PEPFAR

(L to R): Krista Lauer, AIDS Project Los Angeles, Dr Cheikh E. Traoré, Sexual Diversity, UNDP Senior Advisor, Tudor Kovacs, Population Services International, Romania, Ambassador Eric Goosby, U.S. Global AIDS Coordinator and UNAIDS Executive Director Michel Sidibé.
Photo credit: UNAIDS/Jati Lindsay

As part of his official visit to Washington, D.C., UNAIDS Executive Director Michel Sidibé participated in the Forum on HIV, Human Rights and Men Who Have Sex with Men on 16 September 2009. The event was organized by UNAIDS in collaboration with the HIV Policy Working Group on Men Who Have Sex with Men and Other Sexual Minorities, and in cooperation with the Honorable Howard Berman (D-CA) and the Honorable Barbara Lee (D-CA).

The Forum was held to raise attention to the human rights issues that affect men who have sex with men (MSM) and other sexual minorities, as well as the policy and structural barriers that prevent MSM and other sexual minorities from accessing HIV services, including prevention, treatment, care and support.

“We are here because it remains an undeniable fact in all regions of the world—including here in the US—that men who have sex with men lack universal access to HIV services,” said Michel Sidibé.

The meeting also facilitated a conversation on how US policy makers and AIDS organizations could support PEPFAR countries in national AIDS responses that are relevant to men who have sex with men.

“If we are to see a renewed emphasis on human rights in the proposed Global Health Initiative and if we are to see commitment to MSM programming in PEPFAR II—we need to see unwavering leadership,” said Sidibé.

UNAIDS Executive Director Michel Sidibé shared the platform with Ambassador Eric Goosby, U.S. Global AIDS Coordinator. Other speakers included Jaevion Nelson, Jamaica Youth Advocacy Network, Dr Cheikh E. Traoré, Sexual Diversity, UNDP Senior Advisor, Tudor Kovacs, Population Services International, Romania and Krista Lauer, AIDS Project Los Angeles. Evelyn Tomaszewski of the National Association of Social Workers moderated the forum.

Ambassador Eric Goosby, U.S. Global AIDS Coordinator and UNAIDS Executive Director Michel Sidibé during the UNAIDS Forum on HIV, Human Rights and Men Who Have Sex with Men. Washington, September 16, 2009.
Photo credit: UNAIDS/Jati Lindsay

According to UNAIDS, unprotected sex between men accounts for between 5% and 10% of global HIV infections, although the proportion of cases attributed to this mode of transmission varies considerably among countries. It is the predominant mode of HIV transmission in much of the developed world.

Evidence-based research demonstrates that providing HIV services to men who have sex with men helps to reduce the rate of HIV infection among this at-risk group. In many communities taboo and stigma towards men who have sex with men forces them to conceal their sexual practices which in turn may put their female partners at risk of HIV infection. Additionally, criminalizing men who have sex with men excludes them, or encourages them to exclude themselves, from accessing HIV related services out of fear.

In the coming months, UNAIDS and its partners will host a series of events on three high risk, marginalized populations: men who have sex with men, people who inject drugs, and sex workers. These meetings will build understanding of the importance of addressing the human rights needs of marginalized populations within the global AIDS response. The events will address policy and programmatic issues to increase awareness among AIDS policy and advocacy organizations to better address the needs of marginalized populations. The MSM event was the first of this series. UNAIDS will host the next Policy Forum on Sex Workers on 15 October 2009.

The Center for Strategic and International Studies (CSIS) Global Health Policy Center invited the UNAIDS Executive Director Michel Sidibé to share his vision for the future direction of UNAIDS, including prospects for accelerated global action in support of universal access to HIV services.

In his first public address in Washington D.C. since assuming his position as head of UNAIDS, Mr Sidibé recognized the efforts made by the United States in responding to AIDS, from the gay rights movement of the early days of the epidemic to the PEPFAR programme and the leadership of the Obama administration, and in particular the new comprehensive global health strategy. However, he stressed that “Despite these heroic efforts, HIV continues to outstrip our response.”

