not valid -- Senegal

Credit: UNAIDS/Mamadou Gomis

Opinions on sexuality and condom use vary depending on the different beliefs of religious and traditional leaders in Africa. Nonetheless, today at ICASA there was general agreement that regardless of an individual’s choices, human beings should be treated equally and with respect.

“We cannot fight AIDS if part of the population is marginalized,” said panelist Fatima Ball. “We have to take care of everybody but especially the most vulnerable”.

Religious and traditional leaders reflected on their roles and responsibilities in the response to the HIV on Friday in a session moderated by UNAIDS Director of Partnerships and External Relations Mr Elhadj Amadou Sy. The session took the form of a debate, where the audience posed questions to the panel.

Recognizing a shared commitment to the AIDS response, it was underlined at the session that religious and traditional leaders have norms and values that can either contribute effectively to the response or can become inhibiting factors.

The session was moderated by UNAIDS Director of Partnerships and External Relations Mr Elhadj Amadou Sy
Credit: UNAIDS/Mamadou Gomis

Religious leaders often have high expectations placed upon them by their local communities. As a result, they may be charged with reaching out to communities and addressing a complex range of social behaviours and attitudes. Although religious leaders are often best placed to address these aspects, many expressed that they do not have sufficient levels of support to perform their roles.

Equipping traditional leaders with knowledge of HIV and how it is transmitted, and strengthening their skills, was seen as an important way forward.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria
Credit: UNAIDS/Jacky Daniel Ly

Sustainable investment in health is crucial for African countries’ successful development stressed Dr Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria.

“The world has finally understood that health is a priority for development and not a consequence of development,” said Dr Kazatchkine. “Investments in health have an impact and have saved lots of lives”.

Dr Kazatchkine was speaking at the 15th International Conference on AIDS and STIs in Africa (ICASA) where he highlighted the need for a long-term approach to the reinforcement of health systems in sub-Saharan Africa.

Financial resources for AIDS have increased significantly in the last five years because donors and the international community recognize how health can be a key investment in development. Dr Kazatchkine said that this investment coupled with an unprecedented mobilization of civil society has been showing results.

However sustainability is crucial argued Dr Kazatchkine. More predictable resources for countries generate the necessary environment that would allow countries to design programmes with the confidence that they will be sustainable. “If money is made available to countries, more programmes would be implemented and therefore the investment on AIDS would generate better results,” said Dr Kazatchkine.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary
Credit: UNAIDS/Jacky Daniel Ly

Dr Kazatchkine also stressed that addressing the challenges of weak health systems is critical. “Donors have contributed to strengthening health systems all over the world but more resources are required to address the health systems challenges such as infrastructures, facilities or health workers,” said Kazatchkine.

Finally, he added that there is a need for more than resources. The promotion of evidence-based responses that reach out to those most in need, human rights, strengthened social protection and strengthened global and local partnerships are responsibilities shared by countries and the international community.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary which was held on Friday.

Workplace leaders pledge action at ICASA 2008
Credit: ILO

On the occasion of the 15th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), about fifty workplace leaders gathered together on 4 December at the invitation of the International Labour Organization (ILO).

Earlier in the week, the delegates had visited the Workplace Leaders Pledge Centre and committed themselves to implementing specific initiatives to address HIV in their own workplaces once they return home from the conference.

The ILO recorded the workplace pledges of the participants and invited them to join Mr. Mamadou Sow, the Permanent Secretary of the Ministry of Labour of Senegal, Mr. Assane Diop, the ILO Executive director for Social Protection, Mr. Patrick Obath and Mr. Lamine Fall representing respectively the employers and workers organizations as well as Dr. Sophia Kisting, Director of the ILO Programme on HIV/AIDS and the world of work for the group photo.

“Many ICASA delegates are HIV experts in various fields and probably spoke about HIV/AIDS in a number of forums. However, some might not have thought of taking HIV activities into their own workplace,” explained Dr. Kisting.

Each participant who made a pledge received a gift as a reminder of his or her commitment. The ILO ‘Workplace Leaders Pledge Centre’ will welcome participants until the end of the Conference. It is situated at the ILO stand in the exhibition area next to the UNAIDS stand with other co-sponsors.

Ms. Evelyn Serima, ILO HIV/AIDS Technical Specialist with the ILO Sub-regional Office for Southern Africa, explained that the pledges received demonstrate the commitment of employers and workers to contribute to a more sustained response to HIV/AIDS through workplace leadership.

As 5000 delegates from across Africa and the world gather in Dakar this week, condoms are being made freely available for delegates in hotels in the city as part of a HIV prevention drive.

