YouTubers, influencers and virtual activists took part in inspirational conversations about HIV and discrimination in São Paulo, Brazil, on 30 May.

“No one in my group of friends and very few of my generation know anyone who died because of AIDS. Because past generations lived and witnessed so many AIDS-related deaths, there was this culture of fear, which is no longer present among us. However, we have not replaced this culture of fear with anything more positive,” said young Brazilian YouTuber Murilo Araújo, who describes himself in his channel, Muro Pequeno, as, “Proud to be gay, black, catholic, proud to be resistance in a society that tells me all the time that I cannot be any of that.”

Taboos, stigma both within and against the gay community, discrimination against people living with HIV and communicating to a highly connected generation were some of the topics debated. The event was moderated by renowned journalist and UNAIDS Goodwill Ambassador for Brazil Glória Maria, who asked, “Why do you think the HIV epidemic seems to be rebounding among young people, especially among gay men?” to trigger the first conversation.

“We saw all this in our biology classes, we saw it in campaigns. But it’s really hard to associate what they teach us with our real life, with relationships, with affection and with sexual experiences. I think this is the missing link we are trying to connect with our work on YouTube,” said actor and YouTuber Gabriel Estrela, from the Projeto Boa Sorte channel. “It seemed like something very distant from my reality, something that only happens in the movies.”

New HIV infections have grown substantially among young men, especially young men who have sex with men, in Brazil in the past decade. According to data from the Ministry of Health, they almost tripled among youth aged 15 to 19, and more than doubled among those aged between 20 and 24.

Nathan Fernandes, the Editor of Galileu Magazine, one of Brazil’s most influential monthly magazines among young people, said that, “The press played a very important role at the beginning of the epidemic. The first cases were reported even before civil society was able to organize itself for a common response. The problem is that the same press also reinforced stigma and discrimination by describing AIDS as the “gay plague” or “gay cancer”, among other things. We are now very aware that we have to be very careful with what and how we report,” he added.

As gay social networks become popular, discussions about HIV and prevention tend to gain the spotlight, said André Fischer, Director of Hornet Brazil. “We can’t run away from the fact that AIDS is still an important issue for the gay community. It is still a strong taboo subject. But we see more and more people being able to come out and reveal their HIV-positive status.”

Digital activist Matheus Emilio said it is possible to include HIV in the discussions of social networks and help break stigma and discrimination around the subject. Mr Emilio runs the Facebook page Menino Gay, with a focus on the lesbian, gay, bisexual, transgender and intersex community, whose posts reach more than 600 000 followers. “Besides talking about culture, music and lesbian, gay, bisexual, transgender and intersex rights, I also include information on HIV, health and prevention”, said Mr Emilio, who was diagnosed HIV-positive two years ago.

“Our goal is to promote connections among people and to promote a debate on HIV, with a focus on young gay men and other men who have sex with men, going beyond the point of view of science, health and public management. We want to create a debate involving young people, society, digital culture and human rights within the universe of young gay people,” said Georgiana Braga-Orillard, UNAIDS Country Director for Brazil.

The series of debates, #EseFosseComVocê? (What if it happened to you?), was organized by UNAIDS in partnership with the British Embassy in Brazil, Ogilvy Brazil, Hornet and Cultura Inglesa. The event, which was live-streamed on several accounts on Facebook, reached more than 300 000 online viewers. 

Sex workers continue to face criminalization, violence, discrimination and other forms of human rights violations which increase their risk of acquiring HIV.

Sex workers—female, male and transgender adults who have consensual sex in exchange for money or goods, either regularly or occasionally—are among the populations that are being left behind in the HIV response. HIV prevalence among sex workers is 10 times higher than among the general population, and sex workers are poorly served by HIV services.

Many of the human rights challenges, vulnerabilities and barriers sex workers face in accessing HIV services are due to criminalisation and the restrictive laws, regulations and practices they face.  Selling and/or buying sex is partially or fully criminalized in at least 39 countries. In many more countries some aspect of sex work is criminalized, and in other countries general criminal law is applied to criminalize sex work (for example, laws against loitering and vagrancy).

The threat of detention, as well as laws that allow for the use of condoms as evidence of sex work, are serious barriers to the availability and uptake of HIV prevention programmes and services. When possession of condoms is used by the police as evidence of sex work, this greatly increases the risk of HIV among this key population. Even where sex work is not criminalized, sex workers are rarely protected under the law

Furthermore, studies have shown that female sex workers are subjected to high levels of violence—in Haiti, for example, 36.6% of female sex workers report physical violence and 27.1% report sexual violence.

However, sex worker organizations are leading efforts to advance their human rights and access to HIV services in many countries. In South Africa, sex worker-led organizations worked closely with the Ministry of Health to develop the South African National Sex Worker HIV Plan 2016–2019, which calls for an enabling environment for the protection of, and access to HIV services for, sex workers. The nationwide programme enlisted peer motivators to assist in the distribution of condoms and lubricant, information on sexually transmitted infections and HIV prevention, paralegal services and health service referrals. Community empowerment services that aim to reduce violence, stigma and discrimination included sensitization training and a helpline for sex workers.

In India, sex worker organizations are working with the police and the community to reduce violence against sex workers, and to establish health and social services for themselves and their families.

There is growing evidence of the importance of addressing the structural and legal barriers that affect sex workers. Ending the AIDS epidemic as a public health threat would require translating this evidence into practice, including by ensuring that governments and all stakeholders prioritize and intensify efforts to protect the human rights of sex workers and to increase their access to HIV prevention and treatment services. 

