UNICEF The United Nations Children's Fund

Leading academics, policy-makers and HIV and social protection experts met at the World Bank offices in Washington, DC, from 15 to 16 January to identify gaps in research and resources for ending poverty, inequality and the AIDS epidemic by 2030.

The meeting was convened by UNICEF, the World Bank, UNAIDS and Housing Works to find ways to eliminate existing social and structural barriers to accessing HIV services. The meeting brought together people working to end poverty and inequality and people working in the response to AIDS.

The participants highlighted that social protection programmes, including cash transfers in sub-Saharan Africa and parts of the Asia–Pacific region, emerged to mitigate the impact that HIV had among orphans and other vulnerable children and households affected by HIV. Such programmes focused on the vulnerabilities associated with HIV, including poverty, inequality and exclusion. Scaling up social protection programmes was recognized as essential for ending the AIDS epidemic by 2030.

Key messages

• The participants called for the scale-up and expansion of national social protection programmes focused on mitigating the vulnerabilities associated with HIV, including poverty, inequality and exclusion.
• Stronger social protection and HIV research is needed, utilizing impact evaluation approaches that capture the complexity and multisectorality of social protection.
• There is a need to explore new social protection and cash transfer programmes that address the specific HIV prevention needs of 19–24-year-old women, as most cash transfer programmes cease when women are around 19 years old, when they are most at risk.
• There is a need to develop sustainable social protection formulas and strategies that reflect the multiple benefits of social protection and cash transfer programmes.

When Angelina Twoki Terso arrived at the Juba Teaching Hospital’s antenatal clinic in 2004, when one month pregnant with her third child, she met with an HIV counsellor but didn’t think there was a need to get tested for HIV. Ms Twoki thought only people who smoked, drank and did things that she considered immoral contracted HIV.

Her first husband had died a few years before and she had never known the cause of his death. She remembers the counsellor telling her that anyone can contract HIV and she should consider getting tested, just to be sure. When the results came back a few hours later and she learned she was HIV-positive, Ms Twoki was in shock.

“I was going to commit suicide,” said Ms Twoki. “I wanted to run to the Nile. I was going to run there and jump in.” But the counsellor explained that she could get treatment at the hospital to keep her healthy and prevent the transmission of the virus to her baby.

She enrolled in the prevention of mother-to-child HIV transmission (PMTCT) programme and returned every month to the hospital for a check-up and to get her medication. She delivered her baby at the hospital and her daughter, Grace, who is now nine years old, is confirmed free of HIV.

Ever since Grace’s birth, Ms Twoki has dedicated her life to helping other women access and adhere to PMTCT services. She visits eight different antenatal clinics in South Sudan’s capital, Juba. “Every day I share my testimony. Most of the women are accepting testing for HIV because they want to know their status. They want to stay healthy for their family and they want to have a healthy baby. It’s very important,” said Ms Twoki.  

The main problem, she said, is that there are not enough sites where PMTCT services are offered in South Sudan. She counsels women who have to walk more than 12 hours to reach Juba to access services and medicines. She says, despite her best efforts to convince them to stick with the programme, dozens drop out owing to the long distance. “They complain. They say they are tired of running here. The place is very far and they don’t have transport,” said Ms Twoki.  

There are only 75 facilities scattered across South Sudan that have integrated PMTCT services. In 2013, an estimated 2600 children were infected with HIV through mother-to-child transmission, and only 2% of children living with HIV had access to life-saving treatment.

Martha Cayad-an, health specialist at UNICEF, stresses the need to scale up access to quality PMTCT services in South Sudan—especially in rural areas, where more than 75% of women live—and to embed such services in a broader range of health services.

“Rather than asking women to go to one place for an HIV test and to another for immunization, health centres must offer integrated services,” said Dr Cayad-an. “When it’s a one-stop shop, the facilities become more user-friendly for women and children and therefore they attract more clients.”

However, scaling up HIV services will require substantial improvements to the country’s health sector, which is plagued by too few sites, too few health workers and a general shortage of resources as a result of decades of war.

Emmanuel Lino, Deputy Director of HIV/AIDS Services at the Ministry of Health in South Sudan, said the government is committed to scaling up integrated maternal and child health-care services.

“Only 22 PMTCT sites in the country provide antiretroviral treatment, but we are hoping that once the resources are available, those stand-alone PMTCT services will eventually be integrated with long-term HIV prevention and treatment, tuberculosis and malaria services,” said Dr Lino.

Dr Lino acknowledges that it will take time, certainly more than what will satisfy the needs of women living with HIV and advocates such as Ms Twoki. But he said the country is trying to lay the foundation for a system that will not just reduce future infections among children but that provides the comprehensive services to keep the nation healthy. 

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.

Using innovation to improve the lives of millions of the world’s most disadvantaged children and to bridge the divide between those who have almost everything and those with virtually nothing is explored in UNICEF’s The state of the world’s children, published on 20 November.