The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) and UNAIDS have teamed up with the Senegal Hotel Industry around an HIV awareness initiative.

The 15th International Conference on AIDS and STIs in Africa which runs until Sunday this week has drawn aapproximately 5000 delegates and several hundred journalists from all over the world to Dakar. The event presents an opportunity to engage the local hotel industry on issues related to HIV. The hotel industry is a key player in the response to AIDS as it reaches a wide and diverse audience, including employees, with HIV prevention information.

A kit has been distributed in all hotels which includes condoms provided by the United Nations Population Fund (UNFPA); a flyer to present the initiative; and a copy of a short prevention film directed by Accor and Air France for broadcast in hotel rooms or lobbies.

Partnering hotels

The 18 ICASA-accredited hotels were approached to voluntarily take part and they have the option to customize the content according to their specific needs. Additional hotels in Dakar are also free to join.

Two fold initiative

As well as a specific HIV prevention campaign during ICASA, the initiative also will develop an HIV action plan over the long term. This will focus on delivering workshops for senior management (such as hotel managers and human resource managers) to help participating hotels develop a practical plan to respond to AIDS in their own organization.

Training sessions for staff will also be developed and will focus on the risks of HIV in the hotel industry. These sessions will help them understand their respective roles in the practical implementation of an HIV action plan within their organization. UNAIDS is providing seed money for the initial trainings.

Technical Partners

Three local non-governmental organizations ENDA Tiers Monde/Santé, Sida Services and ACI Senegal are the technical partners for the implementation of the training process and the follow up with hotels. These NGOs will conduct an initial mapping of the HIV vulnerability of each hotel. The analysis will be conducted with the participation of hotel personnel.

Background

This is a continuation of the HIV awareness initiative by UNAIDS and the hotel industry during the International AIDS Conference held in Mexico City in August 2008 which reached out to over 5000 employees within 50 hotels.

It’s also part of a global HIV prevention campaign conducted by the GBC within their tourism and travel platform: disseminating HIV awareness videos in airport lounges and on TVs via TV5 Monde, developing a prevention campaign online with a fun quiz on the website of Europe Assistance, conducting voluntary counselling and testing mobile clinics at the Sofitel Terenga, Novotel and Club Med Cap Skirring.

Next steps

On 2 December, a meeting took place at the Sofitel Dakar with 6 hotel managers to gather their suggestions and define the scope of the project and the roadmap. The analysis of hotels’ specific needs, as well as the workshops and training sessions will start after ICASA and spread over 2009.

“West Africa HIV/AIDS epidemiology and response synthesis”

On the opening day of International Conference on AIDS and STIs in Africa (ICASA), taking place in Senegal under the theme “Africa’s Response: Face the facts,” the World Bank launched a new report exploring the character of the HIV epidemics and responses in countries in West Africa.

The “West Africa HIV/AIDS epidemiology and response synthesis” is a review and analysis of surveillance and research data in 15 West African countries: Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, Togo, Cape Verde, The Gambia, Guinea Bissau, Liberia, and Sierra Leone.

Aiming to gain an improved understanding of HIV transmission dynamics in this sub-region, the paper focuses on the degree to which epidemics in each country are concentrated or generalized, and the implications that this has for effective prevention strategies. The report argues that more prevention focus is needed on the specific groups in which HIV transmission is concentrated, including female sex workers and men who have sex with men.

The new publication highlights a need for better understanding of the complex nature of transactional sex in West Africa. Many women involved in commercial sex do not self-identify as sex workers and have other occupations as well. The boundaries between commercial and non-commercial sex are blurred and it is difficult to have an idea of the proportion of men having commercial sex due to substantial under-reporting.

The importance of men who have sex with men (MSM) in the HIV epidemic in West Africa is being increasingly recognized. High proportions of MSM are also married and/or have sex with other women with very low rates of condom use, acting as a bridge for HIV between MSM and women.

“Know your epidemic. Know your response”

The paper was written as part of the work programme by the World Bank’s Global AIDS Monitoring and Evaluation Team (GAMET) to support countries to “know your epidemic, know your response” so that interventions are carefully chosen and prioritized based on a careful characterization of each country’s epidemic.

Understanding the behaviors that are giving rise to most new infections is a crucial first step to being able to develop a results-focused, evidence-based response that will be effective in preventing new infections. In turn this will improve resource allocation, all the more appropriate when global economic outlook may impact AIDS response.

The work was carried out in partnership between the World Bank and UNAIDS and with the collaboration of the National AIDS Councils and AIDS programmes of the countries.

