UNAIDS Executive Director Michel Sidibé (left) plays with a two-year-old boy at a specialized centre for children living with HIV near St Petersburg, Russia.

On the first of a four-day mission to the Russian Federation, UNAIDS Executive Director Michel Sidibé and UNAIDS Goodwill Ambassador James Chau visited a specialized HIV clinic near Saint Petersburg that cares for children who have been orphaned by AIDS and pregnant women living with HIV. The UNAIDS delegation toured the facility with its chief physician, Dr Evegeny Voronin, a leading AIDS expert in Russia.

“We receive children from all over Russia—mainly, the most severe cases of HIV infection,” said Dr Voronin, head of the Centre for Prevention and Treatment of HIV Infection in Pregnant Women and Children. “The overall strategy is that children are treated in their place of residence and sent to us only when there is no other choice,” he added.

Providing high quality treatment is just half the battle, says Dr Voronin.  After addressing a child’s medical needs, he and his team of social workers turn their attention to the social and psychological environment—crucial elements in the health and development of any child, particularly one living with HIV.

“Here at the Centre, we try to do everything we can so that the children don’t feel different from children in families,” said Dr Voronin, adding that his team encourages the children to dance, play music and participate in group activities to help them become more socially engaged. “But this Centre will never be a substitute for a real family,” he said.

During their tour of the Centre, Mr Sidibé and James Chau were treated to a musical performance by five pre-school age girls and one male toddler. “Being here gives me great hope,” said the UNAIDS Executive Director. “When they first came to this Centre, many of the children were unwell and couldn’t speak. Now they are dancing, singing, healthy and thriving,” he said.

According to government statistics, an estimated 5200 children under the age of 15 were living with HIV in the Russian Federation in 2010. More than 22% of children living with HIV are orphans or have been left behind without parental care.

Perceptions around HIV slowly shift

Dr Voronin notes that in Russia’s larger cities, social stigma towards people living with HIV is less pronounced than in remote regions of the country, as people tend to have access to more information. “Here in St Petersburg, HIV is not a rare disease—there are more than 40 000 people living with HIV,” he told the UNAIDS delegation. “People recognize that HIV-positive people are the same as everyone else.”

As HIV becomes more widely understood and accepted in Russia, the number of adoptions of children living with HIV is on the rise, says Dr Voronin. Five years ago, he says, only 10 out of 350 abandoned children were adopted in Russia—mainly by employees at his Centre or people of religious faith. Today, 100 per cent of girls under the age of seven at the Centre are adopted by families.

“These children are sons and daughters,” said James Chau, a well known television personality in China who works with UNAIDS on stigma and discrimination issues. “If we succeed in breaking the last barrier—social stigma—we will turn a fundamental corner in the HIV response. I am incredibly encouraged by what I see at Dr Voronin’s Centre.”

Preventing new HIV infections in children

In addition to caring for children living with HIV, the centre works to prevent new HIV infections. “Over the past two years, we have achieved zero per cent transmission of HIV from mother to child among 300 women seen at our centre,” said Dr Voronin.

He noted, however, that about 15% of pregnant women living with HIV across Russia seek treatment too late in their pregnancies—immediately before or during labor—and give birth to about 50% of all HIV-positive children in the country.

Learners participating in a ‘Positive Speaking’ intervention, in Luanda, Angola
Credit: UNESCO

Students and teachers in four southern African countries are benefiting from an ambitious HIV programme spearheaded by UNESCO. From its start in 2008, the programme was designed to strengthen the education sector’s AIDS response in Angola, Lesotho, Namibia and Swaziland.   

Called ‘Building knowledge, skills and hope: HIV and AIDS education for African children’, the three-year project has encompassed improving the curriculum and learning materials about HIV. It has also focused on supporting teacher training with better programme and policy guidance. The programme aimed to strengthen care and support systems for learners and education personnel affected by HIV as well as to improve the delivery of AIDS education in hundreds of schools. 

Implemented by UNESCO and financed by the Virginio Bruni Tedeschi Foundation, the project was carried out under the UNAIDS Global Initiative on Education and HIV and AIDS (EDUCAIDS) and reinforced ongoing work in each country’s ministry of education.

