Universal access

UNAIDS Deputy Executive Director, Programme, Paul De Lay and South Africa’s Minister of Social Development Bathabile Dlamini addresses an IAG Connector Event in New York, 07 June 2011.
Credit: UNAIDS/J. Szenes

The International Advisory Group (IAG) on universal access to HIV prevention, treatment, care and support which is made up of a diverse group of HIV experts from various sectors, convened together in New York on 7 June on the eve of the UN General Assembly High Level Meeting on AIDS.

Hosted by its co-chairs Bathabile Dlamini, Minister of Social Development, Republic of South Africa and Paul De Lay, UNAIDS Deputy Executive Director, Programme, the event is follow-up action to the IAG’s recently held meeting in Johannesburg which culminated in a bold and strong consensus statement on the need for global solidarity for universal access.

The IAG’s consensus statement identified key priorities to change the trajectory of the HIV epidemic, save lives and contribute towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. The consultation was an opportunity for the advisory group to discuss it has been leveraged by IAG members and various organizations in preparing for the High Level Meeting.

“We urge IAG members to use this experience to influence the regional and country responses to HIV and AIDS in the future,” said Ms Dlamini who suggested that the IAG members to take a leadership role in implementing the outcomes of the High Level Meeting. “It will be important the resolutions take are put into action plans by countries.”

Echoing Ms Dlamini, Dr De Lay said, “The work of the IAG is not finished at this High Level Meeting. In fact, it is just beginning—with each IAG member: as you take the message into the foras where it needs to be heard."

The IAG is mandated by the UNAIDS’ governing body the Programme Coordination Board to review the findings of countries’ and regions’ universal access consultations as well as other global and regional studies and declarations, and advice on the way forward for the global AIDS response.

UN General Assembly High Level Meeting on AIDS

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the world has come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.

(Left to Right): United Nations Secretary-General Ban Ki-moon, President of Rwanda Paul Kagame, United States Global AIDS Coordinator Ambassador Eric Goosby, President of the General Assembly Joseph Deiss at the Heads of State event - AIDS, Health, and Development, held at UN Headquarters, NYC, on June 8, 2011
Credit: UNAIDS/B.Hamilton

NEW YORK/GENEVA, 8 June 2011­­—More than 20 Heads of State and Government have come together at a special event focusing on leadership, cooperation and country ownership in the response to HIV. The event, attended by close to 400 people, was held during the United Nations General Assembly High Level Meeting on AIDS to renew commitment and identify opportunities in scaling up the HIV response, improving health and achieving the 2015 Millennium Development Goals.

The President of Rwanda, Paul Kagame, hosted the debate which outlined ways of accelerating action to help countries move closer towards universal access to HIV prevention, treatment, care and support.

He outlined three main areas as key to the success of the AIDS response: leadership, ownership and collaboration. “Not a single country, not a single individual, business or entity can win this struggle alone,” he said. “Once the leadership and commitment is there in any country and any community, results begin to show.”  

The need to increase access to services for people most vulnerable to HIV and respect for human rights was central to the discussions. Strong and visionary leadership combined with commitment and global solidarity around HIV were underlined as essential to moving the response forward.

“We can bring HIV deaths and new HIV infections to zero,” said United Nations Secretary-General Ban Ki-moon. “Our targets may seem ambitious but they are achievable if we are united.”

Leaders at the event also looked to the future of the HIV response and the importance of investing in youth as the leaders of tomorrow and encouraging their full engagement in the AIDS response.

“If we want to transform the response, we have to bring a new agenda for the future,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “This will only be achieved if we engage young people to lead a new social movement around AIDS and ensure a sustainable response.”

The speakers stressed the need to overcome the challenges to sustainable and predictable financing. In a report launched ahead of the High Level Meeting on AIDS, UNAIDS outlined that US$ 22 billion will be needed by 2015 to halve new HIV infections and expand access to HIV treatment. However, the report also revealed that international funding for HIV had declined from 2009 to 2010.

