Credit: UNAIDS/P.Virot

In the past decade, increased commitment and funding has enabled countries to boost their HIV responses. However, many of the gains remain fragile as countries face challenges to take charge of their own AIDS responses.

Following the High Level Meeting on AIDS where world leaders agreed on bold targets, UNAIDS convened a workshop in Dar es Salaam, Tanzania to strengthen investments in capacity development of six sub-Saharan African countries—Benin, Ethiopia, Ghana, Malawi, Nigeria and Swaziland.

The focus of the workshop was on increasing country ownership in their AIDS response. The workshop also encouraged countries to share experiences and indentify bottlenecks. According to participants, some of the key challenges include limitations in programme implementation, poor governance systems, lack of leadership and human resources and uneven financial and management capacities

“The area of capacity development is a learning area for Ethiopia. Through this workshop we have learnt from the obstacles and challenges faced by countries and how to avoid those pitfalls,” said Alemu Arno Ararso, Director of the Multi-sectoral Response Coordination at the Federal HIV/AIDS Prevention and Control Office (FHAPCO), Ethiopia. “We know that investing in capacity development will help our country achieve its AIDS objectives and expected results,” Mr Ararso added.

The six countries have received grants from the EC to develop and implement technical support plans, addressing issues such as governance systems, leadership development, human resources and financial management capacities.

Ghana, Nigeria and Swaziland have integrated their technical support and capacity development plans into their national AIDS strategic frameworks and are starting implementation. Ghana plans to utilize the EC grant to bring together development partners to discuss the creation of a pooled fund for the provision of technical support. In addition, Ghana is working with academia to establish training programmes in health systems strengthening and monitoring and evaluation, with a view to building long-term and sustainable country capacities.

At the end of the workshop participants emphasized the importance of national partners with organizations such as universities. Special mention was given to the fact that, despite countries’ efforts to scale-up in-country capacities, migration of skilled professionals has reduced the impact.

“As efforts evolve from an emergency to a more sustained response, country capacities now need to be developed in a range of core areas,” said UNAIDS Team Leader in the Aid Effectiveness and Country Capacities Division, Angela Trenton Mbonde. “Country ownership and capacity development should play a more central role in moving forward the AIDS response,” she added.

The country inputs and experiences shared throughout the workshop will inform the revision of the UNAIDS Capacity Development Guidance Note intended to promote a common understanding of capacity development in the context of technical support planning and national HIV programmes.

Young leaders and government policy-makers discussing commitments made regarding young people and the AIDS response. UN HQ, New York. 26 July 2011.
Credit: UNFPA

A new report highlights that global commitments will be achieved only if the unique needs of young women and men are acknowledged and their human rights fulfilled, respected, and protected.

The Global Inter-Agency Task Team on HIV and Young People launched the synthesis report entitled Securing the Future Today containing strategic information about HIV and young people. The report was launched at an event organized by UNAIDS on the sidelines of the United Nations High-level Meeting on Youth which took place in New York from 25-26 July under the theme “Youth: Dialogue and mutual understanding”.

The side event, convened in collaboration with UNFPA, ILO, Global Youth Coalition on HV/AIDS, Population Council and Catholic Relief Services, brought together young leaders and government policy-makers to discuss commitments made regarding young people and the AIDS response. Participants looked for solutions to reach a shared vision of “Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths” among young people.

In order to reduce new HIV infections among young people, achieve the broader equity goals set out in the MDGs and begin to reverse the epidemic, HIV prevention and treatment efforts must be tailored to the specific needs of young people.

Recent epidemiology data from UNAIDS indicates that young people are leading the HIV prevention revolution by taking action to protect themselves from HIV. Young people’s sexual behaviors are changing and HIV prevalence among young people is dropping in 15 of the 21 countries most affected by HIV. However, in 2009, young people accounted for 41% of all new HIV infections among adults with 3 000 young people becoming newly infected with HIV each day. Also in 2009, 4.9 million young women and men were living with HIV worldwide.

The report highlights that young people are a key resource to reverse the global AIDS epidemic and lead the response in decades to come. But it stresses that the legal and policy barriers that prevent young people from accessing HIV services must be addressed, and young people should be engaged more effectively in the response.

