Health and development

GENEVA/WASHINGTON, 15 January 2014—During a high-level meeting and discussions in Washington last week, UNAIDS and the World Bank Group endorsed four areas of action to accelerate efforts that address the interrelated challenges of AIDS, inequality and extreme poverty.

UNAIDS and the World Bank Group have committed to work closely with UNDP and other international partners, to address the social and structural drivers of the HIV epidemic that put people at greater risk of HIV and deny them access to services. These social and structural drivers include gender inequality, stigma and discrimination, lack of access to education and unstable livelihoods. UNAIDS and the World Bank Group will advocate for:

1. Aligning health and development efforts around country-led time-bound goals towards ending extreme poverty and AIDS, with special attention to the inclusion of the poorest and most marginalized populations. Areas of focus will include: supporting countries to adopt progressive legal systems that remove discriminatory laws, especially among populations most vulnerable to HIV infection; increasing access to income, adequate housing and safe working conditions; and accelerating reforms towards universal health coverage and universal access to HIV services and commodities.
2. Urging the post-2015 development agenda to include targets towards ending AIDS alongside the goal of universal health coverage, so that no one falls into poverty or is kept in poverty due to payment for AIDS treatment or health care.
3. Promoting national and global monitoring and implementation research. Actions will include: working closely with global partners and countries to innovate and monitor service delivery, including for HIV, especially to the poorest and the most marginalized; and intensify implementation research to capture and codify innovative approaches to address the linkages between efforts towards ending extreme poverty and ending AIDS. As part of this effort, the World Bank Group will launch a major new trial to better understand how social protection systems reduce HIV infection, particularly among young women in the highest burden hyper-endemic countries.
4. Convening two high-level meetings in 2014 with national policy leaders and experts on ending AIDS and extreme poverty. The first meeting will be convened in Southern Africa to share current research and discuss how it can be translated into practice. The second meeting will be held during the International AIDS Conference in July 2014 in Melbourne.

Despite unprecedented progress over the past decade in the global response to HIV, economic inequality, social marginalization and other structural factors have continued to fuel the HIV epidemic. The epidemic continues to undermine efforts to reduce poverty and marginalization. HIV deepens poverty, exacerbates social and economic inequalities, diminishes opportunities for economic and social advancement and causes profound human hardship.

“Ending the AIDS epidemic and extreme poverty is within our power,” said Michel Sidibé, Executive Director, UNAIDS. “Our combined efforts will contribute to a global movement working to ensure that every person can realize their right to quality healthcare and live free from poverty and discrimination.”

“Just as money alone is insufficient to end poverty, science is powerless to defeat AIDS unless we tackle the underlying social and structural factors,” said Jim Yong Kim, President of the World Bank Group. “To end both AIDS and poverty, we need sustained political will, social activism, and an unwavering commitment to equity and social justice.”

“Stigma, discrimination and marginalization stand in the way of fully realizing the promise of HIV prevention and treatment technologies,” said Helen Clark, UNDP Administrator. “We know that where laws and policies enable people affected by HIV to participate with dignity in daily life without fearing discrimination, they are more likely to seek prevention, care and support services.”

Improving health services and outcomes is critical to ending extreme poverty and boosting shared prosperity. The recent Lancet Commission on Investing in Health estimated that up to 24% of economic growth in low- and middle-income countries was due to better health outcomes. The payoffs are immense: the Commission concluded that investing in health yields a 9 to 20-fold return on investment.

Investing in health also means investing in equity. Essential elements of a human rights-based response to HIV include: enabling laws, policies and initiatives that protect and promote access to effective health and social services, including access to secure housing, adequate nutrition and other essential services. Such measures can help protect people affected by HIV from stigma, discrimination, violence and economic vulnerability. HIV-sensitive social protection is already a key component of the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“Pills on a shelf do not save lives,” said Sveta Moroz of the Union of Women of Ukraine Affected by HIV. “To end the AIDS epidemic for everyone will require a people-centered approach driven by the community and based on social justice. It demands an approach that ensures basic human rights to safe housing, access to healthcare, food security and economic opportunity. These are rights that actively remove barriers to real people’s engagement in effective HIV prevention and care.”

