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Unprecedented global participation at UN General Assembly High Level Meeting on AIDS leads to new commitments, targets, and momentum in the AIDS response

Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), addresses the opening of the General Assembly High-Level Meeting on AIDS on 8 June 2011.
Credit: UN Photo/Paulo Filgueiras

NEW YORK/GENEVA, 10 June 2011­­—The Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomes the bold new targets set by world leaders at the United Nations General Assembly High Level Meeting on AIDS which concluded in New York today. Countries agreed to advance efforts towards reducing sexual transmission of HIV and halving HIV infection among people who inject drugs by 2015.

They also agreed to push towards eliminating new HIV infections among children in the next five years. Leaders pledged to increase the number of people on life saving treatment to 15 million and to reduce tuberculosis related deaths in people living with HIV by half in the same time period.

“This Declaration is strong, the targets are time bound and set a clear and workable roadmap, not only for the next five years, but beyond,” said Joseph Deiss, President of the United Nations General Assembly. “UN Member States have recognized that HIV is one of the most formidable challenges of our time and have demonstrated true leadership through this Declaration in their commitments to work towards a world without AIDS.”

The bold targets come at a time when international assistance for the AIDS response has dropped for the first time since 2001. Member States agreed to increase AIDS-related spending to reach between US$ 22 billion and US$ 24 billion in low- and middle-income countries by 2015.

These far reaching goals are set in the Political Declaration on HIV/AIDS: Intensifying our Efforts to eliminate HIV/AIDS adopted by the General Assembly on 10 June, 2011. The declaration notes that HIV prevention strategies inadequately focus on populations at higher risk—specifically men who have sex with men, people who inject drugs and sex workers, and calls on countries to focus their response based on epidemiological and national contexts.

“These are concrete and real targets that will bring hope to the 34 million people living with HIV and their families,” said Michel Sidibé, Executive Director of UNAIDS. “Through shared responsibility, the world must invest sufficiently today, so we will not have to pay forever.”

The declaration calls on all UN Member States to redouble their efforts to achieve universal access to HIV prevention, treatment, care and support by 2015 as a critical step towards ending the global AIDS epidemic. A pledge to eliminate gender inequality, gender based abuse and violence, and to increase the capacity of women and adolescent girls to protect themselves from HIV infection was also made.

The Declaration recognizes that access to sexual and reproductive health has been and continues to be essential to the AIDS response and that governments have the responsibility of providing public health services focused on the needs of families, particularly women and children. Member states also agreed to review laws and policies that adversely impact on the successful, effective and equitable delivery of HIV prevention, treatment, care and support programmes to people living with and affected by HIV.

With nearly 7000 new HIV infections each day, the declaration reaffirms that preventing HIV must be the cornerstone of national, regional and international responses to the AIDS epidemic. It calls for expanding access to essential HIV prevention commodities, particularly male and female condoms and sterile injecting equipment. Calling for intensifying national HIV testing campaigns; it urges countries to deploy new bio-medical interventions as soon as they are validated including earlier access to treatment as prevention.

Taking note of the UNAIDS strategy, the Declaration commends UNAIDS for its leadership role on AIDS policy coordination and support to countries and calls on the joint programme to revise indicators for success and support the Secretary-General of the United Nations in providing an annual report on the progress made by Member States in realizing the commitments made in the declaration.

First Ladies join forces to call for integration of HIV and maternal, newborn and child health programmes at special event during United Nations High Level Meeting on AIDS

(Left to Right): Michel Sidibé, Executive DIrector of UNAIDS; HE Mrs. Azeb Mesfin, First Lady of Ethiopia; Mrs. Ban Soon-taek, Spouse of Secretary General of the United Nations; Dr. Bun Rany Hun Sen, Cambodia.
Credit: UNAIDS/B. Hamilton

NEW YORK/GENEVA, 8 June 2011—Thirty First Ladies from Africa, Asia, Latin America and the Caribbean gathered at a special event in New York to mobilize support around achieving the Joint United Nations Programme on HIV/AIDS’ (UNAIDS) vision of Zero new HIV infections among children by 2015. The event was held on the opening day of the UN High Level Meeting on AIDS which is taking place in New York from 8-10 June.

