The second in a series of regional dialogues organized by the UNAIDS and Lancet Commission: Defeating AIDS - Advancing global health was held on 19 November in Bangkok. The need for a new approach to leadership on AIDS in the post-2015 era was the main message emerging from the dialogue.

The aim of the dialogue, which took place during the 11th International Congress on AIDS in Asia and the Pacific, was to gather regional perspectives on AIDS in the post-2015 agenda for inclusion in the work of the Commission.

Participants

UNAIDS Deputy Executive Director, Jan Beagle;  James Chau, National UNAIDS Goodwill Ambassador for China;  Hon Justice Michael Kirby, Chair of the UN Commission of Inquiry on North Korea and Commissioner UNAIDS-Lancet Commission;  Dr Prasada Rao, United Nations Secretary-General’s Special Envoy for AIDS in Asia and the Pacific;  Lyn Kok, President and CEO of Standard Charter Bank (Thailand) as well as parliamentarians, activists, people living with HIV, young people, corporate leaders, academia, and representatives of the UN system and other international organizations.

Key messages

• The need for a new approach to leadership on AIDS in the post-2015 era
• The importance of mobilizing broader partnerships, including with the private sector, to build on the momentum of the AIDS response.
• The need to build on lessons learnt in the response to HIV to strengthen the broader sustainable development agenda.
• Dignity, social justice and equity––essential to the post-2015 framework.

Outcomes

The outcomes of these dialogues will help inform the recommendations of the UNAIDS and Lancet Commission to be presented in 2014. 

Additional regional, think tank and civil society dialogues are planned over the coming weeks: Civil society organizations in Eastern and Southern Africa (25 November); Europe (27 November), as part of the European Development Days; a think tank dialogue at the Institute of Global Governance, University College London (2 December); Caribbean (4 December); Latin America (4 December); Africa (7 December) and Eastern Europe-Central Asia (13 December). The first regional dialogue was held in Addis Ababa on 3 November.

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Renewed commitment needed in Eastern Europe and Central Asia, the Middle East and North Africa and for key populations.

GENEVA, 20 November 2013—Accelerated progress has been reported in most parts of the world. However, there are worrying signs that some regions and countries are not on track to meet global targets and commitments on HIV.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that new HIV infections have been on the rise in Eastern Europe and Central Asia by 13% since 2006. The Middle East and North Africa has seen a doubling of new HIV infections since 2001.

In many cases stalled progress is due to inadequate access to essential HIV services. Key populations including men who have sex with men, people who use drugs, transgender people and sex workers are often blocked from accessing life-saving services.

“Every person counts,” said Michel Sidibé, Executive Director of UNAIDS. “If we are going to keep our pledge of leaving no one behind—we have to make sure HIV services reach everyone in need.”

Investments focused on reaching key populations have not kept pace. Funding for HIV prevention services for men who have sex with men is especially limited in East Asia, the Middle East and North Africa, and across sub-Saharan Africa. Investments lag in a number of countries where HIV prevalence among people who inject drugs is high. Ten countries in which HIV prevalence among people who inject drugs exceeds 10%, allocate less than 5% of HIV spending to harm reduction programmes. Notwithstanding sex workers’ disproportionate risk of acquiring HIV, prevention programmes for sex workers account for a meagre share of HIV prevention funding globally.

While much work needs to be done in Eastern Europe, for the first time in 2012, Ukraine has reported a decline in the number of newly identified HIV cases, representing a new turning point for the country. There are an estimated 200 000 people living with HIV in Ukraine. At 21.5%, HIV prevalence is highest among people who inject drugs.

However, by working together, the Ukrainian government and civil society organizations are striving to provide essential HIV services to support key populations, using evidence to guide investments and programmes. In 2011, Ukraine also amended its AIDS law which now guarantees harm reduction services for people who inject drugs, confidentiality of HIV status for people living with HIV and removal of HIV-related travel restrictions.

More attention needed for children and adults aged 50 and over

In priority countries, only three in 10 children receive HIV treatment under 2010 WHO treatment guidelines. Children living with HIV continue to experience persistent treatment gaps. In 2012, 647 000 children under 15 years of age were receiving antiretroviral treatment. HIV treatment coverage for children (34% (31-39%)) remained half of coverage for adults 64% (61-69%)) in 2012 under the old guidelines.

“We have seen tremendous political commitment and results to reduce mother-to-child transmission of HIV—but we are failing the children who become infected,” added Mr Sidibé. “We urgently need better diagnostic tools and child-friendly medicines—irrespective of the market size.”

