On this year’s World AIDS Day, UN and civil society partners jointly announce a global call for nominations for the 2012 Red Ribbon Award, intended to promote and support community organizations to respond to the AIDS epidemic.

The award, which will be presented at the XIX International AIDS Conference (AIDS 2012) in Washington DC in July 2012, will be given to ten organizations that have shown outstanding community leadership and action on AIDS. Additionally, each recipient of the award will receive a US$10 000 grant.

Awards will be given in the following five categories:

• Prevention of sexual transmission
• Prevention among people who use drugs
• Treatment, care and support
• Advocacy and human rights
• Stopping new HIV infections in children and keeping mothers alive; women's health.

Representatives of each winning body will present the work of their organization, their priorities, the challenges they faced and their approaches to community engagement in a dialogue space at the AIDS Conference in Washington.

Additional information regarding the Red Ribbon Award, the categories and criteria for selection, as well as the on-line nomination facility may be found online on the Red Ribbon Award website, www.redribbonaward.org.

China calls for shared responsibility in achieving zero new HIV infections, zero discrimination, zero AIDS-related deaths

UNAIDS Executive Director Michel Sidibé and China’s Premier H.E. Wen Jiabao at a World AIDS Day event in Beijing.

BEIJING/GENEVA, 1 December 2011—China has pledged to fill its HIV resource gap by increasing domestic investments. This pledge was made China’s Premier H.E. Wen Jiabao at a World AIDS Day event in Beijing. The Premier also called on the international community to fully meet its commitments and achieve a world with zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“I see no reason for the Global Fund to withdraw its support to China,” said Premier Wen Jiabao at the AIDS roundtable in Beijing. “I have asked the Minister of Finance to close the gap left by the Global Fund. We will rely on our own efforts.”

This new commitment from China comes at a crucial moment as resources for AIDS are declining and the Global Fund to Fight AIDS, Tuberculosis, and Malaria is facing a major setback in resource mobilization, leading to the cancellation of its next call for country proposals (Round 11), putting millions of lives at risk. 

"China's voice could not have come at a more critical time in the AIDS response. We are in a period of high risk and welcome this bold decision," said Michel Sidibé, Executive Director of UNAIDS, when thanking the Premier of China. "I am confident that a new socially sustainable agenda can be forged that promotes country ownership and shared responsibility.”

More than 6.6 million people are on HIV treatment in low- and middle-income countries and rates of new HIV infections have fallen in most parts of the world. Domestic investments have steadily increased, but the magnitude of the epidemic in Africa means that continued international solidarity and investments are vital.

“Getting Round 11 back on track is a top priority especially as Africa is leading the world in reducing new HIV infections and AIDS-related deaths. Its international partners must come forward and help countries multiply their success,” said Mr Sidibé. “This call is not just about shared responsibility but also of shared values.”

China has scaled up its AIDS response in a short timespan, including its evidence-informed HIV prevention services. By rapidly scaling up access to drug substitution therapies, it has reduced new HIV infections among people using these services to close to zero. China has also made important advances in its anti-discrimination programmes and support for civil society organizations. 

“To defeat AIDS, it will take the whole society,” said Premier Wen Jiabao. “China is willing to play its part.” China’s rapid scale up model can be replicated in other countries—especially in strengthening the capacity of community health workers to deliver HIV services. In addition, China can provide vital technology transfer in key areas of innovation of HIV treatment, including development of new antiretroviral medicines, investing in research and development, telecommunications, e-health infrastructure and supply chain management.

UNAIDS Executive Director, Michel Sidibé and Xinhua’s President Li Congjun at the news agency’s headquarters in Beijing, China on Wednesday, November 30th.

The Chinese news agency, Xinhua and the Joint United Nations Programme for HIV/AIDS (UNAIDS) launched a global media campaign this week to promote public awareness of HIV on the eve of World AIDS Day. UNAIDS Executive Director, Michel Sidibe met with Xinhua’s President Li Congjun at the news agency’s headquarters in Beijing, China on Wednesday, November 30th.

