Ratu Epeli Nailatikau, President of the Republic of Fiji, chairs the panel discussion on Innovation and new technologies, 9 June 2011. Credit: UN Photo/Paulo Filgueiras

Progress in reducing the number of new HIV infections and increasing access to antiretroviral treatment over the past three decades did not happen haphazardly but were in large part due to a concerted international effort that bridged technology and innovation for results in HIV prevention and treatment.

This emerged from an official panel entitled Innovation and new technologies, one of five panels in which high level representatives from member states and civil society are holding as part of the 2011 United Nations General Assembly High Level Meeting on AIDS.

Chaired by HE President Ratu Epeli Nailatikau of Fiji, the panel brought together the Director-General of the World Health Organization, Dr Margaret Chan; the Minister of Health of Mexico, Dr Jose Angel Cordova Villalobos; and Dr Christoforos Mallouris, Director of Programmes, Global Network of People Living with HIV (GNP+).

The panellists shared their insights on how technology and innovation have played instrumental roles in helping realize the results achieved in the AIDS response to date. One example cited was the increase in the past decade of the number of people living with HIV on antiretroviral treatment: in 2010 that figure stood at 6.6 million up from 240 000 in 2001. Cited as central to this unprecedented development was a combination of innovative technology that led to highly effective antiretroviral medicines and improved access to that technology through the availability of low-cost, quality-assured drugs.

“Collaboration with developing countries will be crucial," said President Nailatikau who highlighted the need to find innovative solutions at the heart of the disease. “With this, we have a chance to make a huge impact against one of the greatest health and development challenges of our generation.”

Moderated by British journalist Andrew Jack from the Financial Times, the discussion focused substantially on the several challenges facing the AIDS response from the technology and innovation perspective, mainly the necessity to urgently expand access to newer and improved HIV technologies, such as better diagnostics for CD4 and viral load counts, and increased investments in biomedical prevention technologies such as microbicides.

The panellists agreed that access to proven HIV prevention technologies—from male and female condoms to male circumcision—must continue to be scaled up and governments should ensure policies are in place within their national responses that foster innovation and advancement, from both the public and private sector. Innovative partnerships that create financial or other incentives to spur research and development were viewed as key elements.

“Let’s not let the pace of the epidemic get beyond us. We have the capacity for innovation to recreate ourselves to achieve not only zero new infections, zero discrimination and zero AIDS-related deaths; but also for zero homophobia and transphobia, zero gender-discrimination and human rights for all,” said President Felipe Calderón of Mexico,

Echoing a “positive health, dignity and prevention” approach, Dr Mallouris of GNP+ urged for greater involvement of people living with HIV in prevention. “People living with HIV also need prevention and new prevention technologies. We need to ensure that people living with HIV are involved—we are not just vessels of transmission, we want prevention too,” said Dr Mallouris. 

The panel also 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%. Attention was also given to the ongoing search for an HIV vaccine that, although estimated to be decades away, is considered by many in the AIDS community as an essential component of the future AIDS response.

“Doing more of the same is not enough,” said World Health Organization Director-General Dr Chan. “We need innovation urgently and we are still running behind this devastating epidemic. We know now…beyond doubt that early treatment has a powerful effect on transmission in sero-discordant couples—we must maximize the preventive effects of treatment by early diagnosis.”

However in both the short- and medium-term, the panel stressed the importance of rapidly expanding access to antiretroviral treatment as one of the most pressing issues. With about nine million people in low- and middle-income countries who are eligible for treatment in need, the panel encouraged countries to give priority to transferring research and technology as well as to provide sufficient funding for the research and development of safer, more effective antiretroviral medicines that are also easier to use.

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.

First Ladies join forces to call for integration of HIV and maternal, newborn and child health programmes at special event during United Nations High Level Meeting on AIDS

(Left to Right): Michel Sidibé, Executive DIrector of UNAIDS; HE Mrs. Azeb Mesfin, First Lady of Ethiopia; Mrs. Ban Soon-taek, Spouse of Secretary General of the United Nations; Dr. Bun Rany Hun Sen, Cambodia.
Credit: UNAIDS/B. Hamilton

NEW YORK/GENEVA, 8 June 2011—Thirty First Ladies from Africa, Asia, Latin America and the Caribbean gathered at a special event in New York to mobilize support around achieving the Joint United Nations Programme on HIV/AIDS’ (UNAIDS) vision of Zero new HIV infections among children by 2015. The event was held on the opening day of the UN High Level Meeting on AIDS which is taking place in New York from 8-10 June.