In that sense, the side-event provided a platform for young people to have a direct dialogue with national Governments in order to encourage the scale up of HIV prevention and treatment services for young people as well as the active involvement and leadership of young people, including those living with HIV, in the AIDS response at all levels.

According to the new report, to effectively advance the response among young people, there is a need to increase investments. However, it also cautions that simply directing more resources will not increase HIV testing and uptake of services among young people. Instead, empowering young people and particularly young women to exercise their rights to sexual and reproductive health, improve programmes for young people and repeal national laws and policies that restrict access to HIV services for young people is required to protect future generations from HIV.

On the periphery of the IAS 2011 conference taking place in Rome from 17-20 July 2011, UNAIDS in collaboration with the Global Coalition on Women and AIDS (GCWA), ATHENA, Salamander Trust, WECARe+ and Network Persone Seropositive convened a town hall dialogue to discuss how the HIV response facilitates the achievement of sexual and reproductive health and rights for all women, including women living with HIV, at every stage of their lives. 

For women living with HIV stigma and discrimination and gender-based violence acutely affect their access to comprehensive services and human rights. Within health services, they often face a lack of choice with regard to family planning; disapproval from service providers with regard to meeting sexuality and fertility desires; and violation of their sexual and reproductive rights in the form of coerced or forced abortion or sterilization. Participants agreed that advancing the health and rights of women in all their diversity is fundamental to the success of the HIV response, just as the HIV response is a critical avenue for achieving sexual and reproductive health and rights for women.

The event was also used as a platform to launch a report Community Innovation: Achieving sexual and reproductive health and rights for women and girls through the HIV response. Compiled by UNAIDS and the ATHENA Network, it presents case studies pioneering community undertakings to advance women’s sexual and reproductive health and rights through the HIV response and vice-versa, from different community perspectives. This report recognizes that women face unique challenges to access and fulfil their sexual and reproductive health and rights, including gender-based violence, and therefore have less access to HIV prevention, care and support services.

“Women and girls at every level and throughout different stages of their lives must be supported to demand quality services that meet their needs and those of their community,” said UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay.

Learning from these community case studies is an opportunity to enhance the AIDS response, in light of the Millennium Development Goals and the 2011 Political Declaration on HIV/AIDS. The case studies indicate that for responses to be effective they must include the empowerment and inclusion of women in all their diversity, dedicate attention to sexual and reproductive health, including improvements in maternal and child health, and address the socio-cultural practices underlying gender inequality.

UNAIDS Getting to zero: strategy 2011-2015 also places gender equality and human rights as one of three core pillars. This report is part of that commitment to ensuring that women and girls’ rights are met through the HIV response and it was undertaken in the context of the UNAIDS Agenda for accelerated country action for women, girls, gender equality and HIV. 

“UNAIDS continues to be a strong advocate for women’s health and rights, as well as to strongly stand against stigma and discrimination amongst all marginalized groups. We will continue to do so until we have achieved the vision of zero discrimination,” said Dr De Lay.

UNAIDS Executive Director Michel Sidibé delivering his keynote speech at the opening session of the IAS 2011.

“We are at a scientific watershed in the global AIDS response,” said IAS 2011 International Chair and International AIDS Society President Elly Katabira. “We have witnessed two years of significant biomedical advances, the likes of which we have not seen since the antiretroviral breakthroughs of the mid 1990s. The excitement around these advances in research—whether they are the CAPRISA 004 vaginal gel, the HPTN 052 study on treatment as prevention or the encouraging signs on PrEP and vaccines—is very much driving the debates and discussions that we are going to see in Rome over the next few days.”

It is against this backdrop that the 6^th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) opened in Rome on 17 July. More than 5000 AIDS researchers, scientists, clinicians, community leaders and policy experts have gathered to examine the latest developments in HIV-related research and to explore how scientific advances can inform the global response to AIDS. 

