Middle East and North Africa

(L to r): Mr Ahmed Abbadi Secretary General of Rabita Mohammadia des Ouléma from Morocco, Father Hady Aya, an Antonin Maronite priest, and founder of the Organization for Justice and Mercy and UNAIDS Regional Director for West and Central Africa, Mrs Meskerem Grunitzky-Bekele. 29 March 2010, Casablanca, Morocco

Religious leaders and UNAIDS renewed their commitment to collaborate closely in order to prioritize and strengthen the response to HIV. The reassurance of their commitment came during the launch of the French language version of the UNAIDS strategic framework for partnership with Faith-Based Organizations (FBOs) in its response to HIV, that took place at the 5th Francophone conference on HIV/AIDS taking place in Casablanca from 28 to 31 March 2010.

The framework, launched in English in December 2009, is designed to encourage global and national religious leaders to take supportive public action in the AIDS response and create strong partnerships between UNAIDS and established FBOs working on HIV.

“The framework will serve as a guidance for UNAIDS staff to establish and strengthen the collaboration with the religious leaders,” said UNAIDS Regional Director for West and Central Africa, Mrs Meskerem Grunitzky-Bekele, in Casablanca.

The document details how FBOs can work towards ending stigma and discrimination and help in the inclusion of people living with HIV in the programme design and implementation, as well as research, monitoring and evaluation of programmes and in decision-making processes.

The religious leaders present at the launch stressed the need to meaningfully engage the people living with HIV and that the faith leaders need to act decisively to protect human rights within their communities.

“Our presence in the church stresses on our main vocation to defend human dignity and be witnesses for the mercy of God,” said Father Hady Aya, an Antonin Maronite priest, and founder of the Organization for Justice and Mercy which works on HIV issues in prison settings in Lebanon.

Muslim leader Mr Ahmed Abbadi Secretary General of Rabita Mohammadia des Ouléma from Morocco welcomed the document. "I am in full support of this framework that provides us with tools for a more professional approach in our work among communities of people vulnerable to HIV".

The launch of the French version of the document was officiated by Father Hady Aya and Mr Ahmed Abbadi. Both religious leaders are active members of CHAHAMA, the First Regional Network of Arab Religious Leaders Responding to AIDS in the Middle East and North Africa region. Mrs Meskerem Grunitzky-Bekele, UNAIDS Regional Director for West and Central Africa represented UNAIDS at the event.

The Framework promotes strengthened links, including coordination and oversight, between UNAIDS and FBOs at the country level to ensure that there is an appropriate interface as part of a comprehensive national AIDS response. UNAIDS will continue to advocate for FBOs and other organizations to be appropriately funded so that they can play a role commensurate with their capacities in supporting the development, implementation, monitoring and evaluation of national AIDS plans.

Nicolas Ritter founder of Prevention, Information and Fight against AIDS (PILS) speaking at the technical consultation on positive health, dignity and prevention. Casablanca, Morocco on 28 March 2010.

Nicolas Ritter is a pioneer in the drive to ensure that people living with HIV are at the centre of the AIDS response. He was the first person from Mauritius to announce publicly that he was HIV positive. “It seemed logical that people with HIV should be part of the response, but it took a long time for others with HIV to come forward, because of their fear of stigmatization,” said Ritter.

In 1996, Ritter founded Prevention, Information and Fight against AIDS (PILS) in Mauritius with the mission of campaigning for improving the quality of life for people living with HIV and involving them in all aspects of prevention. Fourteen years later, PILS now has 13 “positive ambassadors” who speak in schools, businesses and to the media about HIV prevention.

As antiretroviral treatment has given millions of people a new lease on life, HIV prevention programmes have begun to refocus their attention on people who know their HIV positive status to ensure people living with HIV are at the forefront of developing and implementing HIV policies. To support this, the Global Network of People living with HIV (GNP+) and UNAIDS held a technical consultation in Casablanca, Morocco on 28 March.

Positive Health, Dignity and Prevention

Around 30 international participants representing people living with HIV, civil society, government agencies, UNAIDS Cosponsors, international donors and development agencies took part in the discussions, which come almost a year after a key meeting in Tunisia. During that consultation, participants moved away from the expression “positive prevention,” finding that it stigmatized people living with HIV. To shift the unfair burden of responsibility for HIV transmission away from HIV positive people, they coined the term “Positive Health, Dignity and Prevention”.

