GENEVA, 24 June 2011—Captains of national football teams competing in the upcoming FIFA Women’s World Cup 2011 soccer championship in Germany are signing up to the Give AIDS the Red Card appeal in support of a global plan to eliminate new HIV infections among children by 2015. The Give AIDS the Red Card appeal, which was launched by the Joint United Nations Programme on HIV/AIDS (UNAIDS) one year ago at the FIFA 2010 World Cup in South Africa, uses the power and outreach of football to unite the world around stopping new HIV infections in children.

UNAIDS Executive Director Michel Sidibé said, “As the most important international competition in women's football, this tournament provides a platform to raise global awareness about the campaign to keep babies from becoming infected with HIV, and their mothers from dying from AIDS.”

Every day more than 1000 babies are born with HIV. However with access to HIV counseling and testing for pregnant women and their partners, and treatment when needed, the risk of transmission can be brought down to less than 5%.

On signing the pledge, team captains appeal to football players and fans across the world to ‘celebrate life and support the global campaign to prevent mothers from dying and babies from becoming infected with HIV’.

The FIFA Women’s World Cup 2011 is taking place from 26 June to 17 July. So far five captains have signed the appeal; Faye White (England), Sandrine Soubeyrand (France), Rebecca Smith (New Zealand), Ingvild Stensland (Norway), and Christie Rampone (United States).

“One of the great things about representing our country on the big stages is the opportunity for us to support causes we care about,” said U.S. Women’s World Cup Team captain Christie Rampone. “I signed onto a global campaign called Give AIDS the Red Card which helps to generate political action towards ending the AIDS epidemic among babies and young children around the world. I am confident about linking this noble cause with the game we all cherish.”

Rampone, who is among the more experienced U.S. players and will be playing in her fourth World Cup added, “UNAIDS asked the U.S. soccer team to help lead this campaign around the world, and we are happy to lend our support on a global stage to a global problem. The UN wants to end pediatric AIDS by 2015 and so do we!”

The captains of the other competing teams, including Australia, Brazil, Canada, Colombia, Equatorial Guinea, Germany, Japan, DPR Korea, Mexico, Nigeria, and Sweden, will also be encouraged to become “Red Card Advocates” by signing the appeal during the tournament and publicize global efforts to eliminate mother-to-child transmission of HIV by 2015.

There are 34 million people globally living with HIV, of whom 22.5 million are in sub-Saharan Africa. Despite progress towards the goal of eliminating new HIV infections among children , in 2009 alone there were 370,000 children born with HIV, bringing to 2.5 million the total number of children under 15 living with HIV.

The 2011 Women’s World Cup is one of several high-profile football championships, including the 2012 African Nations Cup and UEFA Euro 2012, leading up to the 2014 FIFA World Cup in Brazil, that can provide platforms for raising wide awareness about the campaign to eliminate HIV in children.



L to R: UNAIDS Deputy Executive Director, Programme Dr Paul De Lay, UNAIDS Executive Director Michel Sidibé, Health Minister of El Salvador and Chair of the 28th PCB, H. E. Dr Maria Rodriguez
Credit: UNAIDS/F.Chironi

The 28th Meeting of the UNAIDS Programme Coordinating Board (PCB) will meet in Geneva from 21-23 June.

UNAIDS Executive Director Michel Sidibé will present his progress report on 21 June followed by a presentation of the Committee of Cosponsoring Organizations (CCO) report highlighting the joint and specific Cosponsors’ activities during the previous twelve months. The report will be presented by Mr Yury Fedotov, Executive Director of UNODC, on behalf of the current CCO Chair Tony Lake, Executive Director of UNICEF.

The main item at this meeting is the Unified Budget, Results and Accountability Framework (UBRAF) 2012-2015, which the Board will consider for endorsement. As a follow up from the previous PCB meeting that took place in December 2010, the Board will receive a report on the outcomes of the thematic segment on “Food and nutrition security and HIV: how to ensure food and nutrition security are integral parts of HIV programming”, and their integration into the work of the Joint Programme. The Board will also receive a progress report on the implementation of the Agenda for Accelerated Action on Women and Girls by country.

Bishop Yvette Flunder addresses the inter-faith prayer breakfast held at Ford Foundation in New York City on 10 June.
Credit: Barry Mason/EAA

On the closing day of the United Nations General Assembly High Level Meeting on AIDS, faith-leaders came together with people living with HIV, representatives from key populations at higher risk of infection and other partners in the AIDS response to discuss ways to end stigma and to build strong collaborative partnerships for future action at country level. 

The inter-faith prayer breakfast was co-organized by the Ecumenical Advocacy Alliance (EAA), UNAIDS, and UNFPA in collaboration with other religious organizations and was hosted by the Ford Foundation.