Dy Sokha has a ready smile and calls out friendly greetings to doctors, nurses and patients as she walks through the bustling hallways of the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia. She is brightly dressed in a peach pink shirt and is a full-time counsellor with the ARV Users Association (AUA), a community-based organization providing services to people living with HIV.

“Sometimes at the beginning of a counselling session, the client won’t look at my face,” said Dy Sokha. “They put their face down; they scratch their fingernails. They are so shy. For these difficult cases, I must open up about myself.”

Dy Sokha was diagnosed with HIV about 20 years ago and began taking antiretroviral medicine in 2004. The HIV treatment improved her health significantly and now gives her the strength to lead a busy life as a counsellor.

“I have become a role model for my clients, as they can see I am successful and they understand that just because you have HIV, it does not mean you have to disappear from society,” she said.

AUA, which is active in seven hospitals in two provinces, is one of a few community-based HIV organizations in Cambodia whose staff work directly alongside health-care providers. While the organization provides a range of services, such as counselling on treatment adherence and HIV prevention, it places a particular focus on preventing stigma and discrimination in the hospitals in which it works.

Eighty-five per cent of AUA’s 40 staff members are people living with HIV and so they know first-hand how discrimination can lead to social isolation and negatively affect a person’s health and well-being. The group facilitates connections between clients and health-care providers and holds regular meetings with hospital staff to provide feedback.

“We coordinate with different stakeholders to meet and encourage communication between people living with HIV, service providers and civil society,” said Sienghorn Han, Executive Director of AUA.

In 2015, AUA was trained by Asia Catalyst to document human rights violations in health-care settings. The cooperation was part of a study that Asia Catalyst conducted in four countries in Asia, which found discrimination evident in many areas, from denial of services and segregation to arbitrary additional fees for health services.

When AUA receives a discrimination case, it acts as a mediator, trying to find a solution that is acceptable to both health-care workers and clients.

“We keep good contact with all levels of the hospital,” said Dy Sokha. “The staff and I sit together—the doctor, the client and myself—to understand the problem in order to help the doctor do his or her best.”

AUA also holds counselling sessions with clients that aim to give them accurate information, as well as empower them to advocate for their rights and negotiate with health-care providers.

Bopha, who prefers to use a pseudonym and is living with HIV, found that AUA was especially helpful when she became pregnant in 2013. “AUA explained everything, especially how to take care of my pregnancy and how to disclose my HIV status to my doctor so that I could access antiretroviral medicines to prevent the transmission of HIV to my daughter,” she said.

Cambodian health officials acknowledge that AUA provides services that help busy health-care workers. Ngauv Bora, Deputy Chief, Technical Bureau of the National Centre for HIV/AIDS, Dermatology and STDs, said, “For clients, AUA staff are like friends and they trust them more than the hospital counsellors. AUA is helping to create an enabling environment.”

The organization is one of more than a dozen community groups that, along with health officials and international experts from 12 countries, participated in the first Asia Regional Consultation on Addressing HIV-Related Stigma and Discrimination in Healthcare, which took place on 25 and 26 May in Bangkok, Thailand.

The regional consultation provided a platform for countries to achieve tangible objectives, with technical assistance from partners. Community organizations were recognized as crucial partners in the drive to eliminate stigma and discrimination.

UNAIDS is working with countries to empower people living with, at risk of and affected by HIV to know their rights and to access justice and legal services to prevent and challenge violations of human rights.

In a dark room, you see a shadow of yourself on a large screen—white lights create spots that arc across the screen and onto your body.

It’s the deadly Shadowpox trying to infect you.

Watching your shadow-self on the screen, you try to sweep the spots off your body. More spots appear and you realize the virus isn’t just attacking you, it’s attacking everyone around you. What do you do now?

This is the type of question people are faced with in Shadowpox, an art installation that is part of the new Immune Nations exhibition. Using interactive projections, Shadowpox gives participants a unique experience of fighting a virus with a vaccine while trying to save the people around them by what public health officials call herd immunity—when enough people are immunized against a disease that other people who are not immunized have some protection against infection, because the spread of contagious disease is contained.

The questions and decisions people face when interacting with Shadowpox are similar to public health scenarios being played out around the world. And it is exactly the kind of thinking a grant by the Research Council of Norway tried to provoke by bringing artists, researchers and policy-makers into a room together to see how they might reframe the current discourse surrounding vaccination.

“We are interested in exploring the role that art and culture could have in informing global health decision-making,” said Steven Hoffman, a law professor at the University of Ottawa and co-lead of the Vaccine Project.

In the summer of 2015, renowned artists and experts gathered at the University of Ottawa, where concepts for the evidence-based art exhibition emerged. Shadowpox was imagined by a group of collaborators led by Alison Humphrey and Caitlin Fisher. The idea started with a new vaccine-preventable disease composed of viral shadows. The concept was part fact and part science fantasy. The mixed-reality installation combines real-world statistical data with live-animated digital effects. “The final work is equally stunning, fun and provoking—everything needed to engage people on the issue of vaccines,” said Natalie Loveless, a co-lead and curator for the exhibition.

The Vaccine Project is a multiyear collaboration that has spanned continents and cultures. “More than 100 people and organizations are collaborating on this exhibition,” said Sean Caulfield, a co-lead of the project. “We have representatives from virtual reality labs and universities to governments and the United Nations.”