Although the number of children receiving antiretroviral therapy in 2012 increased by 14% in comparison to 2011, the pace of scale-up was substantially slower than for adults (a 21% increase). The failure to expand access in many settings to early infant diagnosis is an important reason explaining why HIV treatment coverage remains much lower for children than for adults. In three priority countries, Chad, Democratic Republic of the Congo and Malawi, coverage of less than 5% was reported for early infant diagnostic services in 2012.

An increasingly significant trend in the global HIV epidemic is the growing number of people aged 50 years and older, who are living with HIV. Worldwide, an estimated 3.6 [3.2–3.9] million people aged 50 years and older are living with HIV. This “aging” of the HIV epidemic is mainly due to three factors: the success of antiretroviral therapy in prolonging the lives of people living with HIV; decreasing HIV incidence among younger adults shifting the disease burden to older ages; and the often-unmeasured, and thus often overlooked, fact that people aged 50 years and older exhibit many of the risk behaviours also found among younger people.

Global AIDS data

New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33% reduction since 2001. New HIV infections among children have been reduced to 260 000 in 2012, a reduction of 52% since 2001. AIDS-related deaths have also dropped by 30% since the peak in 2005 as access to antiretroviral treatment expands.

By the end of 2012, some 9.7 million people in low- and middle-income countries were accessing antiretroviral therapy, an increase of nearly 20% in just one year. In 2011, UN Member States agreed to a 2015 target of reaching 15 million people with HIV treatment. However, as countries scaled up their treatment coverage and as new evidence emerged showing the HIV prevention benefits of antiretroviral therapy, the World Health Organization set new HIV treatment guidelines, expanding the total number of people estimated to be in need of treatment by more than 10 million.

Significant results have also been achieved towards meeting the needs of tuberculosis (TB) patients living with HIV, as TB-related deaths among people living with HIV have declined by 36% since 2004.

Despite a flattening in donor funding for HIV, which has remained around the same as 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. The total global resources available for HIV in 2012 was estimated at US$ 18.9 billion, US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

Speaking at a forum on AIDS leadership held in Bangkok on 18 November, the President Ratu Epeli Nailatikau of Fiji, emphasized the importance of continued leadership to accelerate progress in Asia and the Pacific. He highlighted work towards the ‘Getting to zero’ vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. President Nailatikau stressed that while progress has been made, there is a need to continuously review and renew efforts and commitments to ensure sustained progress.

The leadership forum took place on the eve of the 11th International Conference on AIDS in Asia and the Pacific (18-22 November). The regional conference and was attended by more than 100 representatives from governments, international organizations and civil society groups.

UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle highlighted the need for greater focus in the region’s response to HIV. She noted that by ensuring key populations (such as men who have sex with men, sex workers and people who inject drugs) have access to HIV services—will have a major impact in terms of HIV infections prevented and lives saved. 

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The Executive Director of UNAIDS delivered a key note address at the Congrès de l'Association Internationale des Maires Francophones (AIMF) at the Hôtel de Ville de Paris on “Shared Responsibility and the AIDS response”. The high-level session was attended by French President François Hollande and President Abdou Diouf, Secretary-General of La Francophonie. The event was hosted by Bertrand Delanoe, Mayor of Paris and President of AIMF and included more than 120 mayors of major cities from La Francophonie.

In his remarks, UNAIDS Executive Director highlighted President Hollande’s leadership on AIDS as an example of his commitment to social justice and cited France’s €1B commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria’s upcoming replenishment meeting as an example of France’s leadership on AIDS.

President Hollande cited UNAIDS as the example of global mobilization, and reiterated France's commitment. 

Mayor Delanoë reiterated the common values of La Francophonie—diversity and the promotion of human rights –demanding that francophone mayors advocate for the right to equal freedom of movement, regardless of one’s HIV status. The meeting concluded with a call to adopt a new resolution for a ‘Francophone world with zero HIV-related stigma and discrimination’.

During his participation at the Congress, the Executive Director of UNAIDS also met with French civil society organizations engaged in the HIV response with the City of Paris. In the majority of Francophone countries, large urban cities account for 20% to 60% of national epidemics.

Since 2001, the City of Paris has devoted €20.5 million to support the HIV response in local communities in Francophone cities, mainly in sub-Saharan Africa. With this funding, Parisian AIDS NGOs work in partnership with the City of Paris to support African civil society programmes for HIV testing, prevention, treatment and social support.

In an interactive dialogue, the community of French NGOs called on UNAIDS to continue to focus on HIV in the cities in La Francophonie, many of which are still lagging behind despite commendable progress in the global AIDS response. They called UNAIDS to lead a new global mobilization in La Francophonie for scaling up of HIV treatment and preventing new HIV infections among children.