“Change is possible,” he stated “but only if we are ready to address the underlying drivers of the epidemic.” Mr Sidibé emphasized the need to take the AIDS response out of isolation and link it to the Millennium Development Goals (MDG). “The AIDS plus MDG agenda provides an opportunity to unite the creativity, determination and momentum of the AIDS movement with movements for other MDGs,” he said. “Surely this will accelerate progress on AIDS as well as other MDG targets—reaping bidirectional benefits and multiplier effects,” he added.

UNAIDS Executive Director Michel Sidibé addressed CSIS, 14 September 2009. Credit: CSIS/Daniel J. Porter

During his presentation, Mr Sidibé took the opportunity to outline UNAIDS strategy for the AIDS response. Mr Sidibé underscored that the “value proposition” of UNAIDS—advocating, brokering and convening—is now more urgent than it has ever been.

As part of his official visit to the country’s capital, Mr Sidibé will meet with representatives of the United States Senate, Congress and Administration as well as with the country’s Global AIDS Ambassador Mr Eric Goosby.

Later in the week, Mr Sidibé will participate in the Forum on HIV, Human Rights and Men Who Have Sex with Men. This event will raise attention to the human rights issues that affect men who have sex with men (MSM) and other sexual minorities. It will also look at the policy and structural barriers that prevent MSM and other sexual minorities from accessing HIV services, including prevention, treatment, care and support.

photo credit:

According to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) 2009 Annual Report, PEPFAR has exceeded its five-year goals for treatment of two million and care of ten million people.

PEPFAR has supported life-saving HIV treatment for more than 2.1 million men, women and children worldwide. It also supported care for more than 10.1 million people affected by HIV, including more than 4 million orphans and vulnerable children.

On 12 January Secretary of State Condoleezza Rice delivered opening remarks for the release of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) 2009 Annual Report to Congress. The report outlines the dramatic successes PEPFAR has had in the AIDS response and highlights the programmes’ achievements through its partnerships with host nations around the world.

In 2003, United States President George W. Bush launched the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to tackle the global HIV epidemic. It was the largest commitment by any nation to combat a single disease in history. Through PEPFAR, the U.S. Government has provided $18.8 billion in HIV funding, and the U.S. Congress has authorized up to $48 billion for AIDS, tuberculosis and malaria over the next 5 years.

In the financial year 2008, PEPFAR provided $1.6 billion in support of HIV treatment programmes, in the programme’s focus countries and approximately $712 million to support prevention activities.

U.S. Global AIDS Coordinator, Ambassador Mark Dybul, highlighted the strengthening of health systems as another success of the President’s Emergency Plan. “The data that are available suggest that this intervention in HIV/AIDS is actually building the health care for other areas and having a spillover effect.”

(from left) Michele Moloney-Kitts, Assistant Global AIDS Coordinator, US Department of State: Dr Roy Austin, US Ambassador to Trinidad and Tobago; Dr Karen Sealey, Director, UNAIDS Caribbean Regional Support Team. Credit: Shirley Bahadur

Despite successes in the Caribbean AIDS response, every day in the region 38 people lose their lives to AIDS and 55 become infected with HIV. This was the sobering message delivered by Dr Karen Sealey, UNAIDS Director of the Caribbean Regional Support Team, at the opening of the 7th Annual US Chiefs of Mission Conference on HIV/AIDS in the Caribbean held in Port of Spain, Trinidad and Tobago.

The annual high-level gathering which ran from October 22-23 was organized by the US Embassy in Trinidad and Tobago, in collaboration with USAID and Centers for Disease Control. Ambassadors from the Bahamas, Barbados, Belize, the Dominican Republic, Guyana, Jamaica, Suriname and Trinidad and Tobago attended. Haiti was also represented.

There were myriad challenges to draw their focus. In the region the epidemic is increasingly affecting young women. Disproportionately affected too are people who practice certain behaviours including men who have sex with men, people who buy and sell sex, crack cocaine users and prisoners. Stigma is rife throughout the small island nations of the region and discrimination based on differences in sexual orientation is fuelling the epidemic. Following the recent decriminalization of homosexuality in Panama, the seven countries in the Americas where homosexuality is still effectively a crime are all in the Caribbean.

