The United Nations Secretary Generals’ Special Envoy on AIDS in Asia and the Pacific Prasada Rao visited the Philippines at the end of August to advocate for a scaled up response to HIV in the country.

After more than 20 years of low rates of new HIV infections, the Philippines is now seeing an increase in the number of new HIV infections among key populations at high risk in certain geographical sites. For example, the HIV prevalence among people who use drugs in Cebu—one of the most populated areas in the country—went form 0.6% to 53% between 2009-2011. Similarly, the HIV prevalence among men who have sex with men in 2011 was as high as 6% in Quezon City and 5% in Cebu—the HIV prevalence among the general population in the country was less than 0.1%. According to the Philippines Department of Health, there has been a 523% increase in new cases compared to 2008.

Speaking at the Executive Committee Meeting of the Philippine National AIDS Council (PNAC) Mr Rao urged increased leadership and rapid action to stem the spread of the epidemic. He also noted that policies, plans, antiretroviral treatment and HIV prevention technologies are all available and within reach to ensure progress on reversing current trends. 

During a meeting with Socio-economic Planning Secretary Arsenio Balisacan, who also heads the government’s National Economic and Development Authority, Mr Rao emphasized the need for greater government investment on HIV, noting that current prevention investments of US$ 8 million - US$ 10 million per year fall short of the estimated need of at least US$ 40 million per year.

Secretary Balisacan agreed that investing now in HIV prevention will lead to savings in HIV treatment costs in the future and shared that both he and the President of the Philippines, Benigno C. Aquino III, have requested the Health Secretary to present a ‘prevention strategy’ for the Health agenda, including the issue of HIV.

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At the end of 2012, 9.7 million people worldwide had access to antiretroviral (ARV) therapy in low- and middle-income countries. Credit: UNAIDS

Experts call for increased access to life-saving HIV treatment. The call, made during a meeting held in New York on 4-5 September, follows the recommendations made last year by the independent Global Commission on HIV and the Law on improving access to HIV treatment.

The Global Commission’s landmark report recommended a new intellectual property framework for pharmaceuticals that would meet urgent public health needs while safeguarding the rights of inventors.

“While intellectual property protections are intended to provide an incentive for innovation, the evidence shows that excessive protection hinders access to affordable HIV treatment and other essential medicines,” Helen Clark, UN Development Programme (UNDP) Administrator told participants at the meeting convened by UNDP and UNAIDS. “Access to affordable, quality-assured pharmaceutical products remains an urgent priority for achieving the MDGs and improving health and development outcomes for poor and marginalized populations,” added Ms Clark.

At the end of 2012, 9.7 million people worldwide had access to antiretroviral (ARV) therapy in low- and middle-income countries, compared to just 300 000 people 10 years earlier. However, UNAIDS and the World Health Organisation estimate that another 16 million people are eligible to HIV treatment but lack access to it.

“We need solutions to increase access to life-saving HIV treatment and the recommendations of the Global Commission clearly outline how a people-centred approach can help ensure no one is left behind,” said Michel Sidibé, UNAIDS Executive Director. 

The World Trade Organization's (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights, known as TRIPS, requires countries to abide to high intellectual property standards, including patent criteria that grant pharmaceutical companies long-term monopolies on medicines. When the TRIPS treaty was signed in 1994, it included terms that allow poor countries to produce or import cheaper medicines under specific circumstances. However, external pressure from wealthier countries has often prevented the application of such special clauses.

“The real crux of the Commission’s Recommendations was for a new intellectual property regime for pharmaceutical products – it is not enough to tweak the existing system,” said J.V.R. Prasada Rao, former Commissioner.

Talks at the meeting focused on strategies, tactics, and timelines to confront the growing need for HIV treatment, including how to make intellectual property laws work better for low-and middle-income countries. Next steps are under discussion.

“We should be encouraged that this meeting comes at a pivotal time when we are discussing the post-2015 development agenda, which presents us with significant opportunities,” said Michael Kirby, former Commissioner.

Federal Councillor for Foreign Affairs of Switzerland, Didier Burkhalter (left) and UNAIDS Executive Director Michel Sidibé.

The Federal Council for Foreign Affairs of Switzerland has announced that it will double its annual contributions to UNAIDS over the next three years. Switzerland will contribute a total of CHF 30 million until 2015 to support UNAIDS efforts in helping countries reach the HIV-related Millennium Development Goals. This contribution makes Switzerland UNAIDS’ eighth largest donor.