“What we need is resources, best policy, and law to ensure and protect the rights of people living with HIV,” said Ms Anandi Yuvuarj, Regional Coordinator of the International Community of Women Living with HIV. “Everyone must have access to HIV prevention, treatment, care and support, particularly people most vulnerable to HIV.”

Speakers emphasized the need for systematic improvement of the efficiency and effectiveness of existing AIDS and health spending, as well as the importance of ensuring the best value for money through effective and efficient HIV programming. In addition, they discussed the need for countries to look for new streams of revenue from domestic, regional and international sources.

Success in South-South cooperation efforts were discussed as an effective way of finding new paradigms of development and sharing innovation within regions for an accelerated response to HIV.

Leaders attending the event pledged to increase efforts to improve the effectiveness, efficiency and sustainability of their national AIDS responses to accelerate progress towards achieving universal access to HIV prevention, treatment, care and support services.

Resolution 67/9 on HIV was endorsed at the 67th UN ESCAP Commission held in Bangkok, Thailand from 19-25 May 2011. Credit: UN ESCAP

In the lead-up to the 2011 General Assembly High Level Meeting on AIDS to take place in New York from 8-10 June, the 62 Members and Associate Members of the United Nations (UN) Economic and Social Commission in Asia and the Pacific (ESCAP) have unanimously adopted a new Resolution on HIV. The resolution reconfirms commitment of countries in the region to reach universal access to HIV prevention, treatment, care and support and to address critical barriers hampering responses to AIDS.

Cosponsored by the Governments of Indonesia, Australia, Fiji, Thailand and Myanmar, the 67^th Commission Session, held at the ESCAP headquarters in Bangkok, Thailand, passed the Resolution on Wednesday 25 May 2011.

The HIV Resolution was developed following the Asia Pacific Regional Consultation on Universal Access held at the end of March, at which over 250 representatives from governments, international organizations, donors and civil society from nearly 30 countries agreed upon necessary actions from the region towards the vision of zero new HIV infections, zero discrimination, zero AIDS-related deaths.

“Thirty years since AIDS was first discovered, many countries have made progress in their HIV responses, but the agenda is unfinished. To ‘get to zero’ we need to unite as a region and redouble our efforts, making sure they are focused to reach those who need them most,” said Dr Nafsiah Mboi, Secretary of the Indonesian National AIDS Commission.

Recalling previously adopted Resolutions and commitments on HIV made by the Commission, ESCAP Resolution 67/9 calls upon members and associate members to further intensify actions to reach the unmet goals and targets of the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

The Resolution emphasizes members’ agreements to support the achievement of 80% coverage for populations at higher risk including people who use drugs, people who buy and sell sex, men who have sex with men and transgender people, with a view to achieving targets on universal access to HIV services.

“We welcome this strong endorsement by Members of ESCAP. With less than one month to go before the High Level Meeting on AIDS, this Resolution is timely and shows the commitment of the region to respond to HIV and particularly to removing barriers which can hamper progress,” said UNAIDS Regional Director, Steven Kraus.

The new declaration calls on governments in the region to ensure the commitment of a greater proportion of national resources to improve the programmatic effectiveness of the HIV responses. Resolution 67/9 also urges a review of national laws, policies and practices to enable the full achievement of universal access targets with a view to eliminating all forms of discrimination against people affected and infected with HIV. Finally, it underlines that to better address HIV, countries must continue to develop their national strategies to address all forms of gender-based violence, including sexual violence, particularly against women and girls.

UN ESCAP’s Social Development Director, Nanda Krairiksh underlined the significance of the Resolution endorsement for the region: "Governments in the Asia-Pacific region are moving forward to ensure greater effectiveness in national HIV responses. They are calling for greater financial sustainability, resource allocation and scaling-up of the full range of actions to ensure universal access to HIV prevention, treatment, care and support," she said.  

