The countries of the South are shifting the global power balance with massive strides in economic growth, poverty reduction, education and health.

The world is changing rapidly with developing nations spearheading global economic growth, impressive poverty reduction and the rise of a healthier, better educated middle class, says the UN Development Programme’s (UNDP) Human Development Report 2013.

According to the publication, The Rise of the South: Human Progress in a Diverse World, this rise is “unprecedented in its speed and scale. Never in history have the living conditions and prospects of so many people changed so dramatically and so fast.” 

The momentum of such achievements in poverty reduction, education, income and tackling health issues like HIV, is increasing. It can be seen as an overdue “global rebalancing” with new actors “shaping the development landscape” and gaining in political and economic influence.  

There has been notably rapid progress in more than 40 countries of the South—traditionally referred to as developing nations—whose advancement has been markedly better than expected, the report notes. Coming from all continents and ranging widely in size, they include:  Bangladesh, Brazil, Chile, China, Ghana, India, Mexico, Rwanda, Uganda and Vietnam.  Uganda, for example, through a series of economic, health, education and social measures, has managed to halve extreme poverty before the Millennium Development Goal deadline of 2015. It fell from 56% in 1992-93 to 25% in 2009-10.

The report was launched in Mexico City on March 14 by the UNDP’s Administrator Helen Clark and Mexican President Enrique Peña Nieto.  As well as an extensive analysis of original research, it also contains an updated Human Development Index which measures the progress of nations in terms of health, education and income. In addition, the publication contains data on the critical gender aspect of development in its Gender Inequality Index which shows that despite serious inequities persisting, there has been progress in equality almost everywhere.

As with general development, the pace of success in the AIDS response is quickening in an unprecedented way. The 2012 UNAIDS global report showed that the rate of infection across 25 low- and middle-income countries has been cut by half.

The accelerated development of the South is critical to the success of the global AIDS response as the most heavily burdened countries are low-and middle income. UNAIDS maintains that getting to zero new infections, zero discrimination and zero AIDS-related deaths will need advances not only in the sphere of health and HIV but in terms of poverty reduction, education, gender equality and enhanced life opportunities

Dr Peter Piot, Director of the London School of Hygiene and Tropical Medicine and former UNAIDS Executive Director.
Credit: UNAIDS

The Japanese Government announced on 13 March that it was awarding the Second Hideyo Noguchi Africa prize to Dr Peter Piot, Director of the London School of Hygiene and Tropical Medicine in London, U.K. and former UNAIDS Executive Director and Dr Alex Godwin Coutinho, Executive Director of the Infectious Disease Institute, Makerere University in Kampala, Uganda.

The prize honours medical researchers and practitioners with outstanding achievements in the fields of medical research and medical services in Africa. Dr Piot received the prize for his pivotal research on viruses and diseases endemic to much of the African continent, including HIV and Ebola. The prize honours Dr Hideyo Noguchi who is remembered for his efforts to discover a vaccine for yellow fever in Africa.

The cabinet office of the Government of Japan said that the prize is a clear testimony to Japan’s efforts to be “at the forefront of global health issues with a particular focus on Africa. It is with great joy that we welcome these new laureates who embody the spirit of the Prize.”

Dr Piot was Executive Director of UNAIDS from its creation in 1995 until the end of 2008.Under his leadership the organization became the chief advocate for worldwide action against AIDS. The Government of Japan recognized Dr Piot’s role in bringing the AIDS epidemic to the forefront of global attention, raising international commitments to its funding and building scientifically grounded responses to its control and treatment.

“I am deeply honoured and grateful to have been considered for this award. Dr Noguchi holds a special place in the history of medical research and was in many ways a pioneer of what we now call global health,” said Dr Piot. “While we have collectively achieved many successes, infectious diseases are far from under control, particularly in sub-Saharan Africa. New pathogens will continue to emerge, and we must sustain local and global efforts for many years to come.”

Dr Coutinho received the award for his pioneering efforts in expanding access to live-saving treatment for people living with HIV. He is known as a compassionate clinician who treated thousands of HIV patients at a time when there was a lot of stigma and fear.

