United States of America

During a two-day visit to Atlanta, United States of America, UNAIDS Executive Director Michel Sidibé visited the Emergency Operations Center of the United States Centers for Disease Control and Prevention (CDC) and interacted with CDC staff during a town hall meeting.

He also spoke on leadership in the global AIDS response with students and faculty at a special session at the Rollins School of Public Health moderated by Carlos del Rio, Hubert Professor and Chair of the Department of Global Health at the Rollins School of Public Health and Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine.

In honour of the inauguration of the 20th President of Emory University, Claire Sterk, the first woman President of the University and a renowned public health and HIV researcher, the university held an academic symposium entitled Health Challenges and Bold Opportunities. Speaking alongside Deborah Bruner, Associate Director for Mentorship, Education and Training at the Winship Cancer Institute, Professor in the Nell Hodgson Woodruff School of Nursing and Professor of Radiation Oncology in Emory University School of Medicine, and Elaine Walker, Director of the Development and Mental Health Research Program of Emory University, Mr Sidibé provided an overview of what is needed to end the AIDS epidemic as a public health threat within the framework of the Sustainable Development Goals.

At the close of the symposium, Ms Sterk awarded Mr Sidibé the Emory President’s Medal in recognition of his work as a “passionate champion for health and humanity”, which he accepted on behalf of all people working to end the AIDS epidemic. Past laureates of the President’s medal include President Jimmy Carter, the Dalai Lama, Congressman John Lewis, global health hero William Foege and civil rights activist Rosa Parks.

While in Atlanta, Mr Sidibé also visited the Ponce de Leon Center, one of the largest HIV clinics in the United States of America, serving more than 6000 people annually. Mr Sidibé spoke with staff about the unique challenges of delivering quality HIV care and treatment to people with late stage diagnosis of HIV. Thirty-five years into the epidemic, patients still face high levels of stigma, which can delay and keep people from accessing life-saving treatment.  

Mr Sidibé concluded his visit to Atlanta with a meeting at the Carter Center to explore how UNAIDS and the Carter Center can best leverage combined expertise and knowledge for the greatest impact in areas where the work of the two organizations converges.

On the International Day of the Girl Child, 11 October, Together for Girls and its partners, including the Government of the United States of America, the Government of Canada, five United Nations agencies, including UNAIDS, and several private sector organizations cohosted an event entitled 72 Hours and Counting: Why Every Hour Matters for Post-Rape Care. Panellists at the event called for increased domestic and global programming to address violence against girls.

Every Hour Matters is a new global advocacy campaign designed to raise awareness of the need to ensure that people have timely access to comprehensive services after rape and of the need for such health services to be made available in all communities. Every Hour Matters was launched in 2016 by Together for Girls, a public–private partnership focused on ending violence against children, particularly sexual violence against girls.

New York City was the first city in the world to have its own municipally branded condom, and it currently maintains the largest free condom programme in the United States of America. Even in this high income, cosmopolitan city, free condom distribution is instrumental in preventing HIV, other sexually transmitted infections and unintended pregnancies among key populations.  Free condom distribution is included as a cost-saving and cost-effective prevention strategy within the 2015 Blueprint for ending the AIDS epidemic in New York State by 2020.

New HIV diagnoses in New York City, 2001-2014

Source: New York City Health Department

New York City’s free condom programme started in 1971, with free condoms distributed through the city’s clinics for sexually transmitted infections. In 2007, the Health Department launched the NYC Condom. Since then, every National Condom Awareness Day (held on St Valentine’s Day) has included a change in the look of the NYC condom packaging or the addition of a new layer of social marketing to the programme.

The Health Department supplies male condoms, female condoms and lubricant freely to any New York City organization or business that wishes to distribute them. In 2011, the Health Department created the NYC Condom Finder, a mobile phone application that uses GPS to assist users to find condom outlets across the city; this app has been downloaded by tens of thousands of people.

