Middle East and North Africa

ABUJA, Nigeria, 15 July 2013—A report launched today at the Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria highlights increased, targeted health spending as an essential foundation to greater economic growth and development in Africa. The report, Abuja +12: Shaping the future of health in Africa, published by the African Union (AU) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), reviews progress made since the AU’s 2001 Abuja Declaration—in which leaders pledged to mobilize domestic and international resources for health and remove barriers to the AIDS response—highlights remaining gaps, and prioritizes next steps.

“Africa’s health and our prosperity are inextricably linked.  2001 was a turning point for Africa as African countries committed to take greater responsibility for the health and wellbeing of their citizens,” said Dr Mustapha Sidiki Kaloko, AU Commissioner for Social Affairs. “Since then, we have invested greater resources and efforts to address AIDS, TB and malaria which has produced exceptional results. We urge all AU member states to commemorate Abuja+12 with a renewed commitment to prioritize health and achieve their commitments and targets by 2015.”

The new report highlights five main recommendations for a healthier Africa: unifying leadership, generating innovative financing, making smarter investments in health, strengthening human resources and ensuring no one is left behind. Together, these recommendations aim to leverage health as a force for economic growth and social progress across Africa.

The report also highlights recent successes in the HIV, TB and malaria responses in Africa, including substantial reductions in the number of new HIV and TB infections and deaths from malaria. There is now much broader access to antiretroviral and TB medications and use of malaria control strategies such as insecticide-treated bed nets and indoor residual spraying are becoming more widespread.

“Twelve years ago, African leaders pledged to unite in addressing the health crises which were devastating the continent—and succeeded in making historic progress,” said Michel Sidibé, Executive Director of UNAIDS. “A renewed and bold commitment here in Abuja is essential as drawing from experiences in the AIDS response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa.”

The report cites a number of approaches pioneered as part of the AIDS response that can help improve returns on health investments. These include using investment frameworks to prioritize spending on the most cost-effective interventions; focusing efforts on people most in need; and reducing front-line health care costs by shifting tasks, where appropriate, from physicians to nurses, community health workers or other health practitioners. On strengthening health governance in Africa, the report notes that the principles that have been fundamental to the success of the AIDS response can be leveraged for the post-2015 agenda to advance coordination, innovation and commitment.

A central element of the 2001 Abuja Declaration was the commitment to allocate at least 15% of public expenditures to health by 2015. Over the last five years, health spending in Africa has risen by about 10% annually. However, spending is still nowhere near where it needs to be—just six AU member states (Liberia, Madagascar, Malawi, Rwanda, Togo, and Zambia) have achieved the 15% Abuja target, and an additional US$ 31 billion is required to close the funding gap.

Participants at the Youth and UNAIDS event held in Hammamet, Tunisia from the 20-22 of May. Credit: UNAIDS

AIDS activism has radically changed since the beginning of the epidemic. New modes of communication are amplifying people’s voices, creating cross-national webs of solidarity opening up new opportunities for progressive social change.

Young activists in countries around the world are increasingly demanding HIV services to be tailored to their needs and claiming their seat at the decision-making table.

While the HIV prevalence has fallen by nearly 27% among young people aged 15-24 globally between 2001 and 2011, young people still account for 40% of all new HIV infections among adults. In 2011, there were some 4.6 million young people living with HIV.

Against this backdrop, UNAIDS brought together 12 global and regional youth organizations working on HIV, sexual and reproductive health and rights, and lesbian, gay and transgender rights  with the 16 community, country and regional youth activists that constitute the recently established UNAIDS Youth Advisory Forum. The aim was to strategize on a clear direction to move the AIDS response forward for young people.   

“Many small organizations lack the time, resources, and strategic space to reflect on their work and forge new alliances,” said Pablo Aguilera, director of the HIV Young Leaders Fund and member of the UNAIDS Youth Advisory Forum. “We called for this meeting to ensure the movement is responsive to the needs of young people most affected by HIV.”

To deliver results for young people on the ground, a decentralized, connected global youth movement—that thinks globally but acts locally is needed to initiate a new wave of activism in the AIDS response.

