When Angelina Twoki Terso arrived at the Juba Teaching Hospital’s antenatal clinic in 2004, when one month pregnant with her third child, she met with an HIV counsellor but didn’t think there was a need to get tested for HIV. Ms Twoki thought only people who smoked, drank and did things that she considered immoral contracted HIV.

Her first husband had died a few years before and she had never known the cause of his death. She remembers the counsellor telling her that anyone can contract HIV and she should consider getting tested, just to be sure. When the results came back a few hours later and she learned she was HIV-positive, Ms Twoki was in shock.

“I was going to commit suicide,” said Ms Twoki. “I wanted to run to the Nile. I was going to run there and jump in.” But the counsellor explained that she could get treatment at the hospital to keep her healthy and prevent the transmission of the virus to her baby.

She enrolled in the prevention of mother-to-child HIV transmission (PMTCT) programme and returned every month to the hospital for a check-up and to get her medication. She delivered her baby at the hospital and her daughter, Grace, who is now nine years old, is confirmed free of HIV.

Ever since Grace’s birth, Ms Twoki has dedicated her life to helping other women access and adhere to PMTCT services. She visits eight different antenatal clinics in South Sudan’s capital, Juba. “Every day I share my testimony. Most of the women are accepting testing for HIV because they want to know their status. They want to stay healthy for their family and they want to have a healthy baby. It’s very important,” said Ms Twoki.  

The main problem, she said, is that there are not enough sites where PMTCT services are offered in South Sudan. She counsels women who have to walk more than 12 hours to reach Juba to access services and medicines. She says, despite her best efforts to convince them to stick with the programme, dozens drop out owing to the long distance. “They complain. They say they are tired of running here. The place is very far and they don’t have transport,” said Ms Twoki.  

There are only 75 facilities scattered across South Sudan that have integrated PMTCT services. In 2013, an estimated 2600 children were infected with HIV through mother-to-child transmission, and only 2% of children living with HIV had access to life-saving treatment.

Martha Cayad-an, health specialist at UNICEF, stresses the need to scale up access to quality PMTCT services in South Sudan—especially in rural areas, where more than 75% of women live—and to embed such services in a broader range of health services.

“Rather than asking women to go to one place for an HIV test and to another for immunization, health centres must offer integrated services,” said Dr Cayad-an. “When it’s a one-stop shop, the facilities become more user-friendly for women and children and therefore they attract more clients.”

However, scaling up HIV services will require substantial improvements to the country’s health sector, which is plagued by too few sites, too few health workers and a general shortage of resources as a result of decades of war.

Emmanuel Lino, Deputy Director of HIV/AIDS Services at the Ministry of Health in South Sudan, said the government is committed to scaling up integrated maternal and child health-care services.

“Only 22 PMTCT sites in the country provide antiretroviral treatment, but we are hoping that once the resources are available, those stand-alone PMTCT services will eventually be integrated with long-term HIV prevention and treatment, tuberculosis and malaria services,” said Dr Lino.

Dr Lino acknowledges that it will take time, certainly more than what will satisfy the needs of women living with HIV and advocates such as Ms Twoki. But he said the country is trying to lay the foundation for a system that will not just reduce future infections among children but that provides the comprehensive services to keep the nation healthy. 

Alexei injected drugs for over 15 years before opioid substitution therapy (OST) changed his life. He has now not injected drugs for the past three years, after starting an OST programme at the Psychiatry–Narcology Clinic in Minsk, Belarus.

“I had to do unimaginable things to find at least U$ 50 per day to sustain my heroin addiction,” said Alexei. “Since becoming a client of the methadone programme, I have not injected drugs, have completed my studies, got a job at the local factory and started a family. Thanks to this programme, I am still HIV-negative and I have my life back.”

Belarus aims to sustain and scale up its HIV prevention programme for people who inject drugs. Today, more than 1000 people who used to inject drugs are enrolled on the OST programme, which is available at 18 sites. Clients go every day to a participating health clinic to take a dose of methadone, which helps to treat their addiction to opiates.