The campaign promotes this year’s World AIDS Day theme, “Getting to Zero” which is based on the UNAIDS vision: zero new HIV infections, zero discrimination and zero AIDS-related deaths. Advertisements with the campaign’s messages are running in more than ten Chinese newspapers and magazines owned by Xinhua, as well as on the agency’s Chinese and English websites. Xinhua is also running a public service announcement on the largest screen in Times Square in New York City.

Xinhua’s President Li reiterated the importance of the AIDS response and Xinhua’s commitment to raising public awareness. He said, “My father said don’t make promises easily, but if you make a promise you must keep it.”

Mr Sidibé said “Xinhua has delivered so much in such a short period of time and thanks to President Li’s commitment to the AIDS movement, we are able to promote this year’s World AIDS Day messages to millions of people. This is helping to keep HIV at the forefront of people’s minds.”

In September of this year, UNAIDS and Xinhua signed a two-year Memorandum of Understanding where they agreed to leverage each organization’s skills to reach universal access goals towards HIV prevention, treatment, care and support.

Mr Sidibé’s visit to Xinhua came on the first day of a three day trip to Beijing. On December 1rst, he will be marking World AIDS Day with government officials and health care professionals at an event at the Great Hall of the People and by participating in a High-Level panel on HIV convened by China’s Centres for Disease Control.

GENEVA, 30 November 2011—Global progress in both preventing and treating HIV emphasizes the benefits of sustaining investment in HIV/AIDS over the longer term. The latest report by the World Health Organization (WHO), UNICEF and UNAIDS Report on the Global HIV/AIDS Response indicates that increased access to HIV services  resulted in a 15% reduction of new infections over the past decade and a 22% decline in AIDS-related deaths in the last five years.

"It has taken the world ten years to achieve this level of momentum," says Gottfried Hirnschall, Director of WHO's HIV Department. "There is now a very real possibility of getting ahead of the epidemic. But this can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond."

Advances in HIV science and programme innovations over the past year add hope for future progress. In times of economic austerity it will be essential to rapidly apply new science, technologies and approaches to improve the efficiency and effectiveness of HIV programmes in countries.

The report highlights what is already working:

• Improved access to HIV testing services enabled 61% of pregnant women in eastern and southern Africa to receive testing and counseling for HIV - up from 14% in 2005.
• Close to half (48%) of pregnant women in need receive effective medicines to prevent mother-to-child transmission of HIV (PMTCT) in 2010.
• Antiretroviral therapy (ART), which not only improves the health and well-being of people living with HIV but also stops further HIV transmission, is available now for 6.65 million people in low- and middle-income countries, accounting for 47% of the 14.2 million people eligible to receive it.

When people are healthier, they are better able to cope financially. The report acknowledges that investment in HIV services could lead to total gains of up to US$ 34 billion by 2020 in increased economic activity and productivity, more than offsetting the costs of ART programmes.

“2011 has been a game changing year. With new science, unprecedented political leadership and continued progress in the AIDS response, countries have a window of opportunity to seize this momentum and take their responses to the next level,” said Paul De Lay, Deputy Executive Director, Programme, UNAIDS. “By investing wisely, countries can increase efficiencies, reduce costs and improve on results. However, gains made to date are being threatened by a decline in resources for AIDS.”

The report also points to what still needs to be done:

• More than half of the people who need antiretroviral therapy in low- and middle-income countries are still unable to access it. Many of them do not even know that they have HIV.
• Despite the growing body of evidence as to what countries need to focus on to make a real impact on their epidemics, some are still not tailoring their programmes for those who are most at risk and in need. In many cases, groups including adolescent girls, people who inject drugs, men who have sex with men, transgender people, sex workers, prisoners and migrants remain unable to access HIV prevention and treatment services.

Worldwide, the vast majority (64%) of people aged 15-24 living with HIV today are female. The rate is even higher in sub-Saharan Africa where girls and young women make up 71% of all young people living with HIV - essentially because prevention strategies are not reaching them.

Key populations are continually marginalized. In Eastern Europe and Central Asia, more than 60% of those living with HIV are people who inject drugs. But injecting drug users account for only 22% of those receiving ART. 