Participants highlighted the importance of making positive health, dignity and prevention undeniable elements of combination prevention. Casablanca, Morocco on 28 March 2010.

During the consultation in Casablanca, stakeholders shared best practices, identified challenges, common goals and looked at opportunities in programming, politics and research. “This discussion has been vital in moving the debate forward,” said Nicolas Ritter, “we looked at ways to turn the concept of “Positive Health, Dignity and Prevention” into concrete action.”

Participants highlighted the importance of making positive health, dignity and prevention undeniable elements of combination prevention. They stressed a human rights approach based on legal protection and a policy environment free of discrimination and examined ways to address social vulnerabilities such as poverty, gender-based violence, xenophobia and homophobia. “We looked at the major roadblocks to dramatically increasing the participation of people living with HIV in prevention programmes,” said Helene Badini UNAIDS Regional Adviser, Social Mobilization.

5th Francophone Conference on HIV

The international consultation was held in Casablanca as part of the 5th Francophone Conference on HIV which is taking place from 28 to 31 March. The event brings together over 1,500 health professionals, researchers, government officials, civil society and leading francophone actors of the HIV response. The conference is chaired by Profession Francoise Barré-Sinoussi, Nobel Laureate for Medicine 2008. UNAIDS is collaborating in the event for the first time and in addition to the consultation on “Positive Health, Dignity and Prevention” it is also helping to organize a symposium on HIV and human rights on Tuesday with the United Nations Development Programme. UNAIDS Executive Director Mr Michel Sidibé will be speaking at Wednesday’s closing ceremony.

This year human rights and law will be in the spotlight at the 5th Francophone Conference on AIDS held in Casablanca, Morocco from 28 to 31 March 2010. Credit: UNAIDS/P.Virot

This year human rights and law will be in the spotlight at the 5th Francophone Conference on AIDS held in Casablanca, Morocco from 28 to 31 March 2010. The conference is taking place against a backdrop of continuing discrimination and human rights infringement of people living with HIV across the world. There are reports of harassment, prosecution of and violence against people living with HIV in several francophone countries.

However, leaders and policy makers are increasingly recognising the importance of addressing the legal and policy environment as a fundamental component of national AIDS responses. This is particularly true for populations such as men who have sex with men, prisoners, sex workers and people who use drugs whose marginalisation hinder their access to HIV-related services.

Countries are taking action. Guinea, for example, recently amended its HIV law of 2005 to remove any restriction to access HIV-related services for children and to ensure access to HIV-related prevention, treatment, care and support for populations including men who have sex with men. Similar processes are ongoing in Togo, Benin and Sierra Leone.

In East Africa, UNAIDS is currently supporting the development of a regional Bill on HIV which would protect people against HIV-related stigma and discrimination and other human rights abuses in the context of the HIV epidemic.

In order to help support the current initiatives aimed at ensuring access to HIV-related services as well as access to justice in the context of the HIV epidemic in francophone countries, UNAIDS, UNDP, the African Council of AIDS Service Orgnizations (AfriCASO), the Association Marocaine de Solidarité et Développment (AMSED), International Development Law Organization (IDLO), and the International HIV/AIDS Alliance are organising a preconference meeting on 28 of March which will focus on strengthening and expanding HIV-related legal services in the region.

The meeting will bring together lawyers, advocates, representatives of people living with HIV and representatives of key populations at higher risk to share their experiences and discuss ways to increasing HIV-related support for those who need it most.

“Analyses in many countries reveal the existence of punitive laws and law enforcement that drive people away from HIV-related services,” said Susan Timberlake, UNAIDS Senior Human Rights and Law Adviser. “It is critical to support law reform as well as access to justice through legal services to create a legal environment that will support people to access HIV-related services. To respond effectively to HIV, we need to protect, not punish, with the law.”

UNAIDS believes that a protective legal environment is critical for an effective response to HIV. In 2009 UNAIDS strengthened its focus on the removal of punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS by making it one of ten key priority areas outlined in the UNAIDS Outcome Framework 2009-2011 (Joint action for results: UNAIDS outcome framework, 2009 - 2011).