According to UNESCO the result has been the repositioning of the education sector at the centre of the national AIDS response in all four countries. Reforms are underway in all project countries to integrate HIV and sexuality education into the curricula of schools and teacher training institutions.   

The initiative has led to a number of innovations such as the establishment of the first national networks of teachers affected by HIV. “Since this initiative was launched, we share our experiences, our fears, our hopes and our dreams together,” said Nelao Martin, a teacher living with HIV and a member of the EduSector Support Network on Health and HIV in Namibia. “In the past, someone somewhere has necessarily been through the same difficulties and managed to deal with it.”

The first support groups for children and adolescents affected by AIDS have been established. Also, in partnership with associations of people living with HIV, new approaches have been used to reach out to positive learners in schools. ‘Positive Speaking’ sessions were introduced whereby personal testimonies and experiences of young, openly HIV-positive facilitators allowed pupils to ‘put a face’ to the virus.  

Nkuebe Peete, an HIV-positive 23 year-old living in Lesotho has taken part in such interventions: “I am proud to share my story and experience with younger people so that they do not make the same mistakes that I made and become supportive to those who live with HIV. This has given a new meaning to my life. I now have the feeling of being a much better person than before.”

In addition, innovative teaching and learning materials have been developed such as the series of speaking books on HIV for primary pupils in Swaziland. Most materials for the sensitization of older students have been developed by the learners themselves in creative and interactive ways. One particular approach involved national and regional ‘PhotoVoice’ exhibitions which highlighted testimonies of HIV-positive learners and teachers. In total, project activities have reached more than 4 000 schools, 17 000 teachers and nearly half a million learners.

Building on the groundwork laid by the project new initiatives are being developed. For example, in May 2011 Namibia’s ministry of education mandated and budgeted for the introduction of full-time teachers dedicated solely to life skills education, guidance and counselling in all primary and secondary schools. 

Lesotho and Swaziland are about to adopt policies that recognize the impact of AIDS on their education systems. Such policies call for the integration of strategies for prevention and care adapted to the needs of learners and teachers. Similar efforts have been initiated in Angola, which is addressing the formulation of an education sector strategy and policy on HIV.  

Project partners believe the programme has contributed significantly to improving the AIDS response in the education sectors in all four countries. According to Majoele Likonelo Hlasoa, Director of Planning at the Ministry of Education and Training in Lesotho, “When I first joined the Ministry of Education, I did not understand what the education sector could and should do about HIV, which I  considered then as a health issue falling fully under the responsibility of the Ministry of Health. Since I have been exposed to the EDUCAIDS framework for action, I have changed my mind and have a real understanding of the issues at stake.”

Haitao Gong, Serge Dumont-Fudan Strategic Communications Research Fellowship winner, working at UNAIDS HQ. Geneva, 05 October 2011.
Credit: UNAIDS

UNAIDS extends a warm welcome to Haitao Gong, this year’s Serge Dumont-Fudan Strategic Communications Research Fellowship winner. Haitao is pursuing a master’s degree in marketing communications in the prestigious School of Journalism at the University of Fudan in China and joined the UNAIDS communications team as an intern in September. He will be spending the next three months turning his theoretical knowledge into practice in the high-paced environment of the UNAIDS Geneva Secretariat.

UNAIDS.org met up with Haitao to talk about travelling outside China for the first time and what he hopes to gain from this scholarship.

Tell us about the Serge Dumont scholarship that brings you to UNAIDS all the way from China.

I come from Wei Fang, the famous “Kite City”, in Shandong province in the north of China. It’s about 1000 kilometres from Shanghai. Fudan University, where I study, was founded in 1905 and is one of the top five universities in China.

The Serge Dumont-Fudan Strategic Communications Research Fellowship, through which I have obtained this opportunity to intern with UNAIDS, is jointly run by the Serge Dumont Fund and the School of Journalism of Fudan University to encourage outstanding undergraduates and postgraduates committed to a career in strategic communications. It encourages students to apply their theoretical knowledge in practice and get a much deeper insight into strategic communication.

What motivated you to apply for this scholarship?

