Universal access

Young people working to demand the implementation of programmes that put young people’s leadership at the centre of national HIV responses

From Brazil to Mexico young people in Latin America are busily coordinating their inputs to communicate a unified message in the upcoming regional universal access consultation to be held 1-2 March 2011 in Mexico.

The main recommendation young people in Latin America are proposing is the need to strengthen HIV prevention programmes for young people. Ricardo Baruch from GYCA Mexico, who has been assisting with the consultations says, “HIV prevention continues to be our main challenge. We want evidence-based strategies that respond to all youth, particularly gays, lesbians, trans and intersex youth, youth using drugs and youth doing sex work and others in extreme vulnerability.”   

The regional focal point for Global Youth Coalition on HIV/AIDS  (GYCA) in Latin America, Manuella Donato from Brazil, explained how they have been collecting input from coalition members, Youth RISE, Advocates for Youth, The Global Network of people living with HIV/AIDS (GNP+) and Positive Youth. Participating in the regional consultation is an important part of their strategy for youth engagement in the HIV response in Latin America. It is also part of a broader strategy to place young people at the centre of the upcoming United Nations High-level Meeting on AIDS.

The 2010 data from UNAIDS shows clear evidence that young people are leading the HIV prevention revolution by adopting safer sexual practices. However young people still face challenges in accessing youth friendly sexual and reproductive health services relating to HIV.

“The homophobia and machismo in Latin America is a major barrier to improve access to HIV prevention services and information for all,” notes Mr Baruch.

Young people in Latin America are also demanding the implementation of a comprehensive set of programmes that put young people’s leadership at the centre of national responses. They argue that such programmes should provide rights-based sexual and reproductive health education and services to empower young people to prevent sexual transmission of HIV among their peers.

They are working to achieve access to HIV testing and prevention efforts with and for young people in the context of sexuality education.  They are also advocating for the establishment of enabling legal environments, education and employment opportunities to reduce vulnerability to HIV.

Since the World Youth Conference in 2010 and the HIV and youth empowerment event organised on the side-lines of the conference, young people have participated in a series of national universal access consultations. Now they will voice their joint recommendations through Ms Donato as she delivers the opening statement during the Latin American regional universal access consultation in Mexico.

In line with the strategic direction to revolutionize HIV prevention within the UNAIDS Strategy, the UNAIDS Cosponsor agencies in Latin America have chosen the work with young people as one of their main priorities for 2010-12. Following the Mexico Declaration of sexual education for all, signed on 01 August 2008 by Ministers of Education and Health, the UN response in the region will focus on the development of HIV prevention and sexual and reproductive health policies and programmes for all young people.

UNAIDS Regional Director for Latin America, César A. Núñez emphasizes the importance of engaging young people in the response at all levels. “A partnership between young people, the national AIDS programmes, the UN family and bilateral partners will be crucial to respond to the vision of zero new infections, zero discrimination and zero AIDS related deaths.”

Manuella Donato and her colleagues from Latin America are coming to the consultation ready to move the prevention revolution ahead. “We will mobilize our peers and motivate them to demand that their rights be fulfilled so that we can achieve universal access to prevention, treatment, care and support by 2015”.

 

In his 2011 Letter to Partners, Mr Sidibé outlines a set of six new frontiers to move the global AIDS response forward: The democratization of the response; making the law work for not against AIDS; reducing the upward trajectory of programme costs; making funding for AIDS a shared responsibility; making the AIDS movement a bridge to development; and fostering scientific innovation for HIV prevention and treatment.

According to Mr Sidibé, each of the new frontiers supports the other, and he cautions that a singular advancement in any one sector alone will not be sufficient to move the entire global AIDS response forward.

This Letter to Partners coincides with the 30 years of the AIDS epidemic, the 10th anniversary of the 2001 Declaration of Commitment on HIV/AIDS and five years since the world committed to achieve universal access to HIV prevention, treatment, care and support.