The IAS Conference will also focus on finding ways to translate research into practice, particularly in low- and middle-income countries. In his opening session keynote speech, UNAIDS Executive Director Michel Sidibé described the current gaps in access to HIV treatment within and between countries and key populations as “an affront to humanity,” but also reminded the audience that these gaps “can and must be closed by innovations in developing, pricing and delivering treatments and commodities for HIV, TB, malaria, reproductive health and other health issues”. “We have to remember that history will judge us not by our scientific breakthroughs, but how we apply them,” added Mr Sidibé.

Echoing this call at the opening session, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità Stefano Vella insisted on the need to evenly share the recent advances in biomedical research between the global North and South. “We need to ensure that the advances we are making in research such as the now proven concept of antiretroviral treatment as a means of HIV prevention is translated into action for people in developing countries.”

Mr Vella also used the occasion to call on the Italian government to re-commit to the Global Fund to Fight AIDS, Tuberculosis and Malaria. “Advances in science need to be matched by advances in resourcing. I call on the Italian government to recommit itself as a donor nation to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” said Mr Vella.

IAS 2011 will reveal promising new data across all four scientific tracks – particularly in the areas of HIV treatment as prevention, HIV cure efforts, new drugs and new antiretroviral combinations, and the scale up of effective prevention and treatment interventions in resource-limited settings.

Credit: UNAIDS

The Medicines Patent Pool has begun negotiations with Boehringer-Ingelheim and Bristol-Myers Squibb for patents on HIV medicines essential to treating people living with HIV in the developing world. The announcement was made today during the IAS 2011 conference. The Pool was already in negotiation with five other patent holders and concluded its first licensing agreement with a leading pharmaceutical company, Gilead Sciences, a week ago.

UNAIDS Executive Director Michel Sidibé welcomed the news because “sharing innovation and patents will drive down the price of medicines and bring antiretroviral treatment to millions more people.”

“It is morally wrong that nine million are waiting for treatment and that 5 000 people are dying every day of AIDS-related illnesses,” Mr Sidibé added.

“Of all pharmaceutical companies with HIV medicines patents, only three are currently not in negotiation with the Pool. We call on Johnson & Johnson, Merck, and Abbott to follow the lead of their colleagues and enter into negotiations with us,” said Ellen ‘t Hoen, Executive Director of the Medicines Patent Pool.

The Medicines Patent Pool and Gilead Sciences agreement is for five products for the treatment of HIV and Hepatitis B: the medicines tenofovir, emtricitabine, cobicistat, and elvitegravir, and a combination of these medicines in a single pill known as the “Quad.”

Public health licensing of products in clinical development is rare and is an important advance in a field where many potentially valuable medicines are still in the developmental phase. This licence will allow for generic versions of new products to enter the market shortly after the products are available in rich countries. 

"UNITAID has worked for four years to develop the Medicines Patent Pool concept. Today we are proud to see that it is becoming a tangible reality," said Philippe Douste-Blazy, chair of the UNITAID Executive Board. "I salute these important steps by Gilead and other pharmaceutical companies and urge other pharmaceutical companies to place their patents at the service of global public health."

The Medicines Patent Pool was established by UNITAID in July 2010 to work towards bringing down the prices of HIV drugs and encouraging the development of new formulations, such as medicines for children, through voluntary licensing of critical intellectual property.

L to R: Hendrica Okondo, World YWCA Regional Programme Director for Africa and the Middle East; Babatunde Osotimehin, Executive Director, UNFPA; Mathilda Parau, YWCA of Papua New Guinea; Lissette Herrera, President, YWCA of Peru; Joanna Kerr, Action Aid International; Jan Beagle UNAIDS Deputy Executive Director, Management and External Relations; Gill Greer, Director General, IPPF.
Credit: YWCA

The World YWCA (Young Women’s Christian Association) hosted its fourth International Women's Summit (IWS) in Zurich, Switzerland from 12-13 July 2011. The event brought together more than 1 000 participants from over 100 countries to discuss issues facing women and girls today ranging from gender inequality, young women’s sexual and reproductive health and rights and HIV to the social and economic dimensions of violence against women.

"The Summit is an opportunity to lift our voices and demand women’s protection from violence. It is also an opportunity for possible remedies for survivors of violence and to affirm the leadership of women living with HIV. Our goal is to trigger action, achieve life changing results and make a real difference," said Nyaradzayi Gumbonzvanda, General Secretary of the World YWCA.

