the results[5]. In most cases, if a rapid test is 5

HIV Testing non-reactive, no further testing is required. However, in some cases where there has been a suspected recent high-risk exposure to HIV, laboratory testing can be used to confirm the negative result[5].

EIA Tests EIA tests, also know as ELISA tests, refer to enzyme immunoassay tests, which detect antibodies to HIV[4].

Window periods vary for these tests based on test generation. In antibody-based tests, it is important to be aware of whether the HIV test covers HIV-2 in addition to HIV-1, if an HIV-2 infection is suspected[1].

• 3rd generation EIA detect both IgM and IgG antibodies within approximately 6 to 12 weeks[1,4] • 4th generation (combined) tests combine a test for p24 viral antigen with a 3rd generation HIV antibody test[1,4] P24 antigen levels are detectable in most people by 20 days after infection. However, they being to decline within 3 to 4 weeks after infection and are no longer detectable by 5 to 6 weeks post-infection[4].

Anti-HIV antibodies are detectable after the window period (approximately 6 to 12 weeks) and remain detectable throughout the trajectory of HIV infection.

HIV infection is detectable in “50% of people by 18 days after infection, 95% of people by 34 days and 99% of people by a month and a half[4].”

14 days). However, their high cost limits their use and accessibility, and they are may be primarily used for testing among higher-risk populations[4].

P24 testing Exclusive p24 antigen testing is another testing option that can be used as a confirmation test following a nonreactive rapid test result[4].

Self-Testing Kits Self-testing for HIV can either be supervised and restricted to clinic use or distribution by community health care workers, or can be non-restricted and unsupervised with open access (home-testing kits)[6]. Self-testing kits can either be blood-based (finger-prick) or using oral fluid (e.g. OraQuick In-Home HIV Test)[5,6]. Advantages to self-testing kits include decreased barriers related to stigma and discrimination and improved accessibility to testing[6]. However, there are legal concerns about disclosure of HIV self-testing results depending on national laws, accurate interpretation of test results and ensuring access to appropriate counselling and treatment[5,6]. Overall, accuracy and acceptability for HIV self-tests are high, with blood-based tests have a higher sensitivity and specificity than oral fluid tests[6].

HIV self-tests should also be considered a screening test and not a first-line assay and are only accurate outside of the 6 to 12 week window period[5].

Western Blot Tests Western Blot tests are an antibody-based and are often used to confirm reactive results from an ELISA or rapid HIV tests. They have the longest window period (approximately 2 months), are more expensive and require more skilled training[1,4]. However, their specificity is higher and therefore their utility lies in ruling out falsepositive results from the more sensitive yet less specific EIA tests.

NAAT Testing NAAT testing detects small quantities HIV nucleic acid (e.g. DNA and RNA) and has the shortest window period of all HIV test types (a window period of 7 to 6

1. World Health Organization. Consolidated Guidelines on HIV Testing Services.

Geneva: WHO Press; 2015 [cited 2016 November 5]. Available from http:// apps.who.int/iris/bitstream/10665/179870/1/9789241508926_eng. pdf?ua=1&ua=1 2. UNAIDS. Press Report. 2014. Available from http://www.unaids.org/ en/resources/presscentre/pressreleaseandstatementarchive/2014/ july/20140716prgapreport 3. Wilton, J., & Broeckaert, L., The HIV treatment cascade – patching the leaks to improve HIV prevention. CATIE: 2013 [cited 2016 November 5]. Available from http://www.catie.ca/en/pif/spring-2013/hiv-treatment-cascade-patching-leaksimprove-hiv-prevention 4. Wilton, J. HIV testing technologies. CATIE: 2015 [cited 2015 November 5]. Available from http://www.catie.ca/en/fact-sheets/testing/hiv-testingtechnologies 5. Broeckaert, L., & Challacombe, L. Rapid point-of-care HIV testing: A review of the evidence. CATIE, 2015 [cited 2016 November 5]. Available from http:// www.catie.ca/en/pif/spring-2015/rapid-point-care-hiv-testing-review-evidence 6. UNAIDS. A short technical update on self-testing for HIV. WHO Press: Geneva, 2014 [cited 2016 November 5]. http://www.unaids.org/sites/default/ files/media_asset/JC2603_self-testing_en_0.pdf

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HIV-related Stigma & Discrimination Definition of Stigma HIV-related stigmatization[1], then, is a process by which people living with HIV are discredited. It may affect both those infected or suspected of being infected by HIV and those affected by AIDS by association, such as orphans or the children and families of people living with HIV.

Reasons behind HIV-related Stigma Stigma related to the mode of transmission people are still afraid that HIV can be transmitted through ordinary, daily interactions with people living with HIV and AIDS. Even though the particulars varied in each setting, people are preoccupied with unlikely modes of transmission. Usually, the fear is that HIV could be transmitted by mosquitoes or through non-invasive contact with blood, sweat, diarrhea or other bodily fluids, but sometimes the “what if scenarios” were quite far-fetched. For example, in Ethiopia, there was a fear that raw chicken eggs could transmit the virus, if hens came upon and pecked at used condoms Even though people know that HIV is spread through bodily fluids, this is vague and leaves room for people to extend what they know about other infections to HIV. Fear of transmission leads directly to stigma such as the avoidance or isolation from persons living with HIV and AIDS[2]. Sometimes even healthcare workers share this fear — despite their knowledge of how HIV is transmitted, they lack confidence and knowledge about how HIV is not transmitted.

Stigma related to the fate of the disease This fear of acquiring HIV is amplified when public health campaigns focus primarily on negative images of sick and dying, as well as by sensationalized media reports.