Japan has been a supporter of the global AIDS response and an important partner of UNAIDS. The Prime Minister of Japan, Shinzo Abe will formally award the Second Hideyo Noguchi Africa prize to Dr Piot and Dr Godwin on 1 June during the 5th Tokyo International Conference on African Development which will take place in Yokohama, Japan.

In wide-ranging opening remarks to the current session of the Commission on Narcotic Drugs in Vienna, the Executive Director of the UN Office on Drugs and Crime (UNODC) Yury Fedotov placed HIV and drug use at the heart of the global agenda.

“HIV transmission through injecting drug use continues to be one of the main unresolved challenges of the international community. Widespread stigma, discrimination and lack of access to evidence-informed HIV services are among the key challenges,” he said.

Addressing the gathering of more than 1 000 representatives of Member States and civil society, he suggested that despite “notable progress” in increasing access to HIV services for people who inject drugs, there is still a long way to go.

In an apparent nod to the post-2015 development agenda Mr Fedotov put the challenge of the epidemic within the context of a health and rights-based prism: “[H]uman rights and public health considerations must be at the core of the international response to drug use and HIV,” he maintained.

The global challenge to this pressing issue has been gaining momentum. Through the June 2011 United Nations General Assembly Political Declaration on HIV and AIDS, the world is committed to halving the number of drug users who acquire HIV by 2015.

According to UNAIDS, harm reduction strategies are key to prevent new HIV infections among people who use drugs. A comprehensive, evidence-informed package requires: needle and syringe programmes, opioid substitution therapy, HIV testing and counselling, antiretroviral therapy and condom programmes for people who use drugs and their sexual partners. It also entails prevention and treatment of sexually transmitted infections, tuberculosis and hepatitis as well as information, education and communication materials intended specifically for people who use drugs.

This stigmatized population bears a very heavy burden of the virus, which is often transmitted through the use of unsterilized needles. UNAIDS’ global report 2012 contains some sobering statistics. In 49 countries HIV prevalence among people who inject drugs is at least 22 times higher than among the population as a whole and in 11 countries their level of infection is more than 50 times higher. 

A very large number of individuals are affected. According to the 2012 UNODC World Drug Report, an estimated 15 to 16 million people, in 151 countries, inject drugs.  A 2008 global study showed that 3 million were living with HIV. In several countries—notably in Eastern Europe and Central Asia, one of two regions where the number of new infections is increasing—the AIDS epidemic is being driven by unsafe injecting drug use.

People who use drugs are much less likely to be reached by HIV-related services, such as testing. HIV-positive women who use drugs do not access programmes to prevent their children being born with the virus as often as other women. Surveys in capital cities reveal that drug users also report lower condom use than men who have sex with men or sex workers.

At the fifty-sixth session of the Commission on Narcotic, which is running from 11-15 March, drug use and HIV will be addressed through a number of channels, including a draft resolution calling for the intensification of efforts to reduce HIV to attain the targets of the 2011 Political Declaration on HIV and AIDS.

On Tuesday a side-event will explore the opportunities and challenges facing women who use drugs and how to make care and support services more gender-responsive. The meeting will be chaired by UNODC Director, Division for Operations and Global Coordinator for HIV/AIDS, Aldo Lale-Demoz. Michel Kazatchkine, the United Nations Secretary-General’s Special Envoy for AIDS in Eastern Europe and Central Asia, is scheduled to attend the event as a special guest.

The Commission on Narcotic Drugs is the United Nations central policy-making body mandated to deal with a broad range of drug-related issues.

Co-chaires Hon Thokozani Khupe, Deputy Prime Minister of Zimbabwe (left) and Hon Julia Duncan-Cassell, Minister of Gender and Development of Liberia at the High Level Consultation Accelerating Zero-Tolerance to Gender based violence through the HIV response. New York City on March 9, 2013. Credit: UNAIDS/M. Taamallah

How much progress has the global AIDS response made in ensuring that women and girls live their lives free from violence? What are the next steps needed to strengthen the challenge to gender-based violence and its links to HIV? These critical questions dominated a high level consultation which took place in New York on 9 March during the 57^th session of the Commission on the Status of Women (CSW). 

Convened by UNAIDS and UN Women, and cosponsored by the Government of Ireland, the UN Development Programme and the UN Population Fund the consultation brought together key civil society activists, United Nations organizations and government representatives.