Young women in Dakar, Senegal. Credit: UNAIDS/P.Virot

Sustaining the progress that has been made in preventing new HIV infections and getting more people on antiretroviral treatment are priorities for African countries if they are to get ahead of the AIDS epidemic in the coming years – this is the overarching theme to be discussed at the 15th International Conference on AIDS and STIs in Africa (ICASA) taking place in Dakar, Senegal from 3 to 7 December 2008.

The theme of Africa's leading forum for discussion of HIV developments and trends is “Africa’s Response: Face the facts”.

Experts from UNAIDS, together with many from international and African organizations, civil society groups including people living with HIV, media, and other partners in the AIDS response, will take part in five days of sessions and open forums that will review the successes and challenges to date in Africa’s AIDS response. In particular, international and African experts will evaluate the current state of the HIV and other sexually transmitted infections (STIs) epidemics, assessing political commitments, scientific progress and challenges, community actions, and leadership.

“The AIDS epidemic is not over in any part of Africa,” said UNAIDS Executive Director Dr Peter Piot, who will open ICASA and engage in a number of events, many focused on leadership and youth engagement. “As African countries plan their next steps in addressing AIDS, it is necessary to now take stock of successes and challenges”.

UNAIDS Deputy Executive Director Michel Sidibe, UN Special Envoy Lars Kallings (for Eastern Europe and Central Asia), UNAIDS Special Representatives HRH Princess Mathilde of Belgium and Gaetano Kagwa, as well as several other prominent advocates will be present and contribute to the discussions.

Several sessions are being devoted to ‘knowing your epidemic and your response’, human rights based approaches, including tackling stigma and discrimination, addressing women’s and girl’s vulnerabilities, the role of religion and faith-based organizations, public-private partnerships, technical support to countries, tuberculosis and HIV, and financial mechanisms.

Africa’s AIDS Response

The conference is happening at a unique phase in Africa’s epidemics: the global financial and economic crisis, continued poverty and inequalities pose challenges and obstacles for countries as they find innovative solutions to reducing new HIV infections, curbing AIDS deaths, and getting more people on treatment.

Sub-Saharan Africa remains the region in the world most heavily affected by HIV – there are about 22 million [20.5–23.6 million] people living with HIV in the region.

In 2007, the region accounted for two thirds (67%) of all people living with HIV and for three quarters (75%) of AIDS deaths globally. And AIDS continues to be the leading cause of death in Africa. The nine countries in southern Africa continue to bear a disproportionate share of the global AIDS burden with 35% of HIV infections and 38% of AIDS deaths in occurring in the region.

Despite these sobering figures, progress made over the past few years show that the there are returns on investments in HIV prevention and treatment programmes. As reported in the UNAIDS 2008 Report on the global AIDS epidemic, in a number of heavily affected countries, such as Rwanda and Zimbabwe, changes in sexual behaviour have been followed by declines in the number of new HIV infections. Behaviours include waiting longer to become sexually active, fewer multiple partners, and increased condom usage among people with multiple partners.

UNAIDS and its partners are working with countries to build on HIV prevention results and encourage the implementation of combination HIV prevention as a priority approach – selecting the right mix of behavioural, biomedical and structural HIV prevention actions and tactics to suit epidemics and the needs of those most at risk. National AIDS programmes must also continue to address the factors that continue to put women and girls at risk, while at the same time heighten HIV prevention awareness for other most-at-risk groups, such as sex workers and men who have sex with men.

ICASA is expected to draw around 5,000 participants from a range of countries and backgrounds.

A satellite symposium to highlight the impact that TB has on people living with HIV was held on 3 December 2008 during ICASA. Credit: UNAIDS/Mamadou Gomis

TB is among the leading causes of death in people living with HIV and accounts for an estimated 13% of AIDS deaths worldwide. HIV and TB are so closely connected that they are often referred to as co-epidemics or dual epidemics. Each worsens the impact of the other, yet despite evidence of positive impact of joint interventions, TB and HIV programmes have largely been implemented independently.

Sub-Saharan Africa carries the highest burden of HIV infections and AIDS related mortality in the world, accounting for more than 60% of people living with HIV worldwide. On average, 22% of TB patients in the Region are co-infected with HIV, and approximately 40% of TB deaths are due to HIV.

TB is the most common cause of illness and death among people living with HIV in Africa, despite being preventable and curable. Rising rates of drug resistant TB, especially extensively drug resistant tuberculosis (XDR-TB), further threaten the response to AIDS in the region.