The meeting, called the Youth and UNAIDS: A pact for social transformation took place in Hammamet, Tunisia from the 20-22 of May. The main outcome of the consultation was a pact outlining five key themes that cut across individual organizational agendas where youth organizations can make tangible impact towards the goals set in the 2011 United Nations General Assembly Political Declaration on HIV and AIDS.

The five themes include: Integrating HIV services into sexual and reproductive health services, with a focus on government accountability and sexuality education; enabling legal environments and removing punitive laws that impede access to services for young key populations at higher risk; scaling up treatment and disaggregating data for evidence informed advocacy; using resources effectively; and ensuring that HIV remains a priority in the Post-2015 development framework through strategic lobbying of national delegations.

“This new commitment to collaborate around specific priorities is a radical departure from business as usual in the youth AIDS response. Through strengthening collective action that goes beyond organizational agendas, we hope the movement can achieve concrete change for young people affected by HIV,” said Caitlin Chandler, community representative who co-facilitated the meeting together with Beth Goodey from the youth-led development agency Restless Development.

Supporting increased collaboration and strategic direction of the youth movement in the AIDS response is a key priority for the new UNAIDS youth programme, which aims to increase youth leadership, ownership, and mobilization in the AIDS response at the country, regional, and global level by 2015 and beyond.

“We want to work closer with organizations of young people living with HIV and young key populations at higher risk to create broad alliances,” said Mariangela Simao, UNAIDS Director of Gender, Human Rights and Community Mobilization Department. “It’s an effective strategy to ensure national ownership for progressive social change—because the demand for change will come from within,” she added.

During a meeting on May 23 in Geneva, the Minister of Health of the Kingdom of Bahrain, Dr Sadiq AbdulKarim Al Shehabi and UNAIDS Executive Director Michel Sidibé pledged to strengthen cooperation between UNAIDS and the Ministry of Health.

Mr Sidibé commended the leadership of the Minister Al Shehabi in Bahrain in responding to the AIDS epidemic. He also asked Dr Al Shehabi to champion national and regional initiatives to prevent new HIV infections among children by 2015 and to accelerate scale up of HIV treatment in the Arab Region.

Dr Al Shehabi welcomed the partnership with UNAIDS and committed to putting HIV on the agenda of the Gulf Cooperation Council, currently chaired by the Kingdom of Bahrain.

The Arab Region has one of the fastest growing HIV epidemics in the world. Between 2001 and 2011, the estimated number of people living with HIV in Arab countries increased from 170 000 to 230 000. The numbers of AIDS-related deaths and new HIV infections have also increased significantly. Between 2001 and 2011, there was a 32% increase in AIDS-related deaths and since 2001, the number of people newly infected with HIV in Arab countries has increased by more than 47%—from 19 000 to 28 000. Recent studies suggest that concentrated epidemics are emerging among key populations at higher risk of HIV infection in many countries of the region.

UNAIDS Deputy Executive Director, Programme, Luiz Loures (left) and Ambassador Faeqa Saeed Alsaleh, Assistant Secretary General and Head of social sector at the League of Arab States signing the Memorandum of Understanding on 20 May 2013.

GENEVA, 20 May 2013—The General Secretariat of the League of Arab States and the Joint United Nations Programme on HIV/AIDS (UNAIDS) signed a Memorandum of Understanding (MoU) 20 May marking a new commitment to the HIV response in the Arab Region.  

Guided by the 2011 United Nations General Assembly Political Declaration on HIV and AIDS and global and regional HIV related initiatives, the MoU promotes a set of practical and regionally owned solutions to expand HIV prevention, treatment, care and support services. The agreement calls for the development of an Arab AIDS Strategy, mobilizing political leadership and enhancing accountability among the different stakeholders.

The General Secretariat of the League of Arab States and UNAIDS will work with relevant Arab Ministerial Councils at the League such as Health, Interior, Justice, Media, Youth and Sports, and Social Affairs as well as the Arab Parliament.

