In the north-eastern city of Malakal in South Sudan, an HIV support network with around 150 members met on a regular basis to talk about the challenges they faced in accessing antiretroviral medicines and the food they needed to stay healthy. But in 2013, when the civil war broke out and fighting reached Malakal, everything changed.

Hundreds of people were killed and thousands more fled their homes, many to the camp run by the United Nations Mission in South Sudan (UNMISS) in the outskirts of Malakal. Only six of the members of the network found their way to the camp. Joseph Leggi Pio, who works at the HIV Unit in UNMISS and was one of the founding members of the group, doesn’t know what happened to the rest.

Life isn’t easy for anyone in the camp, but it can be especially difficult for people living with HIV. Medical facilities inside the overcrowded camp are facing logistical problems, including shortages of antiretroviral medicines and food and long waiting times to see health workers. Mr Pio said one of the patients living with HIV at the camp had recently died. Another person managed to move to Juba, where there is better access to HIV treatment services. Many more people living with HIV regularly visit Mr Pio’s office to find out when the medicine will arrive.

More than 100 000 internally displaced people are crammed into 10 UNMISS protection sites throughout the country, none of which were built to shelter anywhere near that number of people.

“Everything is a priority,” said Leku Dominic Samson, Senior Medical Assistant with the International Organization for Migration. “The HIV needs are only starting to be addressed.” Health workers have focused on emergency first aid, while also dealing with widespread diarrhoea and an increasing number of malaria cases.

The Government of South Sudan and health workers are committed to finding ways of providing HIV prevention and treatment services to internally displaced people in the UNMISS sites. Humanitarian organizations and United Nations agencies, including UNMISS, UNAIDS and the Office for the Coordination of Humanitarian Affairs, provided technical and financial support to open an additional primary health-care centre, where HIV testing and counselling services are available.

These organizations are also advocating to install a CD4 machine at the United Nations Hospital in the Malakal camp to help health workers monitor the viral load of people living with HIV. In the meantime, HIV prevention and treatment messages are being disseminated to more than 20 000 people living in the camp.

“Awareness is always an issue in the camp as people continue to arrive from all over the country, including rural areas where access to health information is limited,” said Mr Pio. He added that people’s behaviour in the camps, where they tend to take more risks, is worrisome. He is especially concerned that young people, many of whom were separated from their families during the fighting, are having unprotected sex, at times due to lack of access  to condoms.

Mr Pio and other health activists are training groups of HIV counsellors to mobilize people around the camp to talk about HIV and encourage them to protect themselves. The counsellors also take this opportunity to distribute up to eight boxes of condoms a day.

The counsellor trainings and community dialogues are beginning to show positive impact. For example, Tungwar Wuor—a resident at the Malakal camp—said he had little knowledge about HIV before he went through the training session to become a counsellor in March. Now he has red ribbons on all his clothes and talks easily about how people can protect themselves and others from HIV infection. “I wanted to help other people know their HIV status and how to prevent HIV,” said Mr Wuor. “HIV infection is something that can be stopped.”

He added that many people are initially wary when he starts talking to them about the virus, because of the stigma associated with HIV. He said some of them associate HIV with immorality. He has also been working with religious leaders to include HIV prevention messaging in their services.

“I explain to them that it is possible for anyone to contract the virus if they do not protect themselves and that people living with HIV can access treatment to lead positive lives,” said Mr Wuor. 

To commemorate this year’s Mother’s Day, UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) released a new video and special website featuring mothers who are HIV-positive.

In 2013 and 2014, UNICEF and the Global Fund asked six women in South Africa and Malawi to share their reflections, hopes and fears as they went through their pregnancies and the delivery of their babies, and in the months after their children were born.

A Journey of Motherhood acknowledges the particular challenges HIV-positive mothers experience to give birth to healthy HIV-negative children, and to remain healthy themselves. The initiative also stresses the progress made in providing HIV medicines to prevent new HIV infections among children worldwide.

Each year, approximately 1.5 million women living with HIV give birth. With no medical intervention, the risk of passing on the virus to their babies during pregnancy, delivery and the breastfeeding period can be as high as 45%. But today, medicine to prevent mother-to-child transmission of HIV—a single, daily pill—reduces that risk to 5% or less.

The man known as Geng Le, who launched Blued, the world’s largest gay dating smartphone application, was a respected police officer in China almost 20 years before he left the force in 2009 after fellow officers objected to working with him because of his sexual orientation.