UNAIDS and the World Bank Group will work to ensure that these efforts feature prominently in the post-2015 global development agenda, and are integral elements in ending AIDS, achieving universal health coverage, ending extreme poverty and inequality and building shared prosperity.

Chinese and African leaders during the first day of the 4th International Roundtable on China-Africa Health Cooperation. 6 May 2013

Leaders from China and Africa met in Gabarone, Botswana this week for the 4^th International Roundtable on China-Africa Health Cooperation in order to strengthen collaboration in health development and share knowledge and technology. The two day roundtable from 6-7 May was the first to be held in Africa.

Participants committed to develop concrete action plans to address pressing health issues including HIV, malaria, reproductive health, human resources and access to vaccines and commodities. The forum provided an opportunity for open dialogue about lessons learned as well as exploring South-South cooperation initiatives to overcome challenges such as guaranteeing safe products, ensuring adequate capacity, increasing transparency and strengthening health systems. 

“China and Africa have a long history of collaborating on health, built on shared challenges and experiences addressing similar issues,” said Hon. Rev. Dr. John G. N. Seakgosing, Botswana Minister of Health.  “China has a unique role in supporting African health progress. And with this roundtable, we look forward to deepening our partnership to benefit the health of our citizens.”

South-South cooperation, where mutually beneficial partnerships between developing and emerging economies are adding new thinking and new resources to global health and development was a keynote of the roundtable. Such cooperation, creating a ‘win-win’ scenario, is based on shared experience of similar challenges and priorities: both Africa and China view healthcare as critical to their economic success. 

“Africa’s future is closely linked with our own and improving health is a critical building block toward a common prosperity,” said Dr Ren Minghui, Director General of the Department of International Cooperation at China’s National Health and Family Planning Commission. “African countries have made tremendous gains to improve the health of their citizens. With China and Africa working hand-in-hand on health, we can have even greater impact.” 

The forum examined ways in which China can share its advances in research and development, its commitment to producing high-quality, lower cost, safe health technologies and how it can forge new partnerships with African countries. In return China can learn from the continent’s best practices, including progress made in expanding AIDS treatment, responding to the epidemic in rural areas and stopping new HIV infections among children.

H.E. Dr Mustapha Sidiki Kaloko, Commissioner of Social Affairs of the African Union (left) and Dr Luiz Loures, UNAIDS Deputy Executive Director, Programme at 4th China-Africa Roundtable on Health, 7 May 2013

This exchange was analysed in detail during an HIV session, chaired by UNAIDS, which incorporated an update on the ground-breaking African Union roadmap on shared responsibility and global solidarity for AIDS, TB and malaria. Opportunities for strengthened China-Africa HIV partnership were explored, such as developing antiretroviral therapy drug manufacturing technology through joint ventures and technical support for local production.

“The global health landscape is changing with more partners than ever joining these efforts,” said Dr Luiz Loures, UNAIDS Deputy Executive Director, Programme. “The AIDS response and other experiences paved the way for transformative progress on health and can help China and Africa to engage on a whole new level and innovate on a broad range of health issues.”

In addition, the roundtable discussed pilot project proposals for collaboration in areas such as strengthening laboratory systems; training African health personnel and sharing China’s expertise in cold chain management and surveillance systems to boost immunizations.

It is hoped that the roundtable policy consultations will help to lay the groundwork for a long-term strategic collaboration plan around the upcoming Health Ministerial Meeting of the Forum on China-Africa Cooperation in August. 

The 4th China-Africa Roundtable on Health Cooperation was hosted by the Botswana Ministry of Health, Peking University’s Institute for Global Health and China’s Chamber of Commerce and Ministry of Commerce. Joining African and Chinese Minsters of Health, Commerce and Foreign Affairs and their representatives were leaders of the African Union, the United Nations, international organizations, NGOs and major companies.

Credit: UNAIDS

Big questions were raised about getting the best results in health and development at the World Bank’s Africa Development Forum 2013. The event brought together Ministers of Finance and Health from some 30 African countries to explore effective and creative ways to ensure the future health of the continent. 

With the umbrella theme finance and capacity for results, the aim of the forum was to identify concrete strategies to ensure that investments in health produce sustainable results on a large scale. Also sought, were new ways to finance and build institutional capacity so that African countries can design, implement and evaluate health investments.