Stigma related to values, norms, and moral judgment The link between stigma and morality is an ancient one and is apparent in the original definition of the word, which meant a mark or physical sign of something morally bad.

In addition, there was a tendency across contexts World AIDS Day Manual 2016

to create a continuum between guilt and innocence related to “how” someone acquired the virus. On the innocent side of the continuum are children, followed by health workers obtaining the virus through procedures; while on the guilty end are the drug users and sex workers. Given that sex work and drug use are already socially unacceptable, the “guilty” infected are doubly stigmatized. A Woman living with HIV could be near either end of the continuum, depending upon whether she is believed to have become infected while faithful to her husband (innocent) or otherwise (guilty).

Internalized stigma It should only be expected that PLHIV would also start to stigmatize themselves, since they share the same beliefs as the rest of the community and are constantly subjected to the cruel, thoughtless, and hurtful actions from others. Some of the commonly observed forms of internalized stigma in the ICRW research included loss of hope, feelings of worthlessness (even suicidal feelings) and inferiority, and belief that they no longer had a future. School drop and giving up major plans are also persistent consequences.

Myths and Facts of HIV Myth People with HIV are a public health risk.

Fact HIV is difficult to acquire as It cannot be picked up during day-to-day contact and good hygiene practices are enough to protect healthcare workers. Also by using condoms we can prevent HIV transmission to sexual partners. Mother-to-child transmission of HIV can be prevented in nearly all cases with the right treatment and care[3].

Myth HIV is a death sentence.

Fact Untreated HIV can be fatal

and people do still become ill because of HIV, But HIV treatment is highly effective as most of the people who receive HIV treatment at the right time, take it as prescribed and look after their health will live a long and healthy life. It is true that treatment outcomes and patient adhesion to the treatment are highly influenced by the discrimination faced on a daily basis[3].

Myth

Finding out you have HIV will prevent you from living fully.

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HIV-related Stigma & Discrimination Fact

Most people living with HIV experience health problems, loneliness, exclusion, poverty or unhappiness.

All too often, such experiences are related to the discrimination that people with HIV experience from others. Living with HIV does not imply a constant gloomy lifestyle. Many PLHIV maintain and form new close relationships, have the support of their families, have children without putting others at risk of HIV, have fulfilling love and sex lives, maintain and develop careers and make plans for the future just as anybody else[3].

Definition HIV related discrimination There is discrimination occurring in family and community settings, which has been described by some writers as ‘enacted stigma’. This is what individuals do either deliberately or by omission so as to harm others and deny to them services or entitlements. Examples of this kind of discrimination against people living with HIV include: ostracizing, shunning and avoiding everyday contact, verbal harassment, physical violence, verbal discrediting and blaming, and denial of traditional funeral rites[4].

Then there is discrimination occurring in institutional settings—in particular, in workplaces, health-care services, prisons, educational institutions and social-welfare settings. Such discrimination crystallizes enacted stigma in institutional policies and practices that discriminate against people living with HIV, or indeed in the lack of and discriminatory policies or procedures of redress.

Examples of this kind of discrimination against people living with HIV include the following.

• Health-care services: reduced standard of care, denial of access to care and treatment, HIV testing without consent, breaches of confidentiality including disclosure towards relatives and outside agencies and the criminalization for non-disclosing, negative attitudes and degrading practices by healthcare workers.

• Workplace: denial of employment based on HIVpositive status, compulsory HIV testing, exclusion of HIVpositive individuals from pension schemes or medical benefits.

• Schools: denial of entry to CLHIV, or dismissal of teachers.

exclusion from collective activities. A significant number of countries, for example, have enacted legislation with a view to restricting the rights of PLHIV. These actions include: Compulsory screening and testing of groups and individuals and The prohibition of people living with HIV from certain occupations and types of employment among others.

Effects of Stigma and discrimination One in every eight people living with HIV is being denied health services because of stigma and discrimination[5] Stigma and discrimination in a Healthcare Setting are often rooted in the lack of knowledge about HIV transmission and AIDS, or the association between AIDS and death. Consequently, to the ignorant tendency, misconceptions about a person’s HIV status, behavior, sexual orientation or gender identity could determine discriminatory practices. Such attitude leads to limit access to HIV testing, treatment and other HIV services and furthermore slow down the effort to prevent new transmissions and engage people in HIV care and support program[6,7].

Research has proved that people who are stigmatized and discriminated because of their HIV status often suffer from depression, despair, low self-esteem, isolation[8].

Only when stigma and discrimination are reduced within a society can prevention and treatment services reach their maximum potential levels of efficacy[9].

1. UNAIDS HIV - Related Stigma, Discrimination and Human Rights Violations 2. http://www.aidsmap.com/pdf/HATIP-56-13th-October-2005/ page/1037657/ 3. http://www.aidsmap.com/files/file1001097.pdf 4. UNAIDS HIV - Related Stigma, Discrimination and Human Rights Violations 5. UNAIDS (2015) ‘On the Fast-Track to end AIDS by 2030: Focus on location and population’ 6. Katz, I.T. et al (2013) ‘Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis’ JIAS 16(Supplement 2):18640 7. http://www.avert.org/professionals/hiv-social-issues/stigma-discrimination 8. First ed. 2016 [cited 7 November 2016]. Available from: https://www. engenderhealth.org/files/pubs/hiv-aids-stis/reducing_stigma_participant_ english.pdf 9. HIV Cost-effectiveness | Guidance | Program Resources | HIV/AIDS | CDC. [cited 7 November 2016]. Available from: http://www.cdc.gov/hiv/ programresources/guidance/costeffectiveness/index.html

• Enclosed Settings: mandatory segregation of PLHIV,

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How Can We Help?