Mrs Ban Soon-taek, wife of the United Nations Secretary-General;  Mrs Azeb Mesfin, First Lady of Ethiopia and President of the Organization of African First Ladies Against HIV/AIDS; and Mr. Michel Sidibé, Executive Director of UNAIDS co-hosted the New York event. 

Around 1,000 babies are infected with HIV each day, 90% of whom are in countries in sub-Saharan Africa. HIV is also the leading cause regarding mortality among women of reproductive age in developing countries. The First Ladies agreed to advocate for comprehensive and integrated access to maternal and child health services that include services to prevent HIV transmission among infants and which keep mothers and children healthy. 

Gender inequality, gender violence, discrimination and inequitable laws prevent pregnant women from accessing HIV testing and counselling, prevention, treatment and support services. “Women and girls must be at the centre of the AIDS response,” said Michel Sidibé. “When women protect themselves from HIV, they protect a whole new generation from HIV.”

More than 2 million children worldwide are living with HIV, mostly in sub-Saharan Africa. In Western Europe only 1,400 children are living with HIV, highlighting the global injustice of unequal access to maternal and child health services and the urgent need to increase access to HIV services for pregnant women in low- and middle-income countries.

“If women around the world are not involved in facing the challenge of preventing mother-to-child transmission of HIV, we cannot win. If we all play our part, we cannot fail.” said Mrs Mesfin.

In recent years, a number of countries have made great strides in reducing the rate of new HIV infections among children and globally in 2009, new HIV infections among children dropped by 25%.

“The fact that, in still too many places, HIV positive women are denied the right to give birth to healthy babies is a global injustice that we can end by 2015,” said Mrs Ban.

On return to their respective countries, the First Ladies agreed to advance ten action steps to ensure that children are born free from HIV and to promote lifesaving HIV services for women and children. These include supporting efforts to; increase the number of centres providing free maternal, newborn and child health services, including treatment to prevent the transmission of HIV from mothers to children; strengthen sexual and reproductive health programs for adolescents living with HIV; ensure meaningful engagement of people living with HIV; and promote zero tolerance for stigma and discrimination against people living with HIV.

(Left to Right): United Nations Secretary-General Ban Ki-moon, President of Rwanda Paul Kagame, United States Global AIDS Coordinator Ambassador Eric Goosby, President of the General Assembly Joseph Deiss at the Heads of State event - AIDS, Health, and Development, held at UN Headquarters, NYC, on June 8, 2011
Credit: UNAIDS/B.Hamilton

NEW YORK/GENEVA, 8 June 2011­­—More than 20 Heads of State and Government have come together at a special event focusing on leadership, cooperation and country ownership in the response to HIV. The event, attended by close to 400 people, was held during the United Nations General Assembly High Level Meeting on AIDS to renew commitment and identify opportunities in scaling up the HIV response, improving health and achieving the 2015 Millennium Development Goals.

The President of Rwanda, Paul Kagame, hosted the debate which outlined ways of accelerating action to help countries move closer towards universal access to HIV prevention, treatment, care and support.

He outlined three main areas as key to the success of the AIDS response: leadership, ownership and collaboration. “Not a single country, not a single individual, business or entity can win this struggle alone,” he said. “Once the leadership and commitment is there in any country and any community, results begin to show.”  

The need to increase access to services for people most vulnerable to HIV and respect for human rights was central to the discussions. Strong and visionary leadership combined with commitment and global solidarity around HIV were underlined as essential to moving the response forward.

“We can bring HIV deaths and new HIV infections to zero,” said United Nations Secretary-General Ban Ki-moon. “Our targets may seem ambitious but they are achievable if we are united.”

Leaders at the event also looked to the future of the HIV response and the importance of investing in youth as the leaders of tomorrow and encouraging their full engagement in the AIDS response.

“If we want to transform the response, we have to bring a new agenda for the future,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “This will only be achieved if we engage young people to lead a new social movement around AIDS and ensure a sustainable response.”

The speakers stressed the need to overcome the challenges to sustainable and predictable financing. In a report launched ahead of the High Level Meeting on AIDS, UNAIDS outlined that US$ 22 billion will be needed by 2015 to halve new HIV infections and expand access to HIV treatment. However, the report also revealed that international funding for HIV had declined from 2009 to 2010.

