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.

Credit: UNAIDS

UNAIDS brought together nearly 60 participants from 12 countries across Eastern and Southern Africa to a 3-day training workshop on expanding human rights, gender and HIV prevention programmes in national responses to HIV.  The workshop took place in Johannesburg from 20 – 23 September.

Participants analysed how to incorporate into their National Strategic Plans (NSP) programmes that can reduce stigma, address gender inequality and increase access to justice in the context of HIV. The programmes reviewed were the ones identified in the 2011 Political Declaration, adopted by Member States at the UN High Level Meeting on AIDS, as essential to addressing HIV-related stigma and discrimination in national HIV responses.

Governments committed to implement programmes that focus on sensitizing police and judges; training health care workers in non-discrimination, confidentiality and informed consent; supporting national human rights learning campaigns, legal literacy, and legal services, as well as monitoring the impact of the legal environment on HIV prevention, treatment, care and support. They also committed to protect the rights of women and end gender-based violence in the context of HIV.

Participants agreed that HIV programmes based on human rights and gender equality are key means by which to make national AIDS responses more people-centered. “Unless the legal and social environments are protective of the people living with and vulnerable to HIV, people will not be willing, or able, to come forward for HIV prevention and treatment,” emphasized Sheila Tlou, Director of the UNAIDS Regional Support Team East and Southern Africa.

During the workshop, each participating country team reviewed a human rights and gender analysis of their current National Strategic Plans produced ahead of the meeting by the International HIV/AIDS Alliance and Heard. These analyses confirmed results of earlier studies pointing out that human rights and gender equality are often cited in the introduction of the NSPs as important principles, and some programmes to support them may be mentioned. However, these programmes are often not included at the costing and budgeting phase, and when implemented, are seldom evaluated or taken to scale.

“It is imperative that we promote the incorporation of human rights and gender equality principles in our NSP. We need to move from mere acknowledgement of these principles to putting them at the forefront of the response to the HIV epidemic,” acknowledged Sylvie Pool from the Department of Legal Affairs of the Seychelles in representation of the country team.

By the end of the workshop, each country team had developed national action plans with specific commitments to integrate human rights and gender programmes in their NSP. Such commitments include the review of national strategic plans to identify human rights and gender gaps; costing of gender and human rights activities; training of civil society on human rights and gender issues so they can have better input into the national planning process; and mobilizing additional funding to implement HIV programmes with integrated human rights and gender principles.

“While integrating human rights and gender equality in the national AIDS strategic plan would appear challenging amidst competing priorities, it is possible!” saib Mr Lole Laile Lole, Chairman of the South Sudan Network of People living with HIV.

Participants in the workshop included technical experts involved in HIV strategic planning at country level, officials from national AIDS commissions, Ministries of Health, Gender and Planning, civil society organizations and people living with HIV. A wide range of facilitators also participated including UNDP, the Office of the High Commissioner for Human Rights, the World Bank, the International HIV/AIDS Alliance, Athena and Heard.

Countries selected to participate in the training were those currently engaged in adopting or revising national strategic plans to guide their response to the HIV epidemic. Two other such workshops will be held in 2011, one in Asia Pacific and one in the Middle East and North Africa.

The 3rd Conference on Drug Policies in Latin America that took place in Mexico City from 13-14 September brought together experts, academics, civil society organizations legislators and decision makers to discuss drug consumption trends, drug related problems and the policies and interventions developed in the region.

This year, there has been a very active participation from young people in the conference according to Aram Barra, programme director for youth and drugs in ESPOLEA—a Mexican youth platform working on gender, HIV and drugs from a human rights perspective. “We have been gathering a group of young activists since 2009 to promote the inclusion of young drug users in the yearly conference,” he explains. “This year we have made a difference. We moved from being passive spectators to taking active part in the discussions on an equal footing with experts and other decision makers,” said Mr Barra.

Over the course of three days, the conference promoted a social debate around different issues such as HIV among injecting drug users as well as the need for evidence based information covering the situation of youth and policies based on human rights. Reducing by 50% the number of new HIV infections among injecting drug users by 2015, as stated in the political declaration agreed by Member States at the 2011 High Level Meeting on AIDS was a constant reference throughout the conference.

The HIV epidemic in Latin America is mainly concentrated among men who have sex with men and transgender people. However, some countries like Brazil, Uruguay, Argentina and Mexico are showing prevalence rates around 5 % among injecting drug users.

“We need political will in Latin America to implement the right harm reduction policies and opioid substitution therapy programmes. We need to increase access to information about HIV, clean needles and syringes, create peer support environment and, for people infected with HIV, provide timely access to effective antiretroviral therapy,” said Enrique Zelaya, the UNAIDS Coordinator for Guatemala and Mexico. 