Let’s Make a Difference The HIV pandemic affects every country on every continent in the world. Although in the last decades we have been making great progress in reducing new infections and helping those affected by HIV or AIDS, there is still lots of work to do. Change should come from people of all ages, all origins, all professions and all characters. But why should we, as young medical students, form a major part in the fight against HIV and Aids?

1. We are affected Over two million people became newly infected with HIV in 2015[1]. What’s most striking is the fact that 34% of the global new HIV infections among adults in 2015 trace back to people of the age between 15 and 24[2] — people like you and me. This clearly shows how important it is to focus on youth in terms of awareness, STI-testing, access to treatment and, first and foremost, education!

Every man and every woman should have equal chances to access information about HIV transmission, to ask questions and be responsible for their own safety.

Only who knows how they can get infected can take of themselves when it comes to protection during sexual intercourse, in drug-use or other situations where there is a high risk of a HIV-transmission.

2. We should act as role-models We as students or young doctors play a crucial part in our society since we function as a link between the adolescents and adults. We are young enough to remember our teenage years well, to be understanding towards our younger fellows and build a strong and trustful relationship with them. This is our time to peereducate, to pass on values and knowledge and to be a safe harbor for talking about problems and insecurities.

All this applies to HIV-prevention. If we are not the right persons to talk to teenagers about sex, who is?

We are old enough to be on a par with other adults and engage in public discussions, in health policies and get involved in decision-making processes. Even if it sometimes seems difficult to let our voices be heard, we need to stand up for our opinion, be an active part in the society and not settle for being labelled as the inexperienced. Our experience, our skills and our values World AIDS Day Manual 2016

are worth to be heard and recognized. Keep your chins up!

3. We have precious knowledge to share Let’s not keep the knowledge that we gather in med school for ourselves. Sometimes it is hard to grasp how it can be that so many people become newly infected with HIV in parts of the world where we think information is accessible. We tend to forget how little people talk openly about sexuality and especially about the very most uncomfortable part of it: STIs. If you are not forced to learn about it in university, would you spend your freetime researching on sexually transmitted infections when you have no symptoms or pain?

Let’s give people the feeling there is more to know about and that it is worth spending an afternoon with. Let’s offer easy access and comprehensible information and let’s not be afraid to bring the subject up.

4. We are and will become health workers As health care professionals we face different challenges to make a contribution to the 90-90-90 target. And there is still a whole lot for us to learn.

90% of HIV-positive people know about it The best way to fight HIV is first, to prevent it, and second, to diagnose it. Today’s medicine makes it possible to treat HIV so far that Aids is not an inevitable event anymore. But for treatment to start it is necessary that a patient knows they are HIV-positive.

What we can do as doctors is to train ourselves in: • Discovering a patient’s risk for HIV; • Talking with the patient about their sexual life; • Doing a proper sexual anamnesis; • Encouraging patients to #GetTested 90% of those who know about their HIV-positive diagnosis are being treated with antiretroviral therapy Providing the best possible treatment of an HIVinfection is not only giving access to it. Without the patient’s compliance and his understanding for the necessity of the treatment every medication will be useless.

As future doctors we are the main contact person 9

How Can We Help? for someone living with HIV or AIDS in regard to their condition and therefore we should be eager to provide an open environment for concerns, questions and problems related to HIV/AIDS in all areas of life.

When we are concerned about the patient’s overall well-being which includes for example their social life or their mental health, we can make sure we’re on the same page and offer the best help when we talk with the patient about their treatment.

The most important thing for a patient to agree to visit a doctor on a regular basis and to be treated is to feel welcome. Lots of stigma towards people living with HIV or AIDS does not come from social environment and working place, it comes from the health care providers themselves, mostly out of insecurity how to handle the situation. Often we do not necessarily notice when we stigmatize, so let’s pay attention to some kinds of stigma performed by health care providers: • Judging! Blaming patients for their infection, saying they could have known better.

• Assuming the patient belongs to a population group that is known for a higher risk of HIV infection (e.g. assuming the patient is gay without talking about it).

• Unnecessary caution, e.g. » Treatment only at the end of the consultation hours » Visible warning notes in the patient’s health record, » Examination in extra rooms, » Wearing two pairs of hand gloves, » Overdoing the disinfection of the room after examination and doing a special cleaning of equipment.

90% of the treated HIV-positive patients have viral suppression We need to continue our education permanently! By informing ourselves constantly about results of the latest research, new treatment guidelines and HIVstatistics we ensure that we do the best science can offer for the patient. Also it reduces our insecurity

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in treating an HIV-infection which will help us to communicate confidence and which will make the patient feel to be in good hands.

5. We build the future!

There are so many possibilities for our contribution! If we as IFMSA join altogether we can make a great change, be it our advocacy for solidarity with HIV-positive people, our distribution of information and education or our behavior when we ourselves practice medicine. Be it on a local, national or international level: Every step towards the eradication of HIV/Aids and the associated social injustice counts.

Let’s make a difference !

1. UNAIDS: Fact sheet 2016 - Global statistics 2015. 2016 [cited 3 November 2016]. Available from: http://www.unaids.org/en/resources/fact-sheet 2. UNAIDS: Global Aids Update 2016. 2016 [cited 2 November 2016].

Available from: http://www.unaids.org/sites/default/files/media_asset/globalAIDS-update-2016_en.pdf

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Our Campaign Infographics for the People

Meeting the Voices Unheard

WAD is one of the best occasions to raise awareness about HIV/AIDS and spread information and knowledge about the epidemic because educating is one of the best ways to eradicate HIV/AIDS.