“Signing a joint MoU between the General Secretariat of the League of Arab States and UNAIDS is a major step forward in our response to HIV,” said Dr Faeqa Said AlSaleh, Assistant Secretary General and Head of the Social Affairs Sector at the League of Arab States. “Through this strategic partnership with UNAIDS the League will work for an AIDS-free generation in the Arab Region.”  

The Arab Region has one of the fastest growing HIV epidemics in the world. Between 2001 and 2011, the estimated number of people living with HIV in Arab countries increased from 170 000 to 230 000. The numbers of AIDS-related deaths and new HIV infections have also increased significantly. Between 2001 and 2011, there was a 32% increase in AIDS-related deaths —from 12 000 to 16 000. Recent studies suggest that concentrated epidemics are emerging among key populations at higher risk of HIV infection in many countries. Since 2001, the number of people newly infected with HIV in Arab countries has increased by more than 47%—from 19 000 to 28 000.

 “The Arab region is an inspiration to the world. We are seeing a younger generation find new avenues of influence and become agents of change,” said UNAIDS Executive Director, Michel Sidibe. ”This agreement brings new momentum to the HIV response in the Arab Region and builds on a transformative leadership, new partnerships and innovative methods to scale up the HIV response.”

Currently undergoing the most profound wave of change in their modern history, people around the region have voiced demands for political and economic inclusion, increased opportunities and social mobility. A new relationship between state and society based on human rights, social justice, participation, and accountability is being forged. Within this dynamic movement, the MoU also calls for the meaningful involvement of civil society and people living with HIV as key players for accelerating HIV response in the region.

African ministers and other leaders at the opening of the Annual Meeting of the ECA Conference of African Ministers of Finance, Planning and Economic Development and AU Conference of Ministers of Economy and Finance in Abidjan, Cote d’Ivoire, 25 March 2013.
Credit: UNAIDS/Basil Zoma.

African Ministers of Finance and other leaders have agreed that the continent needs to shift from a reliance on exports of primary commodities to greater industrialization in order to accelerate the continent’s development. 800 ministers, experts and representatives of the United Nations met at the Annual Meeting of the Economic Commission for Africa (ECA) Conference of African Ministers of Finance, Planning and Economic Development and Africa Union (AU) Conference of Ministers of Economy and Finance. The conference on ”Industrialization for an Emerging Africa.” opened in Abidjan, Cote d’Ivoire on 25 March.

The President of Côte d’Ivoire, Alassane Ouattara, who chaired the opening ceremony, said that "political stability, the stability of the macroeconomic framework and infrastructure quality are necessary for the industrialization of African countries." He also noted that his country has chosen to industrialize and diversify its economy.

Africa has experienced remarkable growth in recent years. Conference speakers pointed to the continent’s growth rate of 5% in 2012 compared to 2% for the global economy.

The Chairperson of the African Union Commission Nkosazana Dlamini Zuma said, “Industrialization is not a luxury for the region but a necessity,” and pointed out that “in spite of significant progress in some areas, challenges and opportunities remain.”

Some of the challenges include a number of non-tariff barriers to trade. The Executive Secretary of the United Nations ECA, Carlos Lopes also pointed to “the chronic instability that characterizes the African continent in contrast to Asia.” He said, “There is no doubt that Africa requires structural transformation and not structural adjustment. Industrialization is absolutely indispensable to this objective.”

UNAIDS Executive Director, Michel Sidibé participating at the Annual Meeting of the ECA Conference of African Ministers of Finance, Planning and Economic Development and AU Conference of Ministers of Economy and Finance in Abidjan, Cote d’Ivoire, 25 March 2013.
Credit: UNAIDS/Basil Zoma.

UNAIDS Executive Director, Michel Sidibé participated in the conference and he stressed that Africa has a unique opportunity to develop its pharmaceutical industry. Currently Africa is highly dependent on foreign medicines, importing 70% of its drugs. Mr Sidibé said, “Africa must change its approach, its paradigm and production strategy.”

