PEPFAR

Investments by the United States of America in the global AIDS response are delivering results

GENEVA, 1 December 2016—Upon the release of compelling new evidence of national AIDS programme successes in Malawi, Zambia and Zimbabwe, UNAIDS congratulates the countries as well as the United States of America for its consistently outstanding support to the global AIDS response.

New survey data released by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) show that Malawi, Zambia and Zimbabwe have all made important progress against the epidemic. The initial results from the three Population-Based HIV Impact Assessment (PHIA) surveys are largely consistent with national data and UNAIDS estimates.

PEPFAR announced that the PHIA surveys, led by Columbia University’s ICAP programme, provide additional evidence that the epidemic is becoming controlled among older adults and babies in Malawi, Zambia and Zimbabwe. The surveys also found that the three African countries have achieved viral load suppression among an average of 65% of all adults living with HIV. Estimates of antiretroviral treatment coverage derived from PHIA survey data are also largely consistent with UNAIDS-reported estimates of treatment coverage derived from health facility data and submitted to UNAIDS by national HIV programmes.

“These encouraging results are the fruits of a shared effort—the countries hardest hit by AIDS, working in close collaboration with the international community,” said the UNAIDS Executive Director, Michel Sidibé. “The consistent bipartisan leadership of the United States of America is a major contributor to progress in the global AIDS response. The United States President’s Emergency Plan for AIDS Relief is a critical ally in the drive to achieve the end of AIDS by 2030.”

Additional information on the PEPFAR report and UNAIDS estimates

Health services are being scaled up in many low- and middle-income countries. This has resulted in a substantial increase in the amount of personal health information collected in order to develop and maintain comprehensive health records of a person’s use of the services and to monitor and evaluate the use, cost, outcomes and impacts of programmes or services. Detailed personal health information is also needed to evaluate success towards achieving, for example, the 90–90–90 targets, universal health coverage and the Sustainable Development Goals.

However, if personal health information is not held confidentially and securely, people may be reluctant to use health services, owing to fear of being stigmatized or discriminated against. The confidentiality and security of personally identifiable information therefore has to be protected at all levels of the health system. In many countries, this will require the development and implementation of privacy laws and a confidentiality and security framework for protecting personal health information.

Based on the principles of privacy, confidentiality and security, UNAIDS and PEPFAR have developed an assessment tool and an user manual to support countries to assess the degree that the confidentiality and security of personal health information is protected at facility and data warehouse levels and whether national guidelines that include privacy laws exist.

Many countries are in the process of developing and implementing national health identifiers (NHIDs) to ensure that each patient has a unique identity within the health system. This facilitates the development of comprehensive medical records and allows users of services to be tracked across health-care sectors. The development and use of NHIDs in a country’s health-care system promotes the effectiveness and efficiency of data gathering, but their use further underlines the need to protect the confidentiality and security of personal health information.

While policy-makers and other stakeholders in several countries recognize the need to develop and implement policies for protecting the privacy, confidentiality and security of personal health information, to date few countries have developed, let alone implemented, such policies. A workbook has also been developed that can be used to perform the actual assessments in country to assess to what extent policies have been developed and implemented at facility, data warehouse and national levels. 

UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation hosted a high-level Congressional briefing in the United States Senate to increase momentum around an ambitious Super-Fast-Track framework—Start Free, Stay Free, AIDS Free. The initiative, which was launched by UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners in June 2016, outlines a set of time-bound targets to reach in order to stop new HIV infections among children, prevent new HIV infections among adolescents and young women and ensure access to antiretroviral treatment.

The Start Free, Stay Free, AIDS Free initiative builds on the progress made under the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The Global Plan made a major contribution to a 60% reduction in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa most affected by the epidemic. Speakers highlighted the need to keep up the momentum, warning that complacency could reverse the important gains that have been made.

Michel Sidibé, Executive Director of UNAIDS, brought attention to the need to increase access to treatment for children. He said that despite the treatment scale-up for children, which has grown twofold in the past five years and resulted in a 44% reduction in AIDS-related deaths among children, one in two children living with HIV still does not have access. Without immediate access to treatment, about 50% of children infected at birth will die by age 2.