Alasdair Reid, UNAIDS HIV/TB Adviser
Credit: UNAIDS/Mamadou Gomis

For these reasons, on Wednesday 3 December UNAIDS, WHO and WFP in collaboration with the TB/HIV working group of the Stop TB Partnership organized a satellite symposium to highlight the impact that TB has on people living with HIV and what needs to be done to reduce this unnecessary burden of illness and death.

The symposium underlined what needs to be done by HIV programmes and civil society to improve the prevention, diagnosis and treatment of TB in people living with HIV. It introduced the ‘Three I’s for HIV/TB’, a package of interventions - including Intensified TB case finding (TB screening), Isoniazid preventive therapy and Infection control - that aim to reduce the burden of TB among people living with HIV. Furthermore, the need to jointly address nutrition as an essential element in the response to TB and HIV was promoted. TB and HIV both compromise the nutritional status of affected persons, leading to malnutrition, which in turn aggravates the severity of HIV and TB.

Credit: UNAIDS/Mamadou Gomis

Few countries have comprehensive plans to reduce the burden of TB among people living with HIV in the region. The consequence is that the coverage with key TB and HIV interventions is still very low. Collaborative TB/HIV activities are essential to ensure that TB patients living with HIV are able to access HIV testing and treated appropriately, and to effectively prevent, diagnose and treat TB in people living with HIV.

In 2006, only 22% of TB patients were tested for HIV in sub-Saharan Africa, and less than 1% of people living with HIV were screened for TB disease.

The symposium demonstrated the need for rapid scale up to ensure universal access to TB prevention, diagnosis and treatment services for people living with HIV in Africa.

“The ICASA symposium has helped to enhance the engagement of HIV service providers and affected communities in the implementation of these crucial interventions and strengthen collaboration between TB programmes, HIV programmes and civil society,” said Alasdair Reid, UNAIDS HIV/TB Adviser.

The meeting identified challenges,
opportunities and ways to ensure the
incorporation of human rights and gender
issues in the adoption and amendment of
HIV-related legislation.

In adopting the Declaration of Commitment on HIV/AIDS in 2001 at the UN General Assembly Special Session on HIV/AIDS, Governments have fully recognized the importance of protecting human rights and gender equality through appropriate legal frameworks in national responses to HIV.

The enactment of laws that incorporate the protection of human rights and gender enable those vulnerable to HIV infection to access HIV prevention and also allow those living with HIV to be free from discrimination and human rights abuses. However, insufficient attention is often paid in national responses to HIV to the reform of discriminatory law or to working with Parliaments, judges and police to ensure appropriate enforcement of law. The result is that human rights abuses in the form of discrimination, gender inequality and violence against women, and violations of confidentiality and privacy continue to increase vulnerability to HIV infection and represent a barrier to effective responses to HIV.

In recognition of these concerns, UNAIDS in collaboration with UNDP, UNICEF, UNFPA, UNIFEM, WHO, AWARE/USAID, OSIWA, ECOWAS, OHCHR and the African and Arab Parliamentarian Forum, has held two workshops one in July 2007 and one from 16 – 18 April 2008 in Dakar to assist countries to consider where they stand on developing legislative frameworks in the response to HIV and how to ensure the best possible legislation.

Although the law cannot make HIV prevention or treatment happen - only sufficient HIV programmes and services can - the law can create an environment to empower people with knowledge, social support and protection from discrimination so behaviour change and access to HIV prevention, treatment and care can happen without negative consequences.

Some of the aspects of the Ndjamena Law
that were debated among the participants
involved mandatory HIV testing,
confidentiality or disclosure of HIV
information, the criminalization of HIV
transmission, and the rights of women and
other vulnerable groups.

In 2004, the African and Arab Parliamentarians Forum for Population and Development adopted the “Ndjamena Law” on the prevention, care and control of HIV.  This was a flexible and adaptable legal instrument that States could use to guide their legislation development process according to their legal, social, political and cultural environment. The law contained many positive aspects, but it has also become clear that some provisions in the Ndjamena Law could be substantially improved in order to best meet two of the critical concerns in the response to AIDS: that of protecting public health and that of protecting human rights.

Participants at the April 2008 workshop represented 15 West and Central Africa countries and included parliamentarians, human rights specialists, jurists, civil society members including people living with HIV and representatives of National AIDS Councils. The meeting identified challenges, opportunities and ways to ensure the incorporation of human rights and gender issues in the adoption and amendment of HIV-related legislation.