Under the theme Women creating a safe world, participants defined equitable, safe and inclusive spaces and programmes for women. According to them, safe space is about the personal, economic and political security of women and girls, their right to live free from violence, to make choices about where to live and work, to move freely and participate in all facets of democracy. It is also to have full access to sexual and reproductive health services, including universal access to HIV prevention, treatment, care and support, free of stigma and discrimination.

Organized around plenary sessions, a wide range of speakers from around the world particpated, including H.E. Thokozani Khupe, Vice-Prime Minister of Zimbabwe, Dr Michelle Bachelet, Executive Director of UN Women, Dr Babatunde Osotimehin, Executive Director of UNFPA, and Ms Mary Robinson, President of the Mary Robinson Foundation on Climate Justice. They challenged participants and enriched the debate with powerful ideas around the critical issues of sexual and reproductive health and rights, HIV, violence against women, peace and justice and human rights.

Speaking at the plenary on securing sexual and reproductive rights for all women, UNAIDS Deputy Executive Director, Management and External Relations, Ms Jan Beagle, highlighted that “for most women health is as much about social justice, dignity and equality of access to income, education and food, as it is about hospitals and medicines.”

“For UNAIDS, it is clear that gender equality and human rights, including sexual and reproductive rights, are non-negotiable elements to ensure effective HIV and health responses,” added Ms Beagle.

During the session, participants noted that a lack of contraception and unsafe sex are crucial risk factors for death and disability in women of reproductive age. The sexual and reproductive health and rights (SRHR) of women living with HIV are often ignored and one fifth to a half of girls and young women report that their first sexual encounter was forced.

The key elements to overcoming this situation, according to the participants, are providing comprehensive HIV prevention; building the leadership of women, especially young women, in advocacy and provision of services; creating and sustaining safe and inclusive spaces and access to full and comprehensive information.

The need to link community services and programmes with policy-making and accountability was also highlighted during the summit. Women and girls must be empowered to meaningfully engage in building safer environments, whilst the primary responsibility for provision of services, safety and security lies with States and their public government institutions. Civil society need to engage and monitor states to ensure they fulfil their promises and commitments under international law as suggested by participants.

“National HIV strategies need to be tailored to the needs and rights of women and girls and include specific programmes and budgets that address gender inequalities, in order to translate the commitment and political will into adequate resource investment,” said Ms Beagle. “It is unacceptable that less than half (46%) of all countries allocate resources for the specific needs of women and girls in their national response to HIV,” she added. Ms Beagle also emphasized the need to harness the leadership capacity of young women in developing and implementing policies and programmes to advance the sexual and reproductive health and rights of women and girls.

Medicines Patent Pool sign historic agreement with Gilead Sciences to increase access to HIV medicines in developing countries

GENEVA, 12 July 2011—The Joint United Nations Programme on HIV/AIDS (UNAIDS) strongly welcomes the new license agreement between the Medicines Patent Pool and the pharmaceutical company Gilead Sciences to increase access to antiretroviral therapy in developing countries. This is the first time a pharmaceutical company has signed an agreement with the Medicines Patent Pool and marks a turning point for future private sector collaboration in sharing innovation to advance the response to HIV. 

Under the agreement, Gilead will share intellectual property on a range of medicines to treat HIV. The agreement will allow for the production of the HIV medicines tenofovir, emtricitabine, cobicistat, and elvitegravir as well as a combination of these products in a single pill known as the “Quad.” Cobicistat, elvitegravir and the Quad are products still in clinical development. Companies interested in producing generic versions of the medicines for developing countries will be able to approach the Patent Pool to negotiate licensing terms.

“This agreement between the Medicines Patent Pool and Gilead signals a new era in the response to HIV with private and public sectors working hand in hand for the best interests of public health,” said Michel Sidibé, Executive Director of UNAIDS. “I hope today’s announcement will inspire other pharmaceutical companies to follow suit to share intellectual property and innovation to make new technological advances in HIV treatment available sooner to the people that need them most.” 