Senators Edward Markey and Benjamin Cardin, honorary co-hosts of the briefing, and Congressman James Himes referred to the commitment of the American people through PEPFAR, and the important results that have been achieved through the strong partnerships with the countries most affected by the epidemic. Monica Geingos, First Lady of Namibia, expressed appreciation for the support of PEPFAR and UNAIDS in Namibia, and emphasized the need for continued engagement to address challenges related to HIV prevention, inequality and harmful gender norms. Namibia is a leader in the response to HIV and one of six countries—together with Botswana, Mozambique, South Africa, Swaziland and Uganda—that have reached 90% or more of pregnant women living with HIV with life-saving antiretroviral medicines.

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, presented data illustrating dramatic recent achievements in stopping new HIV infections among children, and described evolving epidemic dynamics that demand new approaches so that the next phase of the response is successful in addressing the needs of the largest generation of young people the world has ever seen.

Director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, shared an overview of the science behind each pillar of Start Free, Stay Free, AIDS Free, showing that the world has the tools required to achieve the targets. Further innovations in treatment and prevention science hold the promise of accelerating the response by making commodities and services easier to access and use, and overall more effective.

Speaking in his capacity as a board member of the Elizabeth Glaser Pediatric AIDS Foundation, former Senator Christopher Dodd reflected on the bipartisan political commitment behind PEPFAR and the courage demonstrated by a number of elected officials at a time when AIDS was considered to be a difficult and controversial issue. He emphasized that this commitment must be constantly reinforced until the vision of an AIDS-free generation is achieved.

On 16 July, UNAIDS Executive Director Michel Sidibé joined Deborah Birx, the United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, in opening the United States President’s Emergency Plan for AIDS Relief (PEPFAR) annual meeting, which this year was held in Durban, South Africa, immediately prior to the 21st International AIDS Conference.

Mr Sidibé offered opening remarks in a session entitled, “Leadership, diplomacy, and partnership to move policy to practice.” He was joined at the podium by Tony Fauci, of the United States National Institutes of Health, and Eric Goosby, the United Nations Secretary-General’s Special Envoy for Tuberculosis. Addressing the group, which included PEPFAR staff, civil society, national governments and multilateral organizations, Mr Sidibé reminded participants that when the conference was last held in Durban, few people had access to treatment, but now, through the power of science, medicine and social change, the reality had changed. 

In describing PEPFAR’s goals for the next year, Ms Birx noted her commitment to the Fast-Track response, including dramatically scaling up access to treatment. Projections show that by the end of 2017, seven PEPFAR-supported countries should reach the first two of the three 90–90–90 targets (i.e. 90% of people living with HIV tested and 90% of people tested accessing antiretroviral therapy).

Additional sessions during the annual meeting focused on the role of communities, key populations, prevention for young women and girls and country action to adopt the World Health Organization’s test-and-start guidelines.

Speaking to the closing session of the meeting, Luiz Loures, UNAIDS Deputy Executive Director, pledged UNAIDS’ continuing commitment to working in full partnership with PEPFAR, civil society and affected communities to ensure that this moment to drive rapid progress towards the Fast-Track Targets is not lost.   

UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have launched a two-year initiative to work with faith-based organizations and strengthen their capacity to respond to HIV.

Unveiled during the seventieth session of the United Nations General Assembly in New York, the first phase of the US$ 4 million programme will increase collaboration with faith communities in several UNAIDS and PEPFAR partner countries across five focus areas. These are: collecting, analysing and disseminating data; challenging stigma and discrimination; increasing demand for HIV services and retaining people in care; improving HIV-related service provision; and strengthening leadership and advocacy.

Faith-based provision of health services has been a cornerstone of the global HIV response from the earliest days of the epidemic. Religious organizations continue to provide health—and other essential services—to local communities around the world. In responding to epidemics and health emergencies, there is evidence showing that no matter how effective a biomedical response is, there is always a need for equally effective collaboration with communities.

This faith initiative will support scale-up of community and faith responses, which are central to achieving the ambitious UNAIDS 90–90–90 treatment target and the PEPFAR 3.0 goals focusing on impact, efficiency, sustainability, partnership and human rights.

The new initiative has been developed in response to 10 recommendations made by faith leaders at a consultation in April 2015, which brought together more than 50 faith leaders from Kenya, Rwanda, Uganda and the United Republic of Tanzania. Recommendations include increased accountability, greater collaboration between faith-based organizations and international partners, and better access to data.