Now Geng Le is the Chief Executive Officer of the Danlan gay men’s network, the non-profit organization behind Blued. During a meeting 6 May with UNAIDS Executive Director Michel Sidibé in Beijing, China, Geng Le pledged to expand Danlan’s HIV prevention programme.

Blued has almost 15 million users, mostly in China, but its popularity is growing outside the country. As a service to its users, it provides information on the risks of unsafe sex and the rights of men who have sex with men. Users are asked questions aimed at increasing their knowledge of HIV treatment, prevention tools and care options. In addition, they are pointed to locations where they can access HIV testing and counselling.

Geng Le said, “We are doing our best to use science and technology to improve the lives of lesbian, gay, bisexual and transgender communities, including their health. Our vision is that all young people can live in dignity, be free of stigma and discrimination and share love no matter where they come from, what they are doing, what their sexual orientation is and what their HIV status is.”

Mr Sidibé’s visit included a demonstration of the application and an online exchange with users.

Danlan runs a free HIV rapid testing outlet, which provides services to men who have sex with men in partnership with public health agencies. “Danlan is an example of an organization for the future. It protects the rights of people not reached by services, everywhere," said Mr Sidibé.

Danlan has organized campaigns against discrimination and gives technical support on web-based HIV prevention and treatment initiatives. It is expanding into other countries and is currently establishing offices in the United States of America and Thailand. 

The clean energy company Hanergy Holding Group and UNAIDS have agreed to cooperate on philanthropic and corporate responsibility initiatives to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths in Africa.

The Chair of Hanergy, Li Hejun, and the Executive Director of UNAIDS, Michel Sidibé, signed a memorandum of understanding in Beijing, China. Under the deal, UNAIDS and Hanergy will work together on a number of social development programmes and will partner to bring clean power solutions to the continent. They will work directly with communities, focusing on the health and education sectors.  

Li Hejun said, “We are committed to building on our work on AIDS and expanding our initiatives to African countries. It is not only a responsibility, it’s the right thing to do.”

Mr Sidibé said, “The provision of clean energy to households, schools and health facilities within Africa is central to ensuring that the total well-being of people is at the centre of a healthy society.”

The agreement was signed during a joint mission to China by Mr Sidibé and Mark Dybul, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). One of the objectives of the visit was to encourage new strategic partnerships between China and Africa, including investments in infrastructure and the economy and innovation in health and human development.

Africa imports 80% of its antiretroviral medicines. Many of the active ingredients come from China. Mr Sidibé and Mr Dybul met with Chi Jianxin, Chief Executive Officer of the China–Africa Development Fund, to promote joint ventures between China and African countries on the local production of medicines and health commodities. They also offered technical support from both organizations on enabling strategic partnerships.

Mr Dybul said, “There is huge potential for cooperation between China and Africa on innovation and the transfer of technology in many sectors and we look forward to taking this further.”

The China–Africa Business Council will promote communication and understanding between young people in China and Africa with the Towards Zero AIDS youth social benefit campaign. Mr Sidibé attended the launch of the campaign at Beijing’s University of Science and Technology and encouraged young Chinese people to show leadership in the AIDS response. The campaign is organized and run by young people from 60 universities in China.

Wenxia Li, a student from Beijing Forestry University, said, “We call for action on safe sex, we call for using condoms properly so that we and others can enjoy a healthy life.”

Mr Sidibé also participated in a policy dialogue on better health in China and Africa. Also present were the Ambassador of Djibouti, Abdallah Abdillahi Miguil, Feng Yong, Director for Africa at the Department of International Cooperation, China National Health Family Planning Commission, and Christoph Benn, Director of External Relations at the Global Fund.

Ambassador Abdullah Abdillahi Miguil said, “For the African continent to go beyond where it is now for its people, we need to build the capacity of our people for innovation.”

The dialogue sought to identify areas of cooperation and innovation and the types of strategic partnership between China and African countries that can be galvanized to support better health. 

Young people in eastern and southern Africa, like many of their peers around the world, often receive conflicting and inaccurate information about sex. This can lead to badly informed decisions about how, when or with whom to have sex and how to protect themselves against HIV. 

With support from UNAIDS, UNESCO and SAfAIDS a major regional series of radio and TV programmes has been launched to address this gap. It is designed to deliver comprehensive sexuality education to young people and give them a forum to discuss issues around sex and sexuality, in a region where HIV prevalence is high. Across Africa, AIDS-related illness is still the leading cause of death among adolescents, and adolescent girls and young women are especially vulnerable to new HIV infections.

