South Africa

The International Advisory Group (IAG) on universal access met in Johannesburg, South Africa on 26-28 April 2011 to crystallize key findings informed by the outcomes of recent series of country and regional consultations on universal access. The meeting was an opportunity to gain consensus on global priorities and the “way forward” which is captured in the IAG statement, Solidarity for Universal Access. The IAG is co-chaired by Mrs Bathabile Dlamini, Minister of Social Development, Republic of South Africa and Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme.

The statement will be shared directly with Member States to contribute towards negotiations on a draft declaration in lead up to the United Nations High Level Meeting on AIDS that will take place in June.

Between 2010 and 2011, 117 countries took stock of their progress towards universal access to HIV prevention, treatment, care and support services. The national assessments informed multiple regional consultations.

While reviewing the findings from the country and regional consultations, the IAG, a multi-stakeholder advisory group, mandated by the UNAIDS Programme Coordinating Board, found overwhelming and ongoing support for the universal access movement.

During the April meeting in South Africa, the IAG endorsed the recommendations from the regional and country  consultations and concluded that five global challenges are pivotal now to achieve universal access to HIV prevention, treatment, care and support by 2015. These global challenges include the need to protect the human rights of all people; improve access to quality and affordable HIV treatment and scale up HIV prevention programmes; engage inspiring and courageous leaders, especially young people, lead the response; use evidence-informed strategies to make smart investments that will yield maximum results; and, finally, share accountability.

“We need to strengthen the human rights approach in our response to AIDS and establish mechanisms to ensure that both public and private services are free of stigma and discrimination or homophobia,” said Dr Jose Angel Cordova Villalobos, Secretary of Health of Mexico and member of the IAG during his participation in the Latin America consultation in March this year.

The advisory body emphasizes in its statement that global solidarity on the identified key priorities will change the trajectory of the epidemic, save lives and contribute towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Treatment Action Campaign activists and UNAIDS HIV prevention commissioners march for scaled-up access to condoms.
Credit: UNAIDS/AFP Photo G. Guercia

A vibrant gathering took place outside the Treatment Action Campaign (TAC) in Site B in Khayelitsha on 4 May, as members of the public joined with high-level commissioners from the UNAIDS Commission on HIV Prevention to scale-up the use of condoms in communities most severely affected by HIV. Donning ‘HIV Positive’ t-shirts and dancing in unison to the music both on and off stage, Khayelitsha residents and others celebrated condoms as a barrier against the spread of the virus.

“Here in Khayelitsha, Treatment Action Coalition is empowering people living with HIV into leaders of the HIV prevention revolution,” said UNAIDS Executive Director Michel Sidibé, who also acknowledged the TAC’s role as a leading a “global movement for access to HIV treatment.”

Says TAC secretary-general, Vuyiseka Dubula, who is also a member of the UNAIDS Commission on HIV Prevention, “Our view at TAC is that condoms are by far the most effective tool to prevent HIV, and we have taken it upon ourselves team up with the City of Cape Town to increase accessibility.”

The partnership is now in its third year and, says Dubula, it has culminated in the distribution of at least one million condoms per annum in the region, with data from local clinics reporting an obvious drop in the incidence of sexual transmitting infections in the same period. But, she cautions, condom distribution needs to form part of a holistic approach to be most effective.

“We take condoms to people in their houses,” she explains. “We also consistently teach others about the correct use of condoms. We also bring supporting educational material in isiXhosa, we talk about the importance of testing, and we also share information about tuberculosis.”

An important figure at the gathering was a man known to most as either ‘Mr Condom’ or the ‘Condom King’. Hailing from Thailand, Mechai Viradaidya has been proactively distributing condoms for 37 years and, he says, his approach is all about the visibility of condoms—an approach that debunks the myths and gets rid of the taboo.

“Keep on mentioning condoms all the time, and let them be seen and be available everywhere,” he advises. “When I say they must be available, I don’t just mean physically, I mean mentally too. You have to have ‘condoms of the mind’ to really change behaviour.”