“What we need is resources, best policy, and law to ensure and protect the rights of people living with HIV,” said Ms Anandi Yuvuarj, Regional Coordinator of the International Community of Women Living with HIV. “Everyone must have access to HIV prevention, treatment, care and support, particularly people most vulnerable to HIV.”

Speakers emphasized the need for systematic improvement of the efficiency and effectiveness of existing AIDS and health spending, as well as the importance of ensuring the best value for money through effective and efficient HIV programming. In addition, they discussed the need for countries to look for new streams of revenue from domestic, regional and international sources.

Success in South-South cooperation efforts were discussed as an effective way of finding new paradigms of development and sharing innovation within regions for an accelerated response to HIV.

Leaders attending the event pledged to increase efforts to improve the effectiveness, efficiency and sustainability of their national AIDS responses to accelerate progress towards achieving universal access to HIV prevention, treatment, care and support services.

BERNE (SWITZERLAND),  6 JUNE 2011–Nearly 3 million individual stamps will circulate within and across borders this year to draw attention to 30 years of the AIDS epidemic and the importance of continuing to prevent new HIV infections. Since the start of the epidemic, 60 million people have become infected with HIV and nearly 30 million people have died of AIDS-related causes.

At least 20 Posts around the world have joined an initiative to issue stamps and other philatelic products to commemorate the landmark year. Participating Posts include: Belarus, Brazil, Burkina Faso, Cameroon, Croatia Post (Mostar), Fiji, Iran, Iraq, Kazakhstan, Luxembourg, New Caledonia, Malawi, Moldova, Pakistan, Slovakia, Romania, Russia, Turkey, Ukraine and Uruguay. The United Nations Postal Administration (UNPA) is also issuing three stamps that will be sold in UN Offices in New York, Geneva and Vienna. For more information, visit the display at the UNPA counter in the General Assembly building in New York.

“Stamps – these formidable mini works of art – are noble ambassadors that leave important messages in the hands of all who receive mail,” said Edouard Dayan, director general of the United Nations specialized agency for postal services. “The Universal Postal Union is proud that so many Posts have responded to our call to raise awareness of critical issues like HIV. Once again, this initiative goes to show the incredible outreach value of postal services worldwide.”

Many stamps are being issued in June to coincide with the 2011 High Level Meeting on AIDS, taking place at the United Nations in New York from 8-10 June. The meeting will provide a platform for UN member states and partners to review progress and chart the future course of the global AIDS response.

“This is an excellent and important initiative to get people around the world talking about AIDS,” said Michel Sidibé, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). ”One of the greatest barriers in the AIDS response is the stigma and discrimination surrounding the disease. By initiating dialogue around HIV, these little stamps will play a big role in helping to break down some of those barriers.”

While most Posts have designed their own stamps, others, like Ukrposhta, Ukraine’s national postal service, have launched a national competition inviting artists to propose a stamp design on the theme of 30 years of AIDS. Ukraine’s winning stamp will be issued on World AIDS Day, December 1, 2011. 

Global campaign

The philatelic initiative is part of the global HIV-campaign launched in 2009 by the Universal Postal Union, UNAIDS, the International Labour Organization and UNI Global. The campaign relies on the global postal network’s vast outreach to draw attention to the importance of HIV prevention.

More than 23,000 post offices around the world have carried out awareness campaigns using posters, postcards, a website (www.unaids.org/preventHIV) and public events to inform people about HIV. The campaigns have potentially reached millions of people. In Cameroon alone, the Post estimates that campaign materials are viewed daily by 36,000 people.

This is the first time that Posts worldwide have made a concerted effort to draw attention to AIDS, but philately has been raising awareness about the disease for years. A quick survey of the UPU’s World Numbering System (www.wnsstamps.ch) reveals that more than 60 different AIDS themed stamps have been issued since 2002, when the database was created.