The International Advisory Group (IAG) on universal access met in Johannesburg, South Africa on 26-28 April 2011 to crystallize key findings informed by the outcomes of recent series of country and regional consultations on universal access. The meeting was an opportunity to gain consensus on global priorities and the “way forward” which is captured in the IAG statement, Solidarity for Universal Access. The IAG is co-chaired by Mrs Bathabile Dlamini, Minister of Social Development, Republic of South Africa and Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme.

The statement will be shared directly with Member States to contribute towards negotiations on a draft declaration in lead up to the United Nations High Level Meeting on AIDS that will take place in June.

Between 2010 and 2011, 117 countries took stock of their progress towards universal access to HIV prevention, treatment, care and support services. The national assessments informed multiple regional consultations.

While reviewing the findings from the country and regional consultations, the IAG, a multi-stakeholder advisory group, mandated by the UNAIDS Programme Coordinating Board, found overwhelming and ongoing support for the universal access movement.

During the April meeting in South Africa, the IAG endorsed the recommendations from the regional and country  consultations and concluded that five global challenges are pivotal now to achieve universal access to HIV prevention, treatment, care and support by 2015. These global challenges include the need to protect the human rights of all people; improve access to quality and affordable HIV treatment and scale up HIV prevention programmes; engage inspiring and courageous leaders, especially young people, lead the response; use evidence-informed strategies to make smart investments that will yield maximum results; and, finally, share accountability.

“We need to strengthen the human rights approach in our response to AIDS and establish mechanisms to ensure that both public and private services are free of stigma and discrimination or homophobia,” said Dr Jose Angel Cordova Villalobos, Secretary of Health of Mexico and member of the IAG during his participation in the Latin America consultation in March this year.

The advisory body emphasizes in its statement that global solidarity on the identified key priorities will change the trajectory of the epidemic, save lives and contribute towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Steve Kraus, Director, UNAIDS Regional Support Team for Aisa and the Pacific, gives an overview on the epidemic and response in the region. Credit: UNAIDS / V. Dithajohn

Nearly 30 countries from Asia and the Pacific have unanimously committed to driving forward the region’s efforts to reach universal access to HIV services by 2015.

This commitment came as more than 250 representatives from government, civil society, people living with HIV, UN agencies and development partners from across the region met in Bangkok, Thailand from 30-31 March, to review progress made and to develop key actions to achieve universal access to HIV prevention, treatment, care an support.

Through a Resolution, unanimously adopted at the end of the review, participants underlined the need for an HIV prevention revolution focusing on key populations at higher risk. Also, the need to sustain gains made in the provision of HIV treatment and to take urgent action to address legal barriers, stigma and discrimination and funding gaps that block progress in the region’s response to AIDS. The Resolution will now be presented to the 67^th Commission of the UN Economic and Social Commission in Asia and the Pacific where it will be considered for official adoption by the entire Commission comprising 62 Member governments.

“This is a region showing it is serious about an effective Asia Pacific response to AIDS, and is willing to stand up for sex workers, people who use drugs, men who have sex with men, transgender persons and policies that uphold the human rights of people living with HIV,” said Mr Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “Commitment and energy have produced a strong and clear agreement on how to achieve universal access in Asia Pacific, giving a strong regional voice in the lead up to the UN High Level Meeting in New York in June,” he added.

Over the two-day meeting, hosted by UNAIDS in collaboration with the UN Economic and Social Commission in Asia and the Pacific, participants noted important progress in the region to date, including that HIV epidemics have significantly slowed or stabilized across the region and that a number of the countries are reaching high levels of coverage for antiretroviral treatment.

However, critical challenges were raised as no country in the region is reaching universal access to HIV prevention, treatment, care and support. One in three people in the region do not have access to HIV treatment; 60% of people living with HIV in the region do not know their HIV status; and key affected communities continue to be subjected to stigma and discrimination, punitive laws, policies and practices which obstruct access to HIV services. Many countries in the region—including those with or approaching middle-income status—rely heavily on international funding for their AIDS responses.