Viravaidya smiles and says he hands out condoms, “Absolutely everywhere except funerals.” He explains that he started bringing condoms out into the open in his native Thailand by having a condom-blowing competition amongst school teachers. “Whoever could blow the condom to the biggest size without it bursting was the winner,” he says.

He also set up the ‘cops and rubbers’ programme in Thailand by getting traffic police to sell and distribute condoms. He says that a condom is made of rubber like a tennis ball, “If you’re scared of condoms, be more scared of tennis balls—they contain a lot more rubber!”

Before TAC and the commissioners headed off on their march and on their community condom demonstrations, the crowd was treated to some words of wisdom from former President of Botswana Festus G. Mogae.

“I was the first African president to report to the UN that my country was in trouble,” he told those gathered. “We became the first to give out antiretroviral therapy for free. I have come here to greet you and inspire you because we are one.” He said that he had not come to preach but rather to ask everyone to carry on campaigning ‘until we win’.

“We will overcome,” he said to loud applause. “We need to all make it our business to ensure that no babies are born HIV positive. It is in our power to stop that from happening.”

UNAIDS Executive Director Mr Sidibé highlighted the significance of the event: “Today’s condom march shows that people with HIV are essential partners in movement for Positive Health, Dignity and Prevention.”

The condom march in Khayelitsha was part of a three-day programme convened by the UNAIDS High Level Commission on HIV Prevention in the Mother City. Other events included a panel discussion on social media and mobile technology in the prevention of HIV, and an historical gathering on Robben Island the following day where Desmond Tutu symbolically passed the baton of HIV activism to a group of youth leaders who, he hoped, would join him in stopping the spread of HIV.

UNAIDS Executive Director Michel Sidibé poses for a team photo with the young people taking part in the Skillz Street practice session at the Football for Hope Centre. Capetown, 4 May 2011.
Credit: UNAIDS/AFP Photo G. Guercia

During the meeting of the UNAIDS High Level Commission on HIV Prevention, which is taking place in South Africa this week, commissioners took time out to visit the Grassroot Soccer initiative in Capetown.

The commissioners visited the Football for Hope Centre during a Skillz Street practice session involving around 100 girls. Grassroot Soccer uses the power of soccer to educate, inspire, and mobilize communities to stop the spread of HIV. It builds basic life skills that help boys and girls adopt healthy behaviours and live risk-free.

UNAIDS Executive Director Michel Sidibé thoroughly enjoyed getting a chance to play football with the girls and was struck by the impact the centre is having on the community. “Here in Khayelitsha, the Football Centre for Hope is not just a project. It is a social meeting point for girls to protect themselves from HIV and become tomorrow’s football stars,” he said.

“Grassroot Soccer is restoring dignity and building self-esteem of young girls living in a challenging environment, transforming them into actors for the HIV prevention revolution.”

The delegation also had a chance to interact with the local staff and coaches to hear about how the programme and curriculum work, as well as the other types of HIV prevention and testing interventions they run in the community.

UNAIDS partnered with Grassroot Soccer in the development of the Skillz Curriculum which includes interactive activities for young people to learn about HIV and get a chance to practice the skills necessary for sustainable behaviour change. Topics in the curriculum include making healthy decisions, avoiding risks, building support networks, reducing stigma and discrimination, increasing knowledge about testing and treatment, addressing gender issues, and assessing values. Each of the commissioners received a set of Skillz Magazines and Skillz Coaches Training DVD.

In 2002 Tommy Clark, the founder and CEO, started Grassroot Soccer with friends who had played professional soccer together in Zimbabwe. They instinctively knew that soccer represented an opportunity in the fight against HIV. The organization has been operating in South Africa since 2006.

Learn more about Grassroot Soccer in this brief video overview:

Commitments made to transform the response to HIV at historic event on Robben Island

From left: Archbishop Desmond Tutu; Michel Sidibé, UNAIDS Executive Director; Dr Aaron Motsoaledi, South Africa Minister of Health.
Credit: UNAIDS/AFP Photo G. Guercia

Robben Island/Geneva, 4 May 2011—Archbishop Desmond Tutu has symbolically passed the baton to a new generation of young leaders focused on AIDS. The handover took place during an event held to inspire a transformation of the AIDS response which was convened by the Joint United Nations Programme on HIV/AIDS (UNAIDS) on Robben Island in South Africa.