There are a lot of misconceptions about what it means to be living with HIV. Ultimately, everyone’s lives are different, how one cope with the diagnosis and how you move forward will be unique.

And this year, to make education simple, easy, captivating and less complicated, we decided to dedicate a part of our campaign to infographics!

This year’s campaign will include a testimonial booklet with small stories or interviews from people whose lives has been touched by HIV in some sort of way. It can be either a HIV-positive person, someone who has a family member or a friend living with the diagnosis, or a healthcare/social worker involved the field of HIV/AIDS in any way.

Through those infographics, we will be tackling different areas related to the HIV/AIDS epidemics which are the following: 1. Advantages of early diagnosis 2. Children Living with HIV 3. Vertical Transmission 4. Pros & Cons of PrEP 5. Myths/Facts 6. HIV transmission in injection drug users And if you’re asking yourself how you would be able to participate in this activity, here are many ways in which you can contribute: 1. If you think have any relevant topic on which you would like to have an infographic, don’t hesitate to send us your suggestion for anyone of the infographics team members!

2. READ, READ & SHARE! The main purpose of this activity is to increase knowledge about different topics related to the HIV epidemic among medical students first but everyone and anyone else too! So please, take your time reading them, share them widely and help us spreading the word!

If you have any questions, suggestions, ideas or contributions to this activity, please feel free to contact anyone of the team members or coordinators!

Members: Baha’a Bilal Al-Momani (IFMSA-Jo): bahaabelalmomani@gmail.com Ahmed Mohamed Saleh (IFMSA-Egypt): ahmed_saleh96@live.com Eliza Maria Froicu (FASMR): elizamariaf@gmail.com

We aim to include stories from all around the world and want to include a broad range of takes and perspectives.

In order to have as global of a representation as possible and make this really impactful we would like to ask all our fantastic SCORAngels for your help to collect and send in a short story from your country to include in this year’s campaign.:) The testimonials will be completely anonymous and can be anything from 150-500 words. They can cover any subject related to HIV, topics such as healthcare experiences, stigma, access to treatment, reasons why people think the fight against HIV is important, or simply anything else the person would like to talk about.

Email your testimonials or any questions to: hivaids@ifmsa.org. Deadline: Nov. 24, 23:59 GMT

Let's show the world!

Our campaign wouldn’t be complete without hitting the internet with an attractive online campaign.

Anyone can upload a temporary profile picture to show support (using a link that will be shared during the campaign). It is really important for passionate SCORAngels to change their profile picture, share the link and spread the word!

This online campaign will help us break the distance barrier and reach a wider audience across the world, thus making our campaign a lot more effective and impactful.

Coordinators: Elissa Abou Khalil (SCORA RA for EMR): ra.scora.emr@ifmsa.org World AIDS Day Manual 2016

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Our Campaign Strengthen the Knowledge On WAD we will have an online capacity building space for all our international community! We will have external guests (excitement) to speak about the 90-90-90 Strategy: aims challenges and barriers with us! The webinar will be approximately of 1h30min and we will provide a space for comments or questions to the speakers!

Quiz: Challenge yourself!

How much do you know about HIV? This year, we want you to test your knowledge on HIV/AIDS, and evaluate the information you were able learn from the campaign! This is why we have created a multiple choice quiz that we will post on the SCORA communication channels; this quiz will have many questions regarding some of the most important information there is to know about HIV/AIDS. We will make it interesting by having many questions based on all the information shared throughout the campaign: the topics tackled in this manual, the infographics and the toolkit!

So show us how aware and informed you are about HIV/AIDS and ace this test!

Step 1: Do this quiz once before you read anything tackled in this campaign Step 2: Do it again after the campaign Step 3: Compare your scores: this way, you will see how much progress you made!

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Suggested National & Local Activities Capacity Building Globally, the HIV/AIDS community has worked hard to realize the Sustainable Development Goal of ending the AIDS epidemic by 2030. One crucial part of this plan is bringing HIV treatment to all who need it. The 90-90-90 concept is one part of this plan. The idea is that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretroviral will be virally suppressed. Last year: stigma and discrimination getting to zero, and we’ve been doing this for the past 4 years. Now, we have to add tackling vertical transmission and children living with HIV/AIDS as the fast track.

So, below are examples on capacity building on which you can use while preparing your national and local activities by going in with the SDGs. Peer education for healthcare students focused on HIV, through workshops, debates, webinars and seminars: On this point, we can brainstorm about various facts on HIV. In that, you may refer to what WHO say about it, its new guidelines and the road to eradication, and our interventions to and impact on fighting HIV/AIDS. Remember also to talk about vertical transmission and prepare advocacy for it, wherever is necessary in your settings.

Organizing Interactive lectures or round-table discussions with prominent externals: This point, despite being more scientific, we can build up knowledge on HIV, create new approaches for delivering the necessary knowledge to our target population with skillful awareness, a contribution to the 90-90-90 concept.

Trainings of future healthcare professionals on how to deliver a positive HIV result: This includes any person with a relation on healthcare provision being whether, a doctor, a medical student, a nurse or public health and community health workers, etc. In our NMOs, we have local and national public health trainers specialized in Behavioral sciences or clinical psychology including counselling on HIV and other stigmatizing diseases. So, let us get their contribution onto this.

Trainings on how to identify, avoid and fight current stigma and discriminatory healthcare practices: This is quite self-explanatory, but we cannot forget to remember that we have to be on the fore front to avoid stigma and World AIDS Day Manual 2016

discrimination and anything which can result to that.