“We appreciate Switzerland’s engagement and leadership in the response to HIV and their unwavering confidence in the work of UNAIDS,” said UNAIDS Executive Director, Michel Sidibé. “Switzerland’s forward thinking policy development on harm reduction and its commitment to scientific research have been essential in advancing the response to HIV both domestically and globally. We look forward to continued close collaboration with Switzerland.”

The Swiss Government stated that UNAIDS was ‘the most important multilateral platform in the response to HIV’ and highlighted the key role of UNAIDS in ensuring a coordinated UN response to the epidemic.

As a member of UNAIDS’ Programme Coordinating Board, Switzerland actively advocates for increased efforts to stop new HIV infections among children and young people. It also strongly supports HIV prevention programmes for people at higher risk of infection such as sex workers, people who use drugs and men who have sex with men and has undertaken pioneering work in this domain. 

Switzerland has a unique role in global health as the host country of leading global health organizations.  Switzerland’s continued engagement in responding to HIV and strong partnership with UNAIDS will be critical in helping to shape the future of AIDS and in achieving UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Community caregivers are an essential component of each country’s primary health care system. Credit: Suzanne Porter/HelpAge International

Community caregivers are the backbone of effective HIV care and support programmes according to a multi-country study funded by UNAIDS and Cordaid and conducted by the Caregivers Action Network (CAN) and Cordaid. The research, carried out in Ethiopia, Malawi, South Africa and Zambia, focused on home-based care concerning HIV prevention, treatment, care and support.

Findings from the research confirm that community caregivers play an invaluable service delivery role and are an essential component of each country’s primary health care system. According to the study, the role of community caregivers has shifted from basic home-based care functions such as visiting and caring for the sick to clinical and social support functions such as delivering medicines, adherence and psycho-social support.

The report highlights that social-support services for people living with HIV are becoming as important as clinical services with adequate food and nutrition, stable incomes and psycho-social support emerging as fundamental priorities.

“The role of community caregivers in addressing stigma and mobilizing people to know their HIV status and seek timely HIV prevention and treatment remains essential,” said UNAIDS Country Co-ordinator for Zambia, Helen Frary.

The general trend outlined in the report shows a tendency from health ministries toward creating a professional community caregivers workforce that works with and extends the reach of formal health care to communities and homes. However, the study warns about the need for caregivers to have access to social protection—such as income generating opportunities or remuneration—to enable them to provide essential care giving services without falling into further poverty themselves.

“This multi-country study clearly demonstrates the crucial role played by community caregivers in the HIV response,” stated CAN facilitator Rachel Albone. “It highlights the need for their expertise and experience to be recognized and appropriately remunerated in strategies to strengthen primary health care.”

For details see: http://www.caregiversactionnetwork.org/web/guest/can-research

On 29 August at the AIDS Vaccine Efficacy Consortium (AVEC) Summit for an AIDS-Free Generation in Thailand, a Thailand-United States partnership working on the development of an HIV vaccine has announced its commitment to build on the success of previous trials, giving a renewed push to vaccine research.

In 2009, the landmark RV144 Thai vaccine study—jointly developed by the Thai health ministry and US military researchers—proved the first evidence in humans that a safe and effective preventive HIV vaccine is possible. Results of the RV144 found 31.2% efficacy at the end of the study among 16 000 Thai volunteers.

Building on this, researchers will work to improve the levels of protection found previously and conduct additional trials in Thailand over the coming years, focusing on key populations at higher risk of infection, including men who have sex with men. The aim of the on-going research is that a modified version of the vaccine would raise the protection rate to around 50%—the figure needed to obtain regulatory approval for public release.

The Thai Government will take a leadership role by supporting the future HIV vaccine efficacy study and assisting in the establishment of flexible manufacturing systems and infrastructure that could support the production of a registered HIV vaccine.

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Dr Luiz Loures, UNAIDS Deputy Executive Director, Programme (right) with Mr Oscar Fernandes, Union Minister for Road Transport and Highways.

India’s rapid progress in expanding access to antiretroviral treatment over the last five years was heralded as “an example of national commitment and strategic action on AIDS,” by UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures, during a mission to the country from 26-27 August.

The number of people living with HIV in the country receiving anti-retroviral therapy approximately doubled from 2007 to 2009 and then again from 2009 to 2012. India is now ranked second globally in terms of total number of people receiving life-saving drugs. Currently more than 650 000 people living with HIV are receiving treatment in the country and efforts are underway to ensure that 1 million people are covered by the national treatment programme in a short time frame.

