United States of America

Barack Obama, President of the United States of America, addresses the general debate of the sixty-sixth session of the General Assembly.
Credit: UN Photo/Marco Castro

The President of the United States, Barack Obama, has stressed his country’s commitment to continue supporting the AIDS response, tuberculosis and malaria. In his speech to the United Nations General Assembly he also underscored the US’ commitment to the health of women and children. The annual high-level debate is taking place in New York from 21 – 30 September.

“To stop disease that spreads across borders, we must strengthen our systems of public health. We will continue the fight against HIV/AIDS, tuberculosis and malaria. We will focus on the health of mothers and children,” said President Obama.

Secretary-General Ban Ki-moon told world leaders present at the 66^th session of the General Assembly that they face critical choices on global issues to ensure the well-being of future generations. “The first and greatest of these is sustainable development — the imperative of the 21st century,” said the Secretary-General. “We must connect the dots between climate change, water scarcity, energy shortages, global health, food security and women’s empowerment. Solutions to one problem must be solutions for all.”

In reaction to commitments to AIDS, health and women’s issues, Executive Director Michel Sidibé said, “When world leaders commit to finding health and development solutions, the burden of responsibility can be shared and the envelope for innovation pushed. I look forward to the world taking on pressing issues such as the elimination of new HIV infections among children by 2015.”

More than 120 heads of State and government are slated to address the Assembly during the debate.

UNAIDS Executive Director Michel Sidibé met with nearly 30 women living with HIV during his visit to Women’s Collective, a non-profit organization that provides HIV services for women and their families. 16 September 2011.
Credit: UNAIDS/ B.Smialowski

During an official visit to Washington DC, UNAIDS Executive Director Michel Sidibé made a special stop at the Women’s Collective, a non-profit organization that provides HIV prevention, testing, care and support for women and their families in some of D.C.’s most underserved communities. 

The Women’s Collective is run by women living with HIV and provides a safe, non-judgmental environment for women, girls and their families who are living with or at risk of HIV. Its objective is to meet the needs of women living with HIV by reducing barriers to care and strengthening their network of support. Their activities include organizing support groups, HIV testing, HIV prevention education, case management and referrals. 

Founder and Executive Director of the Women’s Collective, Patricia Nalls led the visit and described the impact that the epidemic was having among women in the District of Columbia. According to most recent epidemiological data, at least 3 percent of the residents in this District are living with HIV.

She explained how women’s clinical and social services don’t really fit into the current framework of services, which are usually focused on men. Women have families, children, and often worry first about providing for them than taking care of themselves. They worry not only about disclosure, but about co-payments for medicine, housing, employment, and of course, their children. 

During the visit, Mr Sidibé met with nearly 30 women living with HIV to discuss some of the challenges they face in their every day lives and how the Women’s Collective is making a difference for them and their families.

“So often the global response gets all the attention, but we are part of the globe,” said one of the members. “People think that here in the United States we have all the services that we need. That is clearly not true.”

Michel Sidibé expressed that he was he was touched by the women’s collective strength and leadership and emphasized UNAIDS’ commitment to place women at the center of the global AIDS response.

UNAIDS Executive Director Michel Sidibe speaking at the launch of the Congressional HIV/AIDS Caucus on Capitol Hill, Washington, DC. 15 September 2011.

The United States Congress has launched a new bi-partisan caucus to strengthen the US’s response to AIDS both at home and around the world and maintain its position as a global leader on AIDS. The launch of the bipartisan Congressional HIV/AIDS Caucus was announced at an event in Washington DC by the three Caucus co-chairs; Congresswoman Barbara Lee; Congressman Trent Franks and Congressman Jim McDermott.

The co-chairs were joined, among others, by the Executive Director of UNAIDS, Michel Sidibé, who commended the US on its continued commitment to HIV. "The United States' global leadership and the generosity of the American people have made a profound and positive difference in the AIDS epidemic. This sustained commitment, across political administrations for more than a decade, has saved millions of lives. And I am counting on the Congressional HIV/AIDS Caucus to continue to play a critical role in shaping the future of the AIDS response."

The United States has played a leading role in the global responding to HIV and its commitment is the largest by any country for a single disease. In 2003 President George W. Bush launched the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) which now has partnerships in 30 countries worldwide and has committed nearly US$ 39 billion to HIV and TB since its inception.

In 2010, PEPFAR estimates that its funding and programmes directly supported life-saving antiretroviral treatment for more than 3.2 million men, women and children worldwide.