New York City’s Condom Availability Program (NYCAP) has over 3500 condom distribution partners and in 2014 distributed over 37.1 million male condoms and almost 1.2 million female condoms across the five boroughs. These partners focus distribution on neighbourhoods with the highest rates of HIV in the city, and to locations that serve people living with HIV and key populations, such as gay men and other men who have sex with men.

The programme works to increase the awareness, availability and accessibility of condoms to the residents of New York City by maintaining a strong community presence. In 2014, NYCAP participated in over 105 community events, provided 825 presentations in the Health Department’s clinics for sexually transmitted infections, and participated in all official and unofficial Gay Pride events in the city, reaching over 53 500 individuals.

Awareness and access to NYC Condoms is high among key populations. Over 75% of individuals polled at Gay Pride events and an African American Day Parade had seen or heard of NYC Condoms and had obtained them.

At the Health Department’s clinics for sexually transmitted infections, 86% of people surveyed were aware of NYC Condoms and 76% had obtained them. Condom use was also high, ranging from 69% to 81% among people who obtained NYC condoms.

Since the launch of the NYC Condom, more than 300 million NYC Condoms have been distributed. The trend in new diagnoses of heterosexually transmitted HIV infections has been reversed with a reduction of 52% between 2007 and 2014.                   

The United States of America (US) released an updated AIDS strategy on 30 July which sets the course for its domestic response to HIV over the next five years. The National HIV/AIDS Strategy: Updated to 2020 sets ambitious targets which put particular focus on the people and places most in need.

The US strategy mirrors many of the goals of UNAIDS Fast-Track approach. It calls for 90% of people living with HIV to be aware of their status, aims to increase the percentage of people living with HIV who are retained in medical care to at least 90% and to ensure that 80% of all people diagnosed with HIV have a suppressed viral load which reduces the likelihood of transmitting the virus by around 96%.

Commenting on the new strategy President Obama said that it seized upon rapid shifts in science and policy as more had been learned about the disease. He also said it focused on making sure that every American could get access to life-extending care, no matter who they were, where they lived or how much money they had.

The strategy recommends that efforts be concentrated on people who are being left behind in the response to HIV, namely, gay men and other men who have sex with men, especially African American men, heterosexual African American men and women, young people, people who inject drugs and transgender women. It calls for full access to comprehensive pre-exposure prophylaxis (PrEP) services for those for whom they are appropriate and desired. The strategy also prioritizes certain geographic areas where HIV incidence is high and linkage to, and retention in care is low, including the southern US and specific major metropolitan areas, like Washington, DC.         

“I commend President Obama on the bold, new goals set in the updated US strategy which align with the UNAIDS ‘Fast-Track’ approach. The United States joins other nations in pursuit of key prevention, testing and treatment targets that, if met by 2020, put the world on course to end AIDS as a public health threat by 2030,” said Michel Sidibé, Executive Director of UNAIDS.          

According to the latest data available from the Centers for Disease Control and Prevention (CDC), there are an estimated 1.2 million people living with HIV in the US, of whom 1 in 8 are unaware of their HIV status. CDC also estimates that 50% of Americans who are diagnosed with HIV are not retained in medical care and that only 37% are accessing life-saving HIV treatment.

At the event to launch the revised strategy, which was held in Atlanta, Georgia, it was also announced that Mayor Kasim Reed had signed the Paris Declaration—Fast-track cities: Ending the AIDS epidemic. In signing the declaration, the mayor has committed to putting Atlanta on the Fast-Track to ending the AIDS epidemic through a set of commitments. Those commitments include achieving the UNAIDS 90–90–90 targets, which will result in 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on antiretroviral treatment and 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission.

The Fast-Track Cities Initiative is supported by its core partners, namely, the City of Paris, the International Association of Providers of AIDS Care (IAPAC), UNAIDS and the United Nations Human Settlements Programme (UN-Habitat).

The United States of America unveiled on 3 December two new initiatives to scale up efforts to end the AIDS epidemic by 2030.