Co-chaired by Hon Thokozani Khupe, Deputy Prime Minister of Zimbabwe and Hon Julia Duncan-Cassell, Minister of Gender and Development of Liberia, the consultation took the priority theme of the CSW: elimination and prevention of all forms of violence against women and girls as a springboard to find ways to accelerate the attainment of Millennium Development Goals 3 (promoting gender equality) and 6 (halting HIV). Participants also discussed how to position HIV and gender-based violence on the post-2015 development agenda.

“The post-2015 agenda must be seen as finishing the last mile,” said Thokozani Khupe, Deputy Prime Minister of Zimbabwe. “We must see the things that are unfinished and try to tackle them differently,” she added.

Gender based violence is a global epidemic, and it is the most brutal manifestation of gender inequality. According to UNAIDS, at least one in three women is beaten, coerced into sex or otherwise abused by an intimate partner in the course of her lifetime. In some countries, up to 45% of girls under the age of 15 report their first sexual experience as forced.

“Violence is not inevitable,” said Charlotte Watts from the London School of Hygiene and Tropical Medicine. “Even if figures are shocking, we should be inspired by them to work and address them.”

Tackling violence against women and girls is key if their vulnerability to the HIV is to be reduced. Women can be forced to have unwanted and unprotected sex and they can face violence if they reveal that they are living with HIV.  Research in South Africa has shown that young women subjected to intimate partner violence are 12% more likely to become infected with HIV.  Married women in India who experience both physical and sexual violence from their partners are three times more likely to be living with HIV than women not subjected to attacks at all. Cases of coerced sterilizations and abortions undertaken on women living with HIV without their informed consent are widespread and documented in many countries.

Representatives of civil society shared community perspectives of how HIV and gender-based violence are intimately linked. Jennifer Gatsi, from the Namibia Women’s Health Coalition, stressed the negative consequences suffered by women living with HIV.

Group photo of the participants at the High Level Consultation Accelerating Zero-Tolerance to Gender based violence through the HIV response. New York City on March 9, 2013.
Credit: UNAIDS/M. Taamallah

“The birth of a child is commonly the happiest day in a woman’s life,” said Ms Gatsi. “But in certain countries, the day a child is born from a mother with HIV, is the day when she dies or she starts to face discrimination.”

The consultation discussed the fact that, despite the extent and consequences of gender- based violence and its role in fuelling the HIV epidemic, it too often goes unaddressed and unpunished. It was noted that nothing less than working for social transformation of gender relations, including economic and legal empowerment of women, can bring about the changes needed to help them to stay safe.

According to the UNAIDS Director, Rights, Gender and Community Mobilization, Mariangela Simao, making real strides against gender-based violence is a core goal for effective HIV responses, as reflected in the UNAIDS Strategy 2011-1015.

Lynn Collins, a UNFPA HIV advisor who moderated a panel at the event said, "We at UNFPA have welcomed this opportunity to bring together a range of voices, united in the call to end violence in all its heinous forms through education and other means of empowerment, legal reform and redress, and rights-based sexual and reproductive health and HIV services."

The Commission on the Status of Women, which meets annually, is one of the main global policy-making bodies committed to gender equality and the advancement of women. This year’s meeting is taking place from March 4-15.

UNAIDS Executive Director Michel Sidibé with the Minister of Health, Miatta Kargbo. Credit: UNAIDS

Sierra Leone’s President Ernest Bai Koroma stressed his commitment to increasing women’s participation in his government during an event on 8 March, celebrating International Women’s Day in Freetown, Sierra Leone. He said that the many appointments of women to high positions his government has sent “a clear message that discrimination against women no longer has a place in Sierra Leone.”

He said, “My government will enact legislation for a 30% quota for women’s participation in governance pretty soon. Gender is not just a social issue but also a development issue. And so we recognize the fact that men and women have to work side by side to achieve sustainable development.” 

UNAIDS Executive Director, Michel Sidibé participated in the event which aimed to draw international attention to the active involvement of women in Sierra Leone’s socio-economic development through the President’s Agenda for Change. Dr Kandeh Yumkella, UNIDO Director General and Cherie Blair, head of the Cherie Blair Foundation for Women also attended the event.