“We need more money for health and more health for money in Africa,” said the host Makhtar Diop, Vice President of the World Bank Group, Africa Region in his opening remarks. “This landmark conference aims to jointly decide on concrete actions for countries and show partners how to further invest in health and sustainable growth in Africa,” he added.

Urgent change needed 

Several key characteristics of the continent’s health systems need to be urgently addressed, according to the participants. For instance, the average per capita health spending in Africa was seen as low. However, it is higher than in many South Asian countries where health outcomes are considered generally better. Therefore, Africa would not only need more health financing but also, it would need to spend what it has more effectively.  

In addition, out-of-pocket expenses for accessing health services were also defined as extremely high, constituting about one third of all health expenditure in sub-Saharan Africa and more than 60% in several countries like Cameroon and Sierra Leone. Such personal spending may contribute to increase poverty and decrease the use of medical services.

Many African countries are still heavily dependent on external resources to finance their health sector. For some, as much as 40% comes from this stream and in 26 of 33 countries in sub-Saharan Africa, donor support accounts for more than half of HIV investments. Participants defined this dependency as a serious sustainability issue requiring more self-sufficiency and building of domestic capacity with self-financing as the ultimate goal. 

Speaking about sustainable financing, the Minister of Finance of Nigeria Hon. Ngozi Okonjo-Iweala stated that, “It is not only the volume of financing that matters but how that really responds to the need of the poor,” said Minister Okonjo-Iweala. “In a country deciding on how to best respond to those needs, political will and leadership are key.

 In Africa, a shift from investments that focus on inputs and processes to those that focus on results and systemic changes is already underway. Health sector reforms and efficiency improvement initiatives, results-based financing (RBF), and public-private partnerships in many countries have resulted in rapid scaling up of service coverage and improved efficiency in how resources are used for health.

President of The World Bank Group Dr Jim Yong Kim (left) and UNAIDS Executive Director Michel Sidibé.

The RBF approach at the facility level, pioneered in Rwanda, has resulted in a substantial increase in coverage of high-impact activities such as immunization, family planning, the distribution of mosquito nets, and skilled attendance at delivery. Today, more than 20 sub-Saharan African countries are piloting some form of RBF. Development partners are also trying out this mechanism at the country level. For example, the new World Bank financing instrument known as Program-For-Results (PforR) will now be used in Ethiopia to link disbursement directly with achieving national programme results. Many sub-Saharan African countries have also established social safety nets. Through these initiatives, people with limited or no resources may have improved access to basic health services, among other services, so that they do not have to skip necessary care or endure financial hardship related to it.

The AIDS response: a new paradigm  

In charting the way forward Michel Sidibé highlighted the role of the AIDS response in pioneering a new paradigm of sustainable development, shared responsibility and global health solidarity. He stressed that, despite the progress made in reducing new HIV infections in Africa, more funding, both donor and domestic, and more strategic use of that funding for greatest impact were necessary.

“Our world is shifting and we have to think about long-term financing for results,” said UNAIDS Executive Director Mr Sidibé. “Our objectives are to help countries revisit their programmes and find new mechanisms for investments in health and social development. In the AIDS response, we are seeing a major shift with the domestic investments surpassing those of the donors. We also need to maximize external aid and value for money,” he added.

Participants at the forum committed to building on African countries’ successful initiatives and experiences showing promise such as national health financing strategies, efficiency improvement programmes, results-based financing and introducing safety nets for the poor.

Closing the conference, the President of The World Bank Group Dr Jim Yong Kim said, “We need to help countries to get innovative systems for health to lift the burden. We have a unique opportunity to recommit ourselves to universal access to health that is critical for short, medium and long term growth, ending poverty and building shared prosperity.”

L to R: ONE Senior Advisor and Washington Post Columnist Michael Gerson, South Africa’s Minister of Finance, Honourable Pravin Jamnadas Gordhan, EGPAF Family Ambassadors Fortunata Kasege and her daughter Florida Mwesiga, UNAIDS Executive Director Michel Sidibé, CTAOP Founder and UN Messenger of Peace Charlize Theron, BD CEO, President and Chairman of the Board, Vincent Forlenza, US Global AIDS Coordinator, Ambassador Eric Goosby.
Credit: UNAIDS/C.Kleponis

Shared responsibility of the AIDS response must become part of a new global compact. This was the central message of a high-powered breakfast meeting that took place in Washington, DC on 18 April.