Although better services to prevent mother to child transmission of HIV have averted some 350 000 new infections among children, some 3.4 million children are living with HIV - many of whom lack HIV treatment. Only about one in four children in need of HIV treatment in low- and middle-income countries received it in 2010, as compared to 1 in 2 adults.

“While there have been gains in treatment, care and support available to adults, we note that progress for children is slower,” says Leila Pakkala, Director of the UNICEF Office in Geneva.  “The coverage of HIV interventions for children remains alarmingly low. Through concerted action and equity-focused strategies, we must make sure that global efforts are working for children as well as adults”.

HIV in regions and countries

In 2010, HIV epidemics and responses in different parts of the world vary with shifting trends, progress rates and outcomes.

Sub-Saharan Africa recorded the biggest overall annual increase--30%--in the number of people accessing ART. Three countries (Botswana, Namibia and Rwanda) have achieved universal coverage (80%) for HIV prevention, treatment and care services. The regional ART coverage rate stood at 49% at the end of 2010. Approximately 50% of pregnant women living with HIV receive treatment to prevent mother-to child transmission of HIV. And 21% of children in need are able to get paediatric HIV treatments. There were 1.9 million new infections in the region, where 22.9 million people are living with HIV. There are some major disparities in progress between different parts of the region. Countries in Eastern and Southern Africa have reached much higher coverage rates for ART (56%) and PMTCT (64%) than countries in Western and Central Africa (30% and 18% respectively).

Asia shows a stabilizing epidemic overall, but new infections are very high in some communities. Of the 4.8 million people living with HIV in Asia, nearly half (49%) are in India. Antiretroviral treatment coverage is increasing with 39% of adults and children in need of HIV treatment having access. Coverage of PMTCT services is relatively low- (16%).

Eastern Europe and Central Asia presents a dramatic growth in HIV, with new infections increasing by 250% in the past decade. Over 90% of these infections occur in just two countries: Russia and Ukraine. The region demonstrates high coverage rates for PMTCT and paediatric HIV treatment (with 78% and 65% coverage rates respectively). However, ART coverage is very low at 23%, particularly among the most affected people- the ones who inject drugs.

Middle East and North Africa records the highest number of HIV infections ever in the region (59 000) in 2010, which represents a 36% increase over the past year. Coverage of HIV services are very low in the region: 10% for ART, 5% for paediatric treatment and 4% for PMTCT.

Latin America and the Caribbean have a stabilizing epidemic with 1.5 million living with HIV in Latin America and 200 000 in the Caribbean. HIV is predominantly among networks of men who have sex with men in Latin America. In the Caribbean though, women are the more affected group accounting for 53% of people living with HIV. The region has ART coverage of 63% for adults and 39% for children.  Coverage for effective PMTCT regimen is relatively high at 74%.

Sustaining the HIV response through the next 10 years

• Countries are already showing marked efficiency gains in HIV programmes: South Africa reduced HIV drug costs by more than 50% over a two-year period by implementing a new tendering strategy for procurement. Uganda saved US$2 million by shifting to simpler paediatric regimens. Such efficiencies are promoted through Treatment 2.0 - an initiative launched by WHO and UNAIDS in 2010 to promote simpler, cheaper and easier-to-deliver HIV treatment and diagnostic tools, combined with decentralized services that are supported by communities.
• WHO is developing new guidance on the strategic use of antiretroviral drugs for both prevention and treatment.
• WHO's "Global Health Sector Strategy on HIV/AIDS, 2011-2015", endorsed by the World Health Assembly in May 2011 highlights the importance of continuing efforts to optimize HIV treatment and "combination" prevention - the use of a range of different approaches to reduce people's risk of infection.

The 2011 "Report on the Global HIV/AIDS Response" is the comprehensive report on both the epidemiology and progress rates in access to HIV services globally and in regions and countries. It has been jointly developed by WHO, UNICEF, UNAIDS, in collaboration with national and international partners.

The full report is available from: http://www.who.int/hiv/pub/progress_report2011/.

UNAIDS Regional Director for West and Central Africa Meskerem Bekele-Grunitzky participating at the Paris meeting to discuss strategies to accelerate progress in the elimination of new HIV infections among children.
UNICEF France/Gil Fornet

Leaders from West and Central Africa met in Paris from 16 – 17 November to discuss strategies to accelerate progress in the elimination of new HIV infections among children.