Speaking at the opening, Dr Siriwat Tiptaradol, Deputy Permanent Secretary from the Ministry of Health in Thailand urged countries to make health is a policy priority and to ensure a partnership response: “Progress on universal access can only be possible when different arms of the same government, together with civil society, join together with common goals.We must find ways to support each other, particularly at the regional level, to make AIDS funding a collective responsibility.”

Igor Mocorro, a member of ‘Youth Lead’, addresses the plenary at the Asia Pacific Regional Consultation on Universal Access. Credit: UNAIDS / V. Dithajohn

In times of fiscal austerity and competing development priorities, the need to sustain momentum on HIV was echoed throughout the Consultation. “The world’s most populous region cannot afford complacency on AIDS. Political leadership with civil society and the key affected communities as the cornerstone of the response requires fresh perspectives from the ground,” said ESCAP Social Development Division Director, Nanda Krairiksh.

Strongly emphasized was the critical importance of continued engagement and motivation of the region’s youth—particularly those from key populations at higher risk. Young leaders underlined the importance of the full involvement of young people in the HIV response and urged national leaders and partners to ensure their voices are equally heard and heeded.

“We have the passion for change and it’s time for leaders to take young people seriously as equal partners and key actors in society,” said Igor Mocorro, a member of ‘Youth Lead’, a programme to develop youth AIDS leaders from key affected populations. “We know the realities; we can make a difference.”

(L to R): UNAIDS Deputy Executive Director, Management and External Relations, Ms Jan Beagle; Hon Rodger Samuel, Minister in the Office of the Prime Minister responsible for HIV; Dr Ernest Massiah, Director, UNAIDS Caribbean; Mr Sam Condor, Deputy Prime Minister and Minister of Foreign Affairs of St Kitts and Nevis; Mr Ainsley Reid, GIPA, Jamaica; Ms Angelica Hunt, Ag UN Resident Coordinator; and Ms Izola Garcia, UNAIDS Coordinator for Trinidad and Tobago.

Representatives from government, civil society, people living with HIV, UN agencies and development partners from across the Caribbean met in Port of Spain, Trinidad and Tobago, to review progress made towards achieving universal access to HIV prevention, treatment, care and support targets. The two-day meeting held from 23-24 March was convened by UNAIDS in collaboration with partners in the lead up to the UN High Level Meeting on AIDS, which will take place in June 2011.

“This is a unique opportunity for everyone who is part of the AIDS response day after day to reflect and take stock of where we are on our shared journey,” said UNAIDS Deputy Executive Director, Management and External Relations, Jan Beagle.

Political leaders were candid about the challenges and underscored the need to engage young leaders and do things differently as the AIDS response enters a new era and moves towards reaching zero new infections, zero discrimination, and zero AIDS-related deaths.

“Fear, denial, ignorance, stigma and discrimination are still very prominent in the region. It is a barrier to condom use, even accessing HIV treatment and care,” said Rodger Samuel, Minister in the Office of the Prime Minister, Trinidad and Tobago. “The old approaches do not seem to be working, especially with the new generation. If we do not get our youth involved, ‘getting to zero’ will be an immensely hard task.”

There are an estimated 260 000 people living with HIV in the Caribbean. Close to half of people in need of antiretroviral treatment are receiving it. Overall, HIV now affects more women than men in the region. However, there is considerable variation between countries. For example, 60% of people living with HIV in the Bahamas are women. But in Cuba and Suriname, 69% of people living with HIV are men. AIDS remains the leading cause of death in people aged 20-59 years old.

Participants acknowledged important progress in the region to date, including a 43% reduction in AIDS-related mortality between 2001 and 2008, and an 18% reduction in new HIV infections among children during the same time period. There has been significant expansion of programmes to prevent mother-to-child HIV transmission of HIV, with four countries that reaching 95% coverage.