About 30% of the people enrolled are living with HIV, and OST is used as a key tool to enhance their adherence to antiretroviral therapy. People who are HIV-negative rely on the programme to avoid HIV infection, as the virus can be transmitted through unsafe injecting.

Evgeny Golubitskiy, a psychiatrist/narcologist and head of the OST programme at the Minsk Oblast Narcology Clinic, said that the people who have graduated from the programme at his clinic are successfully managing their addiction to drugs, which has a positive impact on their overall health. In addition, he said that only one client had become infected with HIV in over four years of the programme.

According to a study conducted in Belarus, each dollar invested in OST programmes will produce a US$ 6 return. By treating people who inject drugs, savings are made with respect to possible HIV treatment, crime and unemployment. Research also shows that the employment rate among people receiving OST has jumped from 26% to 54% since the programme’s implementation.

“The results of the OST programme are clear and positive,” said Vasily Zharko, Minister of Health of Belarus. “We plan to continue these services by gradually increasing financing and support from the state’s budget."

Belarus plans to double the number of people receiving OST, to 2000, by the end of 2015. The target for 2020 is to have 10% of the 75 000 people who inject drugs in the country on the programme.

During his first official trip to Belarus, Vinay Saldanha, UNAIDS Regional Director for Eastern Europe and Central Asia, visited the OST programme at a health clinic in Minsk and learned that it also provides psychological and social support.

"The harm reduction programme in Belarus, including opiate substitution therapy, is impressive," Mr Saldanha said. “The OST programme in Belarus is saving lives and preventing the spread of HIV among clients.”

The Prime Minister of Cambodia, Hun Sen, has committed to stopping new HIV infections by 2020 and ensuring the sustainability of its HIV response. This comes as Cambodia allocates US$ 3.7 million of national funding to HIV treatment from 2015 to 2017. This is the first time that the government has earmarked funds for its treatment programme, which, owing to the large numbers of people receiving antiretroviral medicines, is where resources are most needed.

The Prime Minister reaffirmed the national commitment to HIV, tuberculosis and malaria programmes during his meeting with the UNAIDS Director of the Regional Support Team for Asia and the Pacific, Steve Kraus, in Phnom Penh, Cambodia. The Prime Minister said “the government will not allow any successful programme to go bankrupt.” He further stressed that “the key to the nation’s success against HIV is a concerted effort by everyone, especially people infected and affected by HIV.”

The country’s progress in its AIDS response has already been internationally recognized. New HIV infections have dropped by 67%, from 3500 in 2005 to 1300 in 2013. More than two thirds of the 75 000 people living with HIV receive antiretroviral therapy, the highest percentage of treatment access in the region. Nearly 80% of mothers living with HIV have received treatment preventing HIV transmission to their children. However, challenges remain. There are high rates of HIV infection among key populations at higher risk of HIV, including men who have sex with men, people who inject drugs, transgender people and entertainment workers. Gaps in access to HIV services persist.

During his meeting with the Prime Minister, Mr Kraus congratulated Cambodia for its remarkable progress and continued strong national leadership. He noted in particular that strategic and well-managed domestic and external investment will further transform the AIDS response.

Cambodia is optimizing available resources by implementing more focused and efficient approaches for HIV prevention, treatment and care, particularly for key populations. More than 24 000 people in key populations used community-led fingerprick testing to learn their HIV status during the year to October 2014. People who test HIV-positive are accompanied by peers and counsellors to clinics to receive HIV treatment. Harm reduction services, including needle and syringe programmes, are also being expanded.

During his visit, Mr Kraus visited the Smartgirl programme, which empowers entertainment workers to know their sexual and reproductive health and rights and offers integrated access to family planning and HIV counselling and testing. Mea Sopheap of Cambodian Women for Peace and Development, which is implementing the Smartgirl programme, said, “we are proud to be part of the solution and work closely with the community, the local authorities and entertainment places.”

Recently the country adopted a landmark ministerial regulation to improve occupational safety and health and working conditions at entertainment places. The policy is the first of its kind in the Asia–Pacific region and reinforces labour rights for entertainment workers, including protection from sexual harassment and access to health services. This is one example of how Cambodia is using HIV programmes to find solutions to other health and human rights issues, an example that could be a model for the region, according to Mr Kraus.