Initially, I never had the courage to imagine that I would win the scholarship and sit here in the offices of UNAIDS. Winning an opportunity to go abroad and become an intern at a world famous international organization like this was the most significant motivation for me. It is a wonderful and attractive project. I want to give myself the opportunity to improve my skills and apply my knowledge in practice.

Why did you want to come abroad?

I was an excellent student there, but that was only in China. I hope that being here will give me a clear perspective of myself and help me find my own position, not only in China, but also in the world. I wish to broaden my vision, experience different cultures and values and develop an international perspective.

What did you know about HIV before you came here?

I didn’t know much about it at a personal level. I only knew what I saw in publicity films that it’s a virus that can cause AIDS. In China they also tell us how to prevent HIV and show respect to people living with the virus. There is a big effort in my country to raise awareness about HIV.

What are your career plans after you graduate?

Before I came here, I wanted to work for a big multinational corporation and pursue my own success. But now I think differently. Working for an international organization such as this can make you think more deeply about making a contribution to the world. And that’s what I want to do.

How has your experience been so far?

This is the first time that I’m away from China. I might not be able to adapt as quickly as other Chinese students who have been abroad before. But I am trying my best to adjust to the new environment here and I will spare no effort in making my own contribution to UNAIDS. 

The Serge Dumont Fellowship was founded to encourage talented students to pursue careers in strategic communications and public relations. As a strategic partner, UNAIDS offers unique internship opportunities each year where students receive real-world experience in its communication programmes to make their own contribution to the HIV response. So far UNAIDS has hosted three fellows from the programme.

Professor Salim Abdool Karim and his team showing CAPRISA’s Ethekweni research facility to UNAIDS Executive Director Michel Sidibé

In 2010 an announcement was made by the Centre for the AIDS Programme of Research in South Africa (CAPRISA) which rocked the AIDS world and promised hope for millions of women around the world.

The researchers discovered that the antiretroviral medicine tenofovir, when applied to the vagina in gel form, is effective in reducing HIV infections in women by up to 54%.

The discovery was made by Professor Salim Abdool Karim and the team at CAPRISA’s Ethekweni research facility. The centre is located in a historic building built in 1946, originally home to the Durban Chest Clinic, a state-run Tuberculosis facility.

In 2000 the local government built the new state of the art Prince Cyril Zulu Communicable Diseases clinic adjoining the old building which was designed specifically to minimize the risk of cross infection among patients.

It is the largest TB centre of its kind in South Africa, with specially designed ventilation to encourage an in out air flow, vast open waiting areas to reduce the risk of cross infection and huge skylights which enable the suns rays which destroy the TB.

The facility is located in central Durban, in the heart of the transport hub for public commuters by rail, bus or minibus taxis.

“This means that the clinic receives a lot of walk-in patients”, explained Santhana Gengiah, Study Coordinator at CAPRISA.  “Accessibility and convenience for clients is paramount”.

The venue provided the perfect location for Professor Karim and his team to set up their HIV research programme as the TB clinic which also has a sexually transmitted infection centre on the first floor, found that around 70% of the patients coming into the clinic also were testing positive for HIV.  

The CAPRISA eThekwini site comprises two sections, a Treatment Clinic for HIV-TB co-infected patients and an HIV prevention clinic.  The prevention section has hosted a number of notable microbicide scientific trials, including the CAPRISA 004 trial and the recently modified Vaginal and Oral Interventions to Control the Epidemic (VOICE) study.

Professor Salim Abdool Karim (left) and UNAIDS Executive Director Michel Sidibé

VOICE is an HIV prevention trial evaluation two antiretroviral based approaches for preventing sexual transmission of HIV in women––daily use of one of two different ARV tablets (tenofovir and Truvada) or of a vaginal gel. The Data and Safety Monitoring Board recommended that VOICE participants in the oral tenofovir arm of the study discontinue their use of the product as the trial was not able to demonstrate that the tablets were effective in preventing HIV in the women enrolled in the trial. VOICE will however continue to test the efficacy of the other oral tablet Truvada and the vaginal gel formulation of tenofovir.

The treatment section of the clinic is perhaps best known for the groundbreaking SAPiT trial, which provided essential evidence for HIV/TB treatment guidelines and informed the current World Health Organization guidelines on the treatment of TB in HIV-positive patients.