The event brought together leaders in the response to AIDS with members of United States Congress, the Administration, the private sector and AIDS advocates to emphasize how the adoption of the ‘shared responsibility’ approach is translating joint efforts into real results.

The Executive Director of UNAIDS, Michel Sidibé thanked the United States for its longstanding leadership in the AIDS response through such ground-breaking initiatives as the multi-billion dollar President’s Emergency Plan for AIDS Relief (PEPFAR) and its support to the Global Fund to Fight AIDS, TB and Malaria. “The continued leadership and investment from the United States is not only helping to leverage additional resources from donor governments but also from the domestic budgets of low-and middle-income countries,” said Mr Sidibé.” 

South Africa’s experience, for example, shows how the shared responsibility is being translated into real results on the ground. The government now accounts for some three-quarters of the AIDS spending in the country and, under a Partnership Framework signed with the US, it will finance almost 90% of its response by 2017.

According to South Africa’s Minister of Finance, the Honourable Pravin Jamnadas Gordhan, “South Africans have turned the tide against AIDS. Our achievement is a tribute to the close collaboration between South Africans—government, business, researchers, and community workers—and the steadfast and generous support of our partners in the international community.”

South African film star, United Nations Messenger of Peace and founder of the Africa Outreach Project, Charlize Theron said, “The tipping point is upon us and we have an incredible opportunity to turn the tide on HIV and end the AIDS epidemic for good.  I ask that you please take this opportunity to heart and from wherever you sit—Congress, corporate America, the community—that you continue to use your power and influence to keep creating hope and help moving the AIDS response forward.  We can, we must, and we will overcome this epidemic together.”

Florida Mwesiga, Family Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, played a special role in highlighting the impact of HIV on young people. “I’m thankful that my mum was able to receive treatment that protected me from HIV while she was pregnant,” said Ms Mwesiga. “My mum continues her fight to ensure all mothers everywhere can experience the gift of an HIV-negative child,” she shared. “My mother’s courage to stand up and demand change inspires me every day. And it’s because of her that I feel so empowered to also make a difference,” added Ms Mwesiga reminding all participants that everyone has an important role to play in the response to AIDS.

It was clear by the end of the meeting that important contributions by the US to the AIDS response are crucial to achieving the ambitious but attainable goal of an AIDS-free generation. Ambassador Goosby concluded that, “Collectively, we've taken great strides in the global AIDS response. PEPFAR is proud of its close collaboration with host countries and other partners in supporting this transformational change. While much work remains to be done, through country ownership, smart investments, and shared responsibility, I am confident that we will create an AIDS-free generation.”

The event was co-hosted by the Charlize Theron Africa Outreach Project, the Elizabeth Glaser Pediatric AIDS Foundation, ONE, the United States Global Leadership Coalition, and UNAIDS. 

How do we promote meaningful empowerment so people everywhere can achieve poverty eradication, social integration, full employment and decent work? This was the key theme of a UNAIDS statement delivered to the 51^st session of the Commission for Social Development in New York on 12 February.

Echoing the priority theme of the entire session, the UNAIDS statement on empowerment highlighted the fact that HIV should be viewed through the prism of a wider development agenda. Citing the seminal 1995 Copenhagen Declaration of the World Summit on Social Development, the statement argued that communicable diseases hinder social progress and often cause poverty and exclusion.

According to the statement, a people-centred approach to the AIDS response will lead to more effective poverty eradication, better social integration and a greater likelihood of having a fulfilling work life. Despite the progress made in this direction to date, the statement also contended that stigma and discrimination are still major barriers to people’s empowerment and that in many countries and communities the human rights of the people living with and affected by HIV are often neglected or flouted.   

UNAIDS called on the gathering to challenge stigma and discrimination in all its forms and promote and protect human rights. This was seen as an imperative not only for an effective challenge to the epidemic but also to achieve sustainable development, social integration and inclusion. 