Global musical artist Rihanna joined UNAIDS Executive Director Michel Sidibé and leaders of the MAC AIDS Fund at the Hollywood opening of a new documentary film focused on how the AIDS epidemic is affecting young people around the world.

The film, It’s Not Over, profiles the lives of three young people from India, South Africa and the United States of America. Directed by award-winning director Andrew Jenks in partnership with the MAC AIDS Fund, the film explores how young people are responding to the epidemic through activism, partnerships and social networking.

“Our global quest to end the AIDS epidemic as a public health threat aims to ensure that young people can come of age in a world that is safer, healthier and more just,” said Mr Sidibé. “This film shows how young people are using emerging communications and social networking technologies to raise awareness about the epidemic and advocate for continued attention to HIV.”

The partnership of the MAC AIDS Fund and UNAIDS has a particular focus on young people. Together, the MAC AIDS Fund and UNAIDS are working to encourage young people to learn their HIV status, leveraging social networking, film and other tools.

In 2014, a grant from the MAC AIDS Fund supported UNAIDS’ efforts to deliver HIV treatment and care for adolescents and young people worldwide.

The Fund is fully supported from the sale of Viva Glam Lipstick and Lipglass, with Rihanna lending her celebrity to spur purchase and awareness.

The United States of America unveiled on 3 December two new initiatives to scale up efforts to end the AIDS epidemic by 2030.

Reaching out to some of the most vulnerable populations being left behind in the AIDS response, the new initiatives will focus on adolescent girls and on speeding up the development and delivery of drugs to treat paediatric AIDS. 

These new United States commitments will bring attention to the urgent need for more effective programmes to reduce the disproportionately high levels of new HIV infections in young women and to urgently scale-up treatment services for children.

UNAIDS Executive Director Michel Sidibé welcomed the announcement and commended the United States President's Emergency Plan for AIDS Relief (PEPFAR) on its significant achievement  in increasing the numbers of people on HIV treatment.

“We congratulate PEPFAR on these two new initiatives. If we are to meet our goal of ending the AIDS epidemic by 2030, we must all fast-track our work to reduce new infections to less than 500 000 a year, scale-up treatment to meet the 90-90-90 targets, and eliminate stigma and discrimination,” said Mr Sidibé. “We will continue to need the United States to help lead the way towards the achievement of these ambitious targets.”

PEPFAR also released a new report titled PEPFAR 3.0 – Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation. The report documents the programme’s progress and unveils PEPFAR’s strategy for working with partners to reach the UNAIDS 90-90-90 targets and to achieve an AIDS-free generation.

The PEPFAR programme is currently providing life-saving HIV treatment to 7.7 million people and has provided HIV testing and counseling for more than 56 million people in 2014.

The continued existence of compulsory drug detention and rehabilitation centres across Asia remains a serious concern. People who are suspected of using drugs or being dependent on drugs, people who have engaged in sex work or children who have been victims of sexual exploitation are often detained in these centres without due process in the name of treatment or rehabilitation.

There are serious human rights issues concerned with compulsory drug detention and rehabilitation centres and they threaten the health of the detainees, including through increased vulnerability to HIV and tuberculosis infection.

Physical and sexual violence, forced labour, substandard conditions, denial of health care and other forms of human rights violations have been documented in many centres. Although reported in many parts of the world, compulsory drug detention and rehabilitation centres are most prevalent in Asia. According to official accounts reported in 2012, more than 235 000 people were detained in over 1000 compulsory drug detention centres in East and South-East Asia.

HIV prevalence among people who inject drugs is estimated to be 28 times higher than among the general population. Stigma, discrimination and punitive laws greatly contribute to the high HIV prevalence among people who use drugs and prevent the provision of evidence-informed drug dependence treatment and HIV services.

In a 2012 joint statement on drug detention and rehabilitation centres, 12 United Nations entities noted that there is “no evidence that these centres represent a favourable or effective environment for the treatment of drug dependence.” The statement further calls on those states that maintain these centres to close them without delay, to release the people detained and to provide appropriate voluntary health care and drug dependence treatment for people in need, at the community level.