On Tuesday 30 March UNAIDS together with UNDP will be holding a symposium event on the legal environment to the AIDS response in Francophone countries during the Conference themed “HIV and the Law: addressing the barriers and realising Universal Access.”

Michel Sidibé, UNAIDS Executive Director encouraged Qatar to increase its contributions to AIDS, health and development.
Credit: UNAIDS

During his official visit to Qatar, UNAIDS Executive Director Michel Sidibé encouraged the country to increase its contributions to AIDS, health and development at this critical time of the global recession.

“I believe that wealthier states, especially in the Gulf region, have a special responsibility to alleviate the world’s distress, and I encourage them to increase their contributions to AIDS, health and development at this critical time.” said Mr Sidibé.

In 2008, Qatar recorded a per capita GDP of US$ 72,000, among the highest in the world. Even under the global economic crisis, its GDP growth remained at 9.5%.

During his meeting with Doha's Minister of Health, H.E Abdullah bin Khaled Al Qahtani, Mr Sidibé congratulated the state of Qatar on its commitment to create a healthcare system that is aiming at providing the most effective and advanced healthcare for its people and become a model of the world to follow.

Since its formation in 2006, Qatar’s National AIDS Committee has taken major steps forward in the efforts to control HIV spread. This includes working closely with the industrial sector to limit HIV spread in the workplace, partnering with the United Nations Development Programme (UNDP) to establish a strategy on HIV prevention, and holding several workshops on HIV targeting community leaders from the media, the religious sector, and other community sectors.

In 2001, Qatar signed a Declaration on the TRIPS Agreement and Public Health that led directly to more than 4 million people gaining access to antiretroviral treatment for AIDS. The same year, Qatar made a pledge by signing a United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS.

Mr Sidibé highlighted the importance of public-private partnerships in helping the developing world launch itself on the path of sustainable development when he met Abdullah H. Al-Nameh, Executive Director and General Manager of the Qatar Charity, a non-government organization that supports the Qatari society and other needy communities abroad.

Established in 1992, the Qatar Charity focuses its work in the fields of humanitarian relief and development through the development of education and culture-related programmes targeting families, women and children. One of the largest charities in the Gulf, its activities covering more than 40 countries in Africa, Asia and Europe, the Qatar Charity uses its field offices or local civil society organizations as implementing partners.

 Credit: UNAIDS/P.Virot

The HIV epidemic in the Middle East and North Africa (MENA) region, while seldom highlighted, is steadily growing. In 2008 there were an estimated 310 000 people living with HIV, up from 200 000 in 2001. In that same year, approximately 35 000 people became newly infected with HIV in the region.

UNAIDS Executive Director Mr Michel Sidibé is in the region to draw attention to some of the key issues which need to be addressed to deliver an effective AIDS response, calling on countries to pursue equity and human rights in their approach to the HIV epidemic.

Stigma and discrimination remains key barriers to an effective regional response to AIDS and in many countries the criminalization of higher risk behaviors pushes affected communities underground–limiting access to HIV prevention, treatment, care and support services.

Given that populations at higher risk are disproportionally affected even in settings where overall HIV prevalence is low, for the good of the public health there is a need for acceptance. “Understanding is an imperative to draw those most at risk out of the shadows and enable them to protect themselves, and by extension, the entire community,” said Mr Sidibé.

UNAIDS’ work in the region

UNAIDS works closely with government and civil society partners in the region to advocate for the removal of punitive laws and polices that block an effective response.

In Yemen, on 29 August, the Parliament voted on a law to protect the rights of people living with HIV with the objective to reduce discrimination. This article 51 law is a major step to protect the rights of individuals living with HIV in the country.

In Egypt, an outreach programme for men who have sex with men has been initiated and in few months the project reached hundreds of people with services in a highly challenging environment. This programme is implemented by UNAIDS in partnerships with number of NGOs and with financial support from USAIDS and the Ford Foundation.

Another positive initiative was the first regional conference on Harm Reduction held in Lebanon last year. This conference was a break-through for the region and brought several experts and partners together and mobilized political support form parliamentarians, national governments and UN agencies.