Mrs Ban Soon-taek, wife of the United Nations Secretary-General;  Mrs Azeb Mesfin, First Lady of Ethiopia and President of the Organization of African First Ladies Against HIV/AIDS; and Mr. Michel Sidibé, Executive Director of UNAIDS co-hosted the New York event. 

Around 1,000 babies are infected with HIV each day, 90% of whom are in countries in sub-Saharan Africa. HIV is also the leading cause regarding mortality among women of reproductive age in developing countries. The First Ladies agreed to advocate for comprehensive and integrated access to maternal and child health services that include services to prevent HIV transmission among infants and which keep mothers and children healthy. 

Gender inequality, gender violence, discrimination and inequitable laws prevent pregnant women from accessing HIV testing and counselling, prevention, treatment and support services. “Women and girls must be at the centre of the AIDS response,” said Michel Sidibé. “When women protect themselves from HIV, they protect a whole new generation from HIV.”

More than 2 million children worldwide are living with HIV, mostly in sub-Saharan Africa. In Western Europe only 1,400 children are living with HIV, highlighting the global injustice of unequal access to maternal and child health services and the urgent need to increase access to HIV services for pregnant women in low- and middle-income countries.

“If women around the world are not involved in facing the challenge of preventing mother-to-child transmission of HIV, we cannot win. If we all play our part, we cannot fail.” said Mrs Mesfin.

In recent years, a number of countries have made great strides in reducing the rate of new HIV infections among children and globally in 2009, new HIV infections among children dropped by 25%.

“The fact that, in still too many places, HIV positive women are denied the right to give birth to healthy babies is a global injustice that we can end by 2015,” said Mrs Ban.

On return to their respective countries, the First Ladies agreed to advance ten action steps to ensure that children are born free from HIV and to promote lifesaving HIV services for women and children. These include supporting efforts to; increase the number of centres providing free maternal, newborn and child health services, including treatment to prevent the transmission of HIV from mothers to children; strengthen sexual and reproductive health programs for adolescents living with HIV; ensure meaningful engagement of people living with HIV; and promote zero tolerance for stigma and discrimination against people living with HIV.

UNAIDS Executive Director addressing the opening plenary of the 2011 General Assembly High Level Meeting on AIDS
Credit: UN Photo/Paulo Filgueiras

Heads of State and Government and other high level representatives representing Member Nations gathered today in the General Assembly Hall of the United Nations (UN) in New York for the opening plenary of the 2011 General Assembly High Level Meeting on AIDS.

More than 30 Heads of State, Government and Vice Presidents will attend the meeting which will include official plenary—in which 150 speakers representing Member States, Observers, civil society and private sector are expected to speak—and five panel sessions along with 40 individual side events.

Joseph Deiss, President of the 65th session of the UN General Assembly, opened the event. Secretary-General Ban Ki-moon also addressed the opening plenary.

Addressing the opening UNAIDS Executive Director Michel Sidibé called on the gathered leaders to “agree on a transformational agenda to end this epidemic—one that will achieve our vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

“Getting to zero is not an aspirational goal or a magic number. It must be our common plan—to be transformed into reality,” Mr Sidibé added.

At a press conference ahead of the meeting, Mr Deiss highlighted the significance of the event. “The momentum around this meeting is unprecedented and promises to make this an historic event. We are looking to UN Member States to make bold commitments which will help us reach our shared goal,” he said.

The gathering takes place thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS. 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.

On the final day of the High Level Meeting on AIDS, UN Member States are expected to adopt a declaration which will guide country responses to HIV over the next five years.

Credit: Caritas

A High Level Meeting side event called Faith-based action to achieve universal access: Confronting the impact of funding cutbacks and advocating for the special needs of mothers and children living with HIV was held on 8 June. It was sponsored by Catholic HIV/AIDS Network (CHAN), Caritas Internationalis (CI), and Catholic Medical Mission Board (CMMB).