The Executive Director of UNAIDS Michel Sidibé recently paid a visit to both the CAPRISA and Prince Cyril Zulu sites, and was impressed by the innovative work being carried out in the name of science and service delivery.

“This is a great example of how scientific innovation meets implementation”, he said. “The scientific research being done here gives hope to millions of men, women and children who will lead a longer, healthier life because of these important discoveries”.

Participants at the roundtable entitled "Closing the gap between science and implementation: Accelerating science to get to South Africa’s vision of zero new HIV infections". South Africa, 30 September 2011.

“The time has come for action,” said Professor Salim Abdool Karim, the Director of The Centre for the AIDS Programme of Research (CAPRISA), at the end of a roundtable discussion held to explore ways of accelerating the time it takes to put new scientific research into action. 

The roundtable was entitled Closing the gap between science and implementation: Accelerating science to get to South Africa’s vision of zero new HIV infections, and looked at ways of maximizing the opportunities created by scientific research around HIV prevention in the past year to reach the country’s target of halving new HIV infections by 2015.

The Executive Director of UNAIDS Michel Sidibé, who was on a seven-day visit to South Africa, engaged in the discussions which were held at CAPRISA’s Centre of Excellence at the University of Kwazulu Natal. He said, “In the last year science has given us the tools to reach our goals, the challenge now is how to apply them.”

Discussions focused on the recent groundbreaking scientific results which have provided the evidence needed to move forwards with a new range of HIV prevention technologies––microbicides, medical male circumcision and treatment for prevention. However participants were concerned that it is taking too long to get these lifesaving interventions to the people that need them most. 

One of the main challenges discussed was the lack of funding for implementation. “Research into microbicides or vaccines attracts big funding,” said one of the participants. “But donors are not as quick to fund the translation of science into implementation.”

“We cannot afford to wait – bold leadership is needed to turn the epidemic around”, said Professor Abdool-Karim. “In the face of cost, it is more costly to do nothing”, he added.

In addition to the new prevention technologies, participants agreed that HIV counselling and testing remain critical to a robust HIV prevention response. They also underlined that high burden countries need to be prioritised and that policymakers and implementers do not use a one-size-fits-all approach to HIV prevention, but rather tailor local responses to local contexts.

A wide range of stakeholders were brought together to engage in the debate including scientific researchers, government, civil society, and the private sector.

Professor Quarrisha Abdool Karim, Associate Scientific Director of CAPRISA, described the meeting as “electric”, adding that, “For the first time a diverse group of people have come together to discuss this issue. It is a complex issue with no easy answers but it is the start of positive discussions around our common goal, which is to wipe out new HIV infections.”

Credit: UNAIDS

“What’s in a name?” asked Yvette Raphael during a meeting with representatives from more than 15 civil society networks in South Africa and the UNAIDS Executive Director. Ms Raphael was talking about the challenges faced by civil society and networks of people living with HIV. She brought up how sometimes something as basic as a “name” or how people talk about HIV can be obstacles to services and life. Ms Raphael gave examples of clinics with depressing names no one wanted to go into and even some of the names given to children living with HIV. “I mean, who wants to marry ‘Sadness’,” she said. “We need to normalize the language and terminology we use when we talk about AIDS.”

Mpho Moteble, a university student lamented the fact that HIV and other health services are not available at her school. While students can get an HIV test and counselling, they can’t get HIV treatment on campus or a pap smear for cervical cancer screening. For these services she must go to a general clinic where she says she isn’t with her peers and it can be very uncomfortable, “I don’t want to see my aunt at the clinic—and have her ask me, aren’t you supposed to be at school?” Ms Moteble said far too few campus clinics offer integrated services, making it difficult for busy students to follow through. 

Civil society groups raised many of the difficult issues facing South Africa, from getting services to people with disabilities living with HIV, hate crimes and violence against women to discordant couples. Another important issue raised was how the country will approach HIV treatment options in the near future when first-line antiretroviral treatment is no longer effective.

Johanna Ncala was one of many who raised the point of how people living with HIV can contribute to HIV prevention efforts. She also talked about daily life and how difficult it can be to disclose one’s status or to always use condoms. Another participant mentioned that while adults have support groups for sharing life experiences, she is seeing a new generation of adolescents born with HIV that are growing up without the life skills and knowledge needed to effectively engage in a relationship.