But stigma and discrimination, homophobia and a punitive legal environment continue to undermine efforts to reach universal access goals towards HIV prevention, treatment, care and support across the Caribbean. There are 11 countries in the region that criminalize sex between people of the same sex, and 13 that criminalize sex work. Five countries, territories and areas continue to impose restrictions on the entry, stay and residence of people living with HIV.

“The HIV response shines a spotlight on inequality and violations of human rights, and compels us to act,” said Ms Beagle. “We must remove punitive laws that are blocking access to critical HIV services. The law should work for the HIV response, not against it.”

Participants also discussed the need to increase investment in stigma and discrimination reduction programmes to secure the rights of people living with HIV. Ainsley Reid, Coordinator for the Greater Involvement of People Living with HIV, Jamaica, underscored this by highlighting that “people living with HIV need more than medicines.” 

“I know people who have died with the medicines in their hands. What we really need is social protection, including food, employment, housing, etc. This is what it takes to move beyond ‘victim mode’ and have empowerment and meaningful involvement,” he added. 

Participants during the universal access consultation that took place in Port of Spain, Trinidad and Tobago. 23-24 March 2011

Civil society reported on the outcomes and conclusions of a one-day meeting which they held prior to the universal access consultation. Representatives called for the removal of punitive laws that block HIV responses and violate human rights. The need for intensified political and community action to take on the continued taboo around issues related sexuality was also stated. Civil society also emphasized the need to train healthcare workers on ethics and confidentiality. A call was made for regional negotiations to drive down the price of medicines.

Changes in the development environment, including signs of reductions in funding flows, was a backdrop to the discussions during the two days. During the last decade the Caribbean region received more than US$ 1.3 billion in external funding for HIV. While some countries already fund their national HIV programmes entirely from domestic resources, others will be under increasing pressure to reduce programme delivery costs and secure new resources as current sources of funding decline.

“It will be imperative to clearly identify where we can make efficiencies in the region, and be ruthlessly honest about dropping what doesn’t yield us results,” said Ernest Massiah, Director of the UNAIDS Regional Support Team for the Caribbean in his remarks during the opening ceremony.

In lead-up to June High Level Meeting, progress report presents overview of efforts needed to help countries achieve universal access to HIV services and zero new HIV infections, discrimination and AIDS-related deaths

Launch of the Report of the Secretary-General. Nairobi, Kenya, 31 March 2011.
Credit: UNAIDS/AFP - S.Maina

NAIROBI, 31 March 2011—Thirty years into the AIDS epidemic, investments in the AIDS response are yielding results, according to a new report released today by United Nations Secretary-General Ban Ki-moon. Titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths, the report highlights that the global rate of new HIV infections is declining, treatment access is expanding and the world has made significant strides in reducing HIV transmission from mother to child.

Between 2001 and 2009, the rate of new HIV infections in 33 countries—including 22 in sub-Saharan Africa—fell by at least 25%. By the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries. And for the first time, in 2009, global coverage of services to prevent mother-to-child transmission of HIV exceeded 50%.

But despite the recent achievements, the report underscores that the gains are fragile. For every person who starts antiretroviral treatment, two people become newly infected with HIV. Every day 7 000 people are newly infected, including 1 000 children. Weak national infrastructures, financing shortfalls and discrimination against vulnerable populations are among the factors that continue to impede access to HIV prevention, treatment, care and support services.

The Secretary-General’s report, based on data submitted by 182 countries, provides five key recommendations that will be reviewed by global leaders at a UN General Assembly High Level Meeting on AIDS, 8–10 June 2011.

“World leaders have a unique opportunity at this critical moment to evaluate achievements and gaps in the global AIDS response,” said Secretary-General Ban Ki-moon at the press briefing in the Kenyan capital. “We must take bold decisions that will dramatically transform the AIDS response and help us move towards an HIV-free generation.”