So, throughout our clinical practices, we should have a daily recall to ourselves, our co-workers including nurses and cleaners that HIV patient’s proper care and confidentiality are their rights and a crucial thing Researches and evaluations: This the last but not the least, which would keep you updated on the current situation on HIV, help you identify the unfilled gaps in your locality or country and is the contribution to evaluation of any governmental or non-governmental interventions. Hence a step towards 90-90-90 target.

Address Stakeholders: As a main goal, try to address more stakeholders and decision makers that actually will be the ones changing the law in order to have more rights guaranteed! Please talk to your Regional Assistant to find the best approach for your community.

Raising Awareness • TED videos DOCUMENTARY night • Bake sale to support concern's HIV and AIDS — easy to organize, this entertaining and recreational activity could be an amazing opportunity to launch a fundraising event.

• Art gallery — encourage artists on campus and in the community to create artwork focused on HIV and AIDS • Free HIV testing campaign — cooperate with your local HIV centers provides tools and resources for incorporating HIV testing • Plant tree and flowers in honor of the persons who have been impacted by HIV and AIDS • Restroom campaign — print posters HIV or AIDS related and develop a unique campaign • Organizing Seminars at the university level and encourage students to attend the seminar; this will increase students’ knowledge on HIV/AIDS related topics • The main goal of awareness among others is to reach many people as possible and deliver the right message.

It is very important to pass awareness message through Radio and Television reminding the society how badly HIV/AIDS is and ways of prevention as the best treatment of HIV is the prevention.

• Walk of awareness during the World AIDS Day and 13

Suggested National & Local Activities Walk of Remembrance during Candlelight Memorial Day, this will help to get attention of many people and disseminate the message easily, Red t-shirts and red ribbon should be used during the walk with banners.

• Using Social Medias like Facebook, Twitter, Instagram and create appropriate hashtag to make HIV/AIDS awareness viral through all networks • Through different activities, fundraising and donation, we can Support people living with HIV. That is a great opportunity to talk with them and remind them the importance of taking • Conducting mass of teaching sessions in the community for instance at the health centers about prevention, treatment, STIs and other HIV/AIDS related topics • Training on HIV Stigma/ Discrimination

Creating and Sharing Advocacy Videos According to Merriam Webster, ‘advocating’ has three definitions: “one that pleads the cause of another; specifically : one that pleads the cause of another before a tribunal or judicial court; one that defends or maintains a cause or proposal; one that supports or promotes the interests of another[1].”

In line with our theme: #GetTested, make a video (a) convinces the viewers to get tested, or (b) that addresses your government (or another country’s government) explaining the importance of 90-90-90 and what the country needs to do in order to help to reach the targets outlined by 2030.

1. Definition of ADVOCATING. Merriam-webster.com. 2016 [cited 6 November 2016]. Available from: http://www.merriam-webster.com/dictionary/advocating

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Basic Information about HIV-related Topics What is HIV? What is AIDS? HIV (Human Immunodeficiency Virus) is a nontransforming human retrovirus belonging to the lentivirus family. There are two genetically different but related forms of HIV (HIV-1 and HIV-2). HIV-1 is more common in United States, Europe and Central Africa, while HIV-2 is the cause of infection in West Africa and India[1].

There are specific cells in the body’s immune system called CD4 cells, those cells help the immune system fight off infections. These cells are the main target of HIV. Moreover, the virus causes reduction in the number of CD4 cells making the body more likely to get

(male and female condoms) can give wide range of HIV and other STIs by 99%. Using clean needles and testing blood before transfusion have made the infection rate decrease a lot.

What are key populations?

Key populations[3] are marginalized social spheres that tend to have a higher rate of HIV acquisition. Their rights are the most vulnerable when discussing with stakeholders. Within these we may have: Men who have sex with men (MSM), People who inject drugs (PWID), Sex workers, Confined/Enclosed Individuals.

opportunistic infections of cancer related infections[2].

What is PrEP? And what is PEP?

AIDS (Acquired Immune Deficiency Syndrome) is caused by HIV. This happens when a body infected with HIV is not treated leading to weakness in the immune system which make it not able to fight off infections. AIDS is known as the last stage of the disease where the body can no longer defend itself leading to variable number of diseases and opportunistic infections, which finally lead to death[3].

PrEP (Pre-exposure prophylaxis) is taking HIV drugs daily to lower the chance of getting infected. People at high risk of HIV infection take a combination of two HIV drugs (tenofovir and emtricitabine) known commercially as Truvada Truvada as an approved daily used PrEP drug. PrEP is not a vaccine, but it is a drug used to attack the virus whenever it enters the bloodstream. Using PrEP doesn’t mean that one should stop all the other protective methods like using condoms and don’t share needles which has been a current mistake in many developed countries leaving other prevention strategies behind.

PrEP is not a miracle pill. It has side effects that can be serious as any other drug.

How is HIV transmitted and how can we avoid infection?

HIV is considered a weak virus that cannot survive outside the human body. The virus is mainly transmitted through different body fluids such as: (blood – semen – preseminal fluid – vaginal secretions – breast milk). These fluids must get in contact with mucous membranes or injured tissue or be injected directly into the bloodstream for the infection to happen[4].

HIV can be transmitted via the following ways: Unprotected sex (Vaginal, Anal & Oral), Sharing needles and syringes, From mother to child during pregnancy, birth or breastfeeding.

HIV infection prevention depends mainly on avoiding the methods it is transmitted through. Using condoms World AIDS Day Manual 2016

PEP (Post-exposure prophylaxis). It means that a person takes antiretroviral medication after being exposed to HIV to prevent acquisition. You should start PEP within 72 hours of the exposure, and the sooner the better. Of course this is when you have confirmed that you had contact with HIV in one of its forms of transmission[4].