According to Charity Banda, HIV/AIDS Coordinator at Zambia’s Ministry of Education, this move is very important. “By facing puberty without being prepared, young people are left confused and unsupported. This ultimately makes them vulnerable to high-risk behaviours that increase their chances of contracting HIV. That’s why this new initiative is so timely.”

The series was first launched in Zambia on 21 February 2015 and is set to be broadcast in five other countries later this year: Malawi, Mozambique, Namibia, South Sudan and United Republic of Tanzania. The Zambian series has 26 TV episodes,  13 radio episodes and includes a 15 minute live talk show every Saturday called The Sexuality Talk Challenge.  

It is being aired on the largest television and radio network in the country, the Zambia National Broadcasting Corporation, which reaches more than 4 million people every day on TV alone. The programmes are being translated into several local languages.  

Guests on the show include young people, youth-led organizations, teachers, government officials, policy-makers and civil society representatives. Topics discussed on air have touched on: love, sex and healthy relationships; self-esteem and understanding yourself and your rights as an adolescent; peer pressure; and challenging misconceptions. One episode has also been dedicated to improving communication between young people and the significant adults in their lives.   

“Evidence has shown that teenagers who have discussed issues with their parents or guardians are more likely to make safer, smarter decisions about sex and their sexuality,” said Patricia Machawira, UNESCO’s Eastern and Southern Africa Regional Advisor on HIV and Education. “This includes waiting longer to begin having sex, having fewer sexual partners, using contraception and having the confidence to say “no” to doing anything they are not comfortable with,” she added.

The series’ frank and open discussions have already been sparking debate. The partners hope that by the time the programme finishes its run in Zambia at the end of June such discussions will have helped break down barriers to communication, with access to accurate information empowering young people to make informed choices for a better, healthier future.

As Medhin Tsehaiu, UNAIDS Country Director for Zambia, sums up, “Information is power and young people need to be equipped with the right information and skill to make right decisions.”

Strengthening and expanding community-based approaches to delivering HIV treatment is vital to the long-term success of the AIDS response, according to a report launched on 20 April by Médecins sans Frontières (MSF) and UNAIDS.

The report highlights MSF’s innovative approaches to the critical challenge of how to scale up treatment to ensure that people living with HIV have access to antiretroviral therapy through ways that fit in with their daily lives.

Taking place in London, on the occasion of the Board Meeting of the Partnership for Maternal and Child Health and of the Strategy and Coordination Group of Every Woman Every Child initiative, the launch was an opportunity to show that the meaningful involvement of the community in antiretroviral therapy delivery, adherence and retention initiatives works. It was emphasized that the scale-up of financing and implementation of community-based service delivery will be essential to end the AIDS epidemic by 2030.

During the launch, Amina Mohammed, the Secretary-General’s Special Adviser on Post-2015 Development Planning, said, “I am glad that we have an opportunity to be reminded of the importance of ensuring that services and commodities reach the people and communities most in need.”

According to Tom Decroo, Operational Research Coordinator at MSF, “This document presents experiences of how community-based antiretroviral therapy delivery can improve both the level of access to HIV treatment and the quality of health outcomes for people living with HIV. They are not one size fits all solutions, but they illustrate that community-based antiretroviral therapy delivery is efficient, effective and responds to the specific needs of people.”

Despite the progress made—there were 13.6 million people on treatment as of June 2014—there is still a long way to go. Only 38% of adults living with HIV and under a quarter of all children living with HIV have access to the life-saving medicines.

Luiz Loures, UNAIDS Deputy Executive Director, noted that the move towards greater emphasis on community involvement could help better identify people in need of treatment, especially among the most marginalized and hard to reach populations. He stressed that community-based antiretroviral therapy delivery is not only good for individuals, their families and their communities, but has been shown to be more cost-effective, owing to better uptake, adherence and lower service provision cost.

Mr Loures also agreed that the pivotal role that civil society and communities have traditionally played in the AIDS response will need to be bolstered further.

“UNAIDS has launched a call for countries to Fast-Track towards ending the AIDS epidemic by 2030. If we are to reach this goal, we expect that by 2020 the percentage of community-based services will need to increase from 5% to 30%. I am proud to share with you today the efficient and effective innovations by MSF. UNAIDS will continue to support the many other organizations who are working to strengthen community-based service delivery to ensure all people in need have access to HIV treatment.”