To view a slideshow of AIDS stamps through the years, please go to: www.upu.int/en/aids_stamps

About the UPU

Created in 1874, the UPU, based in Berne (Switzerland), is an intergovernmental organization and the primary forum for cooperation between governments, Posts and other stakeholders of the worldwide postal sector. In addition to maintaining a genuinely universal network that provides modern products and services, it establishes the rules for international mail exchanges among its 191 members and makes recommendations to stimulate mail volume growth and to improve the quality of service for customers. Some 5.5 million employees process and deliver 433 billion domestic letter-post items annually, as well as some 5.5 billion international items and over 6 billion parcels. Many postal services also offer expedited mail, financial and electronic services. About 660,000 postal establishments make the postal network the largest physical distribution network in the world. The UPU celebrated 60 years as a specialized agency of the United Nations in 2008. Learn more at: www.upu.int

About UNAIDS

UNAIDS, the Joint United Nations Programme on HIV/AIDS, is an innovative United Nations partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. Learn more at: www.unaids.org

Charity event spotlights HIV epidemics in Eastern Europe and Central Asia

VIENNA, 23 May 2011—Celebrities and influential leaders in the global AIDS response gathered at Vienna’s City Hall on 21 May for the 2011 Life Ball, Europe’s largest annual AIDS charity event. This year’s Life Ball commemorated 30 years of AIDS and focused on the rapidly growing HIV epidemics in Eastern Europe and Central Asia.

“The Life Ball is not only about celebrating life, but also about creating a social movement to stop stigma and discrimination,” said Michel Sidibé, Executive Director of UNAIDS, speaking at a press conference on 21 May. “Gery (Keszler) and AIDS LIFE are a voice and force of change in this movement,” he added.

Mr Sidibé was joined at the press conference by Gery Keszler, co-founder and Chairman of AIDS LIFE, a non-profit organization that organizes the Life Ball. Other speakers included singer Janet Jackson representing amfAR, clothing designers Dean and Dan Caten of Dsquared2, and Hollywood actress Brooke Shields.

Before the opening ceremony of Life Ball, a number of eminent guests attended the AIDS Solidarity Gala, a fundraising dinner co-hosted by UNAIDS and AIDS LIFE under the patronage of the President of the Republic of Austria, Heinz Fischer. Proceeds from the event will be used, in part, to support UNAIDS programmes in the Russian Federation and Ukraine.

Over the past decade, the number of people living with HIV in Eastern Europe and Central Asia nearly tripled—from an estimated 530 000 in 2000 to 1.4 million in 2009. The Russian Federation and Ukraine together account for nearly 90% of newly reported HIV infections in the region. Though the epidemics in Eastern Europe and Central Asia are mainly concentrated among people who inject drugs, sex workers and men who have sex with men, these populations have limited access to HIV services.

At the Life Ball opening ceremony, 30 international personalities presented milestones in the epidemic’s 30-year history. The UNAIDS Executive Director highlighted the founding of UNAIDS in 1996 and the “glimmer of hope” that same year when combination antiretroviral therapy proved effective in keeping people living with HIV alive.

Former United States President Bill Clinton noted in his remarks that substantial price reductions in antiretroviral medicines since the year 2002 had greatly expanded access to treatment for millions of people. However, he said, a major treatment gap remains: “Ten million people in poor countries still need to be on (antiretroviral) medicines. If you want to cut the infection rate, if you want to cut the death rate, we have to finish the job.”

Every year, the Life Ball recognizes the work and dedication of pioneers in the AIDS response through the “Crystal of Hope” award. This year’s award of 100 000 EUR was presented to Anya Sarang, President of the Andrey Rylkov Foundation for Health and Social Justice, a non-governmental organization based in the Russian Federation that advocates for the human rights of people who use drugs.



Sri Lanka captain Kumar Sangakkara (second from left) joins the youth drama group during their play on the impact of stigma and discrimination for those living with HIV.

Sri Lankan cricket captain Kumar Sangakkara took time off the pitch during the Cricket World Cup tournament to speak to hundreds of young people about the importance of being informed and responsible about HIV. The event was part of the International Cricket Council (ICC), UNAIDS and UNICEF’s Think Wise campaign for the ICC Cricket World Cup 2011.

“You need to educate yourself and become more aware of the world around you and HIV. Be unafraid and unashamed to speak openly about these subjects with your friends, family and your teachers in school,” said Mr Sangakkara, during the event which was held at his old school, Trinity College, in the city of Kandy.

As part of the event, a youth drama group staged a play to demonstrate the impact of stigma and discrimination for people living with HIV. The drama reinforced the need for more education and life skills to prevent the spread of HIV, particularly among adolescents.

"To use theatre and cricket together was a great idea. No one expected Kumar to be a part of the play and when he came on with us, people really listened. Everything we were saying was reinforced by his presence and in his own words," said Kapila Rasnayaka, one of the young people involved in the drama group.