The 51^st session of the Commission for Social Development is taking place from 6-15 of February and is organised by the Division for Social Policy Development, part of the UN Secretariat’s Department of Economic and Social Affairs.

The international community is in the midst of negotiating the next global development agenda. This new roadmap is to be put in place after 2015, when the Millennium Development Goals will have reached their target date.

In order to capture a diverse a range of voices and views on how AIDS and health should be reflected Post-2015, UNAIDS is hosting an online and open-to-all consultation. This online conversation will run for two weeks, between 21 January and 3 February, and will be hosted on the official UN and Civil Society joint platform on Post-2015 negotiations, the World We Want.

The consultation invites views around three interrelated themes including: How the HIV epidemic remains relevant to the Post-2015 Agenda; how principles and practices forged in the AIDS response may contribute to a more equitable and sustainable health and development agenda; and how to reform systems of decision-making, monitoring, evaluation and accountability to guide efforts towards the end of the HIV epidemic.

The e-Consultation is being moderated by nine international experts on HIV, human rights, health and development. Together with the UNAIDS, moderators will produce a synthesis report at the end of the consultation. This report will be used widely to influence on-going negotiations, including the High-Level Health Thematic meeting (5-6 March, Botswana) and the UNAIDS-Lancet Post-2015 Commission.  

The global HIV epidemic remains one of the world’s leading causes of death and is both a driver and consequence of inequality and social injustice. The AIDS response has always been a pioneer and a pathfinder on many fronts and can make critical contributions to doing health and development differently in the Post-2015 era.

To participate in the e-consultation please visit http://www.worldwewant2015.org/health

UNAIDS Executive Director Michel Sidibé speaking at the 2nd Health Ministers’ meeting of the BRICS countries held in New Delhi, India from 10-11 January. Credit:UNAIDS/N.Raveendran

The 2nd Health Ministers’ meeting of the BRICS countries (Brazil, Russia, India, China and South Africa) concluded in New Delhi, India on January 11, with a strong call for strengthened cooperation in the implementation of affordable, equitable and sustainable solutions for common health challenges.
During his opening remarks, the Honourable Ghulam Nabi Azad, the Minister of Health and Family Welfare of India, highlighted the progress of the BRICS countries in the global AIDS response. “In India, we have reduced new HIV infections by 57% in the last decade, which puts us on track to halt and reverse the spread of HIV.” He was making reference to reaching one key HIV-related development goal by 2015.

Addressing the participants, UNAIDS Executive Director Michel Sidibé emphasized the unique role of the BRICS countries to draw on their positive experience with HIV to serve as an engine for innovation, research and development of health solutions for other developing countries. “Today, the BRICS are demonstrating how health is increasingly a tool of foreign policy and a vehicle for promoting global health and development for the entire world,” said Mr Sidibe. He also described global health as going through an important transition beyond disease specific approaches and adopting a people-centered approach to global health.

Several of the other BRICS Ministers highlighted their national commitments to HIV and the need to create a BRICS platform to enhance cooperation on global health, including HIV.

The five BRICS countries represent 43% of the global population, giving them a unique and growing role in contributing to global health. According to the Minister Azad, “the BRICS are very mature in our outlook, and have almost achieved adulthood. Let us now work together to consolidate our gains and collaborate at the bilateral and multilateral levels to provide global leadership in many areas.”

From L-R: Deputy Health Minister of Russia, Sergey Velmyaykin, UNAIDS Executive Director, Michel Sidibé, South African Health Minister Pakishe Aaron Motsoaledi, Indian Health minister Ghulam Nabi Azad, Chinese Health Minister Chen Zhu and Brazil Health Secretary Jarbas Barbosa shake hands during the 2nd BRICS Health Ministers meeting in New Delhi on January 11, 2013. Credit:UNAIDS/N.Raveendran

The meeting adopted the Delhi Communique, which calls for the BRICS to renew efforts to face the continued challenge posed by HIV.  The Delhi Communique reiterated the commitment of the BRICS countries to “ensure that bilateral and regional trade agreements do not undermine TRIPS flexibilities so as to assure the availability of affordable generic antiretroviral drugs to developing countries.”