The publication presents a number of concrete models of relevant and appropriate community-based antiretroviral therapy delivery systems that are adapted to their particular contexts. These strategies have been explored in eight countries: Democratic Republic of the Congo, Guinea, Kenya, Lesotho, Malawi, Mozambique, South Africa and Zimbabwe. They are largely focused on patients who have been taking HIV medication successfully for some time and who have no concurrent illness and immune systems that are showing signs of improved health.

Examples of community-based antiretroviral therapy programmes include: adherence clubs, where peer counsellors dispense medicines and complete basic medical checks; free community antiretroviral therapy distribution points closer to patients’ homes; self-formed community antiretroviral therapy groups, where members take turns to collect medicines from the clinic and distribute them to others living nearby; and appointment spacing and fast-track refills in which clinical consultations occur less often and medicines are obtained for a longer period.

Adapted to a variety of situations, most of these often unconventional strategies have demonstrated reduced burdens for patients and health systems. They have resulted in more people staying on medication, lowered service provider costs and helped enable people living with HIV to live healthier and more productive lives. 

In the lead up to International Women’s Day, UNAIDS Deputy Executive Director Jan Beagle joined a group of women living with HIV in Auckland, New Zealand, to hear about their experiences. The meeting was one of the regular meetings of Positive Women, a support organization for women living with HIV and their families. The group works on raising awareness of HIV in the community through educational and anti-stigma programmes.

Jane Bruning, National Coordinator of Positive Women Inc. said, “Living with HIV can be very isolating as many women don’t want to tell anyone about their status. So it’s extremely important to have a safe space where women can gather and speak openly without fearing they will be judged.”

Ms Beagle, who is originally from Auckland, said she was touched by the women’s stories. “I’ve visited women living with HIV in many countries, but it is special to hear from women living with HIV in my own country. I am moved by their stories and I am committed to work with them to address the stigma and discrimination that is so much a part of their daily lives.”

The women told Ms Beagle about their fear of disclosing their status publicly. Their reasons were often different. For some, there was concern over losing their employment, while others were worried their children would be ostracized because their mother is living with HIV.

Judith Mukakayange, who is now open about her status, said she came to New Zealand 15 years ago as a refugee, fleeing civil war in Rwanda. When she arrived she was overjoyed to start a new life. However, that dream quickly crumbled when as part of her application process to emigrate she took an HIV test and learned that she was HIV-positive. “When you hear you have HIV you feel so isolated, so it’s important to connect to other people who understand you,” said Ms Mukakayange.

“I have this story that I don’t tell anybody. Even my close friends don’t know. I just can’t say I have AIDS. It’s awkward, awkward, awkward. Coming here to Positive Women is great. I can’t imagine life without Positive Women,” another woman at the meeting said.

From the early days of the AIDS epidemic, New Zealand has taken a lead in the response. The country implemented evidence-informed programmes to ensure that key populations at higher risk of acquiring HIV received priority attention. In 1987, New Zealand was among the first countries to introduce needle exchange programmes for people who use drugs. It was also a regional pioneer in decriminalizing sex work and sex between men.

These initiatives are widely credited with having curbed the epidemic in the country. New Zealand has a very low HIV prevalence, with the Ministry of Health reporting around 0.1% of adults aged 15 to 49 living with HIV. In 2013, around 180 people were newly diagnosed with the virus.  

However, despite this progress, people living with HIV still face stigma and discrimination. A recent survey conducted by local AIDS organizations found that 50% of people surveyed would be uncomfortable having food prepared by someone living with HIV.

Of Positive Women Ms Bruning said, “We may be a small organization but we punch well above our weight. I am proud of what we do.”

During the 36th meeting of the UNAIDS Programme Coordinating Board, held in December 2014 in Geneva, Switzerland, unaids.org spoke to Joel Goldman, the Managing Director of The Elizabeth Taylor AIDS Foundation (ETAF), about how HIV programmes funded by private foundations are contributing to ending the AIDS epidemic, the work done by ETAF and the future of the AIDS response.

What is the goal of The Elizabeth Taylor AIDS Foundation?