HIV treatment and prevention

(from left) Patrick Manning, Prime Minister of Trinidad and Tobago; Dr Roy Austin, US Ambassador to Trinidad and Tobago; Michele Moloney-Kitts, Assistant Global AIDS Coordinator, US Department of State; Dr Karen Sealey, Director, UNAIDS Caribbean Regional Support Team. Credit: Trinidad Express

There has, however, been significant momentum in several areas including treatment. In 2003 4000 people were receiving antiretroviral therapy, by the end of 2007 that figure had increased to 30,000.

According to Patrick Manning, the Prime Minister of Trinidad and Tobago who addressed the conference, his country shares in this notable success: “There has been a 50% reduction in reported deaths. Some people have been able to return to relatively normal lives due to treatment from antiretroviral drugs.” He also stressed that complacency remained a clear danger.

Treatment success however has not been matched by prevention success across the region. For every 50 people put on antiretroviral therapy in 2007, there were 100 new infections.

US President’s Emergency Plan for AIDS Relief

One of the main areas for discussion was the second phase of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and how the Caribbean could spearhead implementation. In July President Bush signed the reauthorization of PEPFAR to the tune of US$ 39 billion for AIDS and the Global Fund over the next five years. Haiti and Guyana have been recipients to date however other countries in the Caribbean are set to receive support from this new PEPFAR allocation. Although details of how the region will benefit have not been decided, UNAIDS is committed to helping ensure that this is maximized by working hand in hand with partners in Washington DC and in the region, such as the Pan Caribbean Partnership against HIV/AIDS (PANCAP).

The conference expanded the knowledge base of the US Ambassadors in the Caribbean and encouraged them to use their leadership role to highlight the epidemic and better support their host country’s challenge to it. In the past this gathering has helped to give the Ambassadors a powerful advocacy voice in the region.

Keeping HIV high on the agenda

Looking ahead to 2009, UNAIDS Regional Director Dr Sealey called for AIDS to be kept on the highest political agenda. The Government of Trinidad and Tobago will host three significant gatherings in the coming year; the Summit of the Americas, the First Caribbean Games and the Commonwealth Heads of Government Meeting which present potential opportunities to create new regional momentum in the challenge to HIV.

President George W. Bush is joined by Annette Lantos, right, and invited guests Wednesday, July 30, 2008 in the East Room of the White House, as he signs H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. White House photo by Joyce N. Boghosian.

On 30 July 2008, US President George W. Bush signed the Tom Lantos and Henry J. Hyde United States Global Leadership against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. This legislation replaces and extends the existing act by five years and also expands it three-fold to US$ 48 billion.

A number of guests joined President Bush in the White House for this historic event. They included senior members of the US House and the US Senate and Congressional and agency staff as well as family members of the politicians Tom Lantos and Henry J. Hyde in whose memory the act honours.

President Bush expressed his appreciation to Dr Peter Piot, UNAIDS Executive Director for attending and thanked him and Rajat Gupta, the Chairman of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria for their presence.

(left to right) Dr Peter Piot, UNAIDS Executive Director and Michele Moloney-Kitts, Assistant U.S. Global AIDS Coordinator at the White House on the day U.S. President George W. Bush signed the Tom Lantos and Henry J. Hyde United States Global Leadership against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, 30 July 2008

Dr Peter Piot paid tribute to the leadership of the President and the US Congress: “The generosity of the US government has helped to truly transform the global response to AIDS and the course of the epidemic. It has enabled all of us to make a qualitative and quantum leap forward.”

President Bush acknowledged that AIDS is a long-term crisis that will require serious commitment and resources for decades: “Defeating HIV/AIDS once and for all will require an unprecedented investment over generations. But it is an investment that yields the best possible return: saved lives.”

President Bush first announced the President's Emergency Plan for AIDS Relief (PEPFAR) in a State of the Union address in 2003 and a US$ 15 billion act was passed by US Congress that same year.