Kumar Sangakkara, along with other leading international cricketers including Graeme Smith (South Africa) and Virender Sehwag (India), is a ‘Champion’ spokesperson for the joint Think Wise partnership. In Kandy he was joined by Sri Lanka team mates Ajantha Mendis and Upul Tharanga who also showed their support for HIV prevention efforts in the country.

“If we are going to ‘get to zero’ on HIV, we need the active engagement of young people—the leaders of tomorrow’s response—now,” said UNAIDS Country Coordinator for Sri Lanka, David Bridger. “Sangakkara’s involvement in the campaign has helped push the boundaries, inciting discussion and a buzz around HIV that we will build on with the hope that young people will take the HIV response into their hands,” he said.

More than 7 000 people worldwide are newly infected with HIV each day—one out of three is a young person between 15 and 24 years-old. The Think Wise campaign encourages young people to be informed, take appropriate action to prevent HIV infection and stand together against the stigma and discrimination often facing people living with HIV.

Captain of the South African cricket team and Think Wise champion Graeme Smith and a young participant take a catch at the training session organized with people living with HIV.

Sonu Kumar grips the cricket ball in his hand, takes his run up and bowls a fast ball. Reacting quickly, his opponent angles his bat and smashes the ball out of the ground for six.

But this is no ordinary cricket match. Sonu is a 14 year-old living with HIV, knocking around balls with cricketing great Graeme Smith and his colleagues from the South African team. The occasion, a special HIV awareness-raising practice session organized as part of the International Cricket Council, UNAIDS and UNICEF Think Wise campaign during the 2011 Cricket World Cup.

The Think Wise campaign encourages young people to learn how to prevent HIV infection and stand up against stigma and discrimination. At the Feroz Shah Kotla Stadium in Delhi, Graeme Smith—South African Captain and official ambassador for the Think Wise campaign— and teammates took time out of their match schedules to promote the campaign messages.

“We play sport and love cricket, like so many others in this country. By training together the cricketers are showing their support for people living with HIV and help break down discrimination we often face,” said Sonu.

In the presence of supporters and media, a group of ten young people joined the elite cricketers, mixing training with talking about HIV. They participated in drills on the field with Richard Pybus, coach of the South African cricket team. Later the young people discussed their experience living with HIV with the team, asking questions about the role of cricketers in addressing issues of HIV related stigma.

 “HIV is a very real disease and has affected people all around the world including in our country and here in India,” said Mr Smith during the practice session. “The key for us is to educate people during the tournament—to help prevent HIV and to show that people living with HIV lead normal lives. I believe this will contribute in reducing stigma,” he said.

Underlining the broad reach of cricket in India and across the world, UNAIDS Country Coordinator Charles Gilks said, “Cricket has a huge following in India and cricket stars can be very powerful agents for change. We are particularly pleased to link up with Think Wise champions as we aim for the UNAIDS’ hat-trick of zero new infections, zero discrimination and zero AIDS-related deaths.”

Hospital gets Sehwag treatment

In another Think Wise activity taking place in India, Think wise champion and India’s opening batsman Virender Sehwag called on cricket fans across the world to stop discrimination against people living with HIV.

Mr Sehwag made his plea after visiting the Haji Sir Ismail Sait Ghosha hospital in Bengaluru where he met people whose lives have been affected by HIV.

“People living with HIV are no different from anybody else. There needs to be more awareness of what it means to be living with HIV,” said Mr Sehwag. “As cricketers, particularly in a country like India, we are in a position to help influence attitudes and behaviour and by being involved in the Think Wise campaign hopefully I can play my part,” he said.

Participants of the ‘Mini Cricket World Cup’ schools tournament are presented with awards in Bangladesh

As the overs are bowled, the wickets fall and the crowds go crazy in the 2011 Cricket World Cup, host-country Bangladesh is giving the tournament an HIV spin. Through the Think Wise campaign the tournament is raising awareness among young people on HIV prevention and reducing stigma.

The Think Wise campaign, led by the International Cricket Council (ICC) in partnership with UNAIDS and UNICEF, harnesses the power of cricket to prevent HIV. Together with co- host countries—India and Sri Lanka—Bangladesh is organizing a number of “Think Wise” activities throughout the World Cup tournament that runs from 19 February – 2 April.