“We cannot fool ourselves into thinking that we have HIV under control, because we don’t,” said Congressman Jim McDermott, Co-Chair of the Congressional HIV/AIDS Caucus. “Despite the enormous progress we have made over 30 years, we still have no vaccine, and treatment remains out of reach for so many. We have to keep our eye on the ball and continue pushing forward: prevention, treatment, and finding a vaccine must remain our focus.” 

The caucus currently has around 60 members and will focus its work on some key thematic areas; sustaining U.S. leadership and funding for HIV; promoting scientific advances; strengthening U.S. domestic programs and expanding the role of faith-based organizations. It will also provide opportunities to galvanize new leadership in preparation for the International AIDS Conference to be held in Washington, D.C. in July 2012.

U.S. Global AIDS Ambassador Eric Goosby, Jeff Crowley of the White House Office of National AIDS Policy, Michael Gerson from the Washington Post, and a number of advocates from the faith community and the U.S. domestic AIDS advocacy community also participated in the launch.

Credit: Carl Kaufman / Yale

The Global Health Leadership Institute (GHLI) of Yale University held its 2011 GHLI Conference from 5-10 June 2011 under the theme of “moving health systems forward”. The Conference convened senior health practitioners from around the world to facilitate collaborative solutions in strengthening health systems.

Speaking on 5 June, UNAIDS Executive Director Michel Sidibé gave an inaugural address to the conference to commemorate 30 years since the start of the AIDS response and shared UNAIDS’ perspective on future directions.

“We are so pleased to have Michel Sidibe join us to open our conference this year and help further bring attention to the role strategic planning and leadership play in helping solve global health issues,” said Elizabeth Bradley, Ph.D., faculty director, Yale Global Health Leadership Institute.  “The conference is about gathering health officials from around the world to share experiences, develop leadership and identify creative ways to solve problems that affect the everyday lives of people in these countries,” she added.

Mr Sidibé stressed the transformative role that the AIDS response has played in community mobilization and strengthening health systems. “The AIDS response has led to enormous progress towards scaling up access to treatment and reaching out to people at risk of HIV infection, with a strong human rights focus. This has been, and continues to be, a catalyst for change in the health systems of many affected countries.”

This year’s week-long event brought together senior health practitioners from Ghana, Liberia, Rwanda, and South Africa to focus on health system issues including mental health, maternal mortality, human resource management and management capacity building. These countries have achieved improvements in health despite limited resources and have gathered to discuss and apply strategic problem solving to national health priorities.

In his speech, Mr Sidibé also recognized the leadership of these four countries and praised their high level representation at the General Assembly High Level Meeting on AIDS.

Each country delegation, comprised of senior leadership from Ministries of Health, non-governmental organizations and academic institutions, brought a health system challenge to address at the conference with the support of Yale faculty and experts. Delegates participated in interactive lectures, cross-country roundtable discussions, keynotes and facilitated work sessions. Delegates met with prominent leaders in global health and received training in strategic problem-solving and leadership.

Global Health Leadership Institute

The Yale Global Health Leadership Institute (GHLI) develops global health leadership through innovative education and research programmes that strengthen the capacity of countries and communities to ensure health equity and quality of care for all.

The Global Business Coalition (GBC) Annual Conference and Awards Dinner took place from 1-2 June in New York. This year’s event marked the 10^thanniversary of the coalition and brought together more than 500 business executives, policy makers, celebrities and thought leaders to discuss on the corporate response to global health challenges and identify new avenues for future business action.

The GBC Annual Conference focuses on the unique role that business plays in addressing health challenges—including HIV, within the workplace and in the world at large. During the conference, the GBC announced an opening of its mandate to address not only infectious pandemic diseases but also the full range of global health challenges upon which the private sector can engage.

One of the panel discussions of the conference focused on the power of men to accelerate progress in eliminating the disparities facing women and girls in the world. Entitled Healthy women, healthy economies: Men who make it their business to improve women's lives. The panel brought together business, political and civil society leaders committed to communicating and demonstrating as men that gender inequity is a source of suffering, not power.

“We must engage with men and boys to promote awareness of the need for a ‘new masculinity’ that see women and girls as equal partners,” said UNAIDS Executive Director Michel Sidibé, a speaker at the event. “We need to share good practices; scale up small-scale projects; promote gender-sensitive education in schools; and push national AIDS programmes to engage with men and boys especially in HIV prevention efforts,” he added.