Marking the twenty-fifth anniversary of the Convention on the Rights of the Child, the report, promotes an agenda for change in which governments, civil society, businesses, community organizers and a broad range of actors work together to find creative solutions to the most pressing problems children face. It calls for these solutions to cross borders, push boundaries and forge new global networks in an increasingly interconnected world so that inequity and injustice are challenged.

The report notes that such action is urgently needed given that millions of children still face discrimination, physical and sexual abuse and neglect. The poorest 20% are twice as likely to die before their fifth birthday as the richest 20% and almost a quarter of children in the least developed countries are engaged in child labour.

A number of innovations, many by young inventors themselves, are showcased. These range from  the Solar Ear, the world’s first rechargeable hearing aid battery charger, to floating boat schools providing education to children in flood-prone areas, and from a urine-powered electricity generator to a new building material made from unwanted rice waste. Personal stories are also highlighted, such as Josephine, a young woman in Zambia who uses mobile technology to provide her peers with free and confidential counselling on HIV and other sexually transmitted diseases. 

In addition, the fully digital report, which includes multimedia and interactive components, invites readers to share their own innovations and creativity to help children around the world. 

Medical and scientific experts participating in the recent international conference Children and HIV: Problems and Prospects, held in Saint Petersburg, Russian Federation, pledged to eradicate mother-to-child transmission of HIV in the Russian Federation by the end of 2015, a first step towards achieving a generation born free of HIV in the country.

More than 400 specialists from across the Russian Federation, health professionals from 18 countries and representatives of international organizations and global research institutes, including UNAIDS, UNICEF, WHO and the Paediatric European Network for Treatment of AIDS, discussed topics such as improving medical care for pregnant women and children, early HIV diagnostics and treatment of coinfections and social support for children living with HIV and their families.

Key recommendations made at the forum to achieve the target of zero new cases of HIV transmitted from mother to child included promoting and implementing modern clinical protocols and standards and strengthening international cooperation to better serve mothers and children.

Global leaders have committed to take action towards ending the AIDS epidemic among adolescents. At a meeting during the 69th session of the United Nations General Assembly, co-hosted by UNICEF, UNAIDS and the Governments of Brazil and Kenya, representatives from countries across six regions came together to join a growing movement to advance the response to HIV among adolescents.

During the meeting, participants pledged their support to All In, a joint initiative between UNICEF, UNAIDS and partners to reduce new HIV infections among adolescents by at least 75% and increase HIV treatment to reach at least 80% of adolescents living with the virus. The initiative outlines that the targets can be achieved through providing HIV prevention, testing, treatment, care and social change programmes that focus on the specific needs of adolescents living with, or at higher risk of acquiring, HIV.

A global movement to advance efforts towards ending the AIDS epidemic among adolescents is urgently needed as this is the only age group among which AIDS-related deaths are actually increasing. AIDS-related illnesses are the second leading cause of death among adolescents aged 10–19 years globally, and the leading cause of death among adolescents in Africa.

In 2013, there were an estimated 2.1 million adolescents living with HIV, more than 80% of whom live in sub-Saharan Africa. Many still do not know their status. Almost two thirds of the 250 000 new infections among 15–19 year olds in 2013 were among adolescent girls.

During the event, speakers, including young people living with HIV, called on leaders to reflect on their current efforts to prevent the spread of HIV among adolescents, and to invest more in the most effective interventions. Government representatives from around the world, including Botswana, Brazil, Thailand and Ukraine, pledged their commitment to go All In for adolescents.

The formal launch of All In is scheduled for early 2015.

The newly-formed Nigerian national youth alliance has made increasing youth-friendly HIV and sexual and reproductive health services its top priority. The group will focus its efforts on ensuring that the needs of young people are met in the post-2015 agenda. It aims to do this by working with national decision-makers and development partners to ensure the priorities of young people are adequately addressed in intergovernmental negotiations on the post-2015 agenda.  

Youth-friendly HIV services should be based on an understanding of, and respect for, the realities of young people. HIV services should be easy to access and welcoming for young people, meet their needs comfortably and should succeed in retaining young people in on-going care. Services should be provided by personnel who are trained to respond to the specific needs of young people and ensure confidentiality and trust.

Sixty youth representatives from across Nigeria participated in the ACT 2015! strategy meeting organized by Education as a Vaccine (EVA) in conjunction with UNAIDS, UNICEF, the Federal Ministry of Youth Development, the Federal Ministry of Health and the National Youth Network on HIV/AIDS. The meeting was held in Abuja from 4 to 6 August 2014.

ACT 2015! is a campaign that seeks to mobilize young people to ensure HIV remains a priority in the post-2015 agenda and that sexual and reproductive health and rights are a priority in United Nations negotiations.

Nine other countries are planning to hold similar events for young activists: Algeria, Bulgaria, Kenya, Mexico, the Philippines, South Africa, Thailand, Zambia and Zimbabwe. 

Among the cattle, helicopters and bands, the 88th Agricultural and Commercial Show of Zambia lived up to its 2014 theme: “Breaking new ground”—with a lively HIV prevention exhibit.