One such activity was the Schools Programme event where the World Cup was used as a platform to promote the sport, as well as to share information on HIV. Sixty of the country’s schools participated in the orientation which included the lively presence of “Stumpy the elephant”, the official mascot of the ICC event.

“I really appreciate this initiative! We don’t get to know this information about HIV usually and my perception about AIDS has changed,” said one of the young participants. A selection of the schools then took part in a ‘mini world cup’ cricket tournament, where HIV messages were shared with players and supporters through video, information and education materials in English and Bangla. “I’m now educated about HIV by coming here! It’s a great initiative for young people,” said one of the young men visiting the special UNAIDS booth.

The Bangladesh campaign received a high-profile boost from an announcement of the country’s team captain Sakib Al Hasan. “As Think Wise Champion, I’m happy to use my current popularity to raise awareness on AIDS,” said Mr Hasan at a press conference announcing his role. “We [cricketers] want to leave behind a legacy of social awareness of AIDS so young people will get to know more about HIV.”

“The involvement of cricketing heroes helps raise the profile among young people—and all cricketing fans,” said UNAIDS Country Coordinator for Bangladesh, Salil Panakadan. “Through the Think Wise campaign we have established important relationships with the Bangladesh Cricket Board, business partners, the media and we have sparked the interest and passion of young people. This gives us a tremendous opportunity to build on even after the last tournament over is bowled,” Dr Panakadan added.

A host of additional activities will take place in Bangladesh, India and Sri Lanka as the tournament continues including site visits and interaction between star players and key affected communities. Cricket teams will wear red ribbons on their shirts in key matches and HIV prevention messages will be promoted at venues on all match days.

Credit: UNAIDS

Sport has a special ability to unify and galvanize people all over the world and therefore is a powerful vehicle for advocacy at the global down to the community level. In light of the potential of sports for AIDS advocacy, UNAIDS organized a consultation with representatives of several sports organizations and other experts from 24-26 October in Geneva to examine current initiatives and ideas for future activities.

“Sport has tremendous worldwide influence and impact, from the highest level of world championship events to children in remote villages playing with a home-made football,” said UNAIDS Executive Director at the opening of the consultation. “Stronger cooperation with the world of sport can invigorate the global AIDS response in a unique way and help us achieve all the Millennium Development Goals,” he added.

The consultation identified new ways to leverage the convening power of sports to promote HIV prevention, treatment, care and support. Participants also reviewed existing relationships and ways to build and strengthen partnerships between UNAIDS at the global, regional and country-levels, and the world of sports, the private sector, civil society and the media.

UNAIDS has established partnerships with sports personalities and organizations to raise awareness on AIDS issues and to help inform people on how to protect themselves against HIV infection. The 2010 FIFA World Cup initiative “Give AIDS the Red Card”, was backed by international football stars including UNAIDS Goodwill Ambassadors Michael Ballack of Germany and Emmanuel Adebayor of Togo. The campaign used the popularity and the outreach potential of football to unite the world around a common cause—preventing the transmission of HIV from mother-to-child.

This week’s consultation provided a forum to review progress around the “Give AIDS the Red Card” campaign and plan for the next phase. It also enabled discussions on future sports initiatives with UNAIDS’ partners including the International Olympic Committee and the International Cricket Council as well as identifying other cooperation opportunities with sports organizations and sports stars and stronger coordination with Cosponsors.

Participants agreed to explore innovative ways to convey HIV messaging through sports. Because the world of music and culture also has great popular appeal, the meeting also considered linkages with sport-related initiatives to amplify the range of the messages.

Other participants included Mr Adolf Ogi, former President of Switzerland and former Special Advisor to the UN Secretary-General on Sport for Development and Peace; Mr Wilfried Lemke, Special Adviser to the UN Secretary-General on Sport for Development and Peace; Mr Krisrten Nematandani, President, South African Football Association; Mr Lebohang Morake (Lebo M), UNAIDS Goodwill Ambassador and producer of the 2010 FIFA World Cup opening ceremony; Ms Katia Mascagni, International Olympic Committee; Mr Chris Hurst, Corporate Communications Manager, International Cricket Council;  Mr Amadou Fall, Vice President for Development in Africa of the NBA; Mr Adonal Foyle, Retired NBA basketball player and founder of the Kerosene Lamp Foundation; and, Mr Driss Guerraoui, Adviser to the Prime Minister of Morocco and Convener of the Global Youth Forum.