The panel was moderated by Isobel Coleman from the Council on Foreign Relations’ Women and Foreign Policy Program. Ambassador Eric Goosby, the United States Global AIDS Coordinator also spoke. Speakers from the private sector included Jeff Seabright, Chief Environmental Officer at The Coca-Cola Company; Aigboje Aig-Imoukhuede, Managing Director and CEO of Nigeria's Access Bank; Gary Cohen, Executive Vice President, BD and Rick Echevarria of Intel Corporation.

Artist and AIDS activist Whoopi Goldberg hosted the Awards Dinner on 2 June, where the Global Coalition honoured its two founding supporters George Soros and Ted Turner. The GBC also paid special tribute to U.S. Ambassador Richard Holbrooke who headed the Coalition from 2001 to 2009 and passed away earlier this year.

Addressing the gala, UNAIDS Executive Director Michel Sidibé acknowledged the legacy of Ambassador Holbrooke who he described as a “tireless AIDS advocate”. Mr Sidibé also congratulated the GBC for its enduring commitment to AIDS and the world’s health as well as to saving lives of mothers and babies through and bringing TB into workplace HIV programmes.

UNAIDS Deputy Executive Director Paul De Lay speaking at the briefing organised by amfAR entitled "Accelerating an HIV Prevention Revolution: A Roadmap".
Credit: amfAR

As part of amfAR’s emerging issues series, a briefing was held on Capitol Hill, in Washington, D.C. on 9 March entitled "Accelerating an HIV Prevention Revolution: A Roadmap". Speaking at the briefing, UNAIDS Deputy Executive Director Paul De Lay stressed the need to scale up combination HIV prevention worldwide.

“Bringing one or two interventions to scale will not suffice to curb the spread of HIV. Rather, we must urgently work to bring multiple prevention strategies to scale simultaneously,” said Dr De Lay. “Like combination antiretroviral therapy, complementary HIV prevention strategies work synergistically when they are combined in a strategic way,” he added.

The briefing highlighted emerging scientific advances in HIV prevention research, innovative community models, opportunities for scaling up prevention programmes, and domestic and global policy implications.

Other panelists at the briefing included Willard Cates, Family Health International, who gave an overview of HIV prevention technologies; Robert Remien, Columbia University, who spoke on behaviour change prevention strategies; and Carl Dieffenbach, Division of AIDS at the National Institutes of Health, who discussed innovative community models for HIV prevention.

Since its inception in 1985, amfAR has invested nearly $325 million into AIDS research and has awarded grants to more than 2 000 research teams worldwide.

Read more on the amfAR event

A wide view of the General Assembly as Deputy Secretary-General Asha-Rose Migiro (on screens) addresses the opening of the fifty-fifth session of the Commission on the Status of Women (CSW). 22 February 2011. United Nations, New York.
Credit: UN Photo/Devra Berkowitz

On 28 February 2011, UNAIDS delivered a  statement on behalf of its cosponsors as well as UN Women at the 55^th session of the Commission on the Status of Women. The joint statement addressed the linkages between HIV, education and employment of girls and women.

The statement highlighted some of the key elements needed to reduce the vulnerability of women and girls to HIV infection. These include women and girls’ access to quality formal and non-formal education; accurate HIV information and comprehensive gender-sensitive sexuality education. The promotion of women’s economic empowerment, including the protection of their property and inheritance rights; as well as equal access to employment are also included.

The UN bodies underscored how gender disparities increase the vulnerability of girls and women to HIV infection. Lack of legal rights, education and economic opportunities for women and girls limit their choices as well as their capacity to refuse sex, to negotiate safer sex or to resist sexual violence and coercion.

Women and girls are also faced with the responsibility to provide AIDS-related care to others, often missing out on education and employment opportunities for their own advancement.

The 55^th session of the Commission on the Status of Women is taking place at United Nations Headquarters in New York from Tuesday, 22 February to Friday, 4 March 2011. The priority theme of this year’s event is “Access and participation of women and girls in education, training, science and technology, including for the promotion of women’s equal access to full employment and decent work.”

Dr Rajiv Shah, administrator of the United States Agency for International Development (USAID) with Mr Michel Sidibé, Executive Director of UNAIDS. 27 January 2011. Credit: UNAIDS.

Dr Rajiv Shah, administrator of the United States Agency for International Development (USAID) visited UNAIDS headquarters in Geneva to meet with Executive Director Michel Sidibé on 27 January.