Compassion to end stigma

A wide range of different faith traditions participated in the prayer breakfast meeting. Imam Abdul-Malik Ali, from New Jersey, prayed for all to accept the challenges posed by HIV and the need to overcome stigma.  Rev T.K. Nakagaki, Pastor of the Buddhist Church in America, reminded participants of the importance of respect for life, of remembering lives lost due to AIDS and of our interdependence. Rabbi J. Rolando Matalon originally from Buenos Aries, offered a prayer for people living with HIV who suffer from stigma and discrimination. 

The panellists then presented their thoughts on how to strengthen and build cross sectoral partnerships in the HIV response in order to ensure that universal access becomes a reality for all by 2015.

His Excellency the President of Fiji Mr Ratu Epeli Nailatikau said he was reminded of the Bible teachings, “which point us in the direction of searching out the one individual who is marginalized and reaching out to them with compassion.”

Her Excellency Mrs Callista Mutharika, First Lady of the Republic of Malawi; highlighted the key role of faith based organizations in providing both HIV health care and home-based care services in Malawi. 

Faith leaders play an important in the AIDS response as religious institutions provide upwards of 30% of health care and education services across Africa where the almost 70% of new HIV infections occurred in 2009. Voluntary care workers, many of whom are faith-based, make a significant contribution to human resources in countries on the African continent which is home to around 22.5 million people living with HIV.

Dr Asha-Rose Migiro, Deputy Secretary-General of the United Nations, reminded the audience of faith leaders and others that those from religious institutions can be among the most effective advocates against stigma. "You are natural activists who can change attitudes."

Bishop Yvette Flunder from the USA spoke on how "our healing must be untied from judgement and tied to justice." This statement became the recurring theme of the breakfast. Building on her words, Mr Pablo Torres Aguilera, a 25-year-old youth advocate from Mexico, issued a strong call for action: “It is time to build a bridge between key affected populations and world religious leaders to make sure no one is left behind in the next steps that we all are going to take,” he said.

This was followed by interactive table discussions among participants in which there was consensus on the importance of responses based on compassion and care as powerful methods of eliminating stigma and discrimination towards people living with HIV.

(From left) UNAIDS Executive Director Mr Michel Sidibé; His Excellency the President of Fiji Mr Ratu Epeli Nailatikau; UNAIDS Deputy Executive Director, Management and External Relations Ms Jan Beagle.
Credit: UNAIDS

Echoing Bishop Flunder's words, participants called for HIV responses that are offered in a way that gives dignity to the people who are most marginalized in society. Participants agreed that the specific naming of the key affected populations is important to give someone dignity and respect—be it men who have sex with men, sex workers, transgender people, people who use drugs or others who face marginalization, stigma and discrimination.

Closing the table discussions co-moderator Bishop Emeritus of Oslo Rev Gunnar Stålsett thanked Mr Torres Aguilera for his remarks, and said: "Thank you for being specific, sometimes we do not dare to mention vulnerable groups by name, you have done that, you have broken the barrier." Co-moderator Rabbi Julie Schonfeld said: "We were blessed with the opportunity to have people of so many faith traditions engaged in dialogue today, with our shared desire to bring HIV deaths to zero"

The breakfast closed with three prayers. Mr Homi D. Gandhi (Zoroastrian Association) offered a prayer for the whole harmony of human kind. Swami Pragyapad from India prayed for protection, nourishment, strength, and that we would not oppose each other. In the closing prayer, the Rev. Leonid Kishkovsky, moderator of Religions for Peace, urged all to "move from words of comfort to courageous action."

Also present at the inter-faith event were Rabbi Julie Schonfeld, Rabbi, Executive Vice President of the Rabbinical Assembly, New York; and Imam Umer Ahmed Ilyasi, President and Chief Imam of the All India Organization of Imams of Mosques, UNAIDS Executive Director Mr Michel Sidibé, Dr Purnima Mane, Deputy Executive Director of UNFPA and Mr Peter Prove, Executive Director of the Ecumenical Advocacy Alliance.

(Left to Right): Paul De Lay, UNAIDS Deputy Executive Director; Ms. Rosilyne Borland, HIV and Health Promotion Coordinator, IOM; Ambassador William Lacy Swing, Deputy General, IOM; Mr. Udo Janz, Director of UNHCR New York; Dr. Sophia Kisting, Director, ILO/AIDS; at Migration and HIV event, held at UN Headquarters, NYC, on June 10, 2011.
Credit: UNAIDS/B. Hamilton

For the world’s 214 million international migrants and 740 million internal migrants the sometimes challenging conditions of the migration process can leave them vulnerable to HIV infection. Yet, even with the increasing interest in the health and human rights of this key group, the links between migration, population mobility and HIV are still not widely understood.