Service provision for key populations is now also being expanded in the Middle East and North Africa region with oral substitution therapy for Injecting Drug Users programmes in Morocco and Lebanon. In Iran medical insurance is provided for people living with HIV and their families, where the insurance fees are completely paid buy the government. Theses success stories are significant and show investments towards universal access to HIV prevention, treatment, care and support much needed in the region.

Highlighting Human Rights at Qatar Conference

While in the region, Mr Sidibé attended the Colloquium on the Empowerment of the Family in the Modern World held in Doha, Qatar. Hosted by the Royal Family of Qatar and the Qatar Foundation in Doha, the Colloquium brings together scholars to discuss issues such as trends and challenges affecting the family, family and rights, and families around the world.

“Families offer the first defence line against stigma and isolation and as well as the primary source of care,” said Mr Sidibé in his key note address. The UNAIDS head also highlighted recent findings from the two year research project of the The Joint Learning Initiative on Children and HIV/AIDS. According to the report families take on approximately 90% of the financial cost of caring for infected and affected children.

Also of key concern is the freedom of movement for people living with HIV, disproportionally affecting migrant workers and their families. Qatar–as many others in the Middle East and North African region– imposes restriction on entry, stay and residence based on HIV status. Such restrictions are widely considered discriminatory and serve no public health benefit.

“Let’s leverage the solidarity of the global AIDS response to draw closer together as a global family unit to end human suffering and stimulate human achievement,” Mr Sidibé concluded his address.

Challenges ahead

To date, a shortage of timely and reliable epidemiological and behavioral data has hindered a clear understanding of the dynamics and trends of the HIV epidemic in the region. Although HIV prevalence remains low, populations at higher risk are often heavily affected; the epidemics in the countries of the region are typically concentrated among injecting drug users, men who have sex with men, sex workers and their clients.

Two broad transmission patterns have been identified. Firstly, many people are contracting HIV while living abroad, often exposing their sexual partners to infection upon their return to their home country. Secondly, HIV transmission is occurring within populations at higher risk such as injecting drug users or men who have sex with men, may also result in ongoing transmission to female sexual partners.

The UNAIDS 2009 AIDS Epidemic Update suggests intensified prevention efforts for the female sexual partners of men who are exposed to HIV during work abroad, drug use, sex with another man or sex with a sex worker.

With arts and culture being pillars of the Jeux de la Francophonie, the Y-PEER network performed a dance and song written by its members about AIDS. Beirut, 28 September 2009. Credit: UNAIDS/Nabil

The UNFPA-supported Y-PEER initiative is a groundbreaking youth programme that raises HIV prevention awareness through street art, music and dance. UNAIDS Executive Director Michel Sidibé had the opportunity this week to attend a dance performance by the Youth Peer Education Network during the Jeux de la Francophonie.

With arts and culture being one of the two pillars of the Jeux de la Francophonie, the Y-PEER network performed a dance and song written specifically by its members for these games. The lyrics include HIV prevention messages in Arabic, French and English, with the dancers forming a large red ribbon of red fabric at the end of the routine.

“UNAIDS and our Cosponsors are committed to including young people’s leadership as an integral part of national responses including empowering young people to prevent sexual and other transmission of HIV infection among their peers,” said Mr Sidibé.

“This evening’s performance was inspiring, putting these goals into action with young people creatively participating in the AIDS response in their own terms,” said Mr Sidibé after the show. “Culture and creative expression are powerful tools for mobilizing people of all ages and I applaud the Y-PEER.”

UNAIDS Executive Director Michel Sidibé writes a message at the UNAIDS booth at Y-PEER event, Beirut, 28 September 2009. Credit: UNAIDS/Nabil

Y-PEER is a groundbreaking and comprehensive youth-to-youth initiative pioneered by UNFPA. The international network includes over 7000 young peer educators in Europe, Central Asia, Latin America, North Africa and the Middle East. The network has adopted an approach of “edutainment”—combining education and entertainment— to communicating HIV facts. Young people work together to raise awareness on sexual and reproductive health including the facts about sexually transmitted infection and HIV prevention.

The Lebanese Y-PEER network was launched in 2008 with the support of UNFPA and through 35 peer educators, the network has reached 1000 young people all over country in just three months.