During the meeting Mr Sidibé thanked Dr Shah for the continued strong partnership with the US government and shared his priorities for action for the AIDS response as outlined in the new UNAIDS Strategy. This strategy sets out ten key results aimed at achieving UNAIDS’ vision of Zero new infections, Zero discrimination and Zero AIDS-related deaths.  

Under the leadership of Dr Shah USAID has recently embarked on a comprehensive reform effort, called USAID FORWARD, with an emphasis on development aid delivering results and driving innovation.

Dr Shah and Mr Sidibé discussed how to ensure that recent breakthroughs in research and development of new HIV prevention technologies, such as the microbicide gel Tenefovir, can reach the people who need them. Dr Shah and Mr Sidibé also considered how the two organizations could strategically work together to ensure HIV prevention efforts are evidence informed.

The United States of America is a leader in development of new HIV prevention technologies and is the largest donor to UNAIDS as well as the largest funder of aid towards the global AIDS response.

UNAIDS speaks with organizations in North America and Europe to better understand patterns of human rights violations and the connections to health

Caption Credit: UNAIDS

The recent suicides among gay teens in the United States of America (USA) after bullying and cruel treatment because of their perceived sexual orientation highlights the fact that homophobia continues to exist in all societies. Despite acceptance in popular culture in many countries, young lesbian, gay, bisexual and transgender people (LGBT) can face some of the same barriers presented by stigma and discrimination as previous generations.

“Violence against members of the LGBT community is unacceptable, no matter where in the world it occurs,” Michel Sidibé said UNAIDS Executive Director. “Governments must fulfill the rights of all people, regardless of sexual orientation and gender identity.”

A public opinion poll conducted in the USA in May this year found that while more than half of Americans believed that gay and lesbian relationships were acceptable, 43% still feel that such relationships are morally unacceptable. 

“Clearly homophobia remains a serious problem in the United States, but I think we’re heading in the right direction—just not quickly enough,” says Chris Collins, Vice President and Director of Public Policy for the American Foundation for AIDS Research (amfAR).

In the wake of recent anti gay-violence, a USA faith alliance called on the Universal Church to work to “end the violence and hatred against out lesbian, gay, bisexual, and transgender brothers and sisters.”

Institutional homophobia is easier to pin-point as discriminatory, such as punitive laws criminalizing same sex behaviour. However negative attitudes towards members of the LGBT community can exist even when protective laws are in place, and these are more difficult to address.

University student Emily Carson, a member of the Global Youth Coalition of HIV/AIDS, is from Connecticut, a state which has protective laws. Growing up in a small conservative town Ms Carson said she was harassed and bullied for years, because she was perceived as different. When first hearing about the suicides among gay teens in the US, Ms Carson said she was heartbroken. She had hoped schools had gotten better.

But Ms Carson also has a different worry: “Every few years this happens (gay kids committing suicide or the political cycle of the gay marriage debate), and people start talking about anti-homophobia. I worry that this public outcry is going to die down until the next time something happens,” she said. “We need to pay attention to this on a daily basis, not only when there is a tragedy involved.”

Social change requires more than legal reform, and the situation is similar in Europe. German-born Alex Müller, a board member of the International Lesbian, Gay, Bisexual, Transgender and Queer Youth and Student Organization (IGLYO), agrees: “On the one side there is legislative progress in Europe, but at the same time homophobic perceptions prevail in all parts of society.”

Reported hate-crimes on the rise in Europe

The number of reported hate-crimes against LGBT people have increased over the last few years in European countries  according to the European Region of the International Lesbian, Gay, Bisexual, Trans & Intersex Association (ILGA Europe)—but these reports are considered the tip of an iceberg by the organization.

“All our member organizations agree that there is a very high rate of under-reporting of hate-crimes,” says Joel Le Deroff, Policy and Programmes officer at ILGA Europe. “The paradox is that a high number of incidences reported, usually means that there is confidence between the law enforcement agencies and the victims.”

That is why it is difficult to know if this trend in increasing number of cases reported represents an actual increase in the number of hate-crimes committed, or a positive change in the environment which promotes the reporting of abuse. One thing that Mr Le Deroff is certain of is that the LGBT community should work together with law enforcement agencies. This to establish the trust needed for people who experience discrimination and violence based on their sexual orientation to report it.

Protective laws and social change

In Denmark, a country generally considered progressive and liberal with regards to sexuality, very little is known about the extent and character of hate crimes against members of the LGBT community according to a recent report by the European Union Agency for Fundamental Rights.