The event joined together world renowned leaders from the UNAIDS High Level Commission on HIV Prevention with a group of young leaders who, in turn, presented the commissioners with a ‘call to action’ articulating the vision of the youth movement on HIV. The Commission on HIV Prevention was established by UNAIDS in 2010 to influence and lead social and political action aimed at galvanizing support for effective HIV prevention programmes.

“Today is about putting our heads and our hearts together to support a renewal of leadership and commitment in HIV prevention,” said Archbishop Tutu, co-chair of the Commission on HIV and long-standing AIDS advocate. “Bold and honest actions are needed and we look to the next generation of leaders to bring about positive change in attitudes and actions.”

The youth representatives convened recently in Mali at a youth leader’s summit on HIV where young people from across the world worked to find innovative ways of strengthening the links between youth and AIDS movements, notably through new media channels.

“Young people have the power to change the future and transform the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “A collective youth movement mobilised around HIV prevention which exchanges important information through new technologies and peer education will stop new infections.”

Archbishop Tutu called on the young participants to commit to taking forward a new generation of leadership in the AIDS response. He also called on the HIV Prevention Commission members to inspire and mentor them in their leadership role.

Commitments were also made by the Commissioners who pledged to take the transformation of the AIDS response forward in their respective sectors. Commissioner Earvin “Magic” Johnson announced by video message that his Foundation will be a founding partner of a global foundations fellowship programme for young people. Elena Pinchuk’s AntiAIDS Foundation announced a global competition for young innovators to develop social networking campaigns. The Global centre for innovation in mobile health and Cell Life pledged to work together with UNAIDS and mobile service providers to promote HIV prevention and behaviour change  dialogue through the use of mobile phones in at least five countries.

The event was held on Robben Island off the coast of Cape Town in South Africa where former president Nelson Mandela was incarcerated. The location is seen as a testimony to the human spirit, symbolising the power of change.

Panel on Social media and HIV prevention from left: Ms Helen Alexander, Sonke Gender Justice Network, Mr Richard Delate, The Johns Hopkins Health and Education in South Africa, Olga Rudnieva, Elena Pinchuk ANTIAIDS Foundation and Mr Ian Royer, What about HIV? Campaign. 2 May 2011.
Credit: Stefan Els, Stellenbosch University.

With more than 7 000 people newly infected with HIV everyday and 1 000 of these new infections occurring in South Africa, Stellenbosch University just outside Cape Town, was the ideal setting of a high level panel discussion on how social media and mobile technology has been and can be leveraged to prevent new HIV infections.

“The potential of new technologies to re-energize the AIDS-movement is clear. We need nothing less than an HIV prevention revolution, with social media and mobile technology at its core,” said Michel Sidibé, Executive Director of UNAIDS in his opening remarks.

Two panels one—on social media one on mobile technology—were livestreamed via the UNAIDS page on Facebook. The discussions brought together technology leaders, AIDS activists, and social media experts to share ideas of how these new tools can be integrated as part and parcel of HIV prevention programmes.

Mobilizing social networks for HIV and young people

During the social media session, a work in progress project was presented by Mr Ian Royer, a delegate at the recent Global Youth Summit on HIV in Mali. Participants at the summit launched a collaborative social media campaign together with an outcome document aimed at mobilizing youth organizations and networks globally to endorse the summit’s call to action. The website www.whatabouthiv.org is the hub of this initiative.

“So far we have had more than 1 000 endorsements and engaged more than 7 000 people from all around the world. Social media is an ideal tool to mobilize young people,” said Mr Royer. “We are scaling up our effort in the lead up to the High Level Meeting on AIDS in June to make sure that our call to action is heard loud and clear!”

With social media being all about two way conversations, the panelists took questions from Twitter and Facebook posed by people following the discussion online. Tweeter @baruchdom made the following comment: “Remember that the majority of  Sex Workers and Drug Users and trans people don't have access to internet or social networking.”