Becky Johnson of the Ecumenical Advocacy Alliance presented recent research conducted among 11 members of the CHAN documenting the effects of flat lining of funding on Catholic health service delivery partners. The position paper includes analysis of impact of funding cuts on HIV responses in medical programmes. Concerned about meeting universal access targets, the paper includes a call to governments that donors maintain their long-term funding commitments to ensure the continuation of current HIV treatment programmes, as well as new programmes where needed and for health infrastructure.

It also recommends the provision of comprehensive and integrated prevention, treatment, care and support for adults and children living with or vulnerable to HIV infection. It identifies a need to build, strengthen and sustain human resource capacity to carry out comprehensive programmes through training and retention of skilled staff and volunteers.

Its third recommendation focuses on children. It calls for improved access to paediatric testing and child friendly treatment for HIV and HIV/TB co-infection; prevention of vertical transmission; and continued support for orphans and vulnerable children.

UNAIDS Deputy Executive Director, Programme, Paul De Lay was an invited speaker at the event. Dr De Lay challenged the participants to think about what we really mean by “universal access”. He drew attention to the fact that AIDS brought together the medical community with the populations most affected by the disease, for the first time in the history of public health. "AIDS has brought to our attention the need to bridge health services with the broader issues of human rights, and social justice to address the root causes of vulnerability," Dr De Lay said.

Msgr Vitillo, Caritas Internationalis Special adviser on HIV/AIDS, made a strong plea for greater investment in the development of child friendly medications for HIV and the difficulties faced by mothers when asked to split adult tablets into six pieces for their children.

The event was moderated by Ms Finola Finnan, Trócaire and Chair of Catholic HIV and AIDS Network and Mr Jack Galbraith, President and CEO, Catholic Medical Mission Board.

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.

UNAIDS Deputy Executive Director, Programme, Paul De Lay and South Africa’s Minister of Social Development Bathabile Dlamini addresses an IAG Connector Event in New York, 07 June 2011.
Credit: UNAIDS/J. Szenes

The International Advisory Group (IAG) on universal access to HIV prevention, treatment, care and support which is made up of a diverse group of HIV experts from various sectors, convened together in New York on 7 June on the eve of the UN General Assembly High Level Meeting on AIDS.

Hosted by its co-chairs Bathabile Dlamini, Minister of Social Development, Republic of South Africa and Paul De Lay, UNAIDS Deputy Executive Director, Programme, the event is follow-up action to the IAG’s recently held meeting in Johannesburg which culminated in a bold and strong consensus statement on the need for global solidarity for universal access.

The IAG’s consensus statement identified key priorities to change the trajectory of the HIV epidemic, save lives and contribute towards achieving the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. The consultation was an opportunity for the advisory group to discuss it has been leveraged by IAG members and various organizations in preparing for the High Level Meeting.

“We urge IAG members to use this experience to influence the regional and country responses to HIV and AIDS in the future,” said Ms Dlamini who suggested that the IAG members to take a leadership role in implementing the outcomes of the High Level Meeting. “It will be important the resolutions take are put into action plans by countries.”

Echoing Ms Dlamini, Dr De Lay said, “The work of the IAG is not finished at this High Level Meeting. In fact, it is just beginning—with each IAG member: as you take the message into the foras where it needs to be heard."

The IAG is mandated by the UNAIDS’ governing body the Programme Coordination Board to review the findings of countries’ and regions’ universal access consultations as well as other global and regional studies and declarations, and advice on the way forward for the global AIDS response.

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.

UN Plus meeting with the Secretary-General Ban Ki-Moon and UNAIDS Cosponsor Executive Heads at UN Headquarters on 8 June 2011.
Credit: UNAIDS/B. Hamilton

UN Plus, the United Nations group of HIV positive employees, met with the UN Secretary-General Ban Ki-moon on 8 June to discuss stigma and discrimination as well as the various health insurances existing in the different UN agencies that are hampering the access of staff members living with HIV, and their families, to continued, comprehensive care.