The exhibition first premiered at Galleri KiT, Trondheim Academy of Fine Arts, in Norway in March 2017 and travelled to UNAIDS headquarters in Geneva, Switzerland, where it will be opened by the First Lady of Namibia Monica Geingos on 23 May. The works of art will be exhibited at UNAIDS until 30 June 2017. 

During a recent visit to Germany, the Executive Director of UNAIDS, Michel Sidibé, met with representatives of the federal government, local government, civil society, communities affected by HIV and the private sector.

Under the leadership of Chancellor Angela Merkel and the Minister of Health, Hermann Gröhe, Germany has prioritized global health on the international agenda, culminating in the first ever Group of Twenty (G20) Health Ministers Meeting, which took place in Berlin, Germany, on 19 and 20 May.

Political commitment

“Ending AIDS is a historic goal and I firmly believe we can reach it. UNAIDS has to maintain its leadership role in the global AIDS response. We have to increase our joint efforts and UNAIDS is central to that work,” said Mr Gröhe. "Health is a prerequisite for social development. This is one of the reasons why Germany made global health a priority under our G20 presidency. With this decision taken by our Federal Chancellor, Angela Merkel, a global health policy is going to be a hallmark of our country’s international responsibility. Only if we cooperate and work together, we can prepare the world for future health crises,” he added.

During the meeting, Mr Sidibé thanked the government, and particularly the Minister of Health, for their longstanding support to UNAIDS and commitment to the AIDS response. “Putting health on the agenda of the G20 and particularly holding a meeting of the G20 Health Ministers for the very first time is revolutionary,” said Mr Sidibé. “It highlights the shared understanding that quality health care is essential to social and economic stability.” They agreed on the danger of complacency and the potential reversal of gains it could bring.

Mr Sidibé also met with the Parliamentary State Secretary for the Ministry of Economic Cooperation and Development, Thomas Silberhorn, where he highlighted the critical role of UNAIDS in ending the AIDS epidemic and the impact it would have on the broader Sustainable Development Goals.

During his visit he also spoke to Bärbel Kofler, Germany’s Commissioner for Human Rights Policy and Humanitarian Aid. She said, “Access to health is a human right.” They discussed the need for continued engagement to break down discrimination and stop exclusion and prejudice, particularly for people who are vulnerable and are being left behind. Mr Sidibé emphasized that fragile communities not only exist in developing countries, but can be found the world over—from Baltimore to Bamako.

Working together to Fast-Track the AIDS response in Germany

Taking the engagement to the local level, Mr Sidibé next met with representatives of the city of Berlin, which joined the Fast-Track cities initiative in 2016. He also met the nongovernmental organization Deutsche AIDS-Hilfe, which recently launched a campaign to End AIDS in Germany by 2020, and its local branch, Berliner AIDS Hilfe, as well as the advocacy group Action Against AIDS Germany.

During the meeting, Mr Sidibé highlighted that city health systems that are inclusive and accessible have the best chance of engaging people who might otherwise be left behind. “Having a strong civil society has made a big difference in the response to HIV,” he said.

Private sector engagement

In addressing the international business community on the eve of the B20 Health Conference Mr Sidibé said. “Today’s global health challenges, including emerging pandemics and antimicrobial resistance, threaten not just individual lives, but impact social cohesion and economic development. The private sector can bring unique innovation, technologies and services and needs to be an integral part of a multisectoral response to build resilient, responsible and responsive health systems.”

As guest of honour, Mr Sidibé congratulated the winners of the newly launched German Global Health Award—the German Healthcare Partnership (GHP), Bio Deutschland and the Voice of German Industry. The initiative exemplifies how the private sector and civil society alike are needed to drive innovation in the health-care sector.

Roland Göhde, Chairman of the Board at GHP, said, “With the German Global Health Award launched in this year of Germany’s G20 presidency, we would like to underline our strong private sector commitment towards multi- and inter-sectoral partnerships engaged in health system strengthening and universal health coverage. We are partners and committed to making the world a healthier and safer place.”

The Democratic Republic of the Congo’s HIV catch-up plan shows that impressive results in the response to HIV can be made when partners work together.

Launched in December 2016, the western and central Africa catch-up plan aims to ensure that 4.5 million people living with HIV in the region will have access to HIV treatment by 2020. In support of the regional plan, the Democratic Republic of the Congo’s country plan—developed and implemented by the Ministry of Health and the National AIDS Commission—aims to increase the number of people on antiretroviral therapy in the country by 80 000 people, to more than 200 000 people by June 2018.

An intensive HIV testing campaign in the country has enabled 2 million people to know their status—essential to enabling people to access HIV treatment.

Coverage of antiretroviral therapy in the country stood at just 33% of people living with HIV in 2015, higher than the region’s coverage (28%), but much lower than the coverage in eastern and southern Africa (54%). According to government estimates, by April 2017, 34 000 more people were on treatment. The increase puts the country on track to reach the June 2018 target, which would see 73% of people living with HIV on treatment.

The encouraging increase in treatment coverage resulted from a range of partners—the Ministry of Health and the National AIDS Commission, United Nations agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief, among others—working together to finance and give technical support to the scale-up. By focusing on the three most affected provinces in the country, resources have been maximized where they are most needed.

Community-based antiretroviral medicine distribution points and community-based early warning systems have helped to reduce drug stock-out and improve the quality of HIV services. These community health services are among the best practices that have been scaled up to increase treatment coverage.

UNAIDS is working with countries to ensure that 30 million people living with HIV have access to treatment through meeting the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—by 2020.