United Nations Secretary-General Ban Ki-moon and UNAIDS Executive Director Michel Sidibé with Rebecca Auma Awiti, mother of three children and field coordinator with the non-governmental organization Women Fighting AIDS in Kenya who told her story at the press conference.
Credit: UNAIDS/AFP - S.Maina

“Thirty years into the epidemic, it is imperative for us to re-energise the response today for success in the years ahead,” said UNAIDS Executive Director Michel Sidibé, who joined Mr Ban for the launch of the report. “Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected—an HIV prevention revolution is needed now more than ever.”

Rebecca Auma Awiti, a mother living with HIV and field coordinator with the non-governmental organization Women Fighting AIDS in Kenya told her story at the press conference. “Thanks to the universal access movement, my three children were born HIV-free and I am able to see them grow up because of treatment access,” she said.

Mobilizing for impact

In the report there are five recommendations made by the UN Secretary-General to strengthen the AIDS response:

• Harness the energy of young people for an HIV prevention revolution;
• Revitalize the push towards achieving universal access to HIV prevention, treatment, care and support by 2015;
• Work with countries to make HIV programmes more cost effective, efficient and sustainable;
• Promote the health, human rights and dignity of women and girls; and
• Ensure mutual accountability in the AIDS response to translate commitments into action.

The Secretary-General calls upon all stakeholders to support the recommendations in the report and use them to work towards realizing six global targets:

• Reduce by 50% the sexual transmission of HIV—including among key populations, such as young people, men who have sex with men, in the context of sex work; and prevent all new HIV infections as a result of injecting drug use;
• Eliminate HIV transmission from mother to child;
• Reduce by 50% tuberculosis deaths in people living with HIV;
• Ensure HIV treatment for 13 million people;
• Reduce by 50% the number of countries with HIV-related restrictions on entry, stay and residence; and
• Ensure equal access to education for children orphaned and made vulnerable by AIDS.

As international funding for HIV assistance declined for the first time in 2009, the report encourages countries to prioritize funding for HIV programmes, including low- and middle-income countries that have the ability to cover their own HIV-related costs. It also stresses the importance of shared responsibility and accountability to ensure the AIDS response has sufficient resources for the coming years.

The report and more information about the High Level Meeting on AIDS can be found online at: unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/

Minister of Heath of Kyrgyzstan, Sabyrbek Dzhumabiekov (left) and, UNAIDS Deputy Executive Director, Programme, Paul De Lay addressing participants at the universal access consultation. Kiev, 17-18 March 2011

Insufficient investment in programmes to prevent HIV infection among key populations at higher risk is hampering efforts to achieve universal access to HIV prevention, treatment, care and support in Eastern Europe and Central Asia. That’s according to participants at the regional consultation that took place in Kiev, Ukraine on 17-18 March 2011.

Government and civil society representatives from 30 countries across the region participated in the universal access consultation. The objective was to discuss gaps in the region’s response to HIV as well as identify key priorities for future action.

“Eastern Europe and Central Asia remain far from achieving universal access, in spite of significant efforts,” said Dr Denis Broun, Director, UNAIDS Regional Support Team, Europe and Central Asia.

The region has seen progress in preventing mother-to-child HIV transmission. HIV treatment coverage has been slowly increasing in recent years. Yet only one out of four people needing treatment are receiving it—the lowest coverage rate in the world.

Insufficient availability of treatment as well as prevention programmes—especially for the key populations at higher risk of HIV such as people who use drugs, men who have sex with men, prisoners and sex workers—were seen as the major gaps in the region leading to the increase of new infections. 

One of the discussions centred around the significant dependence that the region has on international financial support, specifically in the form of Global Fund grants. Participants stressed that national funding levels were low and called for countries to increase their domestic investment in the AIDS response. “Countries should not wait until funding from the Global Fund and other international donors ends. Sustainability of the HIV prevention, treatment, care and support should rely on national budgets,” stated participants in their final recommendations. “Governments should look at AIDS funding not as ‘spending’ but as investing in the economy, in the workforce and the future."  