History of the red ribbon The Ribbon Project was formed in 1991 by Visual AIDS, a New York-based charity group of art professionals that aim to recognize and honor friends and colleagues who have died or are dying of AIDS. Visual AIDS encourages 15

Basic Information about HIV-related Topics arts organizations, museums, commercial galleries, and AIDS support groups to commemorate those lost to AIDS, to create greater awareness of HIV/AIDS transmission, to publicize the needs of persons with AIDS and to call for greater funding of services and research. The color red was chosen for its “connection to blood and the idea of passion – not only anger, but love, like a valentine.”

Is there any treatment or cure?

According to WHO, there is no HIV cure for HIV infection.

However, effective antiretroviral (ARV) drugs can control the virus and help prevent transmission so that people with HIV, and those at substantial risk, can enjoy healthy and productive lives.

Antiretroviral therapy (ART) is treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. The standard treatment consists of a combination of at least three drugs often called highly active antiretroviral therapy or HAART that suppress HIV replication. Three drugs are used in order to reduce the likelihood of the virus developing resistance. ART has the potential both to reduce mortality and morbidity rates among HIV-infected people, and to improve their quality of life. WHO recommends ART for all people living with HIV as soon as possible after diagnosis without any restrictions of CD4 count.

HIV and STIs correlation Numerous studies seem to indicate that there is a stronger association between HIV and other STIs than would be expected simply from a behavioral link. Infection with STIs (including syphilis, gonorrhea and herpes) seems to increase the risk of both acquiring and transmitting HIV over and above a behavioral link.

Depending on the STI involved and the population, studies have reported that having an STI magnifies the risk of acquiring HIV by anything from two to eight times or more. In the case of people living with HIV, having an STI increases viral loads both in the blood and genital secretions, thus making people more infectious even when taking antiretroviral treatment.

Ulcerative STIs such as syphilis, herpes and chancroid, cause lesions on the genital and anus that may serve as ports of entry or exit for HIV. Inflammatory ones, such as gonorrhea, chlamydia and bacterial vaginosis, cause the mucosa of the urethra, cervix and rectum to become inflamed. This makes it not only more fragile and likely to tear and bleed, but greatly increases the numbers of HIV receptive or HIV productive immune cells in the area. Inflammation also increases levels of circulating cytokines, immune stimulating chemicals that activate T-cells.

HIV and Sex Workers

Harm reduction strategies

Sex workers: Is anyone who receives money or goods in exchange for sexual services, and who consciously define those activities as income generating. Evidence shows that HIV prevalence among sex workers is 12 times greater than among the general population. An analysis of 16 countries in sub Saharan Africa in 2012 showed a pooled prevalence of more than 37% among sex workers. “The gap report 2014 of UNAIDS.”

According to International Harm Reduction Association, Harm Reduction refers to policies programs and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop.

The defining features are the focus on the prevention of drug use itself, and the focus on people who continue to use drugs.

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Injecting drug use continues to drive the HIV epidemic in many countries around the world. According to the United Nations Office on Drugs and Crime (UNODC) in 2013 it was estimated that between 11 million and www.ifmsa.org

Basic Information about HIV-related Topics 22 million people inject drugs globally and that 1.6 million were living with HIV. In 2011 United Nations General Assembly Political Declaration on HIV and AIDS, Members of states committed to reduce transmission of HIV among people who inject drugs by 50% by 2015. However, criminalization, stigma and discrimination remain widespread and continue to prevent people who use drugs from accessing essential HIV services.

The World Health Organization (WHO), the united Nations Office on Drugs and Crime's (UNODC) and the joint United Nations Program on HIV/AIDS (UNAIDS) strongly recommend harm reduction as an approach to HIV prevention, treatment and care for people who inject drugs and strategies include: • Needle and syringe programs(NSPs): allow people who inject drugs to obtain new, sterile needles and other drugs at lower or no cost at all • Opioid substitution therapy (OST) and other drug dependence treatment: this an action of replacing an illegal opiate with a prescribed medicine such as methadone or buprenorphine that are administered under medical supervision • HIV testing and counselling, Antiretroviral treatments, Prevention and treatment of STIs • Condom programs for people who inject drugs and their sexual partners • Targeted information, education and communication for people who inject drugs and their partners • Vaccination, diagnosis and treatment of viral hepatitis

1. Kumar, Vinay et al. Robbins And Cotran Pathologic Basis Of Disease.

Philadelphia: Elsevier Saunders, 2005. Print.

2. Welcome To AIDS.Gov". Aids.gov. N.p., 2016. Web. 6 Nov. 2016.

3. AVERT | 30 Years Providing Global Information And Education On HIV".

Avert.org. N.p., 2016. Web. 6 Nov. 2016.

4. CDC Works 24/7". Centers for Disease Control and Prevention. N.p., 2016.

Web. 6 Nov. 2016.