During the General Assembly High Level Meeting on AIDS in New York governments, civil society partners and intergovernmental agencies came together to explore the relationship between migration and the AIDS epidemic and to examine ways of increasing access to HIV services for people on the move.

The side-event, on 10 June, was sponsored by the International Organization for Migration (IOM), the International Labour Organization (ILO), the UN High Commissioner for Refugees (UNHCR) and UNAIDS.

Ambassador William Lacy Swing, IOM’s Director General and Dr Paul De Lay, UNAIDS Deputy Executive Director, Programme, co-hosted the event. This follows the signing of a revised cooperation of agreement between the two organizations in January this year. The agreement addresses the potential vulnerability of migrants to HIV and strengthens efforts to integrate migrants and mobile populations into AIDS policies and programmes at national, regional and international levels.

“We must harness the benefits of migration for migrants and states, by ensuring migrants can access HIV prevention, care, treatment and support services,” said Ambassador Swing.

Dr De Lay raised an issue which many ‘people on the move’ face on a daily basis: discrimination. He spoke of the need to vigorously challenge discrimination directed at migrants, and would-be migrants, which prevents freedom of movement. These include the HIV-related entry, stay and residency restrictions in some countries. “Every individual should have equal access to freedom of movement regardless of HIV status. UNAIDS opposes restrictions that single out HIV for special treatment and that restrict movement based on HIV status only. Such restrictions are discriminatory,” he said.

Best practices

The side-event emphasized the importance of sharing best practices and lessons learned by governments and civil society on managing migration and HIV and ensuring the rights of migrants to access health and social services.

It was acknowledged that while mobility in and of itself does not necessarily result in increased health risks, the sometimes challenging conditions of the migration process—before migration, during movement, in destination communities and upon return—may impact the health of migrants and make them more vulnerable to the virus.

International commitments

The meeting explored progress on a number of international commitments and policy frameworks such as sections of the 2001 UNGASS Declaration of Commitment on AIDS which facilitate access to HIV programmes for migrants and mobile workers.  

Migration-related aspects of the ILO Recommendation on HIV and AIDS and the World of Work, 2010 (No 200) were also discussed. Dr Sophia Kisting, Director of ILO/AIDS, stressed that stigma and discrimination, difficult working conditions and long separation from their families and cultures increase migrant workers’ vulnerability to HIV. “For these reasons, the Recommendation makes special mention of migrant workers.  It calls on countries of origin, transit and destination to take measures to ensure access to HIV prevention, treatment, care and support services for such workers,” she said.

In its Technical cooperation projects, the ILO has promoted an integrated approach involving a variety of actors, such as government, recruitment agencies and trades unions. Programmes in Indonesia, Nepal and Sri Lanka have shown the usefulness of this approach and succeeded in including HIV in pre-departure training for labour migrants and initiating policy dialogue between sending and receiving countries.

Addressing such issues is of key importance given that, for example, according to Sri Lanka’s national AIDS committee, some 30-40% of women in Sri Lanka who test positive for HIV have returned home after living in the Middle East.

Udo Janz, Director of UNHCR New York Office, welcomed the chance afforded by the side-meeting to consolidate gains made and chart future action in ensuring migrants and mobile populations, including those forcibly displaced, are provided with HIV services.    

UN General Assembly High Level Meeting on AIDS

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the world has come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.

Ms. Francoise Barré-Sinoussi, Nobel Lauréate, Institut Pasteur, France; Ms. Aditi Sharma, International Treatment Preparedness Coalition; at Panel 5: Integrating the HIV AIDS Response with Broader Health and Development Agendas, held at UN Headquarters, NYC, on June 10, 2011.
UNAIDS/B. Hamilton

Taking AIDS out of isolation and into integration was the focus of the final official panel discussion on the closing day of the UN General Assembly High Level Meeting on AIDS.

Chaired by His Excellency the Second Vice-President of Burundi Gervais Rufyikiri, the panel was moderated by Laurie Garrett Senior Fellow for Global Health at the Council for Foreign Relations and brought together Nobel lauréate Francoise Barre-Sinoussi from the Institut Pasteur; civil society representative Aditi Sharma from the International Treatment Preparedness Coalition; UN Secretary General’s Special Envoy to Stop TB Jorge Sampaio and Norwegian State Secretary for Health State Secretary Ragnhild Mathisen.

Linking HIV to health and development

Thirty years into the HIV epidemic, AIDS has become an integral part of countries’ health and development challenges. But we need to strengthen these links to achieve universal access and ensure sustainability of the HIV response. Panellists identified key benefits and core elements for integrating HIV with other health and development agendas and discussed how the strengths of the AIDS response can be leveraged to the benefit of these issues.