Quotes

UNAIDS, in collaboration with Cartier, the hotel InterContinental Geneva and Design Miami, is organizing a fundraising gala to take place on 12 June, during Art Basel week in Basel, Switzerland.

The gala will aim to raise funds to increase access to HIV prevention and treatment services for women and children worldwide. The event will be hosted by HRH Princess Eugenie of York, Caroline Rupert and Ndaba Mandela.

This year’s gala will feature a live performance and an exclusive design auction boasting one-of-a-kind contributions by the world’s best designers. It will be led and curated by Simon de Pury and Design Miami, who have enlisted a roll call of who’s who in the design world in support of UNAIDS.

Tickets to participate can be purchased here.

In 2016, the UNAIDS gala raised critical funds to stop new HIV infections among children through donations from people in attendance, a live auction and a silent auction. Last year’s supporters included Keanu Reeves, Michael Chow, Francisco Costa, Wade Guyton, Lenny Kravitz, Doutzen Kroes, Jude Law, Vik Muniz, Behati Prinsloo, Aby Rosen, Ed Ruscha, Cindy Sherman, Patrick Stewart, Charlize Theron, Francesco Vezzoli and Naomi Watts.

UNAIDS GALA 2017

Monday, 12 June 2017
Basel, Switzerland, during Art Basel week

Hosts

HRH Princess Eugenie of York 
Caroline Rupert 
Ndaba Mandela

Master of Ceremonies

James Chau

Auctioneer

Simon de Pury

After-Party

Music by DJ Bas Ibellini

Time
19:30: exclusive Design Miami vernissage exhibition, cocktails and red carpet
21:00: dinner, design auction and special musical performance
22:30: after-party

Location
Halle 1.2, Messe Basel, Switzerland

Made Possible by

Cartier

With the support of

Design Miami

In partnership with

InterContinental Geneva

TABLES/TICKETS
Click here to purchase tickets online

CONTACT FOR EVENT INFORMATION, TICKETS AND TABLE INQUIRIES
+1 646 652 5814 or events@UNAIDS.org

The Martin Ennals Foundation has announced the names of the three finalists for the prestigious global Martin Ennals Award for human rights defenders, which will be awarded in October 2017. One of the three finalists is Karla Avelar, a transgender woman living with HIV from El Salvador who, for more than 20 years, has been defending the human rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people and advocating for access to health care for people living with HIV.

In 1996, Ms Avelar was one of the founders of the first association of transgender people in El Salvador, and in 2008 she founded the first organization of transgender women living with HIV, COMCAVIS TRANS. The organization works to advance, defend and promote the human rights of LGBTI people, scale up HIV prevention and care and improve access to HIV services for people living with HIV and prisoners.

"On a daily basis, lesbian, gay, bisexual, transgender and intersex people are exposed to death threats, extortion, harassment, physical and verbal violence and discrimination because of our gender identity or sexual orientation,” said Ms Avelar. “This situation makes us vulnerable to HIV."

Ms Avelar, together with COMCAVIS TRANS peer educators, promotes HIV testing and HIV prevention and care among the LGBTI people through outreach activities, such as education and information dissemination in different parts of San Salvador.

Ms Avelar and her team also work on strengthening access to HIV prevention and treatment services for LGBTI prisoners in two penitentiary centres. “We are working on two fronts: with lesbian, gay, bisexual, transgender and intersex people, training them on sexual and reproductive health and HIV prevention, and raising awareness among administrative officials and custodial staff on human rights and zero discrimination,” explained Ms Avelar.

In 2013, the partnership between COMCAVIS TRANS and the penitentiary center of SENSUNTEPEQUE led to the adoption of an agreement, which allows prisoners to have access to condoms each month. COMCAVIS TRANS also supports LGBTI prisoners living with HIV to adhere to their treatment and monitors their access in order to ensure their psychosocial and emotional well-being. 

In El Salvador, LGBTI people continue facing a climate of discrimination and violence, exacerbated by high levels of impunity and limited access to justice. “El Salvador is a country with one of the highest rates of violence in Latin America and, as it is the case throughout the region, the life expectancy of a transgender woman does not exceed 35 years,” said Ms Avelar.

She supports LGBTI people who have suffered human rights violations and acts of violence. Together with her team and the group of volunteers, she advises them and accompanies them to file a complaint. Thanks to the collaboration of other organizations, she makes sure that people in need have open channels to legal and economic assistance. “There are still a lot of barriers,” she says. “However, we are promoting a dialogue with representatives of the national civil police and Office of the National Counsel for the Defense of Human Rights and other authorities to improve the mechanisms to denounce and investigate human rights violations and provide proper and sustained monitoring and evaluation.”

Ms Avelar has also played a significant role advocating for legislation reforms to protect and promote the rights of LGBTI people and address their needs. For example, together with UNAIDS and other national organizations, she participated in a review of an HIV law approved last January. Among other things, the law allows transgender people to receive a better health care free of stigma and discrimination, improve their quality of life and access to health services, education and work, ensuring the respect to their gender identity.

“For all those who know her, Karla Avelar is already the winner of the Martin Ennals Award,” said Celina Miranda, UNAIDS Country Director for El Salvador. “In the midst of all adversity, she is a tireless advocate for human rights, making a difference in the lives of lesbian, gay, bisexual, transgender and intersex people in El Salvador.”

About the Martin Ennals Award

The Martin Ennals Award is an annual prize for human rights defenders. Finalists and the laureate are selected by a jury of 10 of the world’s leading human rights nongovernmental organizations.