Dr Loures congratulated the Ministry of Health and Family Welfare and the Department of AIDS Control for their firm commitment and leadership and their on-going efforts to strategically expand the national HIV response. Over the previous decade, India’s efforts in the AIDS response have reduced the number of new HIV infections by more than 50%.

“India’s national AIDS response programme has secured results; it is one of the big global achievers,” he said. “Not only has it significantly expanded coverage of HIV prevention initiatives, but equally is placing emphasis on increased access, availability and coverage of HIV treatment and care services.”

Dr Loures emphasized the need for India to continue to capitalize on the gains achieved and ensure that investments are focused where they are most needed. “To realise greater impact across the country, India’s focus on strategic investments tailored at sub-national level—that consider local contextual realities—is critical. This strategy will be a game changer in influencing the epidemic’s future trajectory,” added Dr Loures.

Among other issues debated with the high-level officials, significant focus was given to the growing anticipation of India’s ability to meaningfully contribute to the global AIDS response and potentially supporting other countries in designing and delivering activities, through transfer of knowledge and exchange programmes.

L to R: Oussama Tawil, UNAIDS Country Coordinator, India; Mr J.D. Seelam, Union Minister of State for Finance; and Dr Luiz Loures, Deputy Executive Director, Programme, UNAIDS.

“We encourage India to continue partnering with other countries on sharing experiences, knowledge and transfer of competencies,” said Dr Loures. “With an ever-increasing interdependence between populations, shared goals can be realised more effectively and efficiently though meaningful collaboration and partnership.” 

Dr Loures’ visit to India was an opportunity for high level policy dialogue with political leaders and Government officials, including the Secretary and senior officials from the Department of AIDS Control. Key discussions were held with the President and the Secretary General of the Forum of Parliamentarians on AIDS, Mr Oscar Fernandes, Union Minister for Road Transport and Highways and Mr J.D. Seelam, Union Minister of State for Finance. Both leaders pledged their full support to enhancing India’s contribution to the AIDS response, globally and within India.

The United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean, Dr Edward Greene, visited the UNAIDS Headquarters in Geneva on 23 August to meet with UNAIDS Executive Director Michel Sidibé. 

Among the issues discussed, Dr Greene highlighted the new initiative of the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) co-lead by him and the Prime Minster of St Kitts & Nevis, Dr Denzil Douglas, called Justice for All: taking action to reduce stigma and discrimination and increase access to justice in national HIV responses in the Caribbean by 2015.

The new initiative will unite stakeholders—including faith-based organizations, people living with AIDS, civil society, legislators and government officials—at national and regional levels to dialogue on the existing legal environment related to HIV in the Caribbean. The initiative aims to develop a roadmap for national and regional actors to reduce stigma and discrimination and to increase access to justice in national HIV responses including the abolition of punitive laws. The first national consultation is planned for St Kitts and Nevis in Fall 2013. 

The Special Envoy also stressed the need to strengthen dialogue with faith-based organisations in the Caribbean and work collaboratively with their representatives. Dr Greene stressed the historical role played by such organizations in delivering social services and support in the region.

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The 33rd SADC Summit was held in Lilongwe, Malawi on 17 and 18 August 2013.

Heads of State and Government from countries in the Southern African Development Community (SADC) met on 18 August to discuss the progress made and the challenges that the region is facing regarding HIV, tuberculosis and malaria.

Given the financial down-turn for the AIDS response, SADC leaders underlined the need to explore ways to increase domestic resources and expressed their support for the replenishment of the Global Fund to fight AIDS, TB and malaria. They also agreed to push for global solidarity and shared responsibility for HIV, TB and malaria responses in Africa in line with the African Union roadmap adopted in July 2012.

SADC Member States underlined the need for regional production and procurement of essential medicines and commodities for AIDS, TB and malaria. They stressed that with increasing demand for HIV treatment, the SADC region should step up its efforts to ensure favourable polices, encourage technology transfer and build capacity of African countries to produce high quality drugs and other pharmaceutical goods. 

Despite progress made in the AIDS response in recent years—coverage of antiretroviral treatment for people living with HIV has increased considerably in several countries—SADC remains the region most affected by HIV, with millions of people still lacking access to life saving treatment and care services.