Africa imports 80% of antiretroviral medicines. This heavy reliance on external markets represents a serious health risk to Africa, as evidence suggests that many leading Asian pharmaceutical companies are shifting their focus to the more lucrative markets of the West to be replaced by companies who may not have the same quality credentials. Local production can result in many benefits including: greater product quality assurance, shorter supply chains and fewer stock-outs and the production of drugs for diseases that affect Africa that the rest of the world does not supply.

Mr Sidibé said that to encourage the development of a pharmaceutical industry in Africa the next step was to equip public and private stakeholders with key strategic information to attract funding. A new partnership among the African Union Commission, UNAIDS and other partners is seeking to redress this gap in strategic information through the establishment of the Pharmaceutical Market Data Initiative.

The annual meeting continues until 26 March.

Community leaders representing internally displaced people meeting with representatives from the NGO, UN and government.

As the pressure for better living conditions rises in the camps in the Harad district of Yemen—Community leaders representing internally displaced people are meeting more regularly “We are 10 people in my tent; we have been waiting for new supplies to arrive, why the delay?” said one of the leaders.

The Harad camps host more than 130 000 people affected by long civil unrest in Yemen. To survive, many people walk the seven kilometres to the boarder of Saudi Arabia, hoping to cross into a country that is seen as having more economic opportunities. Others rely on daily wages from jobs at construction, agriculture and fishing sites and yet many people depend on the food provided by host local community.

But most people are not aware of their increased vulnerability to HIV infection as they sometimes resort to high-risk behaviors to meet their basic needs.

Local authorities are concerned about the lack of HIV information and have partnered with UNAIDS and the Office for the Coordination of Humanitarian Affairs (OCHA) to start an HIV awareness raising programme for displaced people.

“We know that HIV is escalating and can grow into a major epidemic—as we have seen this happen in other countries,” said Dr Majed Al Gonaid, Deputy Minister of Health. 

Funded by OCHA, the programme is being carried out by the local NGOs Women Association for Sustainable Development (WSAD) and the For All Foundation for Development in partnership with the UNAIDS country coordinator.

The programme consists of awareness-raising sessions on HIV, sexually transmitted infections and life skills to enable young people living in the camps to protect themselves from HIV. Also, as part of the programme, 20 male and female youth peer educators from the camps as well as the host communities will be trained on HIV prevention. Sensitization sessions with religious and community leaders and local council members will also be conducted to eliminate the stigma and discrimination as well as the gender based violence faced by people in the camps. Finally, HIV voluntary counselling and testing services will be provided jointly with the awareness raising activities.

“Such initiatives should be taking place in all humanitarian programmes,” emphasized Renu Chahil-Graf, Director of the UNAIDS Regional Support Team for the Middle-East and North Africa. “We hope that it will be seen as a best practice so that we don’t need to wait—for peace to arrive to provide HIV services.”

Integrating HIV in the humanitarian response

The United Nations Resident Coordinator for Yemen Ismail OuldCheikh Ahmed has been advocating for attention to be paid to HIV. “We must promote the integration of HIV and gender-based violence activities in the overall humanitarian programme,” he said.

L to R: Ms Sabah Badri, Chair of NGO For All Foundation, Dr Renu Chahil-Graf, UNAIDS Middle East and North Africa Regional Director and Mr Khaled Marh, Assistant Director of the camp.

 A report on AIDS, Security and Humanitarian Response presented at the 30^th UNAIDS Programme Coordinating Board (June 2012) highlights that a major objective of the work of UNAIDS, its Cosponsors and partners in supporting the HIV response in humanitarian emergencies has been mainstreaming AIDS into the overall humanitarian intervention, integrating it as a cross-cutting issue. The report raises a number of concerns that governments and organizations need to take into account, such as providing refugees and internally displaced people with continued access to antiretroviral therapy and HIV prevention services, as well as strategies which deal with broader issues like gender-based violence.

UNAIDS Executive Director Michel Sidibé met with the Executive Secretary of the Economic Commission for Africa, Dr Carlos Lopes, on the side-lines of the African Union Summit in Addis Ababa, Ethiopia. They discussed how to support Africa’s HIV response through innovative funding mechanisms and the importance of gathering reliable data, documenting Africa’s potential to produce quality-assured medicines, including antiretroviral drugs.