Pholokgolo Ramothwala from Positive Convention moderated the discussion. He noted that much progress had been seen in the last few years and that has re-energized groups to push for more action on these tough issues.

UNAIDS Executive Director Michel Sidibé echoed this theme of not shying away from the complex areas. “You are all agents of change,” he said. “UNAIDS stands in solidarity with you and we will continue to mobilize for the change we all want to see happen.”

UNAIDS Executive Director, Mr. Michel Sidibé (right) receives a token from His Majesty King Goodwill Zwelethini.
Credit: UNAIDS/A.Debiky

During his seven-day visit to South Africa, the UNAIDS Executive Director, Michel Sidibé had the opportunity to meet His Majesty King Goodwill Zwelethini, in his home province of Kwazulu Natal.

The King is a key figure in the response to HIV in the Province, home to the Zulu nation. In what was lauded as a bold move, in mid-2009 the King called for Zulu men and boys to undergo medical male circumcision (MMC) in a bid to protect themselves against HIV. Studies have shown that MMC can reduce the sexual transmission of HIV by approximately 60%.

At the time of the King’s announcement it was mainly Xhosa, Sotho, Ndebele and Shangaan people who underwent traditional circumcision as part of a boy’s initiation into manhood.

Traditional circumcision among Zulu men was banned in the time of King Shaka.

However, now over two centuries later the current King of the Zulus has revived the practice of circumcision to try to save the lives of his people. The King’s decision was motivated by the disproportionate impact of HIV on the Zulu people.

Mr Sidibé commended the King on his vision and leadership around HIV, particularly on male medical circumcision and on his continued personal engagement in the response to HIV.

Thanking Mr Sidibé for his support to South Africa’s AIDS response and calling for the need for strong partnerships the King said, “The health of the nation can only improve if we create a permanent, unified front against the epidemic…..I am on the winning side but without support of the outside world I cannot win this war.”

Mr. Sidibé visited the Halley Stott Primary Health Clinic in Botha’s Hill where Sister S.B. Shawuka, the Operational Nursing Manager of the clinic show him how integrated health services are serving the needs of the local community.
Credit: UNAIDS/A.Debiky

The Province of Kwazulu Natal, South Africa, has been widely acknowledged as leading the provincial response to HIV in the country. Its integrated approach to service delivery means that people who are accessing services are those who need them the most.

Part of this integrated approach is the innovative Operation Sukuma Sakhe (Let us stand and build), where data is collected on the health, social and economic needs of households in the local community.

The data is collected by a War Room Task Team, comprised of community volunteers called cadres, who ‘profile’ households in order to assess their needs. This data is then taken to a ‘War Room’ at the clinic where a committee meets to discuss and process the data they have gathered on households before referring to the appropriate government department to deliver the services needed to the households.

“The district has more than 60 volunteer cadres, which is quite a lot for the size of the district. I do this job because of the thrill I get from knowing that I am helping people with their problems”, says Vukani Ndlovu, the war room task team supervisor.

It is this unique approach to the integration of services which drew UNAIDS’ Executive Director, Mr. Michel Sidibé, to meet with policymakers, implementers and community members in KwaZulu Natal Province on the second day of his official visit to South Africa.

Mr. Sidibé visited the Halley Stott Primary Health Clinic in Botha’s Hill, located in the strikingly beautiful Valley of a Thousand Hills area just outside Durban. At the clinic, Mr. Sidibé was shown how integrated health services are serving the needs of the local community. 

“We offer a range of services at the clinic, from HIV prevention, counselling, testing and treatment, preventing mother-to-child transmission of HIV to TB, paediatric care, cervical and breast cancer screening and even psychiatry and dentistry,” explained Sister S.B. Shawuka, the Operational Nursing Manager of the clinic.

The clinic also does regular community outreach through its mobile clinics, offering HIV testing and counselling, immunisations, cancer screening and raising awareness on the health services offered. They recently conducted a community outreach campaign in partnership with a local NGO to teach women how to do monthly checks for breast cancer.