The trade show served as the stage for UNAIDS and its partners to reach young people with information and services aimed at preventing sexually transmitted infections and HIV.

Each day, more than 80 000 young people attended the trade show, which was held in Lusaka from 30 July to 4 August 2014.  

The UNAIDS office in Zambia brought together popular bands and service providers so that young people could get information on sexual reproductive health and services in an adolescent friendly way. 

Bands from Lusaka and provinces across the country drew large crowds with fun and energetic performances. Musicians playing at the Band Stand, the most popular arena among youth, delivered prevention messages. They also promoted individual responsibility for protecting themselves and their partners.

“The success of our joint initiative highlights that when young people can act immediately on the messages they hear and access services, they are more than willing to do so,” said Helen Frary, UNAIDS Country Director for Zambia. “Providing these services in an environment they identify with can go a long way in stopping stigma.”

Voluntary counselling and testing services and male and female condoms were readily available near the stage. Led by the United Nations Population Fund, the Condomize! Campaign drew attention to the fact that a low rate of condom use is one of the reasons behind HIV infections in Zambia. More than 120 000 condoms were distributed free of charge with UNAIDS support.

“It is refreshing to see young people taking condoms without fear or diffidence,” said Clementine Mumba of the Condomize! campaign.  

More than 1096 people got counselling and testing through the Society for Family Health and the Community for HIV/AIDS Mobilization Program. The number of people who received counselling and testing exceeded expectations, with providers running out of test kits midway through the last day of the event.

The United Nations Children’s Fund called on adolescents and young people present at the event to join its Zambia U-Report SMS platform and interact with counsellors via text messages on issues related to sexual health and HIV. New members topped 2200. 

Partners will advocate for increased funding and price reductions, strengthen efforts to ensure highest quality diagnostic services and forge partnerships to close diagnostic access gaps.   

MEBOURNE/GENEVA, 23 July 2014—The Joint United Nations Programme on HIV/AIDS (UNAIDS) has joined with global and regional partners to launch the Diagnostics Access Initiative which calls for improving laboratory capacity to ensure that all people living with HIV can be linked to effective, high-quality HIV treatment services.

Partners in the initiative include UNAIDS, the World Health Organization (WHO), the Clinton Health Access Initiative, the African Society for Laboratory Medicine (ASLM), UNICEF, and the US President’s Emergency Plan for AIDS Relief (PEPFAR).

"Around 19 million of the 35 million people living with HIV don’t know they have the virus. If they don’t find out they will die,” said Michel Sidibé, UNAIDS Executive Director. “This is why we have to make it simpler for people to test for HIV to be able to start lifesaving treatment when they need it.”

The Diagnostics Access Initiative specifically focuses on ensuring that at least 90% of all people living with HIV know their HIV status. It also aims to ensure that all people accessing HIV treatment have ready access to tests that monitor the levels of the virus in their bodies.

For treatment to be optimally effective, it is essential that all people accessing HIV treatment monitor their viral load frequently. Currently very few high-burden countries routinely offer viral load testing to people receiving HIV treatment. New viral load testing technologies which are made available when people first come in for care, offer promise for expanding access to viral load testing. However they will need to be affordable, appropriately deployed and used effectively.

“To achieve control of the HIV/AIDS epidemic, it’s essential that all people have access to high-quality HIV laboratory services, both for accurate HIV diagnosis and treatment monitoring.  Building a country’s capacity for virologic testing is critical for early identification of virologic failure, drug resistance and overall improved impact of the country’s HIV care and treatment programs,” said Ambassador Deborah Birx, U.S. Global AIDS Coordinator. “The Diagnostic Access Initiative represents an important step in ensuring the close collaboration among all donors and stakeholders to expand access and enable strategic scale-up of HIV laboratory services.”

To ensure early diagnosis of HIV, laboratory procedures need to be simplified and multiple testing tools and strategies made available. These also need to be integrated into community-centred health campaigns that focus on multiple diseases.

“It is essential that people know whether they have HIV infection, and that people who take treatment know whether their medicines are controlling the virus,” said Dr Hiroki Nakatani, Assistant Director-General, WHO.  “As diagnostic technology changes rapidly, and our Member States need guidance on how to use it, WHO will play a key role in this initiative.”

HIV treatment is effective in reducing HIV-related illness and AIDS-related deaths. It also helps to prevent new HIV infections, by sharply suppressing viral load and decreasing the risk of HIV transmission.

“The Diagnostic Access Initiative focuses urgent attention on the importance of developing new, affordable viral load and infant diagnosis technologies and effectively using the laboratory capacity we currently have,” said Dr. Tsehaynesh Messele, Chief Executive Officer of ASLM. “Effectively using existing and emerging viral load and infant diagnosis technologies will demand substantially stronger laboratory capacity as well as strategic planning to ensure that all technologies are optimally used.”

Partners in the initiative will advocate for greater funding for laboratory services and for the development of new diagnostic tools. They will also strengthen efforts to ensure that diagnostic services are of the highest quality and forge well-coordinated partnerships to close diagnostic access gaps.