UNAIDS is working with partners to reaffirm that the full enjoyment of all human rights and fundamental freedoms for all supports the global response to the AIDS epidemic, including in the areas of prevention, treatment, care and support, and address stigma and discrimination against all people living with, presumed to be living with, at risk of and affected by HIV as a critical element in ending the AIDS epidemic and as outlined in the 2016 United Nations Political Declaration on ending AIDS.

At the upcoming World Health Assembly, which will take place in Geneva, Switzerland, from 22 to 31 May, the new Director-General of the World Health Organization will be elected. For the first time, and after a selection process that started in September 2016, all World Health Organization Member States will cast their vote for one of the three final candidates for the position.

Since their nomination, all three candidates have been presenting their ideas and vision around health-related topics. The three final candidates, David Nabarro, Sania Nishtar and Tedros Adhanom Ghebreyesus, have spoken to unaids.org about the AIDS epidemic and global health.

Question: As Director General of WHO, what will be your three priorities to advance progress in ending AIDS by 2030 as part of the Sustainable Development Goals?

DAVID NABARRO

The first priority must be to stop tackling HIV/AIDS as an isolated issue and make services for people affected by HIV/AIDS an integral part of universal health coverage, and also linked with services for other chronic diseases.

The second is to review the lessons of work to empower people at risk of HIV/AIDS using a Sustainable Development Goal (SDG) lens and then use the information derived from this review as a basis for mainstreaming HIV-related action across all the SDGs (see below).

Just as the AIDS movement redefined public health between 2000 and 2015, it now needs to help bring public health into the SDGs with a completely new narrative. This narrative must emphasize the interconnections between the SDGs and the need to leave no one behind, and show that health is central to achieving this.

SANIA NISHTAR

To defeat the epidemic, the World Health Organization (WHO) needs to continue work in partnership and push the ambitious agenda approved at the United Nations General Assembly High-Level Meeting on Ending AIDS. Universal access to early safe treatment—getting to universal coverage still needs a lot of work—and countries need support to be able to work out how to deliver lifelong treatment. WHO will strive to be sure that we are on top of the evidence and able to fail fast and fix fast as new evidence sheds light on how to reach people and sustain them on treatment to reduce the community viral load.

Only then can we expect to curb transmission. For prevention—while we now have some effective interventions to programme—we still need to add to our toolkit and WHO will work to ensure new evidence and experience is brought into programmes as quickly as feasible. Addressing HIV requires universal health coverage for the core evidence-based package, a rights-based approach and an understanding of the key role of social determinants.

With that in mind we need to focus on ending transmission. This means continuing to promote universal testing and treatment, with a focus on the most vulnerable groups, including adolescent girls and people who use drugs, understanding the value of pre-exposure prophylaxis and, of course, ultimately we need a vaccine.  

WHO’s role in this is to continue to provide evidence-based policy guidelines and build up our toolkit to make progress towards universal health coverage. We know that countries are struggling to implement the existing guidelines. WHO needs to continue to bring rigor, evidence and a public health approach to the response so that we can provide practical and clear guidance on how to deliver services in different contexts (rural, urban) and to those people that don’t normally have contact with the health system.

WHO also needs to support countries to have the data and management systems in place to deliver a real-time public health response, with a view to actually preventing transmission. 

TEDROS ADHANOM GHEBREYESUS

Over the last 20 years, we have made tremendous progress on combating AIDS. I commend the advocacy and leadership role of UNAIDS in achieving these results and coordinating and harmonizing the United Nations system’s response to the AIDS epidemic. If elected as Director-General, I will have the following three priorities as part of the health sector AIDS response.

First, I will champion efforts to sustain the progress we have made so far without complacency and to renew our commitments to end AIDS as a public health problem by 2030. The global commitment for the Sustainable Development Goals offers a profound opportunity to tackle the structural, social and economic changes needed to end AIDS. I will ensure the World Health Organization (WHO) is part and parcel of these efforts, working alongside UNAIDS, the United Nations system, Member States, civil society and community groups.

Second, my topmost priority as Director-General of WHO will be universal health coverage, and I will work to ensure that each person living with HIV has access to the HIV prevention, treatment and care services they need. We will give due emphasis to HIV prevention and addressing comorbidities, such as HIV-associated tuberculosis, as well as the growing concern of noncommunicable diseases. Universal health coverage will also help key HIV populations, such as sex workers, men who have sex with men, people who inject drugs, transgender people, migrants and adolescents, reach HIV prevention, treatment and care services. WHO will provide Member States with the normative tools, guidance and support they need to implement these policies.

And finally, I would prioritize building strong, community-based health systems which can design and implement locally tailored prevention and treatment programmes. This will include strengthening primary health-care systems to deliver HIV prevention, treatment and care. Ensuring investment in health systems will not only help us manage HIV/AIDS, it will also support our efforts to prevent and treat other communicable and noncommunicable diseases, as well as prevent and respond to future health emergencies.

READ INDIVIDUAL INTERVIEWS

DAVID NABARRO	SANIA NISHTAR	TEDROS ADHANOM GHEBREYESUS

Question: How important do you feel the lessons learned in the AIDS response are in shaping the future of global health?