“The province is showing a major commitment to HIV prevention by pushing a holistic approach to health services,” said Mr Sidibé. “I am heartened to see how KwaZulu Natal is leading innovation with a successful model which I hope other Provinces will replicate.”

Premier of KwaZulu-Natal Dr Zweli Mkhize (left) and UNAIDS Executive Director. 29 September 2011.
Credit: UNAIDS/A. Debiky

The Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) commended the Premier of KwaZulu-Natal Dr Zweli Mkhize on his commitment to integrating HIV with health and social and economic services.

Through the integrated approach adopted in KwaZulu-Natal local communities have a one stop shop through which they have easy access to information, health services and a broad range of social and economic services addressing poverty, education and development.

“This holistic approach to accessing health and social services is not only efficient but effective and serves as a model for other provinces and indeed other countries across the region,” said Michel Sidibé who was on a seven day visit to South Africa to learn more about the progress and challenges the country is facing in scaling-up its response to HIV. “The work being done here is an example of how to bring services to the heart of the community, to where they are most needed.”

The Premier of KwaZulu-Natal, Dr Zweli Mkhize, has played a leading role decentralising South Africa’s AIDS response and in integrating HIV into the economic and social agenda of the province. The provincial government has put in place integrated programmes to address HIV, TB, breast and cervical cancer, poverty, food security, and a range of other health and social services.    

“By bridging HIV services with other services the community needs we believe that we can help South Africa to reach our national targets of reducing the number of new HIV infections by 50% by 2015 and in significantly expanding the number of people on antiretroviral treatment,” said Dr Zweli Mkhize. “Our model is working.”

HIV prevalence was 39.5% in 2009 in KwaZulu-Natal, the highest in South Africa. The integrated approach adopted by the provincial government of KwaZulu-Natal has already contributed to increasing the uptake of HIV testing reaching 2.9 million people in the Province as of end of June 2011. It has also expanded access to lifesaving antiretroviral therapy to 489 801 in 518 sites in the Province and in reducing the rate of infections from mother to child from 21% five years ago to 2.8% in 2011.

South African Minister of Health Aaron Motsoaledi (left) and UNAIDS Executive Director Michel Sidibé.
Credit: UNAIDS/P.Thekiso

UNAIDS Executive Director Michel Sidibé started a seven-day visit to South Africa on 27 September which will focus on the country’s efforts to ending new HIV infections amongst children by 2015, HIV integration services and bridging the science and implementation divide.

Also high on the agenda is South Africa’s campaign to reach people with HIV testing and counseling services. Mr Sidibé met with South African Minister of Health Aaron Motsoaledi to discuss progress since the launch of the campaign in April 2010.

At the start of the campaign around 2 million people were tested for HIV—by September 2011 that number had risen to more than 13 million.

The Minister outlined that one of the most successful strategies had been bringing HIV testing and counseling to people—from workplaces to villages. By creating an open environment Minister Motsoaledi said, “People didn’t need to ask for an HIV test, it was the government asking people to participate.” At the HIV testing and counseling sites people could find out their HIV status, as well as other health needs such as blood pressure checks and cervical cancer screening.

The Minister also discussed the uptake in HIV treatment, highlighting that an additional 400 000 people nationwide had started on antiretroviral therapy since the beginning of the campaign. The government reports that HIV treatment is now available in more than 2 000 centers—up from 490 at the start of the campaign.

“South Africa has shown visionary leadership in the AIDS response in recent years. In such a short period of time real results for people can be seen across the country.” said Mr Sidibé. “I am looking forward, over the next few days to meeting the men and women who are making this happen and the families which are seeing the benefits.”

During the next week Mr Sidibé will be looking at how UNAIDS can support South Africa in achieving its commitment to ‘Zero new HIV infections’ in children and will visit a clinic providing services to families in Guateng province. He will also be drawing lessons from South Africa’s engagement to integrate HIV services with other health services as he visits a clinic in Durban providing HIV, tuberculosis, sexually transmitted infection and female cancer services.

Mr Sidibé will meet with provincial officials to discuss some of the challenges they face in implementing programmes in urban and rural areas and how they are overcoming them. He will also be meeting with some of South Africa’s top scientists, researchers and implementers to see how recent scientific breakthroughs in the AIDS response can be turned into a reality for the people who need them most.