A reply came from panelist Helen Alexander, with the Sonke Gender Justice Network:  “In South Africa at least, the cell phone is an important tool of the trade for sex workers, as it helps them connect to their clients, and helps to keep them safe. So mobile phones are actually a great way to reach sex workers. It’s anonymous, you don’t have to track people down, and often these are people who are not comfortable coming to a community event,” said Ms Alexander.

Mobile platforms for social change

There are 500 million cell phones in Africa, and mHealth or mobile health is increasingly recognized as an effective channel for HIV programming.

“How can we begin to maximize the use of mobile technology for HIV prevention?” asked Marlon Parker Founder of Reconstructed Living Lab, a South African social enterprise. “We have to use this technology to educate, engage and empower people—and we can take this beyond the platforms to offline action!”

Ms Debbie Rogers, Lead Strategist of Praekelt Foundation, shared lessons learned from their free mobile platform Young Africa Live, which among other things aims to prevent new HIV infections in South Africa. According to Ms Rogers, the platform has reached 32 million page views and more than 950,000 comments posted since its launch.

App-development competition for HIV prevention launched

The internet and social media are widely used by young people everywhere—including low income countries. These tools have the potential to deliver HIV prevention programmes in a cost-effective way to young people through a media that they are already using.

Participants at the social media and mobile technology for HIV prevention hosted at the Stellenbosch University, South Africa. 2 May, 2011.
Credit: Stefan Els, Stellenbosch University.

To move forward this agenda, Ms Olga Rudnieva, Executive Director, Elena Pinchuk ANTIAIDS Foundation, closed the event by announcing a competition for developing social media and/mobile applications for HIV prevention.

"By the end of the next week the criteria will be on the UNAIDS website. The challenge is to come up with a social network project with or without mobile applications to prevent HIV. We are welcoming projects up to USD 10 000. You have to be creative, innovative, do something good for you and for your community!” said Ms Rudnieva.

In the lead up to the High Level Meeting on AIDS, the social media and mobile technology for HIV prevention panels were co-hosted by UNAIDS and Stellenbosch University. It is part of UNAIDS strategy to inspire and catalyze young people to use social media to ignite an HIV prevention revolution.

Credit: UNAIDS

In developing countries one of the major challenges for universal access to treatment is access to affordable commodities. Two events in Cape Town are giving an opportunity for discussion, reflection and developing a strategy for improving access to quality and affordable drugs in Africa.

The International Conference on local pharmaceutical production in Africa is taking place 4-6 April 2011. Bringing together politicians, the pharmaceutical industry and development partners it’s an opportunity for exchange and collaboration—which is essential for promoting local pharmaceutical production. Under discussion are a wide range of issues including access to essential medicines, intellectual property rights, technology transfer as well as the use of TRIPS-flexibilities and the harmonization of drug regulation.

Representatives from the regional intergovernmental organizations the East African Community and the Southern African Development Community are being joined by representatives from the Indian pharmaceutical industry, as well as UNDP and WHO. They were welcomed by Stefano Bologna, UNIDO Representative; Mr Dieter Haller, German Ambassador to Pretoria; and Mr Olajide, from the African Union Commission. Participants also include Mr Anand Grover, UN Special Rapporteur on the Right to Health, and Ms Ellen T’Hoen executive director of the Medicines Patent Pool.

In his keynote address at the opening, UNAIDS Deputy Executive Director, Programme Paul De Lay said that local production of high-quality pharmaceuticals in Africa is an opportunity to sustain the AIDS response over the longer term and put products nearer to those who need them.

“But it requires a strong regulatory environment that can attract private sector investments for the manufacture of medicines within Africa. Domestic production could flourish, just as we have seen in Asia and Latin America,” he said.

“Building regulatory capacity is also critical to facilitate timely access to quality, safe and efficacious medicines,” Dr De Lay added.

Southern African Generic Medicines Association launched

The conference was preceded on 4 April by the public launch of the Southern African Generic Medicines Association (SAGMA). This non-profit association hopes to promote collaboration within the pharmaceutical sector in order to achieve self-sufficiency and reliability in the local production and provision of affordable, efficacious, quality generic medicines in the Southern Africa Development Community.

