United States of America

Secretary-General Ban Ki-moon (fifth from right)
and his wife Yoo Soon-taek (fourth from right) with
members of UNPlus—the UN System HIV Positive
Staff Group, at the opening of the UNPlus
photographic exhibition and launch of their
calendar, in observance of World AIDS Day 2007.
Photo credit: UN/Paulo Figueiras

In observance of World AIDS Day 2007, Secretary-General Ban Ki-moon and his wife Yoo Soon-taek opened a photographic exhibition entitled "UN Plus" at the United Nations headquarters in New York with the members of UNPlus - the UN System HIV Positive Staff Group.

UNPlus also marked the occasion with the launch of their new calendar, which features photos of UN staff ‘living positively’ and which has been distributed around the world.

UNPlus was initiated in March 2005 by a group of UN staff members living with HIV, with the support of the UNAIDS secretariat, to create a more enabling environment of all HIV-positive staff members, irrespective of the level of disclosure of their HIV status. UNPlus aims to create an organized and effective voice for people living with HIV within the United Nations system that challenges stigma and discrimination, and contributes to the development of and improvement of existing policies on HIV among United Nations agencies.

Secretary-General Ban Ki-moon (second from right),
and members of UNPlus tour the UNPlus
photographic exhibition, in observance of the
World AIDS Day.Photo credit: UN/Paulo Figueiras

UN Secretary-General Ban Ki-moon first met UNPlus in May 2007, as part of the 61st session of the General Assembly, to discuss the opportunities and challenges that UN positive staff face at work.

Describing his first meeting with the group as “one of the most moving experiences” of his life, Secretary-General Ban Ki-moon vowed to step up efforts to eliminate the stigma that still surrounds people living with AIDS in so many countries.

Mr. Ban said he was touched by the courage shown by the members of UNPlus, as well as the directness with which they spoke about their lives.

Links:
More on World AIDS Day
UN Plus meets UN Secretary-General (May 2007)
Visit UNplus web site

Stigma and discrimination, human rights abuses and challenging legal environments can prevent members of key populations at higher risk—such as men who have sex with men, people who use drugs and sex workers—from realizing the benefits of recent advances in science. UNAIDS and the New York Academy of Sciences therefore held a symposium in New York on 5 May to explore the links between science, community and policy in order to improve access to HIV services for key populations at higher risk.

The participants recognized that key populations have been left behind by the advances made in science over the past few years. The challenge, they said, is to frame the political and structural agenda in such a way that the fruits of scientific discoveries can be shared with the whole of society.

According to the participants, solutions should be based on strong public health arguments and advocate for client-friendly services that improve access to services and not only reduce morbidity and mortality among the direct beneficiaries but also reduce onward transmission. Scientists are taking up the challenge of the special risks that key populations encounter, in terms of both the rapid spread of HIV infection—requiring new HIV prevention technologies—and in terms of comorbidities and the need for integrated HIV services.

Participants

The symposium brought together scientists, policy-makers and HIV service providers, advocates, and activists and community members from around the world.

Common messages discussed

• Community-led approaches offer ways to improve access to integrated services for most key populations.
• Providing access to HIV services to people in the very earliest stages of HIV infection may reduce the long-term consequences of inflammation and immune dysfunction.
• New HIV prevention technologies, such as pre-exposure prophylaxis, which may soon become available as a three-monthly injection, could provide an important addition to the HIV prevention package for men who have sex with men and for women at higher risk of HIV exposure, such as sex workers in high-prevalence countries.
• Coinfections and comorbidities are particularly relevant to many key populations and hence the advances in treatment for hepatitis C and approaches to manage tuberculosis in prisons, or sexual and reproductive health services for sex workers along trucking routes, are major steps forward.

Michel Sidibé, Executive Director of UNAIDS, delivered a keynote speech at The Foundation for AIDS Research (amfAR) Capitol Hill Conference “Making AIDS History: From Science to Solutions”. The conference gathered leading government, research, policy and advocacy experts in Washington DC to build on the enormous progress seen in the response to HIV and chart a roadmap for ending the AIDS epidemic.

“We have made tremendous progress—but there is still so much to do,” said Ambassador Deborah Birx, Ambassador-at-Large and Coordinator of United States Government Activities to Combat HIV/AIDS. “We are at a critical moment in time—where we can redefine the trajectory of this epidemic.”