With 7,400 new HIV infections daily worldwide and young people aged 15-24 accounting for 45% of these. 

The Jeux de la Francophonie brings together sport and culture to foster dialogue and understanding among French speaking nations. It will run in Beirut until 6 October, bringing together 70 countries from all over the world.

The Director General in the Ministry of Public Health, Lebanon, Dr Walid Ammar (right) met UNAIDS Executive Director Michel Sidibé. Beirut, 28 September 2009. Credit: UNAIDS/Nabil

UNAIDS Executive Director Michel Sidibé concluded an official visit to Lebanon on 29 September. Mr Sidibé recognized and supported the country’s achievements in the HIV response and efforts to target key populations at risk of HIV. He also welcomed the Government of Lebanon’s strong commitment to introduce oral substitution therapy into the country’s public health system.

Mr Sidibé met with the Director General in the Ministry of Public Health, Lebanon, Dr Walid Ammar, and commended the government’s initiative to scale up its harm reduction programme. He stressed the need to expand prevention and treatment efforts among key populations affected with HIV in order to achieve universal access goals.

Mr Sidibé also met with the Executive Secretary of the Economic and Social Commission for Western Asia, Mr Bader Al-Dafa, to discuss approaches to prevent escalation of the HIV epidemic in the countries of the Middle East and North Africa, focusing on gender, socio-economic, marginalization and other factors which increase vulnerability.

Mr Sidibé emphasized the priority of keeping HIV prevalence low in the region, “for low prevalence to continue, I encourage more openness in communicating about AIDS issues. Let us all work together without judgment or discrimination for people living with or at risk of HIV,” said Mr Sidibé.

Mr Sidibé met with civil society groups while in Lebanon. Credit: UNAIDS/Nabil

Recognizing the pivotal role of civil society in the HIV effort, he also met with representatives from non-governmental organizations (NGOs) in the country. These included Helem Association, the first organization working with men who have sex with men (MSM) in the region as well as Soins Infirmiers et Developpement Communautaire (SIDC) which has implemented outreach and HIV prevention for MSM. He also met with Vivre Positif, which works towards ending discrimination and stigmatization towards people living with HIV.

Lebanon’s national AIDS programme has recently introduced 19 voluntary counselling and treatment centres that target key populations and are managed through NGOs. The country also recently launched a centre for antiretroviral distribution along with the provision of psycho-social support for people living with HIV.

According to UNAIDS 2007 estimates, Lebanon is a low HIV prevalence country with a total of 2900 people living with HIV. High mobility and migration levels are important drivers of the epidemic, with 45% of notified HIV cases up to 2004 being linked to travel abroad. Lebanon is among the few countries in the region that has accounted for specific strategies to target each of the key population groups.

Mr Sidibé's visit to Lebanon also included his participation in the Jeux de la Francophonie, of which UNAIDS is an official partner this year.

Jeux de la Francophonie opened in Beirut. Credit: UNAIDS/Nabil

The Jeux de la Francophonie (the Francophone Games) have been opened in Beirut by His Excellency Michel Suleiman, the President of Lebanon. The Jeux de la Francophonie is an event where sport and culture combine to foster dialogue and understanding among French speaking nations. The games are organized by a national organizing committee and the l’Organisation Internationale de la Francophonie (OIF).

“Through partnership change can happen,” said Mr Michel Sidibé, Executive Director of UNAIDS. “I am delighted that this year for the first time, UNAIDS is an official partner to the Jeux de la Francophonie. The OIF has shown leadership and a strong commitment to placing AIDS on the games’ agenda.”

Abdou Diouf, Secretary-General of La Francophonie addresses the opening ceremony
Credit: UNAIDS/Nabil

Observing the opening ceremony, Mr Sidibé noted the ability of the event to unify people all over the world. “The games, with their unique approach of merging sport and culture, have created a space for the open and respectful dialogue needed to challenge the taboos often surrounding issues pertaining to AIDS,” said Mr Sidibé.

Empowering young people to protect themselves from HIV is one of UNAIDS nine priority areas in the Outcome Framework 2009-2011.