“This year we have an historic opportunity to build on and improve the performance of the last three decades,” said Sidibé. “Together, we can make this the defining decade, the decade that signals the beginning of the end of AIDS,” he added in anticipation of the June 2011 General Assembly High Level Meeting on AIDS that will bring together world leaders to renew hope and re-energize the AIDS movement.

Read the 2011 Letter to Partners 

A Forced Migration Review special supplement

Kibati camp for displaced people, DRC. Credit: Christian Als

The interconnections between conflict and HIV are complex. HIV affects the lives of many people caught up in conflict, including the civilian population but also the protagonists, as well as those whose role it is to provide security during and after conflict.

In conflict, people may be subjected to mass displacement and human rights abuses, including sexual violence, or left in conditions of poverty and powerlessness that might force some individuals to sell sex to survive. In addition, infrastructure may be damaged, and prevention and health services disrupted. Such conditions put populations at increased risk of HIV infection, and women and children are especially vulnerable.

A special supplement on HIV has been published by the journal Forced Migration Review, with support from UNAIDS. This edition is largely based on the work of the AIDS, Security and Conflict Initiative (ASCI), which undertook research over a number of years to gather evidence and advance analysis on the connections between HIV and conflict.

Specially tailored programmes to ensure universal access to vulnerable groups must become an integral part of national HIV policies and strategies, and a key item on the agenda of the international community, according to the article by UNAIDS.

The analysis addresses how to achieve greater and better access to HIV prevention, treatment, care and support for people during and after conflict. It concludes that it is unlikely that Millennium Development Goal 6 will be met without HIV services reaching displaced populations and migrants, regardless of their HIV status, as well as the uniformed services that interact with these populations.

The supplement presents a selection of the ASCI case-studies alongside a number of articles on the subject which were submitted in response to a Forced Migration Review call for articles. UNAIDS and its cosponsors UNFPA and UNHCR as well as various research partners contributed articles. In addition, Dr Nafis Sadik, Special Envoy of the UN Secretary General for HIV/AIDS in Asia and the Pacific authored a piece on the linkages between forced migration and HIV in Asia.

Download the full publication here

Sierra Leone's Foreign Minister Zainab Hawa Bangura at the 2010 MDG Award Ceremony, 19 September 2010.

At a ceremony on the eve of the 2010 Millennium Development Goals Summit, held in New York from 20-22 September, the Government of Sierra Leone was presented with an MDG Award for its leadership and progress towards achieving MDG 6, to stop and reverse the spread of HIV by 2015.

The MDG Awards Committee was impressed by Sierra Leone's efforts in developing an innovative and comprehensive national HIV strategy and, in particular, the high-level political commitment and involvement of Sierra Leone’s President, H.E. Ernest Bai Koroma, who chairs the country’s National AIDS Council (NAC).

Under the leadership of the NAC, the technical coordination of the National AIDS Secretariat and the engagement of multi-sector partners, Sierra Leone’s HIV prevalence has stabilized, as highlighted in UNAIDS’ special publication for the MDG Summit, MDG 6.

Partners credit a national commitment towards advancing the greater involvement of people living with HIV in the response and the scale up of HIV prevention, treatment, care and support services as key contributors to Sierra Leone’s progress on MDG 6.

“In a post-conflict country with a host of development challenges, the MDG Award is evidence of dedicated national leadership and true partnership,” said UNAIDS Country Coordinator, Mulunesh Tennagashaw. “The Award is an inspiration for all partners, and it will help drive us towards reaching greater results.”

With the development of a new National Strategic Plan on AIDS, the government has set its sights on zero new HIV infections by 2015.

The MDG Award was presented to Foreign Minister Zainab Hawa Bangura. The Awards are held annually to support and raise awareness of the MDGs by providing a high profile platform to honour and celebrate exemplary efforts by national governments and civil society stakeholders in advancing the achievement of the MDGs.