Mr Michel Sidibé praised the President for his remarkable leadership and said “Sierra Leone’s transformative agenda is geared towards the creation of social justice”. But he added, “if Sierra Leone wants a sustainable agenda, it must put women on the forefront of its reform agenda”.

During the Women’s Day celebrations, the government of Sierra Leone and the Global Fund to Fight AIDS, Tuberculosis and Malaria concluded a new funding agreement, providing US$ 55 million for HIV screening, prevention and treatment in Sierra Leone. The agreement was signed in Freetown by UNAIDS Executive Director Michel Sidibé on behalf of the Executive Director of the Global Fund, Dr Mark Dybul and the Minister of Health of Sierra Leone, Miatta Kargbo.

Sierra Leone’s President Ernest Bai Koroma stressed his commitment to increasing women’s participation in his government during an event on 8 March, celebrating International Women’s Day in Freetown, Sierra Leone.
Credit: UNAIDS

 “President Ernest Bai Koroma is helping to transform the UNAIDS vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths into a reality for Sierra Leone,” said Mr Sidibé.

He urged the President to harness this same commitment to stopping gender-based violence—a risk factor for HIV among women in Sierra Leone and challenged the authorities to do everything possible to end practices like child and sexual trafficking.

A representative of the Woman Coalition on Health and HIV said “Women further seek increased and meaningful involvement of women especially women living with HIV in all spheres of the national response.”

In Sierra Leone, efforts to prevent new HIV infections among children have been strengthened and coverage and access of services for the prevention of mother to child transmission of HIV is now at 74%.

The International Council of Nurses (ICN) and the Florence Nightingale International Foundation (FNIF) have appointed UNAIDS Director for Eastern and Southern Africa Dr Sheila Tlou as Ambassador for the ICN/FNIF Girl Child Education Fund. Her new role as GCEF Ambassador will include promoting the importance of educating girls and raising the profile of the GCEF as a spokesperson in international spheres of nursing, health, education, gender and development.

Founded in 2006, the ICN/FNIF Girl Child Education Fund (GCEF) supports the primary and secondary schooling of girls under the age of 18 in developing countries whose nurse parent or parents have died, paying for fees, uniforms, shoes and books. The GCEF is currently supporting 155 girls in four countries in sub-Saharan Africa: Kenya, Swaziland, Uganda and Zambia.

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On 7 March, the eve of International Women's Day, Sierra Leone’s First Lady Alice Sia Nyama Koroma hosted a dinner in Freetown, where efforts to improve health services for women and children were showcased. The First Lady recently launched a campaign towards eliminating new HIV infections among children in partnership with UNAIDS, Voice of Women and the National AIDS Control Programme.

Michel Sidibé, UNAIDS Executive Director, joined the high level delegation along with Cherie Blair, head of the Cherie Blair Foundation for Women and  Dr Kandeh Yumkella, UNIDO Director General.

The First Lady presented her project “the Women’s Initiative for Safer Health” (WISH), which aims to reduce child and maternal mortality by improving access to health facilities and training health workers. A documentary was also screened on the efforts to eliminate new HIV infections in children and keeping mothers healthy.

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In a new UNAIDS funded report the Treatment Action Group (TAG) and AVAC have compiled information on investments into research and development for HIV treatment. The report was put together in a bid to analyse investment trends and highlight any gaps which may become apparent.

Despite having sent surveys to more than 170 institutions, just 41 funders reported their investments in this field of research. Information on investments from the private-sector proved particularly difficult to obtain with many private companies unable to impart funding details of their work in this highly competitive area.

What the report did unveil is that the institutions that responded to the survey invested more than US$ 2.6 billion in HIV treatment research and development in 2011 and that most of that funding came from public-sector funders. Funders from 18 countries reported, with the US National Institutes of Health responsible for 62% of the total reported amount in 2011. 

“Investments into developing effective antiretroviral treatment has revolutionized our response to HIV and has saved millions of lives," said Bernhard Schwartlander, Director of Evidence, Innovation and Policy at UNAIDS. “The importance of continued investments to encourage innovation and develop better medicines—ones that have even less side effects and are more resilient to the development of resistance—is incredibly important as it could lead us to our collective goal of ending the epidemic."