“HIV responses cannot operate in isolation. Further scale up requires functioning integrated health systems and communities that are empowered through access to essential rights and goods, including food, nutrition and basic education,” said Francoise Barre Sinoussi.

The panel highlighted the lessons from integration of HIV and tuberculosis (TB) programmes and services and discussed links with sexual and reproductive health services and maternal, newborn and child health services, including efforts to eliminate new HIV infections among children and keeping their mothers alive. Mr Sampaio made a passionate plea to implement the recommended package of integrated TB/HIV services in order to prevent one million TB deaths in people living with HIV by 2015.

It was also noted that, as access to antiretroviral therapy expands, the HIV response is evolving from a disease-specific emergency response to a chronic disease management challenge which needs to be addressed within the context of other chronic health conditions. Many countries with a high HIV prevalence are also facing burgeoning epidemics of other chronic infections, such as Hepatitis B and C, and non-communicable diseases (NCD), such as cardio-vascular and chronic respiratory diseases and diabetes.

The panel emphasized that the benefits of an integrated approach to TB and HIV service-delivery to patients, programmes and partners are reflected in better access to comprehensive care, cost savings and reduced morbidity and mortality. Brazil’s combined approach to HIV and Hepatitis C was cited as an example of integrated, client centred approach. Similarly, the prevention of mother-to-child transmission of HIV—including treatment and care for mothers and their children—was highlighted as an integral and critical components to achieve Millennium Development Goal (MDG) 4 and MDG 5 and the UN Secretary-General’s ‘Global Strategy for Women’s and Children’s Health’.

The time is right, concluded the panel, to explore ways in which the scale up of HIV prevention, treatment, care and support may be leveraged to strengthen not only high-quality health services during specific periods of life—such as pregnancy and childhood—but responses to a range of other health conditions and development challenges development issues for example food security, poverty, drug dependence, human rights and gender. Mitigating the impact of HIV is therefore essential to achieving MDG 6 and other development goals.

Watch the event

(Left to Right): Michel Sidibé, UNAIDS Executive Director; President Bill Clinton; Ban Ki-moon, Secretary General of the UN; Goodluck Jonathan, President of Nigeria; Dr Eric Goosby, US Global AIDS Ambassador, Anthony Lake, UNICEF Executive Director, at launch of the Global Plan towards elimination of new HIV infections among children and keeping their mothers alive, at UN Headquarters, NYC, 9 June 2011.
Credit: UNAIDS/B. Hamilton

NEW YORK/GENEVA, 9 June 2011—World leaders gathered in New York for the 2011 United Nations High Level Meeting on AIDS have today launched a Global Plan that will make significant strides towards eliminating new HIV infections among children by 2015 and keeping their mothers alive.

“We believe that by 2015 children everywhere can be born free of HIV and that their mothers can remain healthy,” said Michel Sidibé, Executive Director of UNAIDS. “This new global plan is realistic, it is achievable and it is driven by the most affected countries.”

“Nearly every minute, a child is born with HIV. Working together, we can reverse this tide as we have done in the United States and they are very close to doing in Botswana,” said Ambassador Eric Goosby, the United States Global AIDS Coordinator. “Preventing new HIV infections among children across the globe is truly a smart investment that saves lives and helps to give children a healthy start in life.”

Providing pregnant women living with HIV with antiretroviral prevention and treatment reduces the risk of a child being born with the virus to less than 5%—and keeps their mothers alive to raise them. Neither technical nor scientific barriers stand in the way of responding to this global call to action. The plan notes that what is needed is leadership, shared responsibility and concerted action among donor nations, recipient countries and the private sector to make an AIDS-free generation a reality. 

In answering the Global Plan’s call to action, the United States President's Emergency Plan for AIDS Relief (PEPFAR) announced an additional US$ 75 million to preventing mother-to-child transmission of HIV (PMTCT) efforts. This funding will be on top of the approximately US$ 300 million that PEPFAR already provides annually for PMTCT.

The Bill & Melinda Gates Foundation pledged US$ 40 million, Chevron committed to US$ 20 million and Johnson & Johnson pledged US$ 15 million.

"Investments in preventing mother-to-child transmission are greatly needed and the Bill & Melinda Gates Foundation is committed to ensuring that such initiatives are fully integrated into family planning and maternal, newborn, and child health programmes," said Stefano Bertozzi, Director of HIV and tuberculosis at the Foundation.

“Chevron understands that its sustainability as a business is inextricably linked to the health and well-being of its employees and the communities in which it operates,” stressed Rhonda Zygocki, Executive Vice President, Policy and Planning, for Chevron Corporation. “We are proud to pledge US$ 20 million, joining in this mission to eliminate mother-to-child transmission of HIV.”