ETAF is a nonprofit organization established by Elizabeth Taylor in 1991 to raise awareness and funds to respond to AIDS and to grant assistance to people living with HIV. Today, we support AIDS organizations in the United States of America and around the world—33 countries to date—which deliver direct care and services to people and/or provide HIV prevention education. ETAF has donated more than US$ 15 million in funding thus far.

What makes The Elizabeth Taylor AIDS Foundation unique?

Before she died, Elizabeth Taylor made provisions for her estate to cover all of ETAF’s operating expenses. This means that when people donate to our organization, 100% of every dollar goes directly to caring for people living with HIV and towards funding HIV prevention programmes. In addition, Ms Taylor deemed that 25% of all likeness and image royalties from her estate go to ETAF. So when someone buys an Elizabeth Taylor fragrance, like White Diamonds, or buys from the Elizabeth Taylor jewellery collection on QVC, they are also doing good and contributing to the response to AIDS.

How has the foundation evolved since its creation? And where do you see it going in the future?

Elizabeth Taylor co-founded amfAR in 1985 as a means for researchers to discover treatments and ultimately find a cure for AIDS. As HIV-positive people began to live longer, she also wanted to find direct ways to care and nurture people living with HIV. Since she faced many personal medical issues throughout her lifetime, she recognized the importance of access to medical care, housing, nutritious food and support as a way to fight illness. In 1991, Ms Taylor founded ETAF.

Through ETAF, she funded HIV prevention programmes on sex education, needle exchange, access to condoms, etc. No matter how publically unpopular the topic, she moved it forward. Ms Taylor was one of the fiercest advocates in Washington, DC, and on the global political stage for these and many other issues, including human rights for people living with HIV. Elizabeth Taylor remained at the helm of ETAF until she passed away in 2011.

As we move forward in this legacy era, ETAF is still dedicated to Ms Taylor’s vision of care, education and prevention. In November 2014, our Trustees and Advisory Board members reaffirmed our founder’s original mission and will focus current funding with three priorities in mind: marginalized populations, advocacy and innovation.

What do you think are today’s greatest challenges to an effective response to AIDS? And where can ETAF have the biggest impact?

The biggest challenge in the response to AIDS is the complacency that exists around the issue today, especially among young people. This is evident by the fact that the adolescent death rate from AIDS-related illnesses has risen by 50% over the last decade.

Although she is no longer with us, Elizabeth Taylor’s reputation and brand still retain the cache to partner with the right celebrities, the most effective organizations and foundations, the best corporations and strategic global leaders, like UNAIDS. There are also future marketing campaigns and programmes in the works that will reignite the conversation and heighten awareness for HIV education and prevention among the most vulnerable people.

Is there a particular project funded by the foundation that touched you personally or that you are most proud of?

I am most proud of the Global AIDS Interfaith Alliance (GAIA) / Elizabeth Taylor Mobile Health Clinics in Malawi. Ms Taylor recognized that chronic lack of access to health care is the biggest barrier in the battle against HIV in Africa. She said, “If people cannot get to health care, why can’t we get health care to the people?” In 2008, ETAF partnered with GAIA in creating mobile health clinics that provide HIV testing and prevention programmes to the most affected regions of Malawi. Every day of the week, our seven clinics rotate to a new location. Last year, an average of 1000 patients were treated each day, with 40% of them being children under the age of five.

For 2015, we are proud to acknowledge an important milestone in the Elizabeth Taylor mobile health clinic programme: every one of the 900 000 residents in Malawi’s Phalombe and Mulanje districts now lives within a one hour’s walk to life sustaining health-care services. This is a great achievement, especially given the challenging road infrastructure of the country.

On a personal level, I was diagnosed HIV-positive 23 years ago at a time when few HIV prevention programmes existed. So the projects that touch me most are those that promote HIV prevention among young people. When ETAF funds initiatives like the University of California, Los Angeles, Sex Squad to expand its education programme to high schools and colleges in the Southern region of the United States of America, or Grassroot Soccer to complement our mobile health clinics in Malawi, I am personally excited by these thoughtful, innovative and effective approaches reaching young people.

What do you think is the role of foundations in today’s global health landscape?

Foundations can fill the gaps in which some governmental agencies cannot work. Many private and family foundations have the ability to be flexible and fund innovation at a quicker rate. I was inspired by the UNAIDS Programme Coordinating Board’s bold declaration to end AIDS by 2030. However, many speakers said that the world would need to do business differently in order to achieve this objective. This is where foundations can play a role. If we band together in support of UNAIDS’ message on all fronts, while simultaneously pouring our collaborative efforts into developing and funding projects that bring us closer to this goal, our collective muscle can propel us forward.