5. Treatment And Care". World Health Organization. N.p., 2016. Web. 6 Nov. 2016.

6. UNAIDS". Unaids.org. N.p., 2016. Web. 6 Nov. 2016.

World AIDS Day Manual 2016

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Online Resources ORGANIZATION

WEBSITE

AIDS Education Global Information System (AEGIS) UNICEF Global AIDS Campaign AIDS About AIDS Prevention & Control Project UNFPA American Foundation for AIDS Research US Agency for International Development World AIDS Day, United Kingdom HIV In Site - Gateway to AIDS Knowledge HIV Positive - HIV/AIDS Information USA The World AIDS Campaign International AIDS Economics Netwrok You and AIDS - The HIV/AIDS Portal for South Asia International AIDS Society The UK National AIDS Trust (NAT) Marie Stropes International Australia Project Inform - HIV/AIDS information USA International Community of Women Living with HIV/AIDS The AIDS Memorial Quilt & Names Project Foundation UN Joint Program on HIV/AIDS

www.aegis.com www.unicef.org www.aids.about.com www.apacvhs.org www.unfpa.org www.amfar.org www.usaid.gov www.worldaidsday.org www.hivinsite.ucsf.edu www.hivpositive.com www.worldaidscampaign.org www.iaen.org www.youandaids.org www.ias.se www.nat.org.uk www.mariestopes.org.au www.projectinform.org www.icw.org www.aidsquilt.org www.unaids.org

HIV/AIDS & Other STIs Program Ever since first being celebrated in 1988, World AIDS Day has given the world a chance for communities and countries all around the world to come together and join efforts in the fight against HIV. Itâ&#x20AC;&#x2122;s our combined activities, each single one, big or small, that contributes and add on to the joint global effort that leads to the significant impact of this day. Our collective efforts within IFMSA on this day bring all of us - our goals, expectations, successes and passion together, in order to make them even greater and to see, how big impact we, as the Federation, have on the world of medicine.

With this is mind, we would like to strongly encourage all of you who have conducted any sort of campaign 18

or activity during World AIDS Day this year, to register it under IFMSAâ&#x20AC;&#x2122;s Program for HIV/AIDS and other STIs.

What are IFMSA Programs?

IFMSA Programs aims to encompass mutual efforts within a certain topic of medicine (in this case HIV/ AIDS). By having all the activities within a certain field registered and enrolled under a Program, Program Coordinators are able present our joint impact effort and the difference we have been able to make as a combined Federation. You as a NMO member are then able to use this data when reporting or presenting your activity within your NMO or to external partners. www.ifmsa.org

HIV/AIDS & Other STIs Program An enrolled “activity,” can be anything from projects, campaigns, celebrations, workshops, events, trainings or theme based publications, or even organized advocacy efforts on local, national and international level. It can be anything from activities that are run for a single day or activities that are continuous ongoing.

Enrolment comes with many benefits: • Promotion and recognition of the activities on an international level.

• Permission to use the international IFMSA logo in promotional materials of the activity, thus gaining better opportunities to receive support from the authorities through IFMSA recognition.

• Use of Program Impact Report presenting the impact that the activity has worldwide as means of reporting or fundraising. This can be of great benefit when for example seeking financial support or when working with external partners.

• Use of Program Impact Report as a way to increase visibility of the NMOs Activities worldwide.

• Improvement of the impact of the activity by joining forces with other NMOs. • Opportunity to cooperate and network with other NMOs that work on the same particular area of interest.

• Learn how to plan the activity and how to measure the impact of the activity in the NMO. • Better opportunities to find external partners.

• Building a community of medical students equipped with knowledge and skills on a specific topic.

• Prestige for the activity from being recognized by IFMSA Programs.

3. Awareness campaigns 4. Research projects 5. Fundraising activities 6. Operative work

How to enroll your World AIDS Day activity in the HIV/AIDS and other STI Program?

In order for your World AIDS Day activity to become an official Program Activity it needs to be enrolled in IFMSAs database. Enrolment is quick and easy, simply follow three steps; 1. Submit an activity Candidature Form signed and stamped by the NMO President. Please note that your activity can be registered even after it has been conducted and is finished, enrollment does not necessarily have to be made one month before the starts of the activity as stated in the form.

2. Complete the Activity Enrollment Form. The form should include clear goal(s), objectives and indicators of success. The activity shall have measurable impact on the relevant target group.

3. Finally, you will later on be contacted by the Program Coordinator and sent a link for the report form, this is the tool which be able to showcase the impact of the activity.

If you have any questions regarding enrollment of your World AIDS Day activity or about the IFMSA Programs in general, please don’t hesitate to contact us at hivaids@ifmsa.org.

Examples of activities: 1. Education of medical students, the general public or among specific societal groups 2. Advocacy (lobbying) World AIDS Day Manual 2016

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Acronyms AIDS Acquired Immunodeficiency Syndrome HAART Highly Active Antiretroviral Therapy HIV Human Immunodeficiency Virus IFMSA International Federation of Medical Students’ Associations LORA Local Officer on Sexual and Reproductive Health including HIV/AIDS LRA Liaison Officer for Sexual and Reproductive Health issues including HIV/AIDS NGO Non-Governmental Organization NMO National Member Organization of IFMSA NORA National Officer on Sexual and Reproductive Health including HIV/AIDS The PACT Coalition of Youth Organizations committed and actively working in the HIV response.

PCB Program Coordinator Board (UNAIDS) PLHIV People Living with HIV SCORA Standing Committee on Sexual and Reproductive Health incl. HIV/AIDS SCORA-D Director on Sexual and Reproductive Health including HIV/AIDS SCORA RA SCORA Regional Assistant STI Sexually Transmitted Infection STD Sexually Transmitted Disease UNAIDS Joint United Nations Program on HIV/AIDS WAD World AIDS Day WAC World AIDS Campaign Y+ Global Network of Young People living with HIV YFC Youth-friendly center