“I am very committed to issues that UN Plus advocates and whenever I meet with its members I am personally motivated to take action against such issues as stigma and discrimination,” said UN Secretary-General Ban Ki-moon. “I reiterate the UN’s commitment to continue to collaborate with UN Plus to improve the work environment for UN staff living with HIV,” he added.

The meeting was an opportunity for UN Plus coordinator John Oshima to give an update on the work of the UN system-wide advocacy group. Since its last meeting with the UN Secretary-General in 2009, UN Plus has grown from 165 members to 220. Approximately 70% of its members are women and the majority of them are staff members working in sub-Saharan Africa. UN Plus is currently focusing efforts on reaching out to more staff living with HIV in other regions including Asia, the Caribbean and Latin America.

UN Plus organizes activities across the UN system to support UN staff living with HIV and their family members globally. These activities include advocacy to promote better access to care and support, removing stigma from the workplace, ensuring confidentiality, and lifting entry and travel restrictions for people living with HIV.

Martina Clark from UNICEF talked about access to care and health insurance among HIV-positive staff members. She briefed the Secretary-General on the fact-finding exercise that UN Plus is conducting to identify gaps in health insurance schemes adopted by different agencies as well as several proactive initiatives by a number of agencies to lessen financial burdens caused by costly treatments.

Jacqueline Cortes from UNAIDS in Brazil briefed the Secretary-General on stigma and discrimination at workplace with her own experience and introduced a new campaign co-produced with UN Cares titled Stigma Fuels HIV which is hoped will lead to behaviour change among UN staff members and end HIV-related stigma and discrimination.

Mr Ban said that it is the duty of all Heads of Agency to speak out and act against discriminatory or stigmatizing behaviour at any level. This includes working towards equitable and fair access to health care services for people living with HIV and those with other long-term chronic conditions. In addition, Mr ban said that a person’s HIV status should not adversely impact his or her career progression and that HIV positive staff should have the same opportunities as anyone else.

The UNAIDS Executive Director closed the meeting thanking the Secretary-General, Cosponsor Executives, and UN Plus representatives. Mr Sidibé restated his personal commitment to the importance of the UN in providing an enabling environment for staff living with 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.

Credit: Women Deliver

The International Peace Institute, in collaboration with the Permanent Mission of Norway to the United Nations, Women Deliver, and Family Care International, hosted a policy forum entitled Prevention and Protection Save Lives: Girls, Women, and HIV on the sidelines of the 2011 UN General Assembly High Level Meeting on AIDS on 8 June.

HIV is now recognized as the leading cause of death among women of reproductive age, the forum aimed to identify and strengthen the response to HIV and raise awareness about the interconnectedness of women’s health issue in relation to the broader development agenda.

In this light the high level panel brought together Michelle Bachelet, Executive Director, UN Women; Purnima Mane, Deputy Executive Director (Programs), UNFPA; Carmen Barroso, Regional Director, IPPF/WHR; Jan Beagle Deputy Executive Director, Management and External Relations, UNAIDS; and Ms Lindsay Menard-Freeman programme officer at Global Youth Coalition on HIV/AIDS to discuss lessons learned, current challenges, and the path forward.

“Young people are now the actors, mobilising for prevention, taking ownership of the AIDS response and shaping the attitudes of future leaders,” said UNAIDS International Goodwill Ambassadors Her Royal Highness the Crown Princess of Norway Mette-Marit who opened the forum. “We have to make sure that the next wave of leadership is equipped, engaged and sufficiently supported to maintain and develop the response.”

Also participating in the discussion was UNAIDS International Goodwill Ambassador Annie Lennox, a strong women’s rights activist: “We have the knowledge, we have the treatment,” said Ms Annie Lennox and urged world leaders gathering at the High Level Meeting on AIDS to take action on women and girls: “This is our moment: Don’t let us down.”

The Executive Director of UN Women called for leadership on this: “We know what has to be done and we know what works. And we can do better to stop this epidemic. With political will we can create the fiscal space to make women and girls a priority,” said Ms Bachelet.

The discussion, moderated by James Chau, Goodwill Ambassador, UNAIDS and a journalist with China CCTV, highlighted that young women in particular are vulnerable to HIV.  As a result of a combination of biological and socio-cultural factors, nearly a quarter of all new global HIV infections are among young women aged 15-24. 