Joining the President on the occasion of the signing of the reauthorization, were two people directly benefiting from PEPFAR. Agnes Nyamayarwo, from Uganda, who now travels extensively educating people about HIV and Mohamad Kalyesubula, who works in a clinic caring for HIV positive people.

Latest figures show that after decades of increasing mortality, the annual number of AIDS deaths globally has declined in the past two years, in part as a result of greater access to HIV treatment.

Credit: President's Emergency Plan for
AIDS Relief

The US Senate has voted on legislation authorizing US$ 48 billion for AIDS, TB and malaria over the next five years. The legislation will replace and expand three-fold the current US$ 15 billion act passed by Congress in 2003 which expires at the end of September.

U.S. President George W. Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan) in a State of the Union address in 2003. It was the largest commitment ever by a country for an international health initiative dedicated to a single disease.

There are 15 focus countries in sub-Saharan Africa, Asia and the Caribbean being assisted by the PEPFAR.

Read UNAIDS statement

His Excellency the President of the
Republic of Uganda, Yoweri Kaguta
Museveni (left) greeting UNAIDS Executive
Director Dr Peter Piot (center) and Dr
Michel Kazatchkine, Executive Director of
the Global Fund (right).
Photo credit: UNAIDS/M.Mugisha

What is an HIV implementer? Depending on whom you ask at the 2008 Implementers’ Meeting in Kampala, Uganda, which starts today, June 3, you may get varying responses. But one common thread is likely to run throughout – the drive to share lessons learned and best practices on how HIV services are delivered to people affected by the AIDS epidemic.

Over the next five-days, some 1,700 participants – from governments, NGOs, international organizations, including UNAIDS and other UN partners, the private sector and groups of people living with HIV – will exchange ideas and give examples of efforts to overcome obstacles in implementation of HIV treatment, prevention, care and support.

A co-sponsor of the meeting, UNAIDS, together with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, UNICEF, the World Bank, WHO, and the Global Network of People Living with HIV (GNP+), will share examples of its work, and that of its cosponsors and other partners, in supporting countries in HIV programme implementation.

UNAIDS’ senior colleagues and thematic experts will participate in several events, from plenaries and sessions to satellites, focused on: addressing HIV prevention priorities and scaling up local prevention initiatives; HIV coordination and harmonization among implementation partners; communication for social change, particularly on norms about AIDS; and the role of civil society in strengthening the HIV response.

UNAIDS Executive Director Dr Peter Piot
addressing participants during the opening
ceremony of the 2008 Implementers'
meeting. 03 June Kampala, Uganda.
Photo credit: UNAIDS/M.Mugisha

UNAIDS Executive Director Dr Peter Piot will give an address at the opening ceremony together with His Excellency the President of the Republic of Uganda, Yoweri Kaguta Museveni, Ambassador Mark Dybul, the U.S. Global AIDS Coordinator/PEPFAR, Dr Michel Kazatchkine, Executive Director of the Global Fund, and Dr. Kevin Moody, CEO of GNP+.

This is the second HIV Implementers’ Meeting, with the first taking place in 2007 in Kigali, Rwanda.

At least 57 countries have a crisis shortage of health workers; 36 of those are in Africa. Photo credits: UNAIDS

One of the major constraints to addressing both the AIDS epidemic and global access to essential health care services is the serious shortage of healthcare workers. WHO, UNAIDS and the US President’s Emergency Pan for AIDS Relief (PEPFAR) are launching innovative new guidelines to help strengthen health systems through ‘task shifting’ among the health workforce, at the first ever Global Conference on Task Shifting being held in Addis Ababa from 8-10 January 2008.

‘Task shifting’ is the name given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programmes are expanded. Several countries are already using task shifting to strengthen their health systems and scale up access to AIDS treatment and care.

The Global Conference on Task Shifting will convene health ministers and other senior government officials, opinion leaders, United Nations agencies and non-governmental organizations from both industrialized and resource-constrained countries.

Read more on the conference on WHO’s web site

UNAIDS Executive Director Dr Peter Piot address US Senate Committee

At a special hearing - "Meeting the Global Challenge of AIDS, TB and Malaria" - UNAIDS Executive Director Dr Peter Piot addressed the US Senate Committee on Health, Education, Labor and Pensions (HELP) about AIDS, the work of UNAIDS to address the epidemic and the critical difference that the US President's Emergency Plan for AIDS Relief (PEPFAR) has made in the AIDS response.