Some of the aspects of the Ndjamena Law that were debated among the participants involved mandatory HIV testing, confidentiality or disclosure of HIV information, the criminalization of HIV transmission, and the rights of women and other vulnerable groups.

Participants at the April 2008 workshop
represented 15 West and Central Africa
countries and included parliamentarians,
human rights specialists, jurists, civil
society members including people living
with HIV and representatives of National
AIDS Councils.

UNAIDS and other partners recommended several documents developed since the promulgation of the Ndjamena law that can be used as guidance in order to amend HIV-related legislation in accordance to international legal standards and to ensure that the language used to enact the law does not promote human rights abuses.  These documents include the Political Declaration on HIV/AIDS (2006), the International Guidelines on Human Rights and HIV, Consolidated Version (2006), Taking Action against HIV, Handbook for Parliamentarians (2007) and “UNAIDS Recommendations for Alternative Language in the Ndjamena Legislation on HIV” (2008).

Participants agreed that the process of incorporating human rights and gender in HIV related legal frameworks underlines the need to develop legal measures not as tools for coercion but as instruments to empower people through respect of their human rights. Punitive or coercive legal measures exacerbate already existing HIV stigma and discrimination and drive people away from HIV prevention and treatment programmes, thus undermining the effectiveness of national responses to the epidemic.

“Protecting the rights of people living with HIV does not mean less protection for other members of the community. On the contrary, protecting the rights of people living with HIV and members of vulnerable groups promotes access to HIV prevention, care and support services which benefit the whole community and make for a more effective response to HIV,” said Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa.

SENEGAL/GENEVA, 20 April 2009 – UNAIDS welcomes the decision by Dakar’s court of appeal to release nine members of a Senegalese AIDS awareness organization, imprisoned since December 2008.

The men were sentenced in January 2009 for what the Senegalese courts termed as ‘acts against nature and the creation of an association of criminals’.

The announcement to release the men came further to an appeal supported by civil society organizations, the public sector and partners including UNAIDS, UNDP, the French Embassy and the Swedish Embassy representing the European Union, which had been working towards securing the release of the detainees since their incarceration last year.

UNAIDS had strongly urged all governments to take steps to eliminate stigma and discrimination faced by men who have sex with men and create a social and legal environment that ensures respect for human rights.

“Homophobia and criminalization based on a person’s sexual orientation is fuelling the AIDS epidemic,” said Michel Sidibé, Executive Director of UNAIDS. “I welcome today’s decision by the court of appeal to release these men. We urge Senegal to take steps to remove such laws that block the AIDS response.”

The rights of men who have sex with men need to be protected and stigma and discrimination addressed by amending laws that prohibit sexual acts between consenting adults in private; enforcing anti-discrimination; providing legal aid services; and promoting campaigns that address homophobia. Failure to do so will jeopardize countries abilities to achieve their goals of universal access by 2010.

GENEVA, 15 January 2009 – UNAIDS deplores the arrest and imprisonment of nine members of an association called AIDES Senegal since December 22nd, 2008. On 6 January, 2009 they were tried before the court in Senegal and sentenced for acts against nature and the creation of an association of criminals. The case is currently on appeal.

A coalition bringing together organizations from civil society, the public sector and partners such as UNAIDS, UNDP, the French Embassy and the Swedish Embassy representing the European Union has been working towards the release of the detainees.

“There is no place for homophobia. Universal access to HIV prevention, treatment, care and support must be accessible to all people in Senegal who are in need—including men who have sex with men,” said UNAIDS Executive Director Michel Sidibé. “This will only happen if the men convicted are released and steps taken to rebuild trust with affected communities.”

Homophobia and criminalization of consensual adult sexual behaviour represent major barriers to effective responses to HIV. Such responses depend on the protection of the dignity and rights of all those affected by HIV, including their right and ability to organize and educate their communities, advocate on their behalf, and access HIV prevention and treatment services.

UNAIDS urges the Government of Senegal to take steps to eliminate stigma and discrimination faced by men who have sex with men and create an enabling legal environment for them and the organizations working with them so as to protect their rights and increase access for HIV prevention, treatment, care and support services. Failure to do so will jeopardize Senegal’s target of achieving the goal of universal access by 2010.

UNAIDS would like to see the creation of a social and legal environment that guarantees respect for human rights. UNAIDS recommends that criminal law prohibiting sexual acts between consenting adults in private should be reviewed with the aim of repeal.

UNAIDS urges the Senegalese authorities to take the necessary legal steps for the release of the nine detainees.

Contact: Sophie Barton-Knott | tel. +41 22 791 1697 | bartonknotts@unaids.org