The youth in ESPOLEA emphasized the need for a supportive environment to make the goal set in the 2011 Political Declaration achievable in Latin America. “We need to see policy change that decriminalizes drug users and implement harm reduction programmes that take young drug users needs into account”. 

According to the youth group, the young crack users in the suburbs of Montevideo and the injecting drug users at the Mexican borders are part of a diverse group of drug users all with different needs and exposing themselves to different risks. There is a need to respond to these complex realities when policies are developed and services put in place.

“The youth need to be involved to make programmes work on the ground and increase their impact. Working together with UNAIDS, UNODC and governments we can achieve the goal of reducing infections by 50 % among injecting drug users,” concluded Aram Barra.

Abhinav Singh from India, Ritah Namwiza from Uganda and Anthony Adero, UNAIDS Special Youth Fellows 2011.
Credit: UNAIDS

Abhinav Singh from India, Ritah Namwiza from Uganda and Anthony Adero from Kenya have just joined the UNAIDS headquarter in Geneva, as the fourth round of the UNAIDS Special Youth Fellowship programme. Designed to create opportunities for young people from low- and middle income countries to contribute to HIV programme and policy development, the programme ensures a two-way transfer of skills between the fellows and UNAIDS staff.

Founder of the youth led organization The Dove Foundation, Abhinav Singh was working with the Uttrakhand State AIDS Control Society when he was accepted as the first ever fellow from India.

“Being the first from my country makes me feel delighted and also brings in a lot of responsibility towards the young people in India,” said Abhinav Singh. “I expect to learn profoundly and also gain quality experience for working with young people and HIV in my country. Being in UNAIDS Secretariat is like a dream come true for a public health professional and I feel really privileged to be a part of this global team.”

Most young people still have limited access to good quality education and sexual and reproductive health programmes that provide the information, services and commodities to protect themselves from HIV. The Special Youth Fellowship programme aspires to build the capacities of young people and reinforce their leadership skills to strengthen national responses to HIV.

“I was thrilled to be chosen for the fellowship” said Ritah Namwiza, who previously worked with young people’s HIV outreach programmes in Uganda. “This is a great learning opportunity—I will interact with people who have a wealth of experience in their respective fields. Everybody has been so helpful and welcoming!”

Selected through an open and competitive process, the youth fellows spend 4 months at the headquarters in Geneva, followed by 5 months in the UNAIDS Country Office in the fellow’s country of origin.

Anthony Adero, from Kenya, is a youth peer educator and activist for the rights of the Lesbian, Gay, Bisexual and Transgender communities. He felt it was a dream come true to be accepted to the programme. “To have this opportunity to develop my capacity on youth programs and leadership skills, I am very elated to be part of this programme. I hope to learn, get mentored and grow strategically to develop a strong leadership role in AIDS response in Kenya!” 

Instituted in 2008, so far 12 fellows completed the programme. The SYP alumni are working in various capacities to strengthen the HIV response at global and national level.

The UNAIDS 2010 OUTLOOK report received first prize in the category of popular medicine from the British Medical Association during their annual Book Awards ceremony that took place in London on 14 September 2011. OUTLOOK won in a category with many entries where six other titles were short-listed as highly commended.

“This is a glossy magazine that isn't glossy but its production values are very high and it's attractive and well-designed,” said one of the judges. “The subject matter is well-explained without being overly technical and dry. The interviews and 'human interest' angle mesh well with the facts and technical content. It works very well, I've never seen it done like this before. A good intelligent read, well-dressed up to be appealing.”

The Book Awards aim to encourage and reward excellence in medical publishing. Prizes are awarded in 21 categories, with an overall BMA Medical book of the year award made from the category winners.

The OUTLOOK report was launched in Geneva ahead of the XVIII International AIDS Conference that took place in Vienna from 18 – 23 July 2010. The report is filled with data, powerful testimonies and forward-looking assessments on the global AIDS epidemic.

The report outlined a simplified HIV treatment platform called Treatment 2.0 that could drastically decrease the number of AIDS-related deaths and could also reduce the number of new HIV infections. Also in the report, a UNAIDS and Zogby International public opinion poll shows that nearly 30 years into the AIDS epidemic, region by region, countries continue to rank AIDS high on the list of the most important issues facing the world.

A dedicated web site was also developed in conjunction with the report which provided additional information to some of the articles in the form of videos, images or additional text.

The production of the report was coordinated by the UNAIDS Director of Communications Annemarie Hou who stressed the need for innovative approaches to the AIDS response. “To be recognized by this distinguished institution shows that we can push creative boundaries while keeping true to the science which allows us to reach new audiences with information on important issues in the AIDS response,” she said. “This report could not have happened without the amazing collaboration of partners around the world.”

The BMA is the medical doctors’ professional organization established to look after the professional and personal needs of its members. The BMA represents doctors in all branches of medicine throughout the United Kingdom.