The meeting, co-hosted by the French Ministry of Foreign Affairs and UNICEF, brought to the Institute Pasteur 350 representatives from 26 countries, including the Minister of Health and HIV, Cote d’Ivoire, Professor N`Dri Yoman Thérèse, Nobel Laureate Francoise Barre-Sinoussi, the UNICEF Regional Director for West and Central Africa, David Gressly and the UNAIDS Regional Director for West and Central Africa Meskerem Bekele-Grunitzky.

In her opening remarks Professor Barre-Sinoussi expressed her concern about the fact that nearly 1 000 children are infected with HIV everyday in sub-Saharan Africa, while in western countries, the vertical transmission of HIV has been virtually eliminated. Despite such inequalities, Professor Barre-Sinoussi emphasized that antiretroviral medicines are one of the most effective tools that we have against the virus today. It is possible to reach all pregnant women living with HIV who need these services and end new HIV infections among children by 2015.

Participants discussed the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive in the context of existing capacities in West and Central Africa. They agreed on the need to strengthen political leadership as well as to advocate for governments to fulfill the Abuja commitment to dedicate 15% of the national budget to health.

While only seven of the 22 countries with highest HIV burden of new HIV infections among children are in the West and Central Africa region, they comprised half the global gap to reach 80% of women who required antiretroviral (ARV) treatment in 2009. Nigeria alone comprised 32% of this gap. In 2009, only 23% of women in need of ARVs to prevent transmission of HIV to their children received them, compared to 68% in Eastern and Southern Africa.

Dr Bekele-Grunitzky urged participants to remain committed to the goals of eliminating new HIV infection among children. She noted that most of the countries in the region were just emerging from conflict, which increased the challenges even more. She urged countries to strengthen their AIDS responses and was encouraged by present efforts to accelerate the regional momentum.

Other topics discussed at the meeting included how to strengthen the service delivery coverage by integrating HIV services, addressing human resources for health—including strengthening task shifting and task sharing, reducing loss to follow-up and strengthening male engagement.

Secretary-General Ban Ki-moon speaks to reporters on arrival in Busan, Republic of Korea, to address the Fourth High-Level Forum on Aid Effectiveness.
Credit: UN News

Some 3500 delegates, including heads of state, ministers, civil society, the private sector and leaders of international organizations have come together for the Fourth High-Level Forum on Aid Effectiveness in Busan, Korea, from 29 November to 1 December to review the impact of development aid and chart a bold course for how the future of development cooperation will support the achievement of the Millennium Development Goals.

Speaking at the opening, UN Secretary General Ban Ki-moon underlined the need to move towards a “new cooperation partnership” based on shared responsibility where traditional donors continue aid programmes despite the economic crisis; where countries receiving aid set clear development priorities, deliver on commitments and work more with civil society; and where emerging aid donors and the private sector increase aid efforts and commitments.

"Our agenda today is very clear," Ban said. "We are here to ensure that aid reaches those most in need, the most vulnerable people who we have to take care of."

Underlining how commitment to development assistance has helped to slow the spread of HIV and reduce child mortality, the Secretary General emphasized the urgent need to continue support for “highly productive multilateral initiatives such as the Global Fund to Fight AIDS, TB and Malaria.”

Towards a “new global partnership for development” the Secretary General stressed three principles as the basis for effective aid:  accountability, flexibility and ownership. 

“Countries that are accountable, countries that receive flexible aid, countries that have the most ownership -- will be best placed to achieve the best results,” he said.

New partnership for Africa’s development

In Busan on Tuesday 29 November, UNAIDS Executive Director Michel Sidibé stressed that the time is right for new paradigms for international development cooperation to transform the concept of aid effectiveness. Mr Sidibe spoke at a side event on the impact of development aid in Africa, organized by the New Partnership for Africa’s Development (NEPAD) and the United Nations Development Programme (UNDP).