The agreement is particularly significant and represents a major step forward as Tenofovir is one of the first-line medicines for HIV recommended for use by the World Health Organization as per guidelines released in 2010. Under the new agreement Tenofovir will also be licensed for use to treat Hepatitis B, a common and serious co-infection of HIV.

The inclusion of products still under development is a rare and important advance and will allow for generic versions of new medicines to rapidly enter the market, lessening the inequality between developed and developing countries in accessing new medicines. 

In low- and middle-income countries, UNAIDS estimates that around 6.6 million people are currently accessing HIV treatment––however a further 9 million are still in need. At the recent United Nations High Level Meeting on AIDS, UN Member States unanimously adopted a declaration which set bold new targets which included increasing access to antiretroviral therapy to 15 million people by 2015. 

The Medicines Patent Pool is a creative new approach which was established in 2010 with the support of UNITAID to increase access to newer antiretroviral medicines by creating a
pool of patents and intelligence on antiretroviral production donated by medicine producers. It is currently in negotiations with six other patent holders.

Credit: North Star Alliance

Mobile populations, especially transport workers, are highly vulnerable to HIV. Many truck drivers and other mobile workers spend large amounts of time away from their families and can have multiple sexual partners. These include sex workers and others living along the highway and around truck stops.

The International Labour Organization (ILO), International Transport Workers’ Federation, International Organization for Migration, UNAIDS and Health Economics and HIV and AIDS Research Division organized a workshop in Johannesburg from 29-30 March 2011 to review current evidence related to HIV and the transport sector in southern Africa and to identify gaps and research agendas to strengthen evidence.

“We need to approach the transport sector in an integrated way that cuts across borders,” said Vic Van Vuuren, Director, ILO, East and Southern Africa.

The workshop brought together stakeholders operating in the transport sector in the most HIV affected regions of southern Africa. Participants included transport ministries, National AIDS Councils, civil society, development partners and representatives of the related employers’ and workers’ organisations, from Botswana, Kenya, Malawi, Mozambique, Namibia, South Africa, Kenya, Zimbabwe, Zambia, and Tanzania.

Transportation is integral to development in southern Africa. At a macro-economic level, countries’ ability to import and export goods and move economic inputs and outputs is a key element of GDP growth. At a city and community level, people’s ability to move and trade crucially affects their income and livelihood. There is ample evidence that HIV is impacting negatively on the transportation sector in the region.

A key part of the workshop offered participants and stakeholders, grouped according to their country of origin, to collectively devise strategic action frameworks. Each country agreed to a set of actions that they will take forward within the next two years to ensure progress in the areas of HIV and transportation. This was done in light of the international labour standard, 2010 ILO Recommendation concerning HIV and AIDS and the World of Work.

Conclusions and findings:

Transport sector employees are not the only demographic group that is vulnerable to health issues. Communities and traders that live and operate along transport corridors face health risks as well. According to the participants, there is a need for both a conceptual and pragmatic focus on vulnerable places instead of vulnerable groups.

Evidence shows that HIV programmatic health centres have been better received by end users when the term ‘Wellness Centre’ is used instead of ‘HIV’ or ‘AIDS Centres’. The adoption of a more general term avoids feeding the stigma and discrimination associated with HIV. It also shifts the focus from solely responding to HIV to improving the broader health and general well-being of clients.

Participants also identified the need to strengthen current efforts to unify customs protocols and avoid unnecessary delays at border posts. Delays at border posts increase the time that transport sector workers spend idle and away from their families —increasing their likelihood of engaging in high-risk behaviour.

The engagement of communities in the planning, design and implementation phases of projects was highlighted as key to ensuring that programmes will be well received and that they will be effective in the long-term.

L to R: Director-General of WHO Margaret Chan, Minister of Health and Family Welfare India Ghulam Nabi Azad, Minister of Health Brazil Alexandre Padilha, Minister of Health China Chen Zhu, Deputy Minister of Health and Social Development Russia Veronika Skvortsova, Minister of Health South Africa Aaron Motsoaledi, UNAIDS Executive Director Michel Sidibé.
Credit: UNAIDS

Universal access to medicines was a key topic of discussion at a meeting today of health ministers from Brazil, Russia, India, China and South Africa (BRICS) in Beijing, China. The meeting, hosted by the Government of China, aimed to identify opportunities for BRICS countries to promote wider access to affordable, quality-assured medicines, with a view to reaching the Millennium Development Goals and other public health challenges.