Intellectual property and trade flexibilities within the intellectual property rights system were set out in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).  Evidence from countries across the world shows that the use of TRIPS flexibilities has helped substantially lower the costs of HIV treatment.

At the closing of the meeting, it was announced that the next BRICS Ministerial meeting will be hosted by South Africa in January 2014.

L to R: Luiz Loures, UNAIDS Director of the Political and Public Affairs branch; César Antonio Núñez, Director of the Regional Support Team for Latin America; Dr Carissa Etienne, Director elected of the Pan American Health Organization; Michel Sidibé, Executive Director of UNAIDS; and Ernest Massiah, Director of the Regional Support Team for the Caribbean.

UNAIDS Executive Director Michel Sidibé met on 7 November with the recently appointed Director of the Pan American Health Organization (PAHO) Dr Carissa Etienne at the UNAIDS Headquarters in Geneva to strengthen collaboration towards putting an end to AIDS in the Americas.

"We can build on the successes of the Americas, a region that was one of the first to eliminate measles and polio,” said Mr Sidibé. “There is no reason why this region cannot be the first to end AIDS.”

During the meeting, they exchanged ideas on how to increase joint efforts to achieve the Millennium Development Goals by 2015 and to ensure that health and HIV are part of the post 2015 agenda.

"As we look forward, HIV and health are key for the region, and for global development,” said Dr Etienne. “PAHO will play a key role in moving this agenda forward and with UNAIDS, the Americas can be the first region to see the end of AIDS.”

Dr Carissa Etienne, a native of Dominica, was elected as the new PAHO Director during the 28th Pan American Sanitary Conference that took place from 17-21 September 2012 in Washington D.C. and will begin her five-year term on 1 February 2013. Dr Etienne is currently Assistant Director General, Health Systems and Services, of the World Health Organization (WHO) in Geneva.

L to R : Mrs Fatoumata Daou, Collectif des Femmes pour l’éducation, la santé familiale et l’assainissement Yiriwaton, Minister of Cooperation and Humanitarian action Marie-Josée Jacobs and UNAIDS Executive Director, Michel Sidibé.
Credit: Ministère des Affaires étrangères du Luxembourg

The humanitarian crisis in the Sahel is affecting the lives of millions of people across the region. In eight countries stretching from Chad in the East to Senegal in the West, countries, communities and families are faced with a combination of political instability, drought, poverty, high grain prices, environmental degradation and chronic underdevelopment which has resulted in high levels of malnutrition and insecurity.

“The crisis is devastating the region I grew up in,” said the Executive Director of UNAIDS Michel Sidibé, originally from Mali. “Across the Sahel, I have family and friends whose lives, and communities and countries are directly affected. I will do everything I can to bring attention and resources to help end the crisis.”

There are many complex issues surrounding the crisis and similarities can be drawn with that of the impact and spread of HIV. Like AIDS, it is a humanitarian crisis with political and social origins, and people living with HIV and in need of treatment are particularly vulnerable.

The Grand Duchy of Luxembourg is one of the many countries working hard to further its relief efforts in the region. As part of its annual ‘Assises’, it held a special session on food insecurity in the Sahel. The Assises is a two day session held once a year which brings together politicians, members of the Commission of Foreign affairs, leaders from the departments of Development and Cooperation, representatives from partner countries and around 90 non-governmental organisations in Luxembourg to discuss current pressing issues in the humanitarian agenda.

This year’s discussions focused on three main topics; food insecurity in the Sahel; physical and political insecurity and judicial insecurity. The Executive Director of UNAIDS Michel Sidibé was invited to open the session on food insecurity.

“I am here to support Luxembourg’s efforts to give attention and support to the crisis in the Sahel. Luxembourg is a strong supporter of UNAIDS, but I am even bigger supporter of Luxembourg’s leadership on this particular issue,” said Mr Sidibé.

The United Nations Secretary-General Ban Ki-Moon has called for all United Nations Agencies to coordinate, advocate and advance the UN’s response to the crisis. The Secretary-General has called for a special meeting during the United Nations General Assembly to further advance the UN’s work in alleviating the human suffering caused by the disaster.

During his visit to Luxembourg Mr Sidibé had a chance to discuss both developments in the response to HIV and the issues surrounding the Sahel crisis with the Minister of health, Mars Di Bartolomeo and the Minister of Cooperation and Humanitarian action Marie-Josée Jacobs who officially opened the Assises.