In 2007 a Danish LGBT online portal conducted a survey among their users on whether they had experienced hate crimes on grounds of their sexuality. Of the 9473 respondents, 12% stated that they had experienced physical assaults and 39% reported verbal assaults.

Steffen Jensen, spokesperson for international policy of the Danish National Association for Gay Men, Lesbians, Bisexuals and Transgendered People noted: “the general attitude towards minorities is shifting towards a less tolerant one. We need broad public awareness campaigns, basic information to everybody, and most importantly: education!”

Homophobia and health

The stigma and discrimination that results from homophobia affects whether or not members of the LGBT community are able to seek and obtain the health services that they need. The social marginalization of people who engage in same-sex relationships acts as a barrier to access HIV prevention, treatment, care and support services.

Prevalence of HIV among men who have sex with men and transgender people is almost always higher than the general population. In France, for example, men who have sex with men have an estimated HIV prevalence that is nearly 100 times higher than the national average.

According to Mr Collins from amfAR, homophobia has important implications for both the physical and mental health of LGBT people. A recent study in the USA showed that among LGBT adults people who had experienced strong rejection by their families were 3.4 times more likely to have risky sex and 8.4 times more likely to have tried to commit suicide as compared to people with supportive families.

Political leadership vital

Homophobia can also lead to unwillingness on part of political leaders to invest in the health of men who have sex with men, transgender people and other gender variant individuals.

A study in Italy from 2005 found that one third of the gay male respondents found it difficult to find information about which sexual behaviors carry risk of HIV infection. A majority of the respondents did not identify as gay to their doctors, and one in three was afraid that they would receive worse treatment from health workers because of their sexual orientation.

In 2009 a bill was put before the Italian Parliament to expand provisions for punishing hate crimes and incitation to hatred based on race, ethnicity, or religion to cover crime motivated by homophobia or transphobia—this bill was rejected. The United Nations High Commissioner for Human Rights declared it a step back for human rights in Italy.

“When the Italian parliament rejected this bill, it sent a message to us that hate-crimes were not part of the political priorities and that homophobia is legitimate,” said Mr Le Deroff from ILGA Europe.

It’s clear that the connections between human rights violations, homophobia and health are many. The nuances and different levels of discrimination ranges from the most blatant institutional discrimination outlawing same sex behavior, to not disclosing sexual orientation to a health care professional for fear of ridicule. To ensure an environment where people can live, work and love safely, governments need not only to fulfill and protect the rights of people within LGBT community, but also promote these rights.

UNAIDS is committed to empower all people, regardless of sexual orientation, to protect themselves from HIV infection and for all people living with HIV who need it to fully access antiretroviral therapy. This means ensuring that law enforcement agencies and the judicial system protects the rights of all people, including members of the LGBT community. It also means tackling homophobic sentiments that block an effective response to HIV, wherever such sentiments may exist.

Functioning ARV dispensing site in Port-au-Prince after the devastating 12 of January earthquake. Credit: UNAIDS

Haitian civil society representatives visited Washington, D.C. on 6 April to mobilize political support for reconstructing the AIDS response in Haiti.

The civil society delegation, with support from UNAIDS, gave a testimony of their experiences with the earthquake and highlighted the importance of reconstructing the AIDS response with direct involvement of affected communities, especially people living with HIV. The briefing was held at Capitol Hill during a US Congressional briefing sponsored by US Senator Kirsten Gillibrand (D-NY) and attended by congressional staff, AIDS advocates and US civil society representatives.

Later that same day, the delegation from Haiti visited US Global AIDS Coordinator Ambassador Eric Goosby and his colleagues from USAID. The US government team pledged its support to encourage the Haitian government to include the involvement of people living with HIV in planning the reconstruction of the AIDS response in Haiti.

On 24 March, US President Obama asked the US Congress to approve $2.8 billion as an emergency requirement for relief and reconstruction support for Haiti following the devastating earthquake of 12 January 2010. The request is now pending before US lawmakers who will very soon vote on the proposal.

There were an estimated 120 000 people living with HIV in Haiti before the earthquake. Most of the structural damage happened in the three departments (Ouest, Sud-Est and les Nippes) that accounted for nearly 60% of the population of people living with HIV.

Following an initial rapid assessment of the situation with the Ministry of Public Health and Population, UNAIDS released a concept note Helping Haiti rebuild its AIDS response. The report explains the current situation in Haiti and what may be required to meet the immediate and intermediate AIDS response needs.

Civil society networks of people living with HIV as well as many of the organizations providing HIV services have been affected by the earthquake and are in need to be strengthened.