UNAIDS Deputy Executive Director, Programme Paul De Lay gave one of the keynote speeches at the launch. He spoke of the power of a “pan-African vision and regulatory system” emerging, which would allow for fewer delays in authorisation of medicines, better quality control, stronger support to innovation and a more sustainable response to HIV.

“SAGMA has an essential role to play in supporting the development of a pharmaceutical regulatory plan for Africa that will support universal access to treatment,” said Dr De Lay.

Dr De Lay went on to describe how SAGMA could support countries with “implementation of TRIPS, innovative licensing schemes and the Medicines Patent Pool to keep prices going down and ensure that new generations of good quality drugs become available.”

Ms Joy Phumaphi the Executive Secretary of the African Leaders Malaria Alliance (ALMA) in Botswana, also gave a keynote address. ALMA is an alliance of African Heads of State and Government working to end malaria-related deaths. It was founded by the leaders in order to use their individual and collective power across country and regional borders.

Two panel discussions were also held to share experiences about pharmaceutical manufacturing in southern Africa. Speakers included representatives from private sector pharmaceutical companies.

Credit: UNAIDS/P. Virot

The Lancet Infectious Diseases today published evidence from a World Health Organization-led study. The study showed that giving pregnant women living with HIV a combination of three antiretroviral (ARV) drugs from the last trimester, through delivery and six months of breastfeeding can reduce the risk of their babies being infected with HIV by more than 40%.

The study, named Kesho Bora which means ‘a better future’ in Swahili, was conducted between June 2005 and August 2008 in five sites in Burkina Faso, Kenya and South Africa. The randomized controlled trial aimed to assess the efficacy and safety of triple antiretroviral treatment to reduce mother-to-child transmission of HIV. This was compared to the use of single-dose nevirapine and zidovudine stopped after delivery, as had been recommended by the World Health Organization (WHO) since 2004.

Triple antiretroviral treatment given to pregnant women with a CD4 immune cell count of 200-500 cells/mm3 starting in their last trimester reduced mother-to-child transmission by 43% and reduced the risk of infection during breast-feeding by more than half. It was also shown to be safe for both mother and baby.

The WHO’s Department of Reproductive Health and Research worked in partnership on the study with the French National Agency for Research on AIDS and Viral Hepatitis (ANRS), the US Centers for Disease Control and Prevention (CDC) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.

South Africa has the world's largest population of people living with HIV; an estimated 5.6 million people in the country are living with HIV, representing nearly one sixth of the global disease burden. Credit: UNAIDS

South African Health Minister Dr Aaron Motsoaledi has announced that South Africa has successfully negotiated a range of price reductions for antiretroviral treatment in a bid to increase access to treatment for people living with HIV.

“It is my pleasure to announce the massive reduction in the prices of antiretroviral drugs which has resulted in the 53.1% reduction in the cost of the total tender,” said Dr Motsoaledi. “South Africa can now afford to treat twice as many people on ARVs compared to that which was previously budgeted.”

In a statement released on 14 December, the Health Minister announced that since World AIDS Day 2009, almost 5 million South Africans had been tested for HIV as part of the HIV Counselling and Testing campaign which was launched by President Zuma in April.

The campaign aims to test 15 million people for HIV by the year 2011, up from 2.5 million in 2009 – a six-fold increase in just two years. Of the 5 million people tested since the launch, over 900 000 were found to be HIV positive.

UNAIDS Executive Director, Michel Sidibé attended the launch in April and called for reductions in the price of antiretroviral drugs which were at least 25-30% higher than average international prices and posed a key challenge in South Africa’s efforts to expand treatment.

“This is a significant breakthrough for South Africa’s response to the epidemic,” said Mr Sidibé. “More people are finding out their status as testing is scaled up which is resulting in more people coming forward to access treatment. These price reductions are essential to ensuring that all people in need have timely access to the lifesaving medication.”