“We have a dream that no baby will be born HIV positive and today’s pledge continues the Johnson & Johnson enduring commitment to eliminating mother-to-child transmission of HIV,” said Brian Perkins, Corporate Vice President, Corporate Affairs. “It is another step in fulfilling our commitment to support achievement of the Millennium Development Goals, and reflects our long-standing dedication to improving maternal and child health.”

In 2009, approximately 370 000 children were born with HIV—almost all of them in low- and middle-income countries, mainly in sub-Saharan Africa. Under the Global Plan, the goal would be to work toward reducing this number by 90% by 2015. All 22 of the countries with the highest burden of new HIV infections among children have contributed to the development of the plan and signed up to implement it.

(Left to Right): Babalwa Mbono, Representative of Women Living with HIV; Michel Sidibé, UNAIDS Executive Director; President Bill Clinton at launch of the Global Plan towards elimination of new HIV infections among children and keeping their mothers alive.
Credit: UNAIDS/B. Hamilton

The Global Plan towards the elimination of new HIV Infections among children by 2015 and keeping their mothers alive was developed by a group of more than 30 countries and 50 community groups, non-governmental and international organizations. The group was convened by UNAIDS and PEPFAR.

Babalwa Mbono found out she was HIV positive when she became pregnant. “Helping pregnant women to protect their babies is really important,” she said. “Like all mothers, I would do anything to give my child a healthy start in life—and this prevention should be available to women everywhere.”

"We can only achieve a generation free of HIV and AIDS by focusing our efforts on the mothers and children at greatest risk and in greatest need," urged UNICEF Executive Director Anthony Lake. "The investments we make in preventing maternal-to-child transmission of HIV—and in expanding more women's access to quality care—will yield tremendous returns, not only in the lives of children and families affected by HIV and AIDS, but in improving mothers' and children's health in the poorest countries that bear the greatest burden of the AIDS epidemic."

The plan focuses on a series of specific policy and programmatic measures which countries will take to ensure that all pregnant women living with HIV have access to HIV prevention and treatment services and that new HIV infections among children are eliminated by 2015. The plan also includes efforts to provide treatment to mothers and children living with HIV during breastfeeding and referral to ongoing HIV prevention and treatment programmes thereafter.

The key elements of the Global Plan include ensuring that:

• All women, especially pregnant women, have access to quality life-saving HIV prevention and treatment services—for themselves and their children.
• The rights of women living with HIV are respected and women, families and communities are empowered to fully engage in ensuring their own health and, especially, the health of their children.
• Adequate resources—human and financial—are available from both national and international sources in a timely and predictable manner while acknowledging that success is a shared responsibility.
• HIV, maternal health, newborn and child health and family planning programmes work together, deliver quality results and lead to improved health outcomes.
• Communities, in particular women living with HIV, are enabled and empowered to support women and their families to access the HIV prevention, treatment and care that they need.
• National and global leaders act in concert to support country-driven efforts and are held accountable for delivering results.

The plan also includes a detailed timetable for action at community, national, regional and global levels to ensure rapid progress towards elimination of new HIV infections in children by 2015 and keeping their mothers alive.

About the Global Plan

This Global Plan provides the foundation for country-led movement towards the elimination of new HIV infections among children and keeping their mothers alive. The Global Plan was developed through a consultative process by a high level Global Task Team convened by UNAIDS and co-chaired by UNAIDS Executive Director Michel Sidibé and United States Global AIDS Coordinator Ambassador Eric Goosby. It brought together 30 countries and 50 civil society, private sector, networks of people living with HIV and international organizations to chart a roadmap towards achieving this goal by 2015.

This plan covers all low- and middle-income countries, but focuses on 22 countries ^[1] with the highest estimate of HIV-positive pregnant women. Exceptional global and national efforts are needed in these countries that are home to nearly 90% of pregnant women living with HIV in need of services. Intensified efforts are also needed to support countries with low HIV prevalence and concentrated epidemics to reach out to all women and children at risk of HIV. The Global Plan supports and reinforces the development of costed, country-driven national plans.

UNAIDS

UNAIDS, the Joint United Nations Programme on HIV/AIDS, is an innovative United Nations partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. Learn more at unaids.org.

PEPFAR

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world. This historic commitment is the largest by any nation to combat a single disease internationally, and PEPFAR investments also help alleviate suffering from other diseases across the global health spectrum. PEPFAR is driven by a shared responsibility among donor and partner nations and others to make smart investments to save lives. Learn more at www.pepfar.gov.