Collaborators 2016 World AIDS Day Small Working Group Members: Frederike Booke - bvmd (Germany) Priyanka - MSAI (India) Baha'a Bilal Al-Momani - IFMSA-Jo (Jordan) Ahmed Mohamed Saleh - IFMSA Egypt Ephasia Goodall - IFMSA Poland Eliza Maria Froicu - FASMR (Romania) Christophe Ngendahayo - MEDSAR (Rwanda) Samuel NIYONKURU - MEDSAR (Rwanda) Arden Azim - CFMS (Canada) Basma Yahya - IFMSA Egypt 2016 World AIDS Day SWG Coordinators: Chantal Marchini HIV/AIDS and Other STIs Program Coordinator José Chen SCORP General Assistant Elissa Abou Khalil SCORA Regional Assistant for the EMR Anthony Kerbage SCORA Development Assistant Carlos Andres Acosta SCORA Director SCORA International Team: Carlos Andres Acosta SCORA-D Carles Pericas Escale LRA Anthony Kerbage Development Assistant Pepe Ferrer Arbaizar SCORA RA for Europe Elissa Abou Khalil SCORA RA for the EMR Anshruta Raode SCORA RA for Asia Pacific Jenna Webber SCORA RA for the Americas Afolabi Oluwatoyosi SCORA RA for Africa

YFS Youth-friendly services

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Algeria (Le Souk)

Ghana (FGMSA)

Pakistan (IFMSA-Pakistan)

Antigua and Barbuda (AFMS)

Greece (HelMSIC)

Palestine (IFMSA-Palestine)

Argentina (IFMSA-Argentina)

Grenada (IFMSA-Grenada)

Panama (IFMSA-Panama)

Armenia (AMSP)

Guatemala (ASOCEM)

Paraguay (IFMSA-Paraguay)

Australia (AMSA)

Guinea (AEM)

Peru (IFMSA-Peru)

Austria (AMSA)

Guyana (GuMSA)

Peru (APEMH)

Azerbaijan (AzerMDS)

Haiti (AHEM)

Philippines (AMSA-Philippines)

Bangladesh (BMSS)

Honduras (ASEM)

Poland (IFMSA-Poland)

Belgium (BeMSA)

Hungary (HuMSIRC)

Portugal (PorMSIC)

Benin (AEMB)

Iceland (IMSIC)

Republic of Moldova (ASRM)

Bolivia (IFMSA-Bolivia)

India (MSAI)

Romania (FASMR)

Bosnia and Herzegovina (BoHeMSA)

Indonesia (CIMSA-ISMKI)

Russian Federation (HCCM)

Bosnia and Herzegovina - Republic of

Iraq (IFMSA-Iraq)

Russian Federation - Republic of Tatarstan

Srpska (SaMSIC)

Iraq - Kurdistan (IFMSA-Kurdistan)

(TaMSA)

Brazil (DENEM)

Ireland (AMSI)

Rwanda (MEDSAR)

Brazil (IFMSA-Brazil)

Israel (FIMS)

Serbia (IFMSA-Serbia)

Bulgaria (AMSB)

Italy (SISM)

Sierra Leone (SLEMSA)

Burkina Faso (AEM)

Jamaica (JAMSA)

Singapore (AMSA-Singapore)

Burundi (ABEM)

Japan (IFMSA-Japan)

Slovakia (SloMSA)

Canada (CFMS)

Jordan (IFMSA-Jo)

Slovenia (SloMSIC)

Canada - Québec (IFMSA-Québec)

Kazakhstan (KazMSA)

South Africa (SAMSA)

Catalonia (AECS)

Kenya (MSAKE)

Spain (IFMSA-Spain)

Chile (IFMSA-Chile)

Korea (KMSA)

Sweden (IFMSA-Sweden)

China (IFMSA-China)

Kosovo (EMSA-Pristina)

Switzerland (swimsa)

China - Hong Kong (AMSAHK)

Kuwait (KuMSA)

Syrian Arab Republic (SMSA)

Colombia (ASCEMCOL)

Latvia (LaMSA)

Taiwan (FMS)

Costa Rica (ACEM)

Lebanon (LeMSIC)

Thailand (IFMSA-Thailand)

Croatia (CroMSIC)

Lesotho (LEMSA)

The Former Yougoslav Republic of

Cyprus (CyMSA)

Libya (LMSA)

Macedonia (MMSA)

Czech Republic (IFMSA CZ)

Lithuania (LiMSA)

Tanzania (TaMSA)

Democratic Republic of the Congo

Luxembourg (ALEM)

Togo (AEMP)

(MSA-DRC)

Malawi (UMMSA)

Tunisia (Associa-Med)

Denmark (IMCC)

Mali (APS)

Turkey (TurkMSIC)

Dominican Republic (ODEM)

Malta (MMSA)

Uganda (FUMSA)

Ecuador (AEMPPI)

Mexico (IFMSA-Mexico)

Ukraine (UMSA)

Egypt (IFMSA-Egypt)

Mongolia (MMLA)

United Arab Emirates (EMSS)

El Salvador (IFMSA-El Salvador)

Montenegro (MoMSIC)

United Kindgom of Great Britan and

Estonia (EstMSA)

Morocco (IFMSA-Morocco)

Northern Ireland (Medsin)

Ethiopia (EMSA)

Namibia (MESANA)

United States of America (AMSA)

Fiji (FJMSA)

Nepal (NMSS)

Uruguay (IFMSA-URU)

France (ANEMF)

The Netherlands (IFMSA NL)

Uzbekistan (AMSA-Uzbekistan)

Gambia (UniGaMSA)

Nicaragua (IFMSA-Nicaragua)

Venezuela (FEVESOCEM)

Georgia (GMSA)

Nigeria (NiMSA)

Zambia (ZaMSA)

Germany (bvmd)

Norway (NMSA)

Zimbabwe (ZimSA)

Oman (SQU-MSG)

www.ifmsa.org

medical students worldwide