DAVID NABARRO

The response to AIDS taught us a great deal, and was extremely important in shaping global health. First of all, it taught us to focus on the people and patients, as opposed to the medical condition or the virus. By shifting the focus in this way, the movement was effective in engaging civil society and a wide range of actors in combatting the condition, and, importantly, also the stigma attached to it. The second important issue brought to light in the AIDS response was ensuring that all persons at risk—whatever their place in society—were able to have full access to the services they needed: leaving no one behind. Hard work was done to ensure that HIV status, a person’s gender, sexual preference or substance use should never be an excuse for discrimination, which is certainly crucial to all global health areas of work. Thirdly, the AIDS response demonstrated the importance of multistakeholder and intersectoral approaches and broke new ground in providing a good model of how to work in an integrated way across agencies on complex health issues within the United Nations.

SANIA NISHTAR

The AIDS response more than any other has taught us four critical lessons for the future of global health. The power of ambition, power of community engagement, the benefits of a multisectoral response and lessons to reorient acute-care health systems towards chronic disease management.  

On the first point, the AIDS community was one of the first to push for universal access. Seen as heretical at the time, the AIDS community said everyone, everywhere can and should be treated. Through South–South cooperation antiretrovirals were made accessible to those that needed them most and millions of people are now alive because of it.   

Second, the AIDS response has shown us that the community matters and health is everybody’s business. Community health workers trained in treatment literacy were key to breaking down social stigma and encouraging people to get tested and to take up treatment.

Thirdly, the AIDS response has shown us the power of partnership and while the outcome of a disease may be a health outcome (e.g. people get sick or die) prevention and treatment on a universal scale requires engagement of all players—government, private sector, faith-based organizations, community-based organizations, civil society, academia—and all sectors—education, food security, water and sanitation, transportation.

In the fourth place, the scale-up of services in lower-income countries has created the first large-scale continuity care programmes. Although HIV and chronic noncommunicable diseases (NCDs) are thought of as different challenges, there are many commonalties, as far as the health systems response is concerned, since the availability of treatment has transformed HIV into a chronic condition. HIV programmes have developed the systems, tools and approaches needed to support continuity of care. These lessons can help in mainstreaming the management of NCDs in country health systems planning.

Overall, we have also learned that we cannot see any disease area in isolation—to address HIV/AIDS we need an effective, strong system, which means people, funding, hardware, leadership and data to drive decision-making.

Our experience with HIV has shown us the shortcomings of systems built around one-time episodic care and that success is only possible when the beneficiary and the provider embark on a journey together as part of the continuum of care. As countries are grappling with a declining burden of communicable disease and a rise of NCDs, we need to build strong health systems that are sustainable and more responsive. This requires a long-term view focused on both people and systems.

TEDROS ADHANOM GHEBREYESUS

I have no doubt that the lessons we learned in the AIDS response have been critical to shaping the future of global health, both in terms of what we need to do and how we need to do it. The AIDS response first and foremost taught us the importance of political advocacy, community mobilization and determination to overcome despair with ambition and solidarity. The lessons of the AIDS response showed us the value and power of multistakeholder engagement and that we cannot address a health issue at its root only by focusing on the health sector. We also learned that with global solidarity we can innovate and mobilize dramatic domestic and international resources for health, which not only had a profound impact on HIV, but also on the broader health system. For example, when I was a Minister of Health of Ethiopia, we created a 2% HIV Solidarity Fund (a pool fund of 2% salary contributions of civil servants) to initiate our HIV treatment programme. Particularly in the face of changing political climates, we need this type of creativity, commitment and multisectoral response as we work to place universal health coverage at the centre of the implementation of all Sustainable Development Goals.

Question: As the AIDS response has scaled up to reach millions, one of the key challenges has been the lack of community health workers and the capacity of the health system to deliver services at the scale. How will you address the challenge of building up the health system to prepare for the next disease outbreak and to meet current health challenges including AIDS and non-communicable diseases?

DAVID NABARRO

Governments are increasingly focused on how best to develop health-care infrastructure and staffing so that all people are enabled to access essential health care while—at the same time—ensuring that there are appropriate facilities within which care can be offered to persons who have or are at risk of HIV/AIDS, providing them with health services and lifestyle information. Governments seek to ensure that procurement mechanisms for AIDS medicines work well and enable people in need to access the medicines and take them as directed. They also work hard to ensure the necessary political support to ensure that health infrastructure is rolled out in ways that are sensitive to the needs of people living with HIV. The services offered should take account of the reality that people living with HIV may well end up developing noncommunicable diseases. To this end, national authorities in several countries are looking for ways to incorporate AIDS care within the programmes for chronic diseases. All governments will wish to encourage regional and global collaboration on funding, on technical assistance, on ensuring access to medicines and diagnostics and on securing access to vaccines as they become available.

SANIA NISHTAR

Here you raise three separate but important issues: the lack of health workers, the need to deliver services at scale and the challenge of building health systems, and how best to prepare for the next disease outbreak.

First, community health workers form the backbone of health services in many countries—in many cases the health workers are women. We must do better in remunerating these women on time for their work, as a pure volunteer model is not sustainable in the long run if we want to retain this part of the workforce. More broadly, implementation of the recommendations of the High-Level Commission on Health Employment and Economic Growth will work well, both for addressing health workers’ shortages as well as economic growth and health systems strengthening, overall.

I have always believed that strong health systems can deliver on any disease-specific goal. In fact, this has been the message of my book, Choked Pipes. In addition to disease-specific targets, strong and effective systems can also be crucial for the response to pandemics. I will ensure WHO embarks on a course to strengthen the international framework to coordinate and consolidate efforts towards the achievement of universal health coverage, with health systems strengthening as one of its key features. This will also include efforts to overcome systemic barriers and address collusion in health systems, and provide technical support to countries to develop new stewardship mechanisms to tap the potential of providers of services in the non-state sectors, which play a predominant service delivery role in many parts of the world. Under my leadership, WHO will promote universal health coverage as a health policy goal for all countries, and will help ministries of health galvanize commitment at the head of state level. Embracing universal health coverage means building on previous commitments to primary health care and including long-term social policy commitment, domestic resource allocation and a move linking coverage for essential services to financial risk protection.