In September 2015, at the United Nations General Assembly, UNAIDS, PEPFAR and Emory University released a report based on the recommendations. The report, Building on firm foundations, explores in depth the scale and scope of faith-based responses in the four countries.

A landmark series on faith-based health-care published by the Lancet in July 2015 called for more research into the work of faith-based health-care providers. The series noted that although it is widely known that faith groups provide care and support to often marginalized communities, there is a need to improve the measurement of how they benefit health-care provision. This is among a number of recommendations that the new UNAIDS/PEPFAR partnership is set to address. 

Strong focus on adolescent girls and young women and on ensuring access to treatment will Fast-Track results

NEW YORK/GENEVA, 26 September 2015—UNAIDS welcomes the ambitious new targets set by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) just one day after the Sustainable Development Goals were adopted by United Nations Member States at the UN headquarters in New York which include ending the AIDS epidemic by 2030.

PEPFAR has set specific targets for preventing new HIV infections among adolescent girls and young women aged 15 to 24. The targets also include ensuring access to lifesaving antiretroviral therapy for 12.9 million children, pregnant women and adults by the end of 2017.

“The United States of America’s continued commitment will be a stepping stone towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals,” said Michel Sidibé, Executive Director of UNAIDS. “Under the bold leadership of President Obama, these generous investments are and will continue to save millions of lives.”

The targets set by PEPFAR will make a significant contribution to the UNAIDS Fast-Track approach to ending the AIDS epidemic by 2030. This announcement will create momentum to achieve the 90-90-90 HIV treatment target whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV status are accessing treatment and 90% of people on treatment have suppressed viral loads.

As well as expanding access to HIV treatment, PEPFAR’s newly announced targets aim to reduce HIV incidence among adolescent girls and young women by 40% by the end of 2017 in PEPFAR focus areas across 10 countries—Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe. These 10 countries accounted for nearly half of all new HIV infections among adolescent girls and young women in 2014. The commitments also include the provision to cumulatively reach up to 13 million men with voluntary medical male circumcision for HIV prevention by the end of 2017.

UNAIDS looks forward to continuing to work closely with PEPFAR towards ending the AIDS epidemic as part of the Sustainable Development Goals.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

JOHANNESBURG, 13 April 2015—The Champions for an AIDS-Free Generation gathered together today to announce new efforts to ensure that all children in Africa are born free from HIV and that children living with HIV have access to life-saving treatment. Since young people continue to be deeply affected by the epidemic, the Champions also announced that they will add adolescents and HIV to their portfolio of work. 

“The Champions are determined to keep HIV high on the continental agenda,” said Festus Mogae, Chairperson of the Champions. “We will leave no one behind and we will not rest until Africa has reached the goal of an AIDS-free generation.”

During their three-day meeting, the Champions are scheduled to hold high-level discussions with the President of South Africa, Jacob Zuma, the Deputy President of South Africa, Cyril Ramaphosa, and leading figures from the private sector.

The Champions for an AIDS-Free Generation was launched in 2008 by Mr Mogae, the former President of Botswana. The Champions transcend political partisanship to speak freely and independently about the issues that need solutions, both publically and behind the scenes. Since November, five new leaders have joined their distinguished ranks: Kgalema Motlanthe, former President of South Africa; Joyce Banda, former President of Malawi; Alpha Oumar Konaré, former President of Mali; Olusegun Obasanjo, former President of Nigeria; and Hifikepunye Pohamba, former President of Namibia.

“Today, we come together as a strengthened group of Champions to reaffirm our commitment to ending mother-to-child transmission of HIV and to ensuring that mothers and children already living with HIV stay healthy,” said Ms Banda. “I am proud to be involved in the Champions for an AIDS-Free Generation.”

As the Champions reaffirmed their commitment to an AIDS-free generation, they were joined by partners that include UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and private sector representatives.

“The Champions have been steadfast in calling for improved HIV prevention and treatment options, and there has been progress,” said UNAIDS Executive Director, Michel Sidibé. “Now, with their ranks strengthened, the Champions will be even stronger advocates to fast-track the AIDS response in Africa to ensure that every baby is born free from HIV and that their mothers stay healthy.”     