A version of this story was first published at unicef.org

Malekena George heads home from the Pilot Health Clinic in Lesotho’s Berea district after her first antenatal check-up
Credit: © UNICEF Lesotho/2010

Malekena George, from Lesotho’s Berea district, is eight months pregnant, living with HIV, and exhausted from the five-hour trek she endured to get to the Pilot Health Clinic, for her first antenatal check-up. But because her journey to the clinic was so difficult, this visit may also be her last.

Ms. George's first child died at 13 months, and the Lesotho Ministry of Health is working to ensure that her second baby is not born with HIV.

In 2007, the Government, with help from UNICEF and other partners, initiated a massive effort to improve the country's Prevention of Mother-to-Child HIV Transmission (PMTCT) services. To succeed, they needed to ensure that every clinic in the country could provide HIV testing and treatment.

Lesotho leads the way

Lesotho became one of the first countries in the region to allow nurses to administer antiretroviral (ARV) treatments, which greatly expanded access to these critical interventions in the remote areas of the country where fewer doctors are available.

Malekena George is given her new ‘Mother to Baby Pack’ at the Pilot Health Clinic. The pack includes ARV drugs and antibiotics
Credit: © UNICEF Lesotho/2010

But despite such efforts, major challenges remain, including the fact that many women, like Ms. George, are likely to make only one clinic visit.

This is a typical problem for many health systems in Africa. Though ARV drugs substantially increase the chances that a baby is born free of the virus, providing HIV-positive mothers with the treatment is not easy, especially in remote areas. The combination of distance, lack of transport and poverty prevents many women from making regular antenatal care visits. Such factors also lead many women to drop out of the PMTCT programmes, and to deliver their babies at home without the presence of trained medical professionals.

In a country such as Lesotho, where one in four people is living with HIV, that one antenatal visit has become all the more critical.

Keeping mother and child healthy

Innovative prevention methods are making a huge difference. The Lesotho Government has designed a minimum package for expectant mothers like Ms. George that includes the most effective ARV drugs and antibiotics needed to keep them, and their children, healthy. When they leave the clinic, women are also provided with clear instructions on what medicines they need to take – and when – and what medicines they need to give to their babies after birth.

In an effort to expand this public health innovation ever further, UNICEF and WHO have created a colour-coded take-home box that will be rolled out to five countries in eastern and southern Africa, Lesotho included, by July. Instead of the nurses having to pack all the medicines in small pill bags, this new 'Mother to Baby Pack' clearly separates the ARV drugs and the antibiotics according to when they need to be taken.

"We had to take advantage of the first antenatal visit," said UNICEF HIV and Maternal Health Expert Blandinah Motaung. "In case a woman delivers at home, she will have that package with her."

A dramatic drop in infections

With the new regimen of ARV treatments, and the efforts to facilitate women taking these medicines at home, health experts expect the number of babies born with HIV in Lesotho to drop dramatically.

"The expectation is that with better adherence to treatment and more focus on helping mothers to exclusively breastfeed for six months, we can further reduce the transmission rate to less than five per cent," said Ms. Motaung.

Take home medicine

After her check-up, Ms. George listened carefully to Marethabile Lelia, the clinic nurse, give instructions on the medicines that she would be carrying home. The mother-to-mother counsellor reiterated the importance of sticking to the treatment.

Although Ms. George has another appointment scheduled at the clinic, Ms. Lelia doesn't expect to see her until she returns with a six-week-old for the baby's first round of immunizations and first HIV test - children are again tested at 12, and then 18 months

As she prepared for her five-hour walk home, Ms. George clung to her medicines, understanding clearly that they represented her best hope of ensuring that her baby would escape HIV infection and grow up healthy

Lesotho has the third highest adult HIV prevalence in the world at 23.2%. There are an estimated 270,273 people living with HIV in Lesotho as of end 2007 of which 258,472 are adults and 11.801 children. At the end of 2007, an estimated 3,966 pregnant women with HIV received anti-retroviral treatment to prevent mother to child transmission (PMTCT) of HIV. The coverage of PMTCT programmes has increased from an estimated 5% in 2005 to 42% in the first quarter 2009