The trends which became apparent from the data available were that public-sector funding had increased 6.8% from 2009 to 2010 and then subsequently decreased 1.2% from 2010 to 2011 due to the economic crisis. It also showed that the share of public-sector contribution to the total also decreased—from 75% in 2010 to 69% in 2011.

The report also unveiled encouraging news that the largest share of HIV treatment research and development funding, 52% or US$1.4 billion, was invested in developing new medicines. It also showed that simpler, more effective antiretroviral formulations are in the pipeline and that more effective diagnostic tools are moving towards the market. However, it stressed that ensuring that these life-saving tools become widely accessible will require further commitment to investments in HIV research and development.

Participants at the high-level dialogue on health in the post-2015 development agenda. Gaborone, Botswana. 5-6 March 2013. Credit: UNAIDS

A High-Level Dialogue on health brought together representatives from governments, non-governmental organizations, academic and research institutions and the private sector to debate how to advance health priorities in the post-2015 development agenda. Co-convened by the Governments of Botswana, Sweden, UNICEF and WHO, the health thematic consultation took place in Gaborone, Botswana from 5-6 March 2013.

Opening the consultation, the President of Botswana Ian Khama highlighted the progress made by the country in its response to AIDS in the last 20 years and stressed that “health must remain a priority for Botswana and the world.”

UNAIDS Executive Director Michel Sidibé encouraged participants to seize the opportunity to adopt a bold, transformative vision and goals to guide global health in the post-2015 agenda. According to Mr Sidibé, “We need to completely rethink how global health will engage on issues from intellectual property to the production of essential medicines and the central role of countries and communities.” Reflecting on some of the lessons of the global AIDS response, Mr Sidibé said that “this is the opportunity to better leverage the role of private sector, technology, innovation, and unleash the potential of community activism to advance the future agenda for global health.”

Mr Sidibé also called for stronger attention to critical social enablers such as gender equality, human rights and equity. “Let us measure what we treasure,” said Mr Sidibé. “Health goals and indicators can help us track progress in these cross-cutting issues which are so important,” he added.

UNAIDS Executive Director Michel Sidibé and independent humanitarian expert Graça Machel at the high-level dialogue on health in the post-2015 development agenda. Gaborone, Botswana. 5-6 March 2013.

The outcomes of the consultation will guide and inform a report by the United Nations Secretary-General’s High-level Panel on the post-2015 development agenda which will be submitted to the Secretary-General in May 2013. Gunilla Carlson, Sweden’s Minister for International Development Cooperation and Graça Machel, an independent humanitarian expert also participated in the meeting. They are both members of the UN Secretary General’s High-level Panel to advise on the global development framework beyond 2015.

In July 2012, the Secretary-General launched his High-level Panel of Eminent Persons to provide guidance and recommendations on the post-2015 development agenda. The panel is co-chaired by the Presidents of Indonesia and Liberia and the Prime Minister of the United Kingdom and members include representatives from the private sector, academia, civil society and local authorities.

Ahead of the High-Level Dialogue on Health in the Post-2015 Development Agenda, held in Gaborone Botswana from 5-6 March 2013, four heads of United Nations agencies met with the President of Botswana, Ian Khama to discuss the meeting’s implications to global health.

President Khama said that his country strongly believed in investing in health and other social sectors as a way forward to economic and social development. The President stressed that despite competing priorities, governments should place human resources at the top of their national development agenda. Without a healthy population, all other priorities become void, he added.

In attendance the Director General of the World Health Organization, Dr Margaret Chan, UNICEF Executive Director, Anthony Lake, UNFPA Executive Director, Professor Babatunde Osotimehin and UNAIDS Executive Director, Michel Sidibé.

According to the 2012 UNAIDS Global Report, service coverage in Botswana to prevent new HIV infections among children reached 94% in 2011. Furthermore, by the end of 2011, more than 175 000 people were receiving antiretroviral treatment compared to 57% in 2004—more than 95% of people eligible.

Later in the day, they met with the Vice President of Botswana, Ponatshego Kedikilwe, Minister for Presidential Affairs and Public Administration, Mokgweetsi Masisi, Minister of Health, Rev. Dr John Seakgosing and Minister of Finance and Development Planning, Ontefetse Matambo.

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