For a number of years Luxembourg has been one of UNAIDS’ most important donors––providing funding for activities essential to an effective response to HIV. Earlier this year UNAIDS signed a memorandum of understanding with Luxembourg to further consolidate the partnership and strengthen efforts to end the disease.

L to R: Dr Jarbas Barbosa da Silva Jr (Government of Brazil), Dr Sania Nishtar (Heartfile), Dr Paul De Lay (UNAIDS), Dr Richard Horton (the Lancet), Dr Margaret Chan (WHO), Dr Masato Mugitani (Government of Japan), Dr Ariel Pablos-MÉndez (USAID).
Credit: UNAIDS/Y.Gripas

Advances in HIV care and treatment that keep people alive while controlling, although not curing, their conditions have led to growing numbers of people surviving with chronic illnesses including HIV infection.

A satellite session at the 19th International AIDS Conference in Washington, DC, examined how service delivery has evolved in addressing HIV as a chronic health issue, and what can be learned from the experience when it comes to preventing and controlling other chronic conditions. Titled "Care and treatment for people with chronic conditions: What can we learn from the HIV experience?” the meeting also identified synergies across HIV, Non-communicable diseases (NCDs)–– such as cardiovascular diseases, cancers, diabetes and chronic respiratory diseases—and other chronic conditions when it comes to health systems strengthening. 

As access to antiretroviral therapy expands, the HIV response is evolving from a disease-specific emergency response to a chronic disease management challenge which needs to be addressed within the context of other chronic health conditions. This epidemiological transition, coupled with a fast growing number of people with other chronic diseases has considerable implications for health systems and societies.

Non-communicable diseases (NCDs)––in particular cardiovascular diseases, cancers, chronic respiratory diseases and diabetes––are the biggest cause of death worldwide. More than 36 million people die annually from NCDs, including 9 million people who die before the age of 60. More than 90% of these premature deaths occur in developing countries and could have largely been prevented.

People living with HIV often also have high rates of non-communicable diseases. With HIV programmes rapidly expanding, people with HIV are living longer and ageing, and are developing non-HIV-related chronic conditions similar to the rest of the population.

In this context, the UNAIDS Secretariat and WHO have signed a Letter of Agreement to accelerate collaboration to address common agendas of HIV and non-communicable diseases. Both organisations will now collaborate to facilitate low- and middle-income countries to successfully address their diseases burden of HIV and non-communicable diseases.

“UNAIDS is committed to take AIDS out of isolation and strengthen integration with NCDs by accelerating collaboration with WHO and partners,” said UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay. “2011 United Nations Political Declaration on HIV/AIDS demands that we link and integrate our HIV response to Non Communicable Diseases. We need to take on our biggest health and development challenges of our time HIV and NCDs together,” he added.

In a number of settings, it has already been possible to use the HIV lessons learnt and synergize with NCD programmes. In Ethiopia, for example, lessons learnt from HIV have served to support diabetes services. In Cambodia, two MÉdecins Sans Frontières (Doctors Without Borders) clinics combined HIV, diabetes and hypertension care services, while in Kenya, FHI 360 has added non-communicable diseases care to existing HIV programmes. In South Africa, a massive unified health testing campaign for HIV, elevated blood pressure and diabetes is underway.

HIV and other chronic diseases

Experience in addressing HIV and non-communicable diseases shows that many of the challenges are common: organizing and delivering adequate prevention services; chronic treatment and care; addressing the social and environmental determinants of these health issues; and reaching people without access to services.

The benefits of an integrated approach are reflected in better access to comprehensive care, cost savings and reduced morbidity and mortality. However, a lot still needs to be done.

According to participants at the session, summarized by Dr Masato Mugitani, Assistant Minister for Global Health, Japan and Board Chair of the Global Health Workforce Alliance, activities need to be coordinated across the continuum of care, from prevention to treatment, care and support. A particular challenge is ensuring a prepared, motivated, supported and well-functioning health workforce. Other areas of equal importance are creating equitable access to medicine and technologies; effective and integrated information systems; and robust population based surveillance.