In the Jeux de la Francophonie young athletes and artists of the French-speaking world are given an opportunity to meet through sporting and cultural events. The games have an ambition to foster dialogue and understanding among participants as well as spectators. It also aims to encourage young athletes and artist to contributing to international solidarity and gender equality, as well develop artistic exchanges between francophone countries.

"La Francophonie contre le sida - Francophone countries against AIDS"

Across the city of Beirut UNAIDS Goodwill Ambassadors Michael Ballack and Emmanuel Adebayor feature on 100 billboards with the powerful message “La Francophonie contre le sida” (Francophone countries against AIDS).
Credit: UNAIDS

In a joint campaign, across the city of Beirut UNAIDS Goodwill Ambassadors Michael Ballack and Emmanuel Adebayor feature on 100 billboards with the powerful message “La Francophonie contre le sida” (Francophone countries against AIDS). The UNAIDS logo along with other partners to the Games, is displayed by the organizing committee within the Chamoun stadium, visible to an expected 200, 000 spectators and 50 million people following the games via broadcasting. 

Through the partnership, UNAIDS aims to raise awareness on AIDS issues and to help inform young people how to protect themselves against HIV infection.

With 7,400 new HIV infections daily worldwide and young people aged 15-24 accounting for 45% of these, empowering young people and raising awareness of the epidemic is seen as a key to bring about change.

Running from the 27 September to 6 October, the Jeux de la Francophonie brings together 70 countries from all over the world.

The world of work is a key arena for successfully challenging the AIDS epidemic, which affects the most economically active in every population. The majority of those living with the virus across the globe are workers. To promote this challenge in Morocco, the Ministry of Employment, in collaboration with the International Labour Organization (ILO) and UNAIDS, hosted a two-day national workshop on HIV workplace programmes in Casablanca at the end of June.

Bringing together actors from a number of sectors, the meeting included representatives from trade unions, government ministries, employers and businesses, NGOs, people living with HIV, medical officers and experts. It is the first of this scale and reach to be held and over 60 discussion topics were explored.

The main aim of the workshop was to progress towards the development of a strategic AIDS plan. This three-pronged plan would include: HIV prevention in the workplace; care and support for people living with the virus and tacking stigma and discrimination; and management and coordination of the challenge to AIDS.

In order to arrive at this goal, the first day of the meeting was devoted to exploring the country's AIDS response in the world of work to date, which included a high-level discussion on challenges and lessons learned in developing HIV programmes in this sector. The principles and guidelines of the ILO, with emphasis on its Code of Practice on HIV and the world of work, adopted in 2001, were also examined.

 

It was noted that a great deal of good work had already been achieved by a number of individuals and organizations, including the Association Marocaine de Lutte contre le Sida (Moroccan Association for the Fight against AIDS - ALCS), AIDS Entreprises Morocco (a national network of companies working on HIV and STI programmes in the workplace), as well as trade unions and occupational physicians. However, all still face a number of constraints in integrating the AIDS response into the world of work.

Dr Moucharafou Idohou, the ILO National Project Coordinator in Benin, attended the Conference to present core ILO policy tools and share experience of workplace action in Francophone West Africa. He said he was pleased at progress made so far. "I congratulate the Moroccan authorities on their commitment to the AIDS response on the basis of a multi-sectoral approach and for including the workplace in this response. The initiative of developing a sectoral plan on HIV workplace programmes by the Ministry of Employment makes Morocco a pioneer country among other low prevalence countries."

While working towards the development of the strategic plan, participants took a number of areas into consideration. They debated how to move towards implementing a programme aimed at the most vulnerable, i.e. informal and mobile workers.

Also necessary would be strengthening the capacity of employers’ organizations, unions and other business institutions, while mobilizing their resources for HIV prevention and education activities and challenging stigma and discrimination. How to continue raising awareness of the human rights aspect of HIV and its impact on companies, and setting a legal framework which could serve as a basis for national AIDS programmes responding to HIV in the world of work, were also discussed.

There were a number of conclusions emerging from the workshop. The delegates recommended:

1. Setting up a national committee to focus on HIV in the workplace with representation from employers, unions and the government;
2. Development of advocacy activities to sensitize social partners;
3. Adapting the legislative framework to ensure good HIV programmes in the . workplace;
4. More research on most at risk groups;
5. Mobilization of national and international funding to implement the strategic AIDS plan.