“The five BRICS countries are bringing a new voice, a new perspective and new solutions to today’s global challenges,” said UNAIDS Executive Director Michel Sidibé, who participated in the First BRICS Health Ministers’ Meeting, together with WHO Director-General Margaret Chan. “It is a voice with incredible economic, technological and innovative strength behind it and, at the same time, a voice intimately connected to the needs and interests of the developing world,” he added. 

Brazil, Russia, India, China and South Africa are home to 40% of the global population and nearly one third of all people living with HIV in the world.  While the five BRICS countries have made significant progress in expanding HIV prevention and treatment services for their populations, the goal of universal access remains a critical challenge: In four of five BRICS countries, for example, only one third of people who need HIV treatment are receiving it.

A “Beijing Declaration,” issued on 11 July and signed by ministers of health from the five BRICS countries, underscored the importance of technology transfer among the BRICS countries, as well as with other developing countries, to enhance their capacity to produce affordable medicines and commodities. The Declaration also emphasized the critical role of generic medicines in expanding access to antiretroviral medicines for all.

By signing the Declaration, leaders committed to working together to preserve the provisions contained in the Doha Declaration on TRIPS and Public Health—provisions that allow for countries to overcome intellectual property rights restrictions on medicines in the interest of public health.

“Access to affordable medicines is a fundamental element to bring health services to scale, especially for the poor,” said Chen Zhu, China’s Health Minister.

The five BRICS countries face similar health challenges, including a double burden of communicable and non-communicable diseases, inequitable access to health services and growing health care costs. Through collective action and influence, the BRICS coalition promises to deliver cost-effective, equitable and sustainable solutions for global health.

UNAIDS Executive Director Michel Sidibé (left) and China’s Vice Premier Li Keqiang.
Credit: Xinhua News Agency

During an extended country visit to China UNAIDS Executive Director Mr Michel Sidibé met with China’s Vice Premier Li Keqiang to discuss how China is scaling-up their response to HIV. In their meeting, Mr Li stressed that Getting to Zero—UNAIDS strategy calling for zero new HIV infections, zero discrimination and zero AIDS-related deaths worldwide––constitutes a guiding vision for China’s national HIV strategy.

Mr Li, who is also the Chair of the State Council AIDS Working Committee, noted that the “Three Zeros” are key objectives for China’s response to HIV and that China is committed to turning the vision into a reality. “The Three Zeros can be achieved. We are mobilizing a movement to achieve this,” said the Vice Premier during discussions with Mr Sidibé. “I am committed and the government is committed to making this happen.”

There are around 740 000 people living with HIV in China, which has a national HIV prevalence of 0.06%. However according to government figures, approximately 5% of men who have sex with men in China are living with HIV—88 times higher than the national average. Another key population at higher risk are people who inject drugs, which in 2009 accounted for more than 24% of new HIV infections.

Vice Premier Li noted that China has made important progress in its response to HIV, but that the situation remains serious and new ideas and approaches will be necessary for success. “The challenges remain” said Mr Li. “HIV infections due to sexual transmission and drug use need to be reduced. More needs to be done in these fields.”

Mr Li also stressed the importance of full community participation in the HIV response and of the government’s commitment to facilitating this participation. According to Mr Li, community-based organisations play an irreplaceable role in HIV prevention and in eliminating discrimination. “The government will provide powerful support to these organisations,” he said.  

During the meeting, Mr Sidibé commended China’s strong and sustained leadership in its response to HIV, as well as its adoption of new approaches. “In recent years, China has taken bold, evidence-informed action to strengthen its response to HIV,” said Mr Sidibé. “Whether it is China’s large-scale roll-out of methadone maintenance treatment, nationwide scale-up of antiretroviral treatment or strong investment in preventing mother-to-child transmission of HIV, China is at the forefront.”