Representatives of non-governmental organizations noted that, in general, civil society is not involved in budgetary decision-making when it comes to allocation of government funds. As a consequence, the effectiveness of the overall AIDS response remains low due to the limited capacity of the State to respond to the needs of people at higher risk of infection.

According to participants, there is a lack of sufficient HIV prevention programmes providing information to young people, raising awareness and promoting condom use to prevent sexual transmission of HIV. The existence of HIV-related travel restrictions, criminalization of HIV transmission and same-sex relations and the repressive police practices towards people who inject drugs were identified as significant barriers to establishing relationships of trust with people most-at-risk. Participants also agreed on the need to create legal environments to facilitate the intake of HIV prevention services by populations at higher risk of infection.

The recommendations made by participants will be included in the universal access progress report that will be presented at the United Nations General Assembly High Level Meeting on AIDS that will take place in New York in June 2011.

“The HIV situation in the region is critical. By contributing to the recommendations at a time when they are developed, we have a chance to ensure that the voice of people living with HIV is heard,” said Vladimir Zhovtyak, head of the Eastern European and Central Asia Network of People Living with HIV.

More than 90 delegates participated in the Latin America consultation to review progress made towards achieving universal access to HIV prevention, treatment, care and support. Mexico City, 2-3 March 2011.

The Secretary of Health of Mexico, Dr José A. Córdova, called on countries in Latin America to continue efforts to counter stigma, discrimination and homophobia in the region.

Dr Córdova was one of seven Ministers and Vice Ministers of Health among more than 90 delegates contributing to the review of progress made towards achieving universal access in the AIDS response. The consultation, held in Mexico City from 2-3 March 2011, made regional recommendations and developed a roadmap on how to achieve universal access to HIV prevention, treatment, care and support by 2015.

“We need to strengthen the human rights approach in our response to AIDS and establish mechanisms to ensure that both public and private services are free of stigma and discrimination or homophobia,” said Dr Córdova.

Persistent homophobia, gender-based violence, persecution and even killings of most-at-risk populations such as men who have sex with men (MSM) and transgender people were identified as some of the main obstacles to ensuring access to HIV-related services in the region. Strengthening health systems that do not discriminate people living with HIV and key populations at higher risk of infection was seen by participants as a priority to achieve universal access. Improving access to legal services for human rights violations, discrimination and gender-based violence was also highlighted.

The AIDS epidemic in the region has remained stable for the last 10 years with an HIV prevalence of 0.5%. Antiretroviral therapy coverage is at 51%, which represents the highest in the world. However, young people, sex workers, MSM, and transgender people still have limited access to sexual and reproductive health programmes that provide information, skills, services and commodities to prevent HIV infection.

“We can only improve HIV prevention for the transgender community in Latin America through the respect for their identity in the health services,” said Marcela Romero from REDTRANSLAC, Argentina.

Participants identified a need to strategically position HIV within broader political agendas—including education, justice, equality, labour, and social development. This, it was felt, would secure political commitment and financial sustainability. According to the participants, investment from different sectors would have a multiplier effect that will contribute not only to achieve universal access goals but support the achievement of the broader Millennium Development Goals.

The need to strengthen relations between governments, civil society organizations and networks of people living with HIV throughout the region was another recommendation from the meeting. It was also proposed to jointly purchase antiretroviral drugs for the region rather than as individual countries to achieve economies of scale and to increase HIV treatment coverage. Additional strategies included enhancing production of locally produced antiretroviral drugs.

“Working together we can ensure a unified regional response to the epidemic and set the path towards sustainability in Latin America,” said UNAIDS Regional Director Dr César Núñez.