In his remarks, Mr. Sidibé highlighted how the AIDS response has served as a catalyst for transforming the financing paradigm for global health and development. “The AIDS response has enabled us to change the paradigm of development financing,” said Mr Sidibé. “Today, we are moving even further to help countries implement investment frameworks that will maximize the impact of every dollar.”

He also called for continued, strong support from the US government. “If we don’t have the courage and bold leadership to ensure everyone has access to lifesaving services—including the key populations of young girls and women, men who have sex with men, sex workers, people who use drugs, prisoner and migrants—we will not be able to end this epidemic,” said Mr Sidibé.

At the conference, amfAR board Chair fashion designer Kenneth Cole announced amfAR’s “Countdown to a Cure”—a new initiative designed to raise an additional US$ 100 million for AIDS cure research. “I’ve been involved in AIDS activism for almost 30 years now, and I’ve never seen so much optimism in the world of AIDS research. We are closer to a cure for HIV than ever before because we have learned so much in the past few years,” said Mr Cole. “But we must remain relentless in our commitment to do whatever has to be done with whatever resources are available to support all efforts needed to find a vaccine and a cure.”

Other speakers at the conference included: Douglas Brooks, Director of the White House Office of National AIDS Policy; Paul Farmer, Co-founder of Partners in Health and Chair of Harvard Medical School’s Department of Global Health and Social Medicine; Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health; Gabriela Isler, Miss Universe 2013; World Bank President Jim Kim and various members of the US Congress.

As world leaders gather in the United States to pledge their commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria’s (Global Fund) replenishment conference, UNAIDS is calling for a successful outcome to ensure that no-one is left behind.

The United States is hosting the important replenishment conference which will secure financing for the Global Fund’s AIDS, TB and malaria programmes from 2014 to 2016. Ahead of the meeting, United States President Barack Obama welcomed global leaders to a special event at the White House in Washington DC.

During the event the President announced that the US has met—and in some cases exceeded—the targets set for the President's Emergency Plan for AIDS Relief (PEPFAR). The targets, set in 2011, included ensuring access to antiretroviral therapy for 6 million people living with HIV. President Obama announced that the US is currently supporting 6.7 million people in gaining access to lifesaving treatment.

As the host country, President Obama also called on other world leaders to fully support global efforts to end the AIDS epidemic and stated the US will give US$ 1 to match every US$ 2 pledged to the Global Fund by other donors over the next three years (up to US$ 5 billion). 

UNAIDS Executive Director Michel Sidibé has been awarded the Degree of Doctor of Public Health (Honoris Causa) from Tuskegee University in Alabama – one of the oldest and well known historically black colleges in the United States. The degree was awarded in recognition of Mr Sidibé’s leadership in the international AIDS response.

Mr Sidibé received the honour while attending the University’s Annual Scholarship Convocation on 13 October 2013 as the keynote speaker. In his remarks, Mr Sidibe spoke about the parallels between the American civil rights struggle for justice and equality and the AIDS response, which promotes human rights and dignity for communities affected by the epidemic. He highlighted that in the United States, African Americans account for an estimated 44% of all new HIV infections among adults and adolescents, although representing only about 13% of the US population.

In awarding Mr Sidibe the doctorate, University President Gilbert L Rochon encouraged Mr Sidibe, through his leadership of UNAIDS and his new role as Tuskegee Alma Mater, to strengthen the university’s bridge with the United Nations and African countries to explore new breakthroughs in youth leadership, research and development, and public health. 

Tuskegee University is a renowned historically black university. Established in 1881 by Booker T. Washington, Tuskegee’s campus has been designated as a National Historic Site. Tuskegee University’s National Center for Bioethics in Research and Health Care is the first bioethics center in the United States devoted to exploring research and medical treatment of the African American community and other underserved populations.

L to R: Ambassador Eric Goosby, US Global AIDS Coordinator; President of Rwanda, Paul Kagame; US Secretary of State, John Kerry; President of Namibia, Hifikepunye Pohamba; and South African Ambassador to the United States, Ebrahim Rasool. Credit: PEPFAR

The Secretary of State John Kerry unveiled a United States (US) plan to enter into Country Health Partnerships—a new model of collaborative work—with Namibia, Rwanda and South Africa. The announcement was made by Secretary Kerry during a high-level meeting he hosted on the margins of the 68th United Nations General Assembly.