“At this game-changing moment in the AIDS response, today’s development paradigms look tired and confused – no longer responding to the needs of a changing world,” said Michel Sidibé, UNAIDS Executive Director. “We need to broaden the discourse beyond a focus on just financial sustainability. A socially sustainable agenda for Africa must be agreed upon in Busan.”

Although sub-Saharan Africa remains the region worst-affected by HIV with nearly 70% of the 34 million people living with HIV worldwide, the countries of sub-Saharan Africa have the potential to lead the AIDS response as they have increased access to technology, economic growth and a growing workforce, he stressed.

Youth as ‘transformers’

Mr Sidibé also joined the Korean Minister of Education, Science and Technology, Dr LEE Ju-Ho, at the Youth Forum to hear the perspectives of young people on effective aid and development. The Youth Forum, hosted by the Korean government and organized by the Korean National Commission for UNESCO, addressed ways to increase young people’s participation in aid and development.

Speaking to young people at the opening of the Youth Forum, Mr Sidibé said, “You are not spectators in development architecture—you are transformers. You are the leaders of today - transforming the world and the way development is done through your bold ideas and the innovative use of technology.”

Calling on young people to engage in the development of UNAIDS’ new youth strategy, Mr Sidibé highlighted how social media is a powerful tool for development and innovation. UNAIDS is using crowdsourcing to empower young people, including young people living with HIV, to take ownership and develop the strategy online. To participate in this initiative, go to www.crowdoutaids.org.

Credit: UNAIDS

A delegation of the UNAIDS Programme Coordinating Board (PCB) has just concluded a field visit to Kenya. The delegation learned first hand about the government’s strong commitment to a multi-sectoral and integrated AIDS response, including working with civil society organizations in planning and delivering HIV services.

With 1.6 million people currently living with HIV out of a population of 40 million, Kenya has the second largest epidemic in East and Southern Africa and the fourth largest globally.

The PCB delegation included the chair (El Salvador), vice chair (Poland), representatives from Congo, Finland, Mexico, Thailand, PCB NGOs from Africa and Asia Pacific, UNHCR and the UNAIDS Deputy Executive Director, Management and External Relations.

The delegation met with government representatives, including from the Ministry of State for Special Programmes, the National AIDS Control Council (NACC) and the National AIDS and STI Control Program (NASCOP), and civil society organizations. 

“We have had the privilege of meeting with a range of institutions and individuals who have been the driving force behind Kenya’s progress in its national AIDS response,” said Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations. “While challenges remain, we are encouraged by the combination of political will at the highest level, grass-roots activism and support of all partners in advancing the response in Kenya.” 

The delegation also met representatives of networks of people living with HIV, children heading households and HIV discordant couples (where only one partner is infected with HIV) during their field visit to Kibera—the largest informal settlement in Eastern Africa. They also visited a Millennium Village Project (MVP) in Nyanza Province, where the delegation witnessed an example of a community and family-centred integrated approach where peer mothers, male champions and community health workers each play a key role in preventing new HIV infections among children.

“The Gongo Health Centre in Sauri is a good example of comprehensive and integrated services being made accessible by trained personnel in an efficient manner to those most in need in a rural setting,” said Dr Nieto, Director of the National HIV/STI/AIDS Programme, from the Ministry of Health, El Salvador, current chair of the PCB. “It is a successful model that can and should be replicated in other countries,” she added.

The visit also addressed the crucial role of cultural and traditional leaders, as well as faith-based organizations, in responding to stigma and discrimination against people living with and affected by HIV. The delegation met with the Luo Council of Elders and participated in a meeting of faith-based organizations which focused on the role of these organizations in scaling up HIV prevention and addressing stigma and discrimination.

Kenya’s efforts in promoting a rights-based approach for people living with HIV was evident when the delegation met with the HIV Equity Tribunal that has been established to increase access to justice for people affected by HIV. The Tribunal takes on civil cases of HIV-related stigma and discrimination and is one of the first of its kind in the world.

The delegation also met with representatives of key populations at higher risk, which account for 30% of HIV transmission in the country. “Despite a restrictive legal environment for men who have sex with men, sex workers and people who inject drugs, Kenya has shown that programmes can be extended to key populations at higher risk with the commitment of national AIDS authorities,” said Nadia Rafif, the PCB NGO representative for Africa.