Elizabeth Taylor brought AIDS out of the shadows and into the national and global spotlight. Now, it is up to us to take up her mantle, keep up the momentum I witnessed in Geneva, and eliminate this disease. Now is the time, especially when ending the AIDS epidemic is just beyond our grasp. 

At a ceremony in Abidjan, UNAIDS Executive Director, Michel Sidibé has honoured the First Lady of Côte d’Ivoire, Dominique Ouattara, for her humanitarian work and her commitment to improving access to paediatric treatment for children living with HIV. 

“Ms. Ouattara’s personal involvement is the clearest sign of her commitment to the most disadvantaged and of her interest in the health of mothers and their children, not only in Côte d’Ivoire but in the whole of Africa,” said Mr Sidibé.

Ms Ouattara is to become a Special Advocate for UNAIDS, helping to raise awareness for programmes aimed at preventing new HIV infections among children and advocating for women and children living with HIV to access antiretroviral therapy.

“This distinction will be a catalyst for my commitment to the elimination of AIDS. From now on, every action to prevent mother-to-child transmission of HIV in Côte d’Ivoire, in Africa and in the world will find a favourable echo in me. I am fully engaged in this fight and I will remain committed until we reach an AIDS-free generation,” said Ms Ouattara.

Ms Ouattara has been involved in humanitarian issues for many years. In 1998, she created the Children of Africa Foundation, which has supported several projects in Côte d’Ivoire, including the construction of a school and a centre for unaccompanied children as well as the promotion of child immunization campaigns.

Calls for renewed efforts to reduce the transmission of HIV and hepatitis C among people who inject drugs were heard at the thematic segment of the 35th meeting of the UNAIDS Programme Coordinating Board (PCB), which took place in Geneva, Switzerland, on 11 December.

Speakers at the thematic segment included former President of Switzerland Ruth Dreifuss, a member of the Global Commission on Drug Policy, Efi Kokkini, the chair of the Greek Drug and Substitute Users Union, and representatives of United Nations Member States and organizations such as the United Nations Office on Drugs and Crime, the World Health Organization and the World Bank.

Key issues associated with HIV and injecting drug use were raised, including opportunities for and barriers to implementing harm reduction strategies. Examples from several countries focused on partnerships between governments and civil society that have proved successful in reducing the transmission of HIV among people who inject drugs.

“We need to examine what has failed and what can be done differently,” said UNAIDS Executive Director Michel Sidibé. “Reaching the 90–90–90 targets will not be possible without reducing new HIV infections among people who inject drugs.”

Mr Sidibé said he had witnessed many effective harm reduction programmes throughout the world, stressing that those that enable people who inject drugs to be part of the solution have the greatest impact. He noted that the 2016 Special Session of the United Nations General Assembly on the World Drug Problem was widely seen as critical and offers a key opportunity to redirect and reform global and national policies to reduce the adverse impact of drugs on public health.

In her contribution to the debate, Ms Dreifuss said international drug policy had failed over several decades. She said there needed to be a radical rethink of policies and the construction of practical solutions that respect human rights and empower the people most affected.

Participants at the PCB heard an impassioned contribution from Ms Kokkini, who said people who inject drugs are often excluded from HIV prevention and treatment services. She said that politicians even continued to deny that people inject drugs while in prison.

Detention environments are particularly significant for the issue of HIV and drugs use. In some countries, HIV prevalence among prisoners can be 50 times higher than among the general population, with injecting drug use an ongoing problem in detention settings. During the discussion, PCB participants heard that where implemented, community-based opioid substitution therapies were six times more effective and 12 times less expensive than detention-based programmes.

Major Gairat Rakhmanov, a senior police official from Kyrgyzstan involved in community-based therapies for released prisoners, said the participation of the police and prison services was essential in helping to keeping people who inject drugs alive. Speakers from New York State Health Department and from the peer-led Needle and Syringe Programme described how New York had halted and reversed the HIV epidemic in the decade between 1992 and 2002.

Other participants from Iran, Malaysia and Tanzania described partnerships with various authorities, but each expressed the need to engage with people who inject drugs at every stage of the planning, design and delivery of services for them.

It is currently estimated that worldwide some 12.7 million people inject drugs, around 1.7 million of whom are thought to be living with HIV.