Reaching out to some of the most vulnerable populations being left behind in the AIDS response, the new initiatives will focus on adolescent girls and on speeding up the development and delivery of drugs to treat paediatric AIDS. 

These new United States commitments will bring attention to the urgent need for more effective programmes to reduce the disproportionately high levels of new HIV infections in young women and to urgently scale-up treatment services for children.

UNAIDS Executive Director Michel Sidibé welcomed the announcement and commended the United States President's Emergency Plan for AIDS Relief (PEPFAR) on its significant achievement  in increasing the numbers of people on HIV treatment.

“We congratulate PEPFAR on these two new initiatives. If we are to meet our goal of ending the AIDS epidemic by 2030, we must all fast-track our work to reduce new infections to less than 500 000 a year, scale-up treatment to meet the 90-90-90 targets, and eliminate stigma and discrimination,” said Mr Sidibé. “We will continue to need the United States to help lead the way towards the achievement of these ambitious targets.”

PEPFAR also released a new report titled PEPFAR 3.0 – Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation. The report documents the programme’s progress and unveils PEPFAR’s strategy for working with partners to reach the UNAIDS 90-90-90 targets and to achieve an AIDS-free generation.

The PEPFAR programme is currently providing life-saving HIV treatment to 7.7 million people and has provided HIV testing and counseling for more than 56 million people in 2014.

On 18 November, the University of California, Los Angeles (UCLA), welcomed UNAIDS onto its prestigious campus for the launch of the 2014 UNAIDS World AIDS Day report, Fast-Track: ending the AIDS epidemic by 2030. Held for the first time in Los Angeles, the World AIDS Day report launch brought together students, policy-makers, scientists, AIDS advocates and celebrities to create a new movement of solidarity around ending the AIDS epidemic by 2030.

Leading AIDS advocate David Gere, Professor and Director of the UCLA Art & Global Health Center, hosted the launch, which took the form of an interactive dialogue with the UNAIDS Executive Director, Michel Sidibé. Mr Sidibé shared with the audience his vision for the future of the AIDS response and how the AIDS epidemic could be ended by 2030.

The event was opened with an invigorating clip featuring the UCLA Sex Squad, a group of undergraduate students dedicated to ensuring the sexual health and well-being of high school and college students in Los Angeles.

The Sex Squad is part of a broad nexus of HIV programmes and research at UCLA, which includes vaccine development at the UCLA AIDS Institute, health research at the Fielding School of Public Health and arts-based interventions, such as the Sex Squad, devised by the UCLA Art & Global Health Center. Sex squad member Zakk Marquez gave a live performance, sharing his personal story about the complexities of being in a serodiscordant relationship—a couple in which one person is HIV-negative and the other HIV-positive.

Special guest Charlize Theron, United Nations Messenger of Peace and Founder of the Charlize Theron Africa Outreach Project, welcomed Mr Sidibé to the stage and expressed her support for UNAIDS’ new Fast-Track Targets. She also urged for continued efforts to address the specific needs of adolescents affected by HIV to ensure that no one is left behind.

It will be impossible to end the AIDS epidemic without the activism and leadership of young people, said UNAIDS Executive Director Michel Sidibé during a special town hall meeting in New York sponsored by the public affairs journal The Atlantic.

The meeting, entitled Rebels with a Cause: Igniting a Culture of Activism in Youth, used AIDS as a prime example of how young people are mobilizing for important causes.

Participants noted that activism by young people has played a pivotal role in the history of AIDS, making many of the achievements over the past decade possible. During the first decade of the epidemic, young activists demanded action on the epidemic and successfully advocated for radical changes to the clinical trials and drug approval processes.

During an interview-style session with Nancy Mahon, Global Director of the MAC AIDS Fund, Mr Sidibé underscored the importance of youth leadership in the AIDS response. He stressed the need to involve young people as partners in order to build responses that work for them.

Examples of activism by young people were highlighted during the event, specially the importance of personal narratives in making a difference. According to the participants, it is vital to use the energy and leadership of young people to demand action to lay the groundwork to put an end to the epidemic.