Discussing the need to scale up access to HIV testing and treatment, structural, financial, human resources and human rights challenges were identified by the SADC leaders as the main obstacles to attain the goal of universal access. HIV testing and counselling is a critical and essential gateway to HIV services. WHO and UNAIDS, having endorsed the concept of universal access to knowledge of HIV status, recommend that HIV testing be conducted on a voluntary basis, consistent with WHO/UNAIDS guidelines. In this context, SADC leaders welcomed WHO’s new treatment guidelines which provides for earlier initiation of HIV treatment.

The meeting took place on the margins of the 33rd SADC Summit held from 17–18 August in Lilongwe, Malawi. It was attended by many Heads of States, including Presidents of Botswana, the Democratic Republic of Congo, Mozambique, United Republic of Tanzania, South Africa and Zimbabwe.

Chinese Vice Premier Liu Yandong met with UNAIDS Executive Director Michel Sidibé in Beijing last Friday, ahead of the Ministerial Forum of China-Africa Health Development. During the meeting, Liu thanked UNAIDS for its support to China’s HIV response, and emphasized that addressing HIV is a key priority for the Chinese government.

Mr Sidibé commended China’s strong commitment to its HIV response, and noted the impressive results achieved to date, including the increase in the number of people receiving antiretroviral treatment and the 65% reduction of AIDS-related mortality. Mr Sidibé also stressed China’s leadership in responding to the epidemic among people who use drugs. The country is implementing the largest harm reduction programme in the world.

During the meeting, Minister Liu and Mr Sidibé also discussed the future of the cooperation between China and Africa on health. Mr Sidibé highlighted the production of medical commodities and pharmaceuticals as areas for potential collaboration.

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Chinese President Xi Jinping welcomed the participants of the Ministerial Forum of China-Africa Health Development, launching a new era in cooperation between China and Africa. “Human development is at the core of development. We hope this forum will substantially push forward health cooperation between China and Africa," said President Xi Jinping at the opening ceremony at the Great Hall of the People in Beijing.

Addressing the opening plenary, UNAIDS Executive Director Michel Sidibé emphasized the enormous positive impact of stronger China-Africa cooperation for health. “The response to HIV can act as a pathfinder for the China-Africa partnership in health development,” said Mr Sidibé. “China can help African countries build on their leadership in the HIV response to advance Africa’s response to a range of other health issues.” Mr Sidibé also highlighted the importance of commodity security, with China’s unique potential to support Africa to develop sustainable capacity for local manufacture of antiretroviral drugs and other pharmaceuticals. The forum was also attended by the heads of international health organizations—Margaret Chan (WHO), Babatunde Osotimehin (UNFPA), and Mark Dybul (Global Fund).

Speaking during the Forum’s opening ceremony, Minister of China’s Health and Family Planning Commission Li Bin reiterated China’s commitment to building stronger China-Africa ties, noting the long and positive history of China-Africa cooperation on health. “China will continue to strengthen cooperation with international cooperation on global health and population development, and make use of international platforms to explore new approaches to South-South cooperation in the area of health with developing countries in Africa and elsewhere,” said Minister Li.

The Forum featured the negotiation and adoption of the Beijing Declaration, which outlines the commitment and direction of future cooperation between China and Africa in this important area. On behalf of the international organizations attending the forum, Mr Sidibé delivered a statement in support of the Beijing Declaration.

Statement of the International Organizations at the Ministerial Forum of China-Africa Health Development

• The international organizations represented at the Ministerial Forum of China-Africa Health Development (World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF), the Global Fund to Fight AIDS, Tuberculosis & Malaria, the World Bank, and the GAVI Alliance) commend its participants on their leadership efforts to advance health development, and give our strongest endorsement of the Beijing Declaration, which inaugurates a new era of China-Africa collaboration.
• We recognize this Declaration as a pillar of the larger partnership between China and Africa, which is one of the most important geopolitical and economic relationships of the 21st Century.
• We underscore the Declaration's importance for strengthening China's collaboration with regional institutions - the African Union and Africa's regional economic committees.
• We commit special attention and support for the implementation of the Beijing Declaration. We will seek to make available, where appropriate, the knowledge and resources of the relevant agencies to promote China-Africa health collaboration as a new platform to accelerate progress towards the Millennium Development Goals and to promote global health in the post-2015 development agenda.
• We welcome the Ministerial Forum of China-Africa Health Development as an innovative mechanism to convene the participation and dialogue of high-level leadership in support of health development and cooperation between China and Africa, and we encourage the regular reporting of progress towards its important objectives.

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