There has been coordinated and concerted action by the United Nations system at the country, regional and global levels to engage governments on the issue. These efforts have supported a series of intergovernmental dialogues in Asia that have promoted emerging best practices in implementing evidence-informed and rights-based drug dependence treatment.

However, progress at the country level has remained largely insufficient. Some countries in the region have recently been reported to be planning to increase the capacity of their drug detention centres, or to consider legislation to further entrench them.

During a recent visit to Asia, UNAIDS Executive Director Michel Sidibé called for accelerating reform towards voluntary and community-based drug treatment programmes as a human rights and public health imperative. “Now is the time for pragmatism and evidence. Countries must expand rights-based policies and programmes that work in addressing drug dependence and vulnerability to HIV,” said Mr Sidibé.

The urgent need to expand evidence-informed and rights-based drug dependence treatment in Asia is clear and needs to be a central part of upcoming discussions on drug policy and health, such as the third intergovernmental dialogue on compulsory drug detention centres in Asia in 2015 and concrete advances made ahead of the 2016 United Nations General Assembly Special Session on Drugs.

At its 35th meeting, in December 2014, the UNAIDS Programme Coordinating Board will hold a series of discussions on reducing HIV transmission among people who inject drugs as a critical component of efforts to end the AIDS epidemic by 2030.

When looking after people in health-care settings, health-care workers can be exposed to a broad range of infections, including HIV. Accidental exposure to HIV in health-care settings can largely be prevented by countries creating an enabling environment and providing the services that allow health-care workers to protect themselves and others from the risk of HIV infection. However, the use of criminal law can lead to miscarriages of justice.

In Uganda, the High Court of Kampala has released Rosemary Namubiru, a 64-year-old nurse living with HIV who was convicted of negligently exposing a child to HIV while at work. The decision of the High Court to release Ms Namubiru, who has been in detention since January 2014, comes after several months of advocacy and legal procedure.

A coalition of civil society organizations, legal experts and public health professionals led the efforts and, with the support of UNAIDS, engaged the government and the judiciary to advocate for a measured, evidence-informed and rights-based response to the case.

“I am relieved that dignity has prevailed and that Ms Namubiru can return to her family,” said UNAIDS Executive Director Michel Sidibé, who joined efforts to support her release. “I thank all those in Uganda and globally who have supported this outcome. Let us continue our efforts to expand evidence and human rights as critical to ending the AIDS epidemic.”

When Sopheap comes back from work at 2 a.m., she tiptoes around her one-room flat, because everyone is sleeping. The 35-year-old mother slides into the bed she shares with her two young sons and catches a few hours of sleep, before getting up to make breakfast.

“I’m the family breadwinner. I support my boys, my niece and my mother,” said Sopheap. “I also send money home to my brothers and sisters.”

Like other mothers working the night shift, she enjoys being able to spend her days in quality time with her children: playing, cooking and caring for them. At night her own mother babysits.

Sopheap is an entertainment worker, who spends her evenings in a beer garden in Phnom Penh. She got into the business after she moved to the Cambodian capital seven years ago—a far cry from her job as a fruit and vegetable seller in the local market in her home town.

“I make about US$ 120 a month now, that’s a lot more than what I brought in as vendor. Before, I couldn’t make ends meet,” said Sopheap.

Like many other Cambodian entertainment workers, with her finances precarious she decided to head for the capital. She says she was lucky because she was pretty and liked to sing. Her first job was entertaining clients in a restaurant and then she moved to her current establishment a year ago.

“It’s not easy. You know sometimes the men force us to drink. They harass us and can even become violent. But I’m lucky because my boss is understanding. If we aren’t feeling well, he even lets us take sick leave,” said Sopheap.

Sick leave is one of the basic worker rights recognized by Cambodia’s Labour Law, but until recently few entertainment workers were given that benefit. Now sick leave is recognized as a right for all entertainment workers. This comes following last month’s decision by the Cambodian Ministry of Labour and Vocational Training to issue a new ministerial regulation that calls for the protection of the occupational safety and health and labour rights of all entertainment workers. The term entertainment workers applies to a range of people in Cambodia who work in hotels, restaurants, guesthouses, karaoke parlours, discotheques, beer gardens, casinos and massage parlours, among other settings. While Sopheap says she does not engage in sex work, it is generally recognized that the job can lead to paid sex.