^[1] Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

Thematic panel discussion, “Women, Girls, and HIV”, which focuses on the disproportionate burden of HIV that is carried by women and girls around the world. (Left to right): Stephanie Nolan, journalist at the “Globe and Mail”; Hanno Pevkur, Minister of Social Affairs for Estonia; and Dr Aaron Motsoaledi, Minister of Health for the Republic of South Africa. UN Headquarters in New York, 9 June 2011
Credit: UN Photo/Eskinder Debebe

Women, girls and HIV was the theme of a high level panel which was held at the United Nations on Thursday 9 June. The event, which forms part of the UN General Assembly High Level Meeting on AIDS, was chaired by Hanno Pevkur, Minister of Social Affairs, Estonia.

The interactive discussion was moderated by Stephanie Nolen and the high level panel included Dr Aaron Motsoaledi, Minister of Health, Republic of South Africa; Dr Babatunde Osotimehin, Executive Director of UNFPA, represented the United Nations; and Siphiwe Hlophe, the co-founder of the non-governmental organization Swaziland for Positive Living.

“In 30 years of dealing with HIV,” explained Mr Pevkur, “we have learned that it is as much a social as a medical problem; and the lack of quality of sexual reproductive health and rights services, violence, harmful cultural practices, are fuelling the epidemic.”

To explore the issue, the panellists and speakers from the floor responded to a series of questions and identified strategies that will help the HIV response to spark social transformation for women and girls to secure their human rights and protect themselves against HIV. They discussed ways to ensure that the specific needs and vulnerabilities of women and girls are adequately addressed in the response to HIV.

Unequal opportunities

In many societies, women face barriers in accessing HIV prevention, treatment, care and support services due to limited decision-making power, lack of control over financial resources, restricted mobility and unequal care responsibilities. Lack of education is another major barrier; around two-thirds of the world’s 796 million illiterate adults are women.

“We will not attain a sustainable response if we do not invest in women with education and economic empowerment,” said Ms Hlophe who highlighted need to engage communities including at the rural level so that all women are empowered. There was consensus that comprehensive sexuality education, which includes HIV education, is a key component of effective evidence-informed HIV prevention. Such education should be made available in a non judgemental, youth-friendly way, to adolescents and young people in and out of schools, and must include human rights and gender equality.

Challenge violence against women

One of the event findings was that stopping AIDS requires acting to stop violence against women at every level. “Violence against women is both a cause and a consequence of HIV,” said Minister Pevkur. The participants discussed how to better address the linkages between violence against women and girls and HIV as well as the social determinants that increase their vulnerability to HIV infection.

The risk of HIV among women who have experienced violence may be up to three times higher than those who have not. The prevalence of forced first sex among adolescent girls below 15 years ranges between 11% and 45% globally. Laws and policies that prevent and punish violence against women, including harmful traditional norms, and effective implementation, are paramount the speakers concluded.

Ensure access to comprehensive HIV and sexual and reproductive health services

There were calls for political leaders and stakeholders to champion “women- and girl- tailored” approaches in policy and programming. Another recommendation was the need to ensure that women in all their diversity, including adolescent girls and young women, have access to comprehensive HIV and sexual and reproductive health services, free of violence, discrimination, and coercion.

Uphold women’s human rights

It is crucial for governments to commit to fulfil all women’s human rights, including their sexual and reproductive health and rights. There is an urgent need for a clear target which views women in their entirety, across their lifespan, and not solely as mothers.

Invest in women and girls                    

The discussion also highlighted the need for greater and sustainable investment in the leadership of women and girls, as well as in strengthening women’s rights organizations and networks of women living with HIV, is needed to achieve the meaningful engagement of women and girls in the response to HIV

UN General Assembly High Level Meeting on AIDS

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the world has come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.

Agnes Binagwaho, Minister of Health, Rwanda at Ministerial Round Table Addressing Access: Taking Programmes to Scale. UN Headquarters, NYC, on June 9, 2011.
Credit: UNAIDS/B. Hamilton

With unprecedented high level participation at this week’s UN General Assembly Meeting on AIDS, with more thirty Heads of State and Government and Vice Presidents and some 100 ministers in attendance. A special side event was convened for the ministers to come together to share their experiences across the new landscape and outlook for HIV treatment, including treatment for prevention. It brought together ministers from a wide spectrum of sectors—including health, justice, social development and labour—with members of civil society, to exchange a diversity of country experiences.

Panellists in the session included Aaron Motsoaledi, Minister of Health, South Africa; José Angel Cordova Villalobos Secretary of Health, Mexico; Marijke Wijnroks, AIDS Ambassador, Netherlands; Ruben Pecchio, Director REDLA+ (Network of People Living with HIV, Latin America) and UNAIDS Executive Director Michel Sidibé.

Treatment for prevention

The panel drew attention to the recent results of the HPTN 052 study announced by the United States National Institutes of Health which demonstrated that if an HIV-positive person adheres to an effective antiretroviral therapy regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%.