May 17 is the International Day Against Homophobia. Homophobia is considered one of the main obstacles in implementing HIV prevention strategies. Of the 192 member states of the United Nations, 85 have laws that still criminalize homosexual behaviour and, in some of these countries, conviction can even result in the death penalty.

Speaking on the occasion, UNAIDS Executive Director Michel Sidibé said, “I urge all governments to take steps to eliminate stigma and discrimination faced by men who have sex with men, lesbians and transgender populations. They must also create social and legal environments that ensure respect for human rights and enable universal access to HIV prevention, treatment, care and support.”


Video message from UNAIDS Executive Director

At least 5-10% of HIV infections worldwide are estimated to occur through sex between men, though this figure varies considerably between countries and regions. Yet men who have sex with men continue to face discrimination from healthcare workers, other service providers, employers and the police. Discrimination prevents men who have sex with men from disclosing their sexual orientation, or reporting for HIV services. Consequently their vulnerability to infection is increased, and national data do not reflect the size of the HIV epidemic that is linked to same-sex behaviour involving men.

Removing punitive laws, policies, practices, stigma and discrimination that block effective responses to AIDS is one of UNAIDS’ 10 priority areas in the Joint Outcome Framework for 2009-2011. Another key priority of the Framework is also to empower men who have sex with men, sex workers and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy.

The 2001 UN General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/ AIDS adopted by all UN Member States emphasized the importance of “addressing the needs of those at the greatest risk of, and most vulnerable to, new infection as indicated by such factors as […] sexual practices.” In the 2006 United Nations Political Declaration on HIV/AIDS, governments committed to removing legal barriers and passing laws to protect vulnerable populations.

Many governments have not acknowledged that sex between men happens and that unprotected anal sex contributes to the transmission of HIV. Often if recognized, there is insufficient political will, funding and programming to address it.

“Homophobia and transphobia drive significant parts of HIV epidemics underground in all regions of the world. Only around one in 10 MSM and transgender people have access to HIV prevention services", said Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “The Global Fund is fully committed to addressing these inequities for the benefit of MSM and transgender communities and broader populations”.

UNAIDS hosted an event at its headquarters in Geneva that included the screening of a short video on homophobia in Jamaica and how it impacts people, titled A Deadly Cycle and a film Translatina, a full-length documentary that offers a realistic look at the challenges faced by transgender people in accessing education, work, justice, health care, and other services in Latin America.

Also on the agenda were discussions by Frank Mugisha, Executive Director, Sexual Minorities of Uganda; LGBT rights activist Ashok Row Kavi, who is also Technical Officer, Sexual Minorities, UNAIDS country office for India; and Dr Gottfried Hirnschall, WHO HIV director.

In 1990, the World Health Assembly approved the 10th Edition of the International Classification of Diseases (World Health Organization) on May 17, which established that sexual orientation (heterosexual, bisexual or homosexual), on its own, would no longer “be considered as a disorder”. For this reason May 17 is used to mark the International Day against Homophobia.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. Credit: UNAIDS/P.Virot

The 18th Stop TB Partnership Coordinating Board meeting is being held from 4 – 5 May 2010 in Hanoi, Viet Nam. The meeting will bring together UNAIDS and the Stop TB Partnership to strengthen their joint response to HIV/TB co-infection and to agree on a compact intended to halve TB deaths in people living with HIV by 2015.

‘One in four AIDS deaths is linked to tuberculosis. This compact represents an important milestone in ensuring that no person living with HIV dies of TB, a preventable and curable condition’ noted UNAIDS Deputy Director, Programme Paul De Lay

Every three minutes a person living with HIV dies of tuberculosis. Mortality rates have escalated (to an estimated 500,000 a year) over the past 10 years. The emergence of drug resistant strains of TB is a particularly lethal threat in populations with high rates of HIV infection.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. UNAIDS hopes to achieve this goal by ensuring an effective integrated delivery of services for HIV and tuberculosis as well as nutritional support in all settings.