Video

Excerpt from the speech of François Hollande, President of France addressing Congrès de l'Association Internationale des Maires Francophones (AIMF) at the Hôtel de Ville de Paris on "Shared Responsibility and the AIDS response". 

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More innovation, story-telling and new products for UNAIDS website.

Ahead of World AIDS Day, UNAIDS has released a newly designed website for a more visual and streamlined user experience. The new design features all the latest information about UNAIDS––available through a range of multi-media options.

“We have seen phenomenal progress in the AIDS response,” said Annemarie Hou, Director of Communications and Global Advocacy. “Now we can better share stories about the people, the data and the evidence behind the successes.”

The platform’s clean, uncluttered design focuses on providing the user with faster ways to find and share information. New ways of presenting UNAIDS core work through images, story and photo galleries are now available––all which have been optimized for smart phones and tablets.

“We know more people get their inspiration on the go—so we’ve tried to make the website a visual experience for every visitor,” added Ms Hou.

The site also highlights progress towards the goals and targets set by the United Nations Member States, as well as advances towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. 

PCB delegates attends a lesson on comprehensive sexuality education at a primary school in Lusaka.

An international delegation of the UNAIDS Programme Coordinating Board (PCB), made a recent visit to Zambia from 4-6 November to learn more about the successes and challenges in a country where almost 13% of the adult population is living with HIV. 

“The AIDS response in Zambia is at a tipping point and now is not the time to become complacent about HIV but to build on the significant gains achieved.” said UNAIDS Deputy Executive Director Jan Beagle who was leading the visit.

There has been significant progress in reducing overall HIV prevalence and scaling up access to treatment, as well as in stopping new HIV infections among children. Yet there is an increasing number of new infections among young people, relatively low rates of testing, and lack of access to services for key populations.

The delegation included members from Australia, Brazil, Congo, India, Norway, Poland and Zimbabwe, as well as representatives of PCB NGOs and UNAIDS Cosponsors who met with a range of stakeholders in Zambia’s multi-layered, multisectoral response to HIV. The delegation met the Vice President, the First Lady, the Minister of Health, the Minister of Chiefs and Traditional Affairs, government officials, development partners, and civil society and youth representatives, including people living with HIV.

The meetings provided an opportunity for the delegation to express support and to discuss the importance of shared responsibility and global solidarity in the AIDS response. Ms Beagle welcomed the development of a national investment case which explores what is needed for an effective and targeted response to HIV which is focused on results.

PCB Delegation in Lusaka. From left to right: Ms Ebony Johnson (NGO Delegation), Dr Tapuwa Magure (Zimbabwe), Ms Sheila Tlou (UNAIDS), Mr Joel Nana (NGO Delegation), Ms Joanna Glazewska (Poland), Ms Helen Frary (UNAIDS), Ms Cristina Raposo (Brazil), Mr Morten Ussing (UNAIDS), Ms Fenande Mvila (Congo), Mr Alastair Mckenzie (Australia), Ms Jan Beagle (UNAIDS).

At a UNAIDS reception the First Lady, Dr Christine Kaseba stressed the need to address HIV as a public health imperative with great attention to rights and highlighted the specific vulnerabilities and needs of women and girls and men who have sex with men.  

During the visit the delegation also participated in the third National HIV Prevention Convention, opened by the Vice President, who spoke about the vital role of traditional leaders and chiefs in behaviour change.

In addition the PCB saw the on-the-ground realities of the epidemic and met people most affected by HIV with visits to a prison, clinic and school. The delegation attended a class on comprehensive sexuality education and met with young people living with HIV who demonstrated their willingness to discuss sexuality, take responsibility for protecting their own health, and help guarantee a healthy future for Zambia's next generation.

“The visit to Zambia was an excellent opportunity for a PCB delegation to see the particular challenges of a severe epidemic in Africa and to see the positive impact of UNAIDS’ work in bringing together all stakeholders in support of an effective response that delivers real impact," Ms Beagle concluded.

Men who have sex with men have been particularly affected by the AIDS epidemic.  Across the European Union a multi-country survey found that in 2010 around 8% of men who have sex with men were reported to be living with HIV. In 2012, France reported the highest HIV prevalence among men who have sex with men at around 18%, followed by Spain, Greece, Germany, Switzerland, Belgium and Portugal, all with rates well above 10%. The dual stigma and discrimination which continues to surround HIV and homosexuality is one of the barriers preventing people from accessing lifesaving HIV services.

On 6 November leading European policy makers, experts, lesbian, gay, bisexual, transgender and intersex (LGBTI) human rights activists and HIV organizations came together in Brussels to highlight the severe impact of HIV for LGBTI communities in Europe. At the European Parliament hearing “Achieving the right to health of LGBTI people – How can we reverse the crisis of HIV, health and human rights affecting LGBTI people in Europe” the participants discussed ways forward to strengthen rights of people affected by HIV in compliance with the EU Charter on Fundamental Rights.