Involvement of people living with HIV essential

In the discussion, moderated by Al Jazeera television host Riz Khan, the participants highlighted the need to involve people living with HIV in treatment and prevention programmes. “Testing needs to be available to everyone—people living with HIV need to know their status as early as possible to enable them to effectively engage in prevention. ‘Positive prevention’ must be at the centre of prevention efforts and treatment for prevention plays a critical role,” said Mr Pecchio.

Addressing stigma in the context of treatment

According to Secretary of Health of Mexico, José Angel Cordova Villalobos, Mexicohas created a financial vehicle to guarantee sustainable access to treatment over long term. “But we must also work to strengthen education to fight stigma and discrimination and homophobia and to increase people’s willingness to get tested,” said Mr Cordova Villalobos.

With the largest number of people living with HIV in the world, at 5.6 million, South Africa also has the largest antiretroviral treatment programme in the world. The country has also recently launched a national HIV testing campaign in which 12 million South Africans have been tested for HIV between April 2010 and June 2011.

“South Africa has no option but to scale up treatment. As testing is scaled up, more people learn their status, and given the evidence of its impact on prevention, this is an important approach,” said Aaron Motsoaledi, Minister of Health of South Africa.

Recent developments in scientific understanding and approaches were highlighted and shown how they can be seen as “game changers.” Country representatives discussed how they can apply this information to further scale up HIV treatment programmes. New information about the prevention benefits of HIV treatment provides an opportunity for increased collaboration within the HIV response.

Investment needs

According to the new UNAIDS investment framework published in the Lancet ahead of the High Level Meeting on AIDS, a relatively small amount of additional money would be required to reach the US$ 22 billion needed for universal access to HIV treatment by 2015. However new data indicate that international investments in AIDS appear to be falling for the first time in 10 years.

“We must consider the investments we make now as down-payments that will reduce costs later,” stressed Mr Sidibé. “It is unacceptable that we have the evidence of the incredible effectiveness of treatment for prevention, yet nine million people living with HIV still don’t have access to it.“

Credit: UNAIDS

What lessons can be learned from market-based approaches to providing medicines and healthcare in low- and middle-income settings? What are the challenges and future opportunities? These were the key questions raised at an event organised by UNITAID, UNAIDS and the Medicines Patent Pool at the High Level Meeting on AIDS in New York on 9 June.

The event, which took the form of a lively debate, was chaired by Philippe Douste-Blazy, Chair of UNITAID’s Executive Board. Andrew Jack of the Financial Times served as moderator. Speakers included UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay, Dr Precious Matsosa, South Africa’s Director General for Health, Brenda Waning, Coordinator of Market Dynamics at UNITAID, Ellen t’Hoen, Executive Director of the Medicines Patent Pool, and Clifford Samuel of Gilead Sciences.

A changing landscape

The participants discussed how globalization and economic development are changing the international health landscape and examined current challenges to innovation and access. They also looked at interventions needed to ensure that emerging new medicines and technologies can be absorbed by health systems in developing countries.

It was noted that the recent adoption of market-based approaches to public health provision by several donors and international organisations, such as UNITAID—which has committed over US$1.5 billion since 2006—has led to sustainable markets for manufacturers, encouraging price reductions and the development of new medicines, such as AIDS drugs.

Paradigm shift

However, this paradigm is beginning to shift. For example, by 2008 India had provided 87% of AIDS medicines used in developing countries. Today, Indian manufacturers are turning their attention towards research and development and service in middle-and high-income markets. This leaves potential space for local producers in low-income countries to establish medicine production for their own markets if such access can be promoted. 

In his introductory remarks on future challenges and gaps in innovation and access, Dr De Lay stressed that one key innovation challenge was to provide simplified drug regimens and diagnostics to ensure easier supply and greater adherence to treatment in developing countries.

“We need a research and development agenda that meets the specific needs of low- and middle-income countries. This includes ARV that can be used safely with TB treatment, for children, and during pregnancy,” said Dr De Lay.

“We expect that drug optimization will proceed in several phases which will include optimizing existing treatment including dose reductions and frequency, where possible and implementing emerging new technologies including point of care viral load and CD4 testing; next-generation of low cost, highly effective first and second line treatments; and first generation of long-lasting injectable ART.”

Commenting on exactly why new market approaches were needed to meet today’s challenges, Mr Douste-Blazy explained, “UNITAID works to impact on markets and increase access to innovative products at affordable prices. This is the beginning of an era that sees the poorest people start to gain access to the newest, most expensive products at a price their governments can afford.”

Talking specifically about how to promote innovation in the field of HIV that seeks to address developing country needs, Ms t’Hoen contended that the recently created Medicines Patent Pool “could spur innovation in needed formulations for children and combination medicines as well as bring down prices by promoting generic production of newer medicines.”