Universal access and MDG targets for HIV and TB will be difficult, if not impossible, to achieve without greater attention to marginalized and vulnerable groups, such as prisoners, drug users, women, and migrants, and the strengthening of a human rights approach to ensure equitable access and risk-reduction.

A wide variety of participants are expected to attend the meeting, including Ministers of Health of Viet Nam, South Africa and Myanmar, the Regional Director of the World Health Organization Western Pacific Region as well as high-level representatives from UNAIDS, the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Discussions will range from an overview of the TB epidemic in Viet Nam and the Western Pacific Region to a review of progress in the development of new TB drugs, diagnostics and vaccines.

The Board meeting is also meant to be a follow-up from the Beijing Ministerial Meeting held in April 2009 where ministers from countries with high burden of multi-drug-resistant tuberculosis (MDR-TB) and extremely drug-resistant tuberculosis (XDR-TB) met to address the disease’s alarming threat. The 18th Stop TB Partnership Coordinating Board meeting will review the progress made by countries since Beijing and recommend further actions to overcome bottlenecks and accelerate action.

The Stop TB Partnership is a leading public-private global health partnership, established in 2001, with the aim of eliminating tuberculosis as a public health problem and, ultimately, to obtain a world free of TB. It comprises a network of more than 900 international organizations, countries, donors from the public and private sectors, governmental and nongovernmental organizations and individuals.

Hon. Dr. Leslie Ramsammy, Minister of Health of Guyana launching the national HIV prevention, principles, standards and guidelines. 24 March 2010.

On Wednesday 24th March 2010, Guyana unveiled the country’s new national principles, standards and guidelines for the prevention of HIV as part of its efforts to achieving universal access to HIV prevention, treatment, care and support.

“By 2020 Guyana must be well on the road towards elimination of HIV as a major public health problem,” said Dr Leslie Ramsammy, Guyana’s Minister of Health.

The principles, standards and guidelines are the result of two years of work under the leadership of the Ministry of Health’s National AIDS Programme, in close collaboration with UNAIDS. Guyana’s HIV prevention quality standards are fully in line with the UNAIDS Executive Director’s call for a global “prevention revolution” to reduce the number of new HIV infections.

“Prevention is a key priority. We need to construct a compelling prevention narrative. One built upon equality and human rights. One that recognizes the importance of responses that are strategically tailored to local epidemics, that include biomedical, behavioural and structural approaches, and that meaningfully involves beneficiaries,” said UNAIDS Executive Director Michel Sidibé.

According to UNAIDS, the national HIV prevention principles, standards and guidelines represent an important step forward for intensifying HIV prevention activities in Guyana, and should serve as a model for other countries in the region. The guidelines feature a scorecard for rating the quality of prevention programmes being implemented.

Rev. Gunnar Stålsett, Bishop Emeritus of the Church of Norway (right) with His Holiness Abune Paulos signing the personal commitment to action at the Summit of High Level Religious Leaders on the Response to HIV. 22-23 March, The Netherlands.
Credit: UNAIDS

A Summit of High Level Religious Leaders on the Response to HIV took place in The Netherlands from 22 to 23 March. The meeting explored opportunities for religious leaders to promote universal access to HIV prevention, treatment, care and support in their communities and speak out against stigma and discrimination affecting people living with HIV. It brought together some 40 Baha’í, Buddhist, Christian, Hindu, Jewish, Muslim and Sikh leaders together with the Executive Directors of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Population Fund (UNFPA), the AIDS Ambassadors of The Netherlands and Sweden, leaders and representatives of networks of people living with HIV and other organizations active in the response to HIV.

Speaking at the opening ceremony, UNAIDS Executive Director Michel Sidibé said, "As I travel the world, I see increasing evidence of social injustice. Growing economic disparities, inequality and social injustice stalk the earth. The greatest impact is felt by the poorest segments of society, on women and girls and on the marginalized. Social injustice only serves to increase the vulnerability of the vulnerable and push them farther out of reach of HIV services. I sincerely hope that this meeting will produce a call for action to make these services available and virtually eliminate mother to child transmission of HIV. Nothing would be more noble than a world with no more babies born with HIV."