Also addressing the Committee in Panel I were U.S. Global AIDS Coordinator, Ambassador Mark Dybul and Director of the US Centers for Disease Control and Prevention. Joining Dr Piot in Panel II were World Vision HIV educator Princess Zulu, Professor of the University of California, Dr Norman Hearst and Vice Chair of the IOM Evaluation Committee, Dr Helen Smits.

The 2007 HIV/AIDS Implementers’ Meeting is
expected to attract over 1,500 people under the
theme ‘scaling up through partnerships’.

Donors, AIDS experts and implementers from around the world are gathering in Kigali, Rwanda to attend the 2007 HIV/AIDS Implementers’ Meeting.

The meeting, hosted by the government of Rwanda and cosponsored by PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria; the UNAIDS Secretariat, UNICEF, WHO and the World Bank, will take place from 16-19 June and is expected to attract over 1,500 people under the theme ‘scaling up through partnerships’.

Participants will include civil society representatives, donors, governments, UN organizations and non governmental organizations, who will share concrete, country-level programmatic examples of what’s working in the AIDS response and what needs improvement.

In past years the meeting has served principally as an annual gathering for the U.S. Government and its global AIDS grantees, but this year, the 2007 HIV/AIDS Implementers Meeting has adopted a much broader scope and involved many more partners. 

“We have worked closely with the US government, the Government of Rwanda and other partners over the past few months to help shape the meetings structure and agenda,” said Dr Kékoura Kourouma, UNAIDS Country Coordinator in Rwanda. “The strong participation of many international cosponsors––combined with the exemplary leadership of the Government of Rwanda––is a strong signal of the increasing and very necessary, coordination and collaboration now evident in the global AIDS response,” he added.

More than 500 project summaries will be presented,
representing some of the many HIV prevention, care
and treatment programmes being implemented
around the world.

Unlike the biannual International AIDS Conferences, and other similar meetings, which primarily provide a platform for exchanging research findings, announcing important technological advancements and advocating around global AIDS policy issues, the 2007 HIV/AIDS Implementers Meeting will focus specifically on implementation.

Issues will be raised on; how best to coordinate as more partners become involved in the AIDS response; how to maximize on lessons learnt, on resources raised and on the leadership that has been leveraged to scale up HIV prevention, treatment, care and support on the ground to move the AIDS response to the next level.

More than 500 project summaries will be presented, representing some of the many HIV prevention, care and treatment programmes being implemented around the world.

Summaries include:

• Integrating HIV and TB services in district hospitals in Kenya.
• District level planning, monitoring and evaluation capacity – Experience of Rwanda
• Contracting––‘Retired but not yet tired’ Health staff in Tanzania.
• Involvement of traditional birth attendants for the prevention of mother to child transmission of HIV in Uganda.
• Know your epidemic – Secondary School Communications clubs for behaviour change.
• The impact of safe blood-bank screening and transfusion practices in Mozambique.
• Challenges of HIV testing and counselling in health facilities, all countries.

Through sharing lessons learnt in the scale-up of AIDS programmes, the meeting will promote an open dialogue about future directions with a strong emphasis on implementation and identification of critical barriers that are causing ‘bottlenecks’ in terms of getting vital resources to the people that need them most and ‘making the money work’.

“This meeting will be a real opportunity for partners in the AIDS response to come together to tackle the tough challenges and move forward with one voice to accelerate and sustain global AIDS efforts,” said Michel Sidibe, UNAIDS Deputy Executive Director. “Only through joint efforts from all sectors and at all levels, will we be able to move towards universal access to HIV prevention, treatment, care and support–– especially towards implementation––this meeting is an important step in making this possible,” he added.

Links:

Read press release ( en | fr | kr )

Read speech delivered by Michel Sidibe, UNAIDS Deputy Executive Director on behalf of Dr Peter Piot, UNAIDS Executive Director

Visit the implementers' meeting web site