Dominant national purchasers emerging

The participants also discussed how industrial and economic developments are helping to change the power-base within the global health landscape from large donors to a few dominant national purchasers. For example, the recent tender by the South African government represents approximately 25% of the developing country market for AIDS medicines and the government also self-funds 75% of the country’s ARV purchases in 2010-2011.

Dr Matsoso expanded on the role national governments play in shaping regional and global markets and underlined the importance of fast tracking the registration of new medicines in developing countries. “We need to harmonise medicines regulation at the regional level to ensure faster uptake of new and innovative products in our countries,” she said.

All those taking part in the event committed to redoubling efforts to protect lives by helping to ensure that attractive markets are created for producers while promoting public health goals of continued innovation and universal access to HIV treatment.

As Dr De Lay summed up: “We have all contributed to the accomplishment of vastly increasing the numbers of people living with HIV who are on ART. For the foreseeable future ART demand will be increasing and we expect to see pressures on ART supply, and continuing innovation in research and development of new ART formulations, as well as for laboratory diagnostic and monitoring tests, is required, and this may require new incentive mechanisms.”

Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations
Credit: UNAIDS

Although there is growing international attention for the rights of people with disabilities, governments and policymakers rarely consider disability issues when formulating their HIV strategic plans.

To highlight the significance of this area of work and advocate for national integration of the needs of persons with disabilities into all aspects of the AIDS response, a partner’s forum on AIDS and Disability was held on 9 June during the High Level Meeting on AIDS.

The event was co-chaired by Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations and Professor Nora Ellen Groce, Director, Leonard Cheshire Disability & Inclusive Development Centre at University College London.

“Both the AIDS movement and the disability movement have at their core a respect for human rights of the individual. Both are movements which are confronting sigma and discrimination of different kinds. Both HIV and disability affect not only the individual but also the household, in ways that you all know so well. Where you have both HIV and disability, there's a double stigma, and a double burden,” said Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations, introducing the event.

Mary Muthoni Rop is a mother of three children who lives in rural Kenya. She has multiple disabilities and is living with HIV. She has become an activist with Thika Disabled Fighting HIV and AIDS and spoke at the event of the myriad difficulties and vulnerability the HIV epidemic has brought to people living with a disability which include obstacles to access to HIV services due to distances and infrastructure of health facilities. “We find that most of the health facilities are not accessible to people with disability: for example a hospital having stairs all over,” she said. HIV prevention information is also often inaccessible. “We find that in most of our health facilities, we don't have people who can give proper information to people with disability.  We don't have workers trained in sign language interpretation.”

In 2006 the United Nations Convention on the Rights of Persons with Disabilities was adopted in 2006 and ratified in 2008. This Convention obliges states to provide access to sexual and reproductive health including HIV information and services for all persons with disabilities. The UN Development Group under the leadership of the UNDP Administrator has developed specific guidance for UN country teams on integrating disability into all its work and that of the UN system at global and regional levels.

Stephen Lewis, co-founder and co-director of AIDS-Free World spoke about the need for national government to transform this global instrument into a tool, saying “countries need to understand that they need to take the Convention and turn international law into national law in order for it to be effective and implemented.”

Disabled people’s organizations in different countries in Africa and Asia are becoming more and more involved in the HIV arena to mainstream disability into HIV programmes. Richard Kabeto Matlhare head of Botswana’s National AIDS Coordinating Agency shared insights from his country’s response.

Etienne Krug, Director of Violence and Injury Prevention and Disability gave an overview of the global report which was launched by the World Health Organization earlier in the day “and the big message of the report is that we cannot continue to ignore the needs of 1 billion people in the world.”

“What the report clearly states is that disability results from impairment, but much more from the barriers that society erects. Barriers such as stigma and discrimination, lack of adequate health care and rehabilitation services, inaccessible transport, buildings, information, communication technologies." said Dr Krug

What’s needed is “attacking those barriers, which contribute to a large number of negative outcomes: poorer health status, poorer employment status, less access to education,” he added.

Summing up the discussion as co-chair, Jan Beagle stressed the actions needed to ensure the needs of persons with disabilities are included into all aspects of the AIDS response. “We know that there's very far to go. However, we know how to do it, and the way to do it is by working together. We've all got to work together: governments in North and South, civil society and in particular, people living with disabilities and people living with HIV.”

The AIDS and Disability Partners Forum was organized by UNAIDS in collaboration with Global Partnership for Disability and Development, Health Canada, USAID, US State Department, ILO, UNDESA, UNICEF and WHO.

UN General Assembly High Level Meeting on AIDS

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the world has come together to review progress and chart the future course of the global AIDS response at the 2011 UN General Assembly High Level Meeting on AIDS from 8–10 June 2011 in New York. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response.