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The first of a series in regional dialogues organized by the UNAIDS and Lancet Commission: Defeating AIDS - Advancing global health was held on 3 November in Addis Ababa. One of the main messages that emerged from the consultation was the need to include ambitious and measurable targets towards ending AIDS in the post-2015 development agenda.

Co-convened by the United Nations Economic Commission for Africa (UNECA) and UNAIDS, the Africa-focused dialogue was held on the margins of the Africa Regional Consultative Meeting on the Sustainable Development Goals. The aim of the consultation was to stimulate debate on how to ensure that the achievements of the AIDS response are carried forward to the new development agenda that is currently being worked on to replace the Millennium Development Goals when they expire in 2015.

Participants included officials from the African Union Commission, Regional Economic Communities, Ministers, Ambassadors, African Members of Parliament, as well as representatives of civil society, including networks of people living with HIV, young people, the private sector, and the UN system and other international organizations.

Over the coming weeks, additional regional dialogues are planned, including for Latin America (18 November), Asia-Pacific (19 November), Southern Africa (7 December) and Eastern Europe-Central Asia (13 December). The outcomes of these dialogues will help inform the recommendations of the UNAIDS and Lancet Commission to be presented in early 2014. 

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The World Council of Churches (WCC), a fellowship of Christian Churches, opened its 10th Assembly in the South Korean city of Busan on Wednesday 30 October. Some 3000 delegates from more than 100 countries gathered to focus on the theme ‘God of life: lead us to justice and peace.’

UNAIDS Executive Director Michel Sidibé was invited to participate in the conference and began his visit with a lively meeting with people living with HIV and people working on HIV through church communities across the world. He also met with the Anglican Archbishops of Canterbury, South Africa and Burundi where they discussed the role of the Church in the HIV response and the importance of speaking out to break the silence around sexual violence and HIV as well as the importance of access to affordable medicines.

Mr Sidibé was asked by the Assembly organisers to give a talk which would set the tone for the WCC Assembly’s discussions on ‘Justice and Peace’ and give direction for the WCC’s future action. Recognizing the critical role of churches in health care world-wide he the challenged delegates to push the boundaries on sensitive issues such as sexuality, to speak out against injustice, to push forward the drive to provide medicines for everyone in need and to rise to the challenge of bringing the most marginalized to the table where policy is set and decisions are made. 

Mr Sidibé was joined in the thematic plenary session by the Anglican Bishop of Colombo, Dr Tawfik, a Theologian from the Coptic Orthodox Church of Alexandria and MÉlisande Schifter, a young theologian from Germany who challenged participants to focus their rich experience into suggestions for action to young people present at the Assembly. 

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Shifting demographics of the AIDS epidemic demands a new focus to reach people above the age of 50––a population currently underserved by HIV services.

GENEVA, 1 November 2013—The United Nations Joint Programme on HIV/AIDS (UNAIDS) has released a supplement to the 2013 UNAIDS Report on the global AIDS epidemic focused on the issue HIV and aging.

The supplement reveals that out of the global total of 35.3 million [32.2 million – 38.8 million] people living with HIV, an estimated 3.6 million [3.2 million–3.9 million] are people aged 50 years or older. The majority––2.9 million [2.6 million–3.1 million]—are in low-and middle-income countries where the percentage of adults living with HIV who are 50 years or older is now above 10%. The supplement also reveals that in high-income countries almost one-third of adults living with HIV are 50 years or older.

“People 50 years and above are frequently being missed by HIV services,” said Michel Sidibé, UNAIDS Executive Director. “This is costing lives. Much more attention needs to be given to their specific needs and to integrating HIV services into other health services which people 50 years and over may already have access to.”

The “aging” of the HIV epidemic is due to three main factors: the success of antiretroviral therapy in prolonging the lives of people living with HIV, decreasing HIV incidence among younger adults––shifting the disease burden to older ages, and that people aged 50 and above are engaging in risk taking behaviour such as unprotected sex and injecting drug use which are leading to new HIV infections.

The supplement highlights that HIV prevention services, including HIV testing, tailored to the needs of people aged 50 and above, are essential and that these services should also reflect the needs of key populations in this age group. The supplement also outlines the importance of timely initiation of antiretroviral therapy as the immune system weakens with age.

The supplement concludes that HIV responses therefore need to adapt to this important demographic trend. It also underlines the need to integrate HIV services for people over the age of 50 with other health screening services available to this age group.