Dr Lopes said he was committed to strengthening the Commission’s partnership with UNAIDS in order to provide a rigorous and consistent evidence base that can influence the policy debate on AIDS and broader health and development.

The Organization of African First Ladies against HIV/AIDS (OAFLA) came together on 28 January to mark its 10-year anniversary and held its annual Extra Ordinary General Assembly on the side-lines of the African Union Summit in Addis Ababa, Ethiopia. UNAIDS Executive Director Michel Sidibé attended the anniversary luncheon and congratulated the organization for its contribution to the AIDS response.

OAFLA was established in 2002 by 37 First Ladies from Africa committed to take action against AIDS and improve the lives of women, young people and children. Women account for 58% of people living with HIV in sub-Saharan Africa.

The First Ladies of Africa, together with national partners have launched many high impact campaigns, including ‘FLAME’ which kicked off in 2011 in nine countries to promote the virtual elimination of new HIV infections among children and keeping their mothers alive.

Led by the First Lady of Namibia, Penehupifo Pohamba, OAFLA currently has 40 First Ladies from the continent as signatories to the organization.

South Africa’s President Jacob Zuma at the New Partnership for Africa’s Development meeting held on the side-lines of 20th African Union Summit in Addis Ababa, Ethiopia on 26 January 2013. Credit:UNAIDS/J.Ose

South Africa’s President Jacob Zuma called on African leaders to effectively deal with HIV and as such eliminate one of the main causes of maternal deaths on the continent.

Addressing the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA), President Zuma was one of more than 15 Heads of State and policy makers who participated in the High-Level Meeting. The African leaders reviewed past successes and future opportunities for reducing maternal and child mortality in Africa.

“HIV still contributes to about 40% of maternal and child deaths in South Africa. This means that unless we deal decisively with HIV we will not be able to reduce maternal and child mortality to any significant extent,” said President Zuma.

He declared that the extent of the HIV epidemic and decreasing donor funding makes it imperative for Africa to develop its local capacities to produce antiretrovirals for HIV treatment as well as male and female condoms.

“We need to ensure that we can sustain the gains that we have made as reported in the 2012 Global AIDS Report prepared by the UNAIDS, and that we are able to expand access to commodities like condoms and medicines and antiretrovirals,” underscored President Zuma.

Speaking alongside President Zuma, the outgoing Chair of the African Union and President of Benin, Dr Thomas Boni Yayi said thanks to incredible leadership, African countries have turned the story of AIDS from tragedy to hope.

Dr Boni Yayi said “breakthroughs in prevention and treatment have been rolled out, contributing to achievements in several countries.” But he said, “Despite these gains, AIDS is far from over and complacency and competing priorities meant that “we must remain vigilant and committed today, more than ever”.

Benin’s President also pointed to the initiative Roadmap on Shared Responsibility and Global Solidarity, adopted by the African Union in July 2012 as a response to the challenge. “Our Roadmap on Shared Responsibility and Global Solidarity is a new course for our Continent’s response to AIDS, TB and malaria,” said Dr Boni Yayi. “It optimizes the returns from AIDS investments, boosts capacity on the African continent to manufacture essential quality-assured medicines, strengthens mutual accountability and enhances governance.”  

According to the World Health Organization’s report, “Trends in Maternal Mortality”, Africa has reduced maternal mortality by 41% and mortality of children under the age of five by 33% between 1990 and 2010.

The Chairperson of the African Union Commission, Dr Nkosazana Dlamini-Zuma emphasized that as Africa celebrates its progress, it must also reassess the persistent challenges to find comprehensive solutions. “We need to adopt an integrated approach to reducing maternal, new-born and child mortality within the overall continuum of care,” she said. “The impact of our combined efforts shall be much greater than the sum of our individual efforts.” 

In May 2009, the Conference of Africa Union Ministers of Health launched CARMMA under the theme of “Universal Access to Quality Services: Improve Maternal, Neonatal and Child Health”; with the slogan “Africa cares; no woman should die giving life.” 37 countries have implemented the initiative at a national level, galvanising high level political commitment, country ownership, and social mobilization for maternal, new-born and child health issues in Africa.