The government of Morocco, through the Ministry of Employment, reiterated its commitment and willingness to work with its partners to effectively implement a national plan to respond to HIV and STIs in the workplace.

According to UNAIDS Country Coordinator for Morocco, Dr Kamal Alami, “The challenge to AIDS in the workplace is a key opportunity on the road to achieving universal access. We must pay special attention to the workers who are most at risk in terms of HIV infection and to the informal sector."

The concept of ‘positive prevention’ provides an opportunity to highlight the prevention needs of people who know their positive serostatus.

Ever since HIV testing was developed in the early days of the epidemic, the role of people living with HIV in HIV prevention has been an important aspect of the AIDS response. Following the advent of combination antiretroviral treatment which significantly prolongs life and improves quality of life for people living with HIV, there have been increasing calls to incorporate what is known as ‘positive prevention’ in the continuum of prevention and care programmes and services.

The concept of ‘positive prevention’ provides an opportunity to highlight the prevention needs of people who know their positive serostatus, and is a useful lens through which to understand the important linkages between prevention, treatment, care and support.

However, despite increasing funding directed towards positive prevention, there is a lack of clear understanding globally and regionally of the concept, objectives and programmatic features of ‘positive prevention’, either within the community and representatives of people living with HIV, or between civil society and other partners.

As a direct consequence, the Global Network of People living with HIV (GNP+) and UNAIDS are convening a technical consultation on 27-28 April 2009 in Tunisia on the subject to help develop a common understanding of ‘positive prevention’, as well as guidelines and action plans to inform policies and programmes.

The term ‘positive prevention’ itself will be discussed during the technical consultation as, even though it is the most commonly used term, other terms are also used by different organizations and programmes such as ‘Prevention and Care for People Living with HIV/AIDS’ or ‘prevention with HIV-positive people’.

Participants at the consultation will represent civil society, government agencies, UNAIDS Cosponsors and Secretariat and international development agencies. A majority of the participants will be people living with HIV as the conversation around positive prevention has too often occurred without the involvement of people living with HIV at the design stage and has led to significant shortcomings in most current approaches.

The technical consultation follows the significant Positive Leadership Summit held in Mexico in 2008 and is part of an ongoing process to ensure that positive prevention efforts are based on a solid consensus among positive people. To that end, experts will identify strategies to gather experiences and knowledge of stakeholders, in particular people living with HIV at regional, national and local levels.

If the prevention needs of positive people are to be adequately addressed, people who know they are living with HIV must be involved in defining and developing programmes.

It is expected that the meeting will facilitate the development of a set of principles that will guide the work of and partnerships between multilateral, bilateral, governmental and civil society organizations in designing positive prevention programmes. Participants will also develop recommendations on the scaling up of programmes and policies, informed by the local context.

“Positive prevention” programmes

Many HIV programmes worldwide seek to include people living with HIV in their prevention efforts. Diverse programmatic activities are undertaken, including support for self-help groups and community empowerment, counselling in the context of HIV testing or of family planning, engagement of positive people in education programming (e.g. in delivering personal testimonies), and behaviour change programming directed at HIV-positive people or discordant partners. The aims of these programming efforts vary widely, and are not always explicit or consistent. Quite often, positive prevention programmes have focused on HIV testing and so are seen as irrelevant to people who already know their serostatus. Most existing interventions focus almost entirely on preventing the onward transmission of HIV, which may be counter-productive to programmes intended to address prevention, care and support for HIV positive people in a holistic manner.

If the prevention needs of positive people are to be adequately addressed, people who know they are living with HIV must be involved in defining and developing programmes. A human rights approach combating stigma and discrimination is essential to the success of positive prevention. Positive prevention requires addressing social vulnerabilities such as poverty, gender-based violence, xenophobia and homophobia. It is also inextricably linked with access to treatment, care and support.

While most agree that among the measures of success of positive prevention is the reduction of HIV transmission, it is also widely felt that positive prevention should not be exclusively about preventing onward transmission of HIV. The discussion about positive prevention needs to explore the efforts of people who know they are living with HIV to learn and practice ways to promote their own health and prevent disease.