(L to R): Dr Toure, Coordinator for WHO’s inter-country team for West Africa, Hedia Belhadj, UNAIDS Director of Partnerships, Mr Jean Tchoffo, Permanent Secretary for the Ministry of Finance, Cameroon, Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa, Dr Sabine Ntakirutimana, Minister of Health and the Response to HIV, Dr Marie Ahouanto, French Cooperation, Bureau des politiques de Santé et de la Protection Sociale, Dr.Manuel Rodrigues Boal, Conseiller du Ministre de la Santém, Cap Vert, Yamina Chakkar, UNAIDS regional support adviser, Macoura Oulare, UNICEF Senior HIV Specialist, Leiliane Corcher M’boa, Secrétaire Exécutive, RAP+ Afrique de l’Ouest

Stakeholders in the AIDS response across West and Central Africa met in Dakar, Senegal from 3–4 March 2011 to review progress made towards achieving universal access to HIV prevention, treatment, care and support. The regional consultation was organized by UNAIDS in collaboration with its Cosponsors, regional civil society networks, government representatives and development partners.

Dr Modou Diagne Fada, Minister of Health and Prevention of Senegal stressed the importance of national ownership, “Leadership and national ownership of the AIDS response will accelerate our action towards achieving universal access and the Millennium Development Goals.”

Participants acknowledged that there has been progress on scaling up towards universal access to HIV prevention, treatment, care and support in the region. Access to antiretroviral treatment has increased from 1% in 2001 to 25% in 2010. There has also been an increase in coverage of prevention of mother-to-child transmission services from 4% in 2005 to 23% in 2010. Most noticeably, the HIV incidence has dropped in ten countries and HIV prevalence has been stable in seven.

The consultation also identified existing implementation gaps in order to achieve the MDGs by 2015. One example discussed was the strong dependence on external financing for HIV and Health programmes. “Advocacy for increased sustainable financing of national AIDS programmes should be evidence based and strongly linked to countries’ development agendas in order to achieve the MDGs,” said Mr Jean Tchoffo, Permanent Secretary for the Ministry of Finance of Cameroon.

Another gap identified was the weak linkages of the HIV response with other health services. The Minister of Health from Burundi, Dr Sabine Ntakirutimana, highlighted the need for an enhanced integration with health services in order to achieve universal access and in particular the virtual elimination of mother-to-child transmission of HIV. “HIV should be used as an entry point to more integrated delivery of health services,” added Dr Ntakirutimana.

Political and social instability in most countries of the region, which aggravates the lack of institutional frameworks related to an effective response to HIV, was also raised by participants as a major obstacle. “In a region where more than 50% of States are either in conflict or post conflict situations it is imperative that the humanitarian response addresses the needs of people living with HIV,” said Dr Meskerem Grunitzky-Bekele, Director of the UNAIDS Regional Support Team for West and Central Africa.

Participants discussed the case of the post-electoral crisis in Ivory Coast and the ensuing instability threatening access to treatment for people living with HIV in the country. With increasing poverty levels and an HIV prevalence rate of 4.7%, the health sector in the Ivory Coast is directly affected by the current economic sanctions. Participants agreed that there is an urgent need to proactively respond to the issue, working with responsible actors to ensure access to HIV treatment is not interrupted.

According to the participants, other gaps hampering progress towards achieving universal access in the region were the inadequate allocation of resources towards the main modes of HIV transmission as well as lack of good governance and mechanisms for accountability. Stigma and discrimination and weak health systems are limiting the supply of services for HIV prevention, treatment and care.

At the end of the meeting, recommendations for enhanced national ownership to achieve universal access in the region were developed and key priorities agreed. These include: strengthening leadership; optimization of domestic and external resources; improving access to treatment; revitalization of HIV prevention; the involvement of young people as agents of change; and the promotion of human rights, gender and social equity in national AIDS plans.

Inputs from a pre-Civil Society Consultation, held on 28 February and a National Ownership Meeting on 1–2 March which also took place in Dakar were also taken into account during the consultation.