As Kenya’s AIDS response is reliant on external funding–more than 80%—the delegation welcomed the commitment of the Kenyan government to address the issue of sustainable financing and increase domestic resource allocation for HIV.

UNAIDS Goodwill Ambassador Naomi Watts during her visit to Safdarjung Hospital in New Delhi.

Ahead of this year’s World AIDS Day (1 December), UNAIDS Goodwill Ambassador Naomi Watts travelled to Safdarjung Hospital in New Delhi, India, to meet with mothers living with HIV and find out about some of the challenges they face in their daily lives.

Ms Watts toured the hospital and met with a group of mothers on the HIV ward. “I felt the many challenges they face, including the impact of stigma and shame, and yet it was their strength and determination to raise healthy children that shone through. We need to ensure that all mothers living with HIV get the services they and their families need. No mother needs to lose a child to AIDS and no child needs to be orphaned by AIDS.”

Safdarjung Hospital is a multi-specialty hospital in New Delhi and one of the largest government hospitals in India. The hospital provides medical care to people from across the country free of cost, including HIV prevention, treatment care and support services.

During her visit, Ms Watts was greeted by staff of the hospital, who guided her through different HIV facilities that Safdarjung Hospital offers including preventing new infections in children. Ms Watts met with hospital staff and was able to get new insights into how HIV prevention programmes are run in India.

“We test over 400 men and women from across India per day,” said Dr Renu Arora, Head of the Preventing Parent to Child Transmission of HIV Centre at Safdarjung hospital. She highlighted, however, that about 15% of pregnant women living with HIV across India seek treatment too late in their pregnancies—immediately before or during labour—and that they give birth to about 50% of all HIV-positive children in the country.

Ms Watts spent time talking with women living with HIV, discussing the challenges they face including stigma.

Ms Watts spent time talking with women living with HIV, discussing the challenges they face including stigma. She learned that the virus just doesn’t impact the women but their communities and families as well––emotionally and financially. Stigma and discrimination create a silence that prevents women from coming forward to access vital HIV prevention information and services both in India and across the world.

Sukhhvinder Kaur said, “I was diagnosed with HIV while I was pregnant. My in-laws abandoned my baby and me and we now live with my parents without any financial support. If people had more awareness about HIV maybe my child and I would be accepted in society.”

There are an estimated 2.4 million people living with HIV in India, one of the countries with the highest numbers of people living with HIV globally.

UNAIDS Executive Director Michel Sidibé speaking at the symposium.
Credit: Eric Roset

To mark the tenth anniversary of the Doha Declaration on TRIPS and Public Health adopted in November 2001, UNAIDS released a study evaluating how the use of the TRIPS flexibilities has helped improve access to antiretroviral therapy over the past decade.

Today, nearly half of people eligible for HIV treatment in low- and middle-income countries are now receiving it – 6.6 million out of the 14.2 million eligible - compared to 300,000 in 2002.  The most dramatic increases in antiretroviral therapy coverage have occurred in sub-Saharan Africa, with a 30% increase between 2009 and 2010 alone.

This effective scaling up of access to antiretroviral therapy has been largely due to a drastic fall in antiretroviral drug prices over the past decade. In 2000, three-drug antiretroviral therapy combinations cost US$ 10 000–15 000 per person, per year. Today the price for a similar regimen is less than US$ 120 per person, per year in many countries - a 99% reduction in cost.

UNAIDS recognizes the positive impact of the World Trade Organization’s Declaration on Trade-Related Aspects of Intellectual Property (TRIPS) and Public Health, otherwise known as the Doha Declaration. The Declaration clarified the scope of the TRIPS agreement and provided guidance for implementing TRIPS flexibilities to improve access to affordable medicines, including generic antiretroviral drugs and other essential drugs for AIDS-related illnesses.

“Although we have seen significant progress in the first decade since the Doha Declaration was adopted, much more needs to be done in the second decade if we are to achieve universal access to HIV prevention, treatment, care and support,” said Michel Sidibé, UNAIDS Executive Director. “Nearly half of people eligible for HIV treatment are now receiving it, but we have to redouble our efforts to ensure that children and adults everywhere have access to antiretroviral therapy.”