South Africa funds more than two thirds of its AIDS response. In 2010, South African leaders committed $1 billion US dollars to the AIDS response – a 30% increase over the previous year.

South Africa has the world's largest population of people living with HIV; an estimated 5.6 million people in the country are living with HIV, representing nearly one sixth of the global disease burden. Approximately 18% of adults in South Africa are infected with HIV.

Kumar Sangakkara taking part in community visits to support the Think Wise partnership during the ICC World Twenty20 2010 earlier this year in West Indies. Credit: ICC

International cricket will mark World AIDS Day and show its support for people living with HIV this week. Players will wear red ribbons on their shirts during international matches.

On 1 December 2010 players and match officials will wear red ribbons in the One-Day International matches between Bangladesh-Zimbabwe, India-New Zealand and Sri Lanka-West Indies; as well as on the opening day of the Ashes Test Match between Australia and England on 3 December. There will also be activities taking place at South Africa’s domestic matches to show support for people living with HIV.

Sri Lanka captain and Think Wise champion Kumar Sangakkara believes it is vital that cricketers show their support for the Think Wise initiative, a joint partnership between the ICC, UNAIDS, UNICEF and the Global Media AIDS Initiative. The campaign to raise awareness around HIV prevention and reduce discrimination towards people living with HIV has been running since 2003.

“It is very important because many of the people living with HIV across the world live in cricket-playing countries. It is something that you cannot escape no matter where we play,” said Sangakkara.

“Lack of awareness about HIV is compounded by the discrimination that people living with HIV face. It is therefore important to create awareness to stop the spread of the virus while also curbing discrimination, and as international cricketers, we can help to achieve this objective,” he said.

The UNAIDS Global Report gives new evidence that investments in HIV prevention are producing significant results in many of the highest burden countries. Despite these gains, an estimated 2.6 million people became newly infected with HIV and 1.8 million people died from AIDS-related illnesses in 2009, and 33.3 million people were estimated to be living with HIV.

“The red ribbon that we wear symbolizes our support for the cause to help those with HIV and AIDS to live a full and productive life in society without giving up hope. It is a disease that we should fight by understanding how it spreads and encouraging people to talk about things like sexuality in their homes,” said Sangakkara.

ICC Cricket World Cup 2011

Players will also wear red ribbons in important matches at the ICC Cricket World Cup 2011, including the quarter-final, semi-final and final matches. South Africa’s skipper Graeme Smith, also a Think Wise champion, is delighted that that cricket will continue to show its public support for people living with HIV, particularly at the sport’s flagship event.

“You only have to look at the statistics to understand why I am passionate, as the captain of South Africa, to make a difference to HIV awareness. 1.8 million people die of AIDS-related deaths each year and nearly three-quarters of them come from Sub-Saharan Africa. These are people who watch me play cricket on television, support me in the stadium and this makes it all seem very real to me,” said Graeme Smith.

“If I can use my position as international cricketer to deliver important social messages, such as encouraging young people to use protection and wear a condom, and reduce the number of new infections then it is something that I am happy to do. By wearing a red ribbon we are sending a message to the millions of fans across the world that you shouldn’t discriminate against people living with HIV,” he concluded.

After nearly 20 years of research, the results of the CAPRISA 004 trial provided the first evidence that the use of a vaginal microbicide could provide a safe and effective way to prevent HIV infection in women.

Following results from a South African study (CAPRISA 004) showing that a vaginal microbicide gel containing the antiretroviral drug tenofovir was 39% effective in reducing a woman’s risk of becoming infected with HIV during sex, WHO and UNAIDS convened a meeting in August 2010, just a month following the announcement, to review the implications of the CAPRISA 004 results and determine the appropriate next steps.

The meeting participants agreed on the below priority actions for follow-up:

• Additional safety studies;
• Effectiveness trial in South Africa to confirm the CAPRISA 004 BAT 24 dosing regimen;
• Effectiveness and safety trial of simplified dosing and HIV testing schedules;
• Implementation study in South Africa; and,
• Treatment outcome and resistance study.

To find out more, read the executive summary of the meeting report , or download the full report.