The new initiative is intended to strengthen collaboration with selected country partner governments leading to greater and mutual accountability and long-term sustainability.

“The Country Health Partnerships are about shared responsibility, shared accountability, budget transparency, and a commitment to investing strategically based on what we’ve learned from improved data collection and analysis,” said Secretary Kerry. “South Africa, Rwanda, and Namibia are all on the front lines of these efforts.”

The meeting featured the participation of the President of Namibia, the President of Rwanda, the South African Ambassador to the United States and global health leaders including UNAIDS Executive Director, Michel Sidibé.

“To convene this meeting with key African heads of state and partners during the UN General Assembly sends a strong signal of the continued leadership and support of the US Government for the global AIDS response,” said Mr Sidibé. He also highlighted the continued commitment of UNAIDS to provide the strategic information and support for investment approaches that would help to ensure the success of the new partnerships.

During the roundtable, the Secretary of State also announced that the US will host the next Global Fund Replenishment Meeting in Washington, DC in December 2013.  Secretary Kerry highlighted the strong commitment from other donors to support the successful replenishment of the Global Fund to fight AIDS, Tuberculosis and Malaria. Earlier this year, Germany, the Nordic Countries, France and the United Kingdom have already announced important contributions to the Global Fund for the 2014 – 2016 period to support countries in their response to HIV, tuberculosis and malaria.

Clinical Director Chuck Cloniger (R) seeing his patient, Tanesh Watson for medical counseling at St. James Infirmary in San Francisco, a medical and social service organization for current and former sex workers of all genders, on 14 June 2012 in California. Credit: UNAIDS/K.Hoshino

On 20 June 2013, the United States (US) Supreme Court struck down section 7631(f) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (The Leadership Act). This provision which the Court called the “policy requirement” mandates that no funds made available under the Leadership Act may “provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”

The US Supreme Court ruled in response to a challenge filed on 23 September 2005 by 5 civil society organizations against the provision and its negative impact on their efforts to address HIV.  The organizations include: Alliance for Open Society International; the Open Society Institute; Pathfinder International; the Global Health Council; and InterAction.

The US Supreme Court held that the policy requirement violates the First Amendment of the US Constitution which protects free speech. In particular, the Court held that the “policy requirement compels as a condition of federal funding the affirmation of a belief that by its nature cannot be confined with the scope of the Government program.”  The Court noted that “the First Amendment prohibits the government from telling people what they must say.”

Commenting on the decision of the Court, Purnima Mane of Pathfinder International said, “It has been a long and uphill battle, but we are very happy that the Court has spoken out in defense of our ability to engage with sex workers so we can better put in place programs that protect them and their clients from HIV.”

Respondents had claimed, among other things, that adopting a policy explicitly opposing prostitution may diminish the effectiveness of some of their HIV programs by making it more difficult to work with sex workers—a population at higher risk of HIV infection.

In its 2012 report, the Global Commission on HIV and the Law already noted that, “The pledge puts grantees in an impossible bind. If they don’t sign, they are denied the funds they need to control and combat HIV. If they sign, recipient organisations are barred from supporting sex workers in taking control of their own lives.”

Female sex workers are 13.5 times more likely to be living with HIV than other women of reproductive age in low-income and middle-income countries. In sub-Saharan Africa, the region with the highest HIV prevalence, the pooled HIV prevalence among sex workers is 36.9%.

The involvement and empowerment of sex workers with regard to HIV prevention, treatment and care services has shown to have great impact in reducing HIV infections among both female sex workers and the overall adult population. “The end of this requirement is a significant victory for sex workers and their advocates globally. Our contributions to effective HIV responses have now been recognised,” said Ruth Morgan-Thomas of the Global Network of Sex Work Project.

Given the importance of the case for the global AIDS response, the UNAIDS Secretariat participated as an amicus curiae (friend of the court). In that role, UNAIDS provided public health evidence and human rights arguments to support greater access to funding and resources for organisations engaged in HIV prevention, treatment, care and support services with and for sex workers. UNAIDS main points to the Supreme Court included:  1) Sex workers are among the populations most affected by HIV; 2) engagement with sex workers is essential to an effective response to HIV; and 3) any effective response requires adequate funding for programmes designed to ensure HIV prevention, treatment, care and support for sex workers.