Finally, on disease outbreaks, there are actions to be taken both in countries as well as within WHO. WHO must work more effectively with Member States to enhance their core public health capacities as demanded by the International Health Regulations. Improvement in disease surveillance will improve health planning, and quick detection and response to outbreaks will save lives. Internally within WHO a new Health Emergencies Programme has been initialized, which I am strongly supportive of and which I will strengthen as a priority. 

TEDROS ADHANOM GHEBREYESUS

Scaling up community health workers and health system capacity must be a fundamental component of our efforts to achieve universal health coverage, which will be my topmost priority if elected as Director-General. These efforts can build on the tremendous progress made and experiences gained in the last two decades tackling HIV, tuberculosis, malaria, neglected tropical diseases, and child and maternal mortality. As part of this effort, we also need to strengthen primary health-care systems with integrated community engagement to address communicable and noncommunicable diseases, such as cancer, heart disease, chronic respiratory diseases, diabetes and injuries. These efforts will help not only to deliver evidence-based health promotion, prevention, treatment and rehabilitation services, but also to enhance prevention, detection, response and recovery efforts for health emergencies.

As Director-General, I will build on my first-hand experience addressing this capacity gap in Ethiopia to support Member States and national health authorities’ efforts to develop and implement policies aimed at ensuring universal health care. In Ethiopia, for example, our flagship Health Extension Programme deployed nearly 40 000 community health workers in every village of the country. HIV prevention was one of their key activities—a focus which has resulted in a 90% reduction of new HIV infections between 2001 and 2012. WHO has a key role to play in sharing these types of lessons learned across countries. It also needs to help build and maintain partnerships among the diverse group of players involved in global health—country governments, donors, the private sector, civil society and academics—to overcome barriers to achieving universal health coverage, including improving access to quality diagnosis and care, essential drugs and financial protections. Finally, I will also work to put and keep universal health coverage on the agenda at the highest political levels possible, maintaining the political will and resources needed to achieve these goals.

Question: How will you ensure that people affected by HIV especially key populations-such as sex workers, gay and other men who have sex with men, people who inject drugs, transgender people and migrants are not left behind in efforts to achieve universal health coverage.

DAVID NABARRO

I see many examples of health professionals, civil society, faith groups, the United Nations and others with an interest working with governments with a view to reducing the stigma in relation to persons who are at risk of HIV and reducing the extent to which they are subject to discrimination that results in their not being able to have proper access to care. To be better able to do this work, health professionals and other stakeholders need support so that they can practice in ways that reduce stigma and discrimination, need access to evidence, need to be able to interact with the general public and need to be able to work closely with each other in solidarity, as it can be challenging and difficult work associated with setbacks as well as successes.

SANIA NISHTAR

Everyone has a right to health. As with all areas of its work, while recognizing the criticality of national sovereignty, to fulfil its mandate of health for all, WHO must also be the steward and champion of both the right to health and a human rights approach to health.

The 2030 Agenda and the Sustainable Development Goals reaffirm the responsibility of Member States to “respect, protect and promote human rights, without distinction of any kind as to race, colour, sex, language, religion, political or other opinions, national and social origin, property, birth, disability or other status,” signalling a renewed commitment to human rights in the coming global health and development agenda.

Throughout my work as a doctor, in government, civil society, academia and working with international agencies, I have always based my work on the foundation that everyone has the right to quality health services. It was this strong grounding that led me to set up an innovative financing facility in Pakistan that assists the poorest and most marginalized communities to avoid catastrophic expenses when accessing health. I will continue to walk the walk on the right to health as Director-General of WHO.

TEDROS ADHANOM GHEBREYESUS

Our efforts to achieve universal health coverage need to prioritize the needs of the vulnerable and marginalized. Specifically, I believe WHO must champion mechanisms to meaningfully listen to, learn from and engage these groups. This engagement—and what we learn from it—should then be at the centre of our efforts to mobilize resources and hold authorities accountable for the health of all, regardless of age, gender, income, sexual orientation or religion. In addition, it will be essential to improve our evidence base around effective ways to reach the most vulnerable and most marginalized. New research can help us develop data-driven and results-oriented solutions, which will help us maximize the impact of interventions we invest in. Part of this effort will also require us to build and improve the infrastructure for data collection and ensure that the data we collect are used to inform policies. Lastly, WHO is ideally positioned to address inequality in health care, and, if I am elected Director-General, I will be a strong voice and committed champion to ensuring everyone has the right to health care.

Question: What does UNAIDS mean to you? 

DAVID NABARRO

UNAIDS is a very important expression of the spirit and solidarity with which we all need to work together to empower actions that will lead to a reduction of the disadvantage and suffering experienced by people who are at risk of HIV and AIDS, as well as those who are actually affected by the disease. It has had a powerful influence on the behaviour not only of the United Nations system but of the whole community of actors engaged in ensuring equitable access to requirements for HIV/AIDS prevention, diagnosis and treatment.