“An AIDS-free generation is within our grasp if we use the scientific knowledge, data and tools at our disposal,” said Ambassador Deborah Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “I am inspired today by this committed group of leaders, who are using their wisdom and influence to move towards an AIDS-free generation in Africa.”  

“We need leaders like the Champions who are unafraid to speak out and put AIDS at the very top of Africa’s health agenda,” said Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Other partners of the Champions for an AIDS-Free Generation include UNICEF, the World Bank, the South African Development Community (SADC), the SADC Parliamentary Forum, the Economic Community of West African States and the South African Broadcasting Corporation.    

The risk of a mother living with HIV passing the virus to her child can be reduced to 5% or less if she has access to antiretroviral medicines during pregnancy, delivery and breastfeeding. 

“Women need strong partners like the Champions so they receive access to proper HIV counselling, treatment and prevention services,” said Lorraine Mashishi, a mother living with HIV. “Women living with HIV can avoid passing the virus on to their children if they get the support they need.”

Currently 21 of the 22 countries that are part of the Global Plan to eliminate new HIV infections among children by 2015 and keeping their mothers alive are in Africa. Since 2009, there has been a 43% decline in new HIV infections among children in these countries, but there were still 210 000 (180 000–250 000) new HIV infections among children in sub-Saharan Africa in 2013. Only 42% of children exposed to HIV were tested for the virus within the recommended two months. Without treatment, half of all children living with HIV will die by the age of two and the majority will die by the age of five.

Sub-Saharan Africa remains the region most affected by the AIDS epidemic—in 2013, there were 24.7 million (23.5 million—26.1 million) people living with HIV in the region.

The Champions are:

• Festus Mogae, former President of Botswana and Chairperson of the Champions.
• Joyce Banda, former President of Malawi.
• Joaquim Chissano, former President of Mozambique.
• Kenneth Kaunda, former President of Zambia.
• Alpha Oumar Konaré, former President of Mali. 
• Benjamin William Mkapa, former President of the United Republic of Tanzania.
• Kgalema Motlanthe, former President of South Africa.
• Olusegun Obasanjo, former President of Nigeria.
• Hifikepunye Pohamba, former President of Namibia.
• Desmond Tutu, Archbishop Emeritus of Cape Town and Nobel Peace Prize Laureate.
• Speciosa Wandira-Kazibwe, former Vice-President of Uganda. 
• Edwin Cameron, Justice of the Constitutional Court of South Africa.
• Miriam Were, former Chairperson of the Kenya National AIDS Control Council.

Champions for an AIDS-Free Generation

The Champions for an AIDS-Free Generation is a distinguished group of former presidents and influential African leaders committed to an AIDS-free generation. Individually and collectively, the Champions rally and support regional leaders towards ending the AIDS epidemic as a public health threat. The Champions transcend political partisanship to speak freely and independently about the issues that need solutions, both publically and behind the scenes. www.aidsfreechampions.org

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030. Learn more at unaids.org and connect with us on Facebook and Twitter.

Adolescents are being left behind in the global AIDS response. HIV is the number one contributor to adolescent mortality in sub-Saharan African and number two globally. Adolescents often lack access to proven, life-saving services, such as HIV treatment. To address this situation, a meeting was held in Geneva, Switzerland, from 3 to 5 December to design a strategy to address the challenges that adolescents face.

The global strategy consultation brought together around 50 activists from youth networks, governments, implementers, donors and UNAIDS cosponsors, all committed to making real progress through improving programmes, driving innovation and amplifying advocacy.

The participants took stock of ongoing efforts and reviewed a results framework to create accountability towards, and track progress for, the often neglected population. They looked at establishing milestones to measure progress and at what can be done to accelerate change for adolescents using innovative approaches and improved data. Critically, there was consensus among all partners that much more needs to be done to tap the inherent potential of adolescents and young people for progressive social change.

An action plan was developed outlining catalytic efforts in which partners could join to deliver results. Partners will now work together to finalize the All In agenda, which will be launched in February 2015.

The consultation was convened by UNAIDS and the United Nations Children’s Fund. The United Nations Population Fund and the World Health Organization were co-convenors, in collaboration with youth networks and other core members of the All In Leadership Group: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President’s Emergency Plan for AIDS Relief and the MTV Staying Alive Foundation.