UNAIDS Executive Director, Michel Sidibé praised the groups that were courageous enough to challenge the provision. “This shows civil society at its best - advocating for global health for all.  No group, including sex workers, should be left behind in our efforts to bring the AIDS epidemic to an end.”

US funding critical to HIV response

US leadership and generosity has been instrumental in the progress made in the global AIDS response over the last decade. Since the adoption of the Leadership Act, some 45.7 billion dollars have been made available to address HIV worldwide. The President’s Emergency Plan for AIDS Relief (PEPFAR), authorized by the Leadership Act, has been the largest health initiative ever undertaken by one country to address a global health epidemic. Thanks to US funding, access to HIV treatment has been expanded in low- and middle-income countries, and millions of lives are being saved. The decision of the US Supreme Court to strike down the policy requirement will greatly contribute to expand and improve the global AIDS response even further.

A high-level task force for ICPD presenting the paper Policy Recommendations for ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All. 25 April 2013, New York. Credit: Elsa M. Ruiz

In 1994 at the International Conference on Population Development (ICPD) in Cairo, 179 countries adopted a landmark 20-year Programme of Action, placing gender equality and women’s empowerment and reproductive rights at the center of population and sustainable development.

Last week, in a review of progress which took place in New York, a high-level task force strongly urged governments and the international community to take much bolder action in order to meet the commitments.

In a paper Policy Recommendations for ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All,  the task force outline specific steps to ensure that the commitments made become central components not only of next year’s conference, but also the post-2015 and sustainable development goals agenda. The task force is also calling for increased accountability mechanisms to ensure concerted action by governments to achieve these goals.

Co-chaired by former Presidents Joaquim Chissano of Mozambique and Tarja Halonen of Finland, the task force is comprised of 26 eminent government, civil society, and private sector leaders. Its mission is to galvanize political will and advance a forward-looking agenda for the ICPD Programme of Action that fulfills sexual and reproductive health and rights of all people.

“While we are encouraged by the achievements of ICPD implementation, the challenge is that too many people around the world are still denied their sexual and reproductive health and rights,” said Former President Halonen. “These are fundamental freedoms and human rights that lie at the very core of human dignity.”

The global panel of experts highlighted four main recommendations for government action:

• Respecting, protecting and fulfilling sexual and reproductive rights for all through public education and legal and policy reforms
• Achieving universal access to quality, comprehensive and integrated sexual and reproductive health information, education and services
• Ensuring universal access to comprehensive sexuality education for all young people
• Eliminating violence against women and girls and securing universal access to critical services for all victims/survivors of gender-based violence

Within those four areas are recommendations for specific actions on a range of issues including; ending unsafe abortion, ending acts of violence against women and girls; and ensuring equality under the law regardless of sexual orientation or gender identity, HIV or other status.

UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle participating at the launch of the policy recommendations. Credit: Elsa M. Ruiz

All four key recommendations are highly relevant for UNAIDS and the global AIDS response. The HIV epidemic continues to disproportionately affect young women and girls, with infection rates twice as high as young men. Every minute a young woman is newly infected with HIV. Globally, AIDS is the leading cause of death in women of reproductive age.

UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle, stressed that sexual and reproductive health and rights for women and girls, gender equality and the elimination of violence against women are central to the work of UNAIDS in achieving the targets of the 2011 United Nations General Assembly Political Declaration on HIV/AIDS.

“To achieve our objective of inclusive development rooted in equality and social justice, we need to leverage synergies across movements, bringing together the capacity and innovation of the AIDS response with movements to advance sexual and reproductive health and rights, gender equality and the empowerment of women and young people,” said Ms Beagle.

The panelists at the launch were: Luis Ubiñas, President of the Ford Foundation; H.E. Tarja Halonen Former President of Finland, and Co-Chair of the High-Level Task Force for the ICPD; H.E. Joaquim Chissano Former President of Mozambique, and Co-Chair of the High-Level Task Force for the ICPD; Dr. Babatunde Osotimehin, Executive Director, United Nations Population Fund; Ishita Chaudhry, CEO & Founder of The YP Foundation, and Member of the High-Level Task Force for the ICPD; Her Royal Highness Crown Princess Mary of Denmark, and Member of the High-Level Task Force for the ICPD; H.E. Joy Phumaphi, Former Minister of Health of Botswana & Member of the Global Leaders Council for Reproductive Health.