SANIA NISHTAR

UNAIDS was one of the first examples of a partnership that harnessed the strengths and core competencies of all the United Nations agencies. Under the stewardship of UNAIDs, the United Nations has driven an ambitious agenda, and collectively we have pushed farther and faster towards ending the epidemic—ambitious goals for access to treatment and prevention of mother-to-child transmission of HIV are being met in some countries, and, for the first time, epidemic control and ending transmission seems as possible in a handful of African countries hardest hit.

UNAIDS has also played a key role to keeping a human rights-based approach to our response and ensuring that access to critical prevention and treatment is extended to key populations at risk, including harm reduction for intravenous drug users, and adolescents. UNAIDS has also led the way on how we in health can work with multiple actors—civil society, communities, volunteers and the private sector—to improve coordination and to better leverage the skills, experiences and resources of partners.

TEDROS ADHANOM GHEBREYESUS

I will start with a personal note. It has also been a great pleasure and honour to have had a chance to chair the Programme Coordinating Board (PCB) during my time as Ethiopia’s Minister of Health in 2009–2010, and to consider UNAIDS a close partner for more than a decade. It was during my time on the PCB that UNAIDS increased its focus on health systems strengthening and HIV prevention, including country ownership—setting the stage for our universal health coverage efforts. We also worked to implement the new UNAIDS mission statement, which outlined its priorities and vision for the future.

I believe UNAIDS’ provocative leadership has been critical in addressing the AIDS epidemic and converting it from a death sentence to a chronic health condition. Its global role has not only garnered the highest political support for the AIDS response, but also ensured the voices of those affected by HIV and their families are at the centre of the response, including placing civil society within its governance structure. I believe consolidating these experiences will be useful to tackle the structural, social and economic changes needed to end AIDS as part of the Sustainable Development Goals. I also take note of the recent recommendations of the Global Review Panel on the Future of the UNAIDS Joint Programme Model.

If elected Director-General of WHO, I would look forward to continuing our work together and our close partnership.

Sitting in his Mini Cooper, sporting traditional Bavarian lederhosen and a smart black waistcoat, Maik is a picture of health. It is hard to believe that nine years ago he was fighting for his life.

Maik is a 43-year-old engineer and test driver for a large German car manufacturer. He speaks slowly and softly, “Back then I didn’t think I’d ever drive a car again.”

Nine years ago Maik had left his doctors baffled. He had lost 30 kilos, and had become very ill. At the back of his mind, Maik knew he might have HIV—as a gay man he knew he was at higher risk of infection, but he was careful, and his last HIV test, 10 years ago, was negative. But he was worried. “I had the old pictures of AIDS in my head,” he said. “I was very scared.”

Despite the unmistakable symptoms, his doctor didn’t offer him an HIV test, but sent him home with throat lozenges for his mouth infection. “For me,” said Maik “This was proof enough that I didn’t have HIV.”

It was only when he was referred to a specialist that the possibility of HIV was raised and Maik was offered an HIV test. The results came back positive. Maik had HIV and his immune system was weakening. “I thought, I’m going to die because I didn’t have the courage to take an HIV test.”

At home he gave his partner the choice. “Either leave now or stay and watch me die.”

His partner stayed and Maik was given antiretroviral therapy.

Incredibly, just six weeks later, he was back at work. “I have been improbably lucky,” said Maik. He now works a full 40-hour week and makes time for sport.

Maik has shared his story to inspire and encourage others to test for HIV as part of the campaign by the German nongovernmental organization Deutsche AIDS-Hilfe to end AIDS in Germany by 2020. The campaign, Kein AIDS für Alle, aims to stop new HIV infections and ensure that by 2020 no one in Germany will develop AIDS.

“Ending the AIDS epidemic is within reach for Germany and ensuring that people know their status and can access treatment is critical to reaching that goal,” said Michel Sidibé, Executive Director of UNAIDS.

HIV treatment has been available in Germany for more than 20 years, preventing the onset of AIDS and allowing people living with HIV to live longer, healthier lives. However, it is estimated that every year more than 1000 people in Germany develop AIDS because of late diagnosis or because they are not accessing treatment.

“There are many reasons why people don’t take an HIV test. Some think they’re not at risk, even doctors don’t always recognize the need to test for HIV,” said Silke Klumb of Deutsche AIDS Hilfe. “There’s also still a huge fear of stigma and discrimination in Germany. And, unfortunately, not everyone has access to HIV services; undocumented migrants, for example, are one group that is being left behind.”

The Kein AIDS für Alle campaign will inform people about the risks of HIV infection and show that a positive test for HIV is not a death sentence, but the first step to living a long and healthy life.

“Don’t wait until it's too late,” affirms Maik. “Get tested regularly. A positive HIV diagnosis is a dramatic experience. But you can live well with HIV, providing you get treatment.”

HIV is the virus that causes HIV infection. AIDS is the most advanced stage of HIV infection.

The campaign will aim to eliminate stigma and discrimination around HIV and encourage members of key populations to access HIV prevention, testing, treatment and care services through innovative initiatives. There will also be support for doctors as part of efforts to improve timely diagnosis of HIV.

Deutsche AIDS Hilfe is an independent, non-profit association with 120 autonomous member organizations, including AIDS and drug treatment service organizations, HIV prevention projects, gay and lesbian centres and housing and home care projects. Together, they are committed to HIV prevention, treatment care and support and advocacy around HIV in Germany.

As part of efforts to achieve the commitments in the 2016 United Nations Political Declaration on Ending AIDS, UNAIDS is working to support community-led service delivery and build the capacity of civil society organizations to deliver HIV prevention, treatment and care services based on a non-discriminatory approach that respects, promotes and protects human rights.