The move was welcomed by trade union representatives. “The government has finally recognized that entertainment workers are actually workers like all others and should be protected under labour law,” said Chan Dyna, representative of the National Entertainment Workers’ Network.

Many entertainment workers face poor working conditions, with excessively long hours, low pay and sexual harassment. Employers also often demand that their employees pay penalties when they are late or unexpectedly sick, trapping workers as they try to pay off their debts. The new regulations prohibit such penalties, as well as forced labour of any sort, and forced alcohol and drug consumption and abortions, helping to build an enabling environment for entertainment workers to receive health education and access to health services.  

The International Labour Organization (ILO) is working with the Cambodian Government to train all labour inspectors on the new regulations by June 2015. The training programme includes not only education in occupational safety and labour rights but also HIV prevention and reducing stigma and discrimination of entertainment workers living with HIV.

“This latest positive development in labour rights for entertainment workers really evolved out of all the work that was done around HIV,” said Richard Howard, Senior Specialist on HIV and AIDS at the Regional Office for Asia and the Pacific of the ILO.

Through their participation in HIV programmes, entertainment workers learned not only to prevent and mitigate the impact of HIV, but to call for their sexual and reproductive rights, as well as social protection.

“The HIV movement helped empower women. It built the foundation for solidarity and became a platform for broader rights,” said Mr Howard.

Sopheap is also a peer outreach worker and shares information on HIV with other entertainment workers. “We face a lot of stigma and discrimination. I hope the new guidelines will encourage people to respect us as professional women,” she said. 

The Government of Namibia has launched a three-year strategic action plan to accelerate nationwide HIV testing and counselling. The action plan, launched on 4 November, was developed by the Ministry of Health and Social Services in consultation with the United States Centers for Disease Control and Prevention, the United Nations Joint Team on AIDS and other development partners.

The main aims of the plan are to improve early detection of HIV and create effective linkages to integrated HIV prevention, treatment and care services in Namibia. It will also focus on strengthening linkages to increase early initiation of treatment, improving testing among key populations and scaling up integration of routine testing in clinics.

“The impact of the HIV testing and counselling strategy depends on linkages to care and treatment services, particularly for people living with HIV. This strategy marks our move from emergency response programming to a more sustainable and evidence-based approach,” said Petrina Haingura, Deputy Minister of Health and Social Services.

Government figures show that around 178 200 people living with HIV were receiving antiretroviral therapy in Namibia by the end of 2013. Between 2005 and 2013, Namibia had an estimated 33% reduction in new HIV infections and 8400 fewer AIDS-related deaths. However, most of the people living with HIV in Namibia do not know their status and often come for testing late, preventing timely access to HIV services.

“The new strategy will allow Namibia to move closer to reaching the new UNAIDS 90-90-90 target. Through our continued collaboration, quick response to epidemic changes and creative use of combination interventions we can achieve and AIDS-free generation in Namibia,” said Simon Alogory, CDC Director of the Centers for Disease Control and Prevention in Namibia.

The Executive Director of UNAIDS, Michel Sidibé, was in Namibia for the launch of the plan, where he stressed the importance the new plan would have on achieving the new 90–90–90 targets recently announced by UNAIDS. Achieving the 90–90–90 targets would mean 90% of people living with HIV knowing their HIV status, 90% of people who know their status accessing HIV treatment and 90% of people on HIV treatment having a supressed viral load.

“The 90–90–90 target reinforces everyone’s right to know their HIV status and to access the best possible treatment,” said Michel Sidibé, Executive Director of UNAIDS.

Besides creating linkages to services, 90–90–90 is an essential entry point to addressing challenging social and structural issues, including equity, stigma and violence against women.

The Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Dybul, was also present at the launch. He said, “Integration is about putting people at the centre of our service delivery. It is about bringing communities together to lift up that adolescent girl.”