During the Summit, participants addressed the realities of how stigma and discrimination are perpetuated both in religious communities and society at large. They identified best practices to strengthen the voice and action of religious leaders and bring about collaboration among different faiths and with other sectors involved in the response to HIV.

“The leaders gathered at this summit have the ability to inspire and empower change – within their own communities, across countries, and throughout wider communities,” said Rev. Dr. Richard Fee, Chair of the Board of Directors of the Ecumenical Advocacy Alliance and General Secretary, Life and Mission Agency, Presbyterian Church in Canada. “In the midst of what appears to be ‘AIDS fatigue” they have the potential to galvanize efforts against a disease that continues to spread, driven by silence, fear, violence and injustice.”

Since the beginning of the HIV epidemic, religious communities, mosques, temples, churches, hospitals and clinics have reached out to provide support to those living with and affected by HIV. Strengthening their leadership can greatly influence the lives of many people, and leaders speaking out responsibly about AIDS can make a powerful impact at both community and international level.

"Participants affirmed in their concluding statement the "renewed sense of urgency" to prioritize and strengthen the response to HIV. Such response includes "holistic prevention" in addition to reaching universal access to treatment, care and support. The statement called for the "Universal respect for the human rights of all people living with and affected by and at risk of HIV infection" and the "respect for the dignity of every human being". Leaders also called for "a massive social mobilization" to support services for women to eliminate the transmission of HIV from mother to child.

In addition, religious leaders drafted and personally signed a pledge to commit themselves to strengthened efforts to respond to HIV. The pledge includes "deepening meaningful engagement with people living with HIV" and "acting decisively to protect human rights within my faith community; through collaboration among other religious leaders of different faiths; and by influencing local, national, regional and global decision-making processes on HIV."

Dr Thoraya Ahmed Obaid, Executive Director of UNFPA, in her closing remarks said, "Our work together proves that interventions can be successful and sustainable if change is inclusive, if it emerges from within the faith and cultures of the people themselves, if people of all age groups living with (or without) HIV are secure in their sense of belonging and are fully engaged, and all partners are equally valued and respected."

The co-chairs of the event were His Holiness Sri Sri Ravi Shankar, Founder of the Art of Living Foundation; Rabbi David Rosen, Director of Interreligious Affairs of the American Jewish Committee; Ms. Nyaradzayi Gumbonzvanda, General Secretary of the World YWCA; and the Right Rev. Gunnar Stålsett, Bishop Emeritus of the Church of Norway.

The Summit was organized by the Ecumenical Advocacy Alliance and Cordaid, with support from the Dutch Ministry of Foreign Affairs, UNAIDS, International Network of Religious Leaders Living with or Personally Affected by HIV or AIDS (INERELA+), the World AIDS Campaign and the European Council of Religious Leaders (Religions for Peace).

Although the Caribbean as a region has the second highest HIV prevalence after sub-Saharan Africa, most countries have concentrated epidemics which disproportionately affect certain groups including gay men and other men who have sex with men (MSM). In many countries men who have sex with men experience considerable social stigma and are not reached with vital HIV prevention, treatment, care and support services. Not only are men afraid of disclosing their sexual activity, they are also deterred from finding out what they need to know to reduce their risk or to buy condoms.

An environment of homophobia is often reinforced by anti-sodomy legislation which exists in 11 of 16 Caribbean countries*. This can contribute to an intolerant cultural and social environment which risks keeping men who have sex with men away from accessing HIV testing and counselling and education services that would reduce the vulnerability to HIV infection.