The UNAIDS Executive Director was participating in a one-day symposium hosted by Geneva’s Graduate Institute of International and Development Studies, entitled “10 Years after the Doha Declaration: The future agenda at the interface of Public Health, Innovation and Trade”. Keynote speakers included Margaret Chan, Director-General of the World Health Organization, Pascal Lamy, Director-General of the World Trade Organization and Francis Gurry, Director-General of the World Intellectual Property Organization.

Over the past decade, the Doha Declaration has had a positive impact on increasing access to affordable medicines in low- and middle-income countries. Over 60 low- and middle-income countries have proactively used the TRIPS flexibilities to promote the production and purchase of generic antiretrovirals, according to the study findings. By using these flexibilities to introduce generic competition, countries, including Brazil, Malaysia, and Thailand, have been able to bring down the prices of originator medicines.

Furthermore, the United Nations Development Programme, the World Health Organization, the World Trade Organization, and the Global Fund to Fight AIDS, TB and Malaria have adopted clear policies supporting the use of TRIPS flexibilities. Civil society groups have used the Doha Declaration in their advocacy campaigns to support HIV treatment. Additionally, generic companies have increased investments in antiretroviral production. Today, close to 90% of the 6.6 million people in low- and middle-income countries accessing antiretrovirals use generics.

To expand access to HIV treatment in the future, including access to pediatric formulations of antiretrovirals, a greater number of countries will need to consider using the TRIPS flexibilities. Innovative mechanisms such as the Medicines Patent Pool*, and UNITAID will need to be leveraged. 

The UNAIDS study is based on an extensive review of policy documents on the Doha Declaration and the use of TRIPS flexibilities in low- and middle-income countries.

The Medicines Patent Pool was established in 2010 with the support of UNITAID. Multiple patents are ‘pooled’ and licensed out by one entity, in order to cut down on transaction costs for all parties involved. This allows more affordable and more adapted versions of patented drugs to be produced as generics, long before their 20-year patent terms run out. 

Credit: MC ASEAN/Nyoman Budhiana

The Heads of State and government from the ten countries that make up the Association of Southeast Asian Nations (ASEAN) have committed to making Zero New HIV Infections, Zero Discrimination and Zero HIV Related Deaths a reality, in a declaration adopted at the 19^th ASEAN Summit in Bali, Indonesia (17-19 November 2011).

Reinforcing the commitments made at the High Level Meeting on AIDS in June 2011, the leaders—from Brunei Darussalam, Cambodia, Indonesia Lao People’s Democratic Republic, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam— pledged to, by 2015, halve sexual transmission of HIV and HIV transmission among people who use drugs and ensure accelerated efforts to achieve the goal of universal access to antiretroviral treatment. They also agreed to push towards eliminating new HIV infections among children in the next five years.

The 2011 Declaration details specific commitments by the ten ASEAN countries to ensure that adequate financial resources are provided for scaling up evidence-based HIV prevention programmes for key populations at higher risk such as people who use drugs, sex workers, men having sex with men and transgender people.

"We underline the importance of effective and comprehensive response to prevent and reduce the number of new infections and provide appropriate treatment, care and support to key affected populations and other vulnerable groups," said President of Indonesia and Chair of the 19^th ASEAN Summit, Susilo Bambang Yudhoyono, in his Chair’s Statement at the close of the Summit.

The ten ASEAN nations underlined the importance of ensuring financial sustainability, national ownership and leadership for improved regional and national responses to HIV. Through the declaration they committed to ensuring mobilization of a greater proportion of domestic resources for the AIDS response in the spirit of shared responsibility.

“These bold commitments by ASEAN leaders recognize the need for shared responsibility and that we are at a game changing moment for the AIDS response,” UNAIDS Executive Director Michel Sidibé . “To capitalize on the opportunities before us, the world must invest sufficiently today, so we will not have to pay forever.”

Through the Declaration, ASEAN Sectoral Ministerial Bodies as well as other relevant bodies are tasked with implementing the outlined commitments with all ASEAN Member States encouraged to support in accomplishing the goals.