The meeting took place on the side-lines of the 20^th African Union Summit held in Addis Ababa, Ethiopia where the United Nations Secretary-General Ban Ki-moon addressed the opening.

Ending AIDS in Africa

Mr Ban commended the incredible leadership that enabled Africa to make tremendous progress in reducing new HIV infections and AIDS-related deaths. He said the progress was due to “good policies, strong leadership and global partnerships as well as scientific advances,” and he added, “The UN will continue to support you as we work for an AIDS-free generation, especially by ending HIV in new-borns.”

UNAIDS Executive Director Michel Sidibé meets with President of Benin, Dr Thomas Boni Yayi, and Vice President, Africa, World bank, Makhtar Diop, at the 20th African Union Summit in Addis, 27 January 2013. Credit: UNAIDS/J.Ose

Africa has made remarkable progress in the AIDS response. According to the UNAIDS World AIDS Day 2012 Report, new HIV infections dropped by 50% in 13 countries across Africa. The number of children newly infected with HIV, in sub-Saharan Africa fell by 24% between 2009 and 2011.

While acknowledging Africa’s gains towards the Millennium Development Goals (MDGs), Mr Ban raised his concerns over the remaining challenges. “I am still concerned about the hundreds of millions of Africans living in poverty,” said Mr Ban. “We must accelerate our efforts as we near the 2015 deadline.”

He called on African leaders to participate in the Special Event on the Millennium Development Goals at the United Nations General Assembly in September 2013, where world leaders convene to deliberate on MDG targets and the Post 2015 development agenda.

Delivering on Africa’s commitments

The opening of the AU Summit was preceded by the NEPAD Heads of State and Government Orientation Committee (HSGOC) Meeting. Addressing the meeting, NEPAD’s Chief Executive Officer Dr Ibrahim Mayaki stressed the need for continued advocacy for mutual accountability and the fulfilment of past commitments by development partners in Africa. “We are engaging the African Union Commission and UNAIDS on an Accountability report to combat HIV and AIDS, Tuberculosis and Malaria under the G8-Africa framework for 2013,” said Dr Mayaki.

Students that have completed the course on HIV as part of their Master’s Degree in International Health at the Senghor University.
Credit: Senghor University

More than 35 students from 22 countries across sub-Saharan Africa, the Middle East and North Africa, Haiti and France have completed a course on HIV as part of their Master’s Degree in International Health at the Senghor University based in Alexandria. The module was established by UNAIDS and the Department of Health at the University in 2011 in a bid to give students a better understanding of the complexities of the global response to HIV.

This is the second year that students have participated in the programme. “I welcome this strong cooperation between UNAIDS and the Senghor University,” said Professor Albert Lourde, Rector of the Senghor University. “It shows how Francophone expertise is unique and how we need to encourage education and knowledge sharing across Francophone countries to effectively deal with issues related to HIV.”

The course comprises of 10 sessions which aim to strengthen the student’s scientific and global public health knowledge and enable them to support their national AIDS responses once they return to their home countries. This year’s course included sessions on sharing epidemiology and medical knowledge on HIV and the contribution of communities and civil society to the AIDS response.

During the course, students were encouraged to reflect on some of the major challenges to achieving the targets and commitments in the 2011 United Nations Political Declaration on HIV/AIDS. The course concluded with an interactive video-conference opened by Professor Lourde that highlighted the major international initiatives to promote effective and efficient responses to HIV. These include an initiative that aims to ensure 15 million people are on antiretroviral treatment by 2015 as well as the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. During the conference, participants also discussed human rights in the context of HIV and analyzed the specific challenges faced by the West and Central African region.

As part of the programme some of the students had the opportunity to complete a mandatory three month internship at UNAIDS offices in West and Central Africa and the Middle East and North Africa where they learnt first-hand about the complexities of responding to HIV. UNAIDS will continue its partnership with the University to ensure that AIDS remains as part of the curriculum of its Master’s degree in International Health programme as the university expands its campuses to other French speaking countries throughout Africa.