In Jamaica—a country with anti-sodomy laws—there is 32% HIV prevalence among MSM, versus 1.6% in the general population. In Trinidad & Tobago and Guyana, countries which also criminalize sex between men, the HIV prevalence ranges from 20% to 32%. While in Cuba, Suriname, the Bahamas, Dominican Republic, countries without such legislation, the HIV prevalence in MSM ranges from 1% to 8%.

According to 2007 UNGASS Country Progress reports less than 40% of MSM in the Caribbean are reached by prevention programmes. Local groups in many countries in the Caribbean have been urging civil society and government programmes to include MSM issues and organizations within the AIDS response. These efforts have been supported by regional networks including PANCAP.

UNAIDS Executive Director Michel Sidibé has called for an end to punitive laws which hamper the AIDS response in this region.

“In most of the countries in the Caribbean that don't have repressive laws, HIV prevalence is between 1% and 8% among men who have sex with men,” said UNAIDS Executive Director Michel Sidibé. “This contrasts sharply with a range of between 20% and 32% in countries which outlaw sex between men.”

“Reducing homophobia and removing punitive laws that criminalize sex between men creates the right conditions for achieving universal access,” Mr Sidibé continued.

A collaborative effort is underway between UNAIDS, UNDP and PAHO/WHO to develop strategies for Latin America and the Caribbean on human rights and improvement of access to health services for MSM and other sexual minorities.

UNAIDS will lead a regional effort in the Caribbean to strengthen HIV prevention programmes among these groups, to bring together the human rights and service provision components for their improved health, human rights and well-being.


* Countries in the Caribbean with laws that criminalize men who have sex with men: Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago. Countries in the Caribbean with no laws criminalizing men who have sex with men: Bahamas, Cuba, Dominican Republic, Haiti, Suriname. According to ILGA web site accessed 16 March 2010

A review carried out by the 2009 Reference Group to the UN on HIV and Injecting Drug Use concludes that coverage of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide is very low and unlikely to be sufficient to prevent, halt, or turn around HIV epidemics. Credit: UNAIDS/P.Virot

A review carried out by the 2009 Reference Group to the UN on HIV and Injecting Drug Use for the first time quantifies the scale of coverage of HIV prevention, treatment, and care services for injecting drug users (IDUs) worldwide. The study concludes that with, specific exceptions, worldwide coverage of these services in IDU populations is very low and unlikely to be sufficient to prevent, halt, or turn around HIV epidemics.

The paper, published by The Lancet in its online edition of 1 March 2010, also highlights the need for improved data collection on injecting drug users in each region in order to get a clearer picture of the extent of their needs. “We still do not know enough about the nature and size of the populations we need to target.”

Already the gaps in services are apparent. In prevention, the study estimates that two needles per month were distributed per person who injects drugs. In the countries that estimate the number of condoms distributed to IDUs, an average of 12 condoms were distributed to each IDU per year.

These global averages hide even greater regional and national variations in services.

While nearly all countries in western and eastern Europe, central Asia, Australasia, and North America had needle and syringe programmes (NSPs), these services aren’t present in nine of 25 countries in east, southeast, and south Asia where injecting drug use occurs. NSPs were also absent or unreported in 14 of the 16 countries in sub-Saharan Africa where injecting drug use occurs.

Opioid substitution therapy (OST) coverage also varied from 1% or less of IDUs in central Asia, Latin America, and sub-Saharan Africa, to very high levels of 61% in western Europe.

Access to services for all drug users

UNAIDS believes that drug users can be protected from becoming infected with HIV if comprehensive, evidence-informed and human-rights-based interventions are made accessible to all drug users.

“Effective harm reduction approaches include access to clean needles, opioid substitution therapy for opiate users, access to antiretroviral therapy and reducing sexual transmission of HIV from drug users to their sexual partners through condom promotion,” said UNAIDS Executive Director Michel Sidibé. “But current coverage of these services is appallingly low.”

The study was funded by the UN Office on Drugs and Crime (UNODC), Australian National Drug and Alcohol Research Centre, University of New South Wales; and Australian National Health and Medical Research Council.