“Knowing your epidemic” in gender terms is critical. The human rights, including the sexual and reproductive rights of all women and girls – in particular women and girls living with HIV – must be protected and promoted in all HIV and global health programmes.”

However, progress has been made. More than 60 countries have shown their commitment to gender equality by implementing the UNAIDS Agenda for Women and Girls and HIV, engaging over 400 civil society organizations.

“It’s important to remember that young people are actors, and young people are asking for what they need,” said Ms Menard-Freeman. “Now that we are here [at the High Level Meeting on AIDS], we need the voices of young people to be heard.”

One of the critical examples raised as a model for a consolidated approach to women’s health was the United Nation’s Every Woman Every Child campaign. The campaign, launched during the United Nations Millennium Development Goals Summit, has so far seen a US$ 40 billion commitment by countries to improve the health of women and children. If implemented, it is estimated that the strategy could save up to 10 million lives of women and children by 2015.

The new UNAIDS Strategy 2011 - 2015: Getting to Zero has made advancing human rights and gender equality for the HIV response one of its three key strategic directions, and is committed to ensure that the rights of women and girls in the context of 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.

(Left to Right): United Nations Secretary-General Ban Ki-moon, President of Rwanda Paul Kagame, United States Global AIDS Coordinator Ambassador Eric Goosby, President of the General Assembly Joseph Deiss at the Heads of State event - AIDS, Health, and Development, held at UN Headquarters, NYC, on June 8, 2011
Credit: UNAIDS/B.Hamilton

NEW YORK/GENEVA, 8 June 2011­­—More than 20 Heads of State and Government have come together at a special event focusing on leadership, cooperation and country ownership in the response to HIV. The event, attended by close to 400 people, was held during the United Nations General Assembly High Level Meeting on AIDS to renew commitment and identify opportunities in scaling up the HIV response, improving health and achieving the 2015 Millennium Development Goals.

The President of Rwanda, Paul Kagame, hosted the debate which outlined ways of accelerating action to help countries move closer towards universal access to HIV prevention, treatment, care and support.

He outlined three main areas as key to the success of the AIDS response: leadership, ownership and collaboration. “Not a single country, not a single individual, business or entity can win this struggle alone,” he said. “Once the leadership and commitment is there in any country and any community, results begin to show.”  

The need to increase access to services for people most vulnerable to HIV and respect for human rights was central to the discussions. Strong and visionary leadership combined with commitment and global solidarity around HIV were underlined as essential to moving the response forward.

“We can bring HIV deaths and new HIV infections to zero,” said United Nations Secretary-General Ban Ki-moon. “Our targets may seem ambitious but they are achievable if we are united.”

Leaders at the event also looked to the future of the HIV response and the importance of investing in youth as the leaders of tomorrow and encouraging their full engagement in the AIDS response.

“If we want to transform the response, we have to bring a new agenda for the future,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). “This will only be achieved if we engage young people to lead a new social movement around AIDS and ensure a sustainable response.”

The speakers stressed the need to overcome the challenges to sustainable and predictable financing. In a report launched ahead of the High Level Meeting on AIDS, UNAIDS outlined that US$ 22 billion will be needed by 2015 to halve new HIV infections and expand access to HIV treatment. However, the report also revealed that international funding for HIV had declined from 2009 to 2010.

“What we need is resources, best policy, and law to ensure and protect the rights of people living with HIV,” said Ms Anandi Yuvuarj, Regional Coordinator of the International Community of Women Living with HIV. “Everyone must have access to HIV prevention, treatment, care and support, particularly people most vulnerable to HIV.”

Speakers emphasized the need for systematic improvement of the efficiency and effectiveness of existing AIDS and health spending, as well as the importance of ensuring the best value for money through effective and efficient HIV programming. In addition, they discussed the need for countries to look for new streams of revenue from domestic, regional and international sources.

Success in South-South cooperation efforts were discussed as an effective way of finding new paradigms of development and sharing innovation within regions for an accelerated response to HIV.

Leaders attending the event pledged to increase efforts to improve the effectiveness, efficiency and sustainability of their national AIDS responses to accelerate progress towards achieving universal access to HIV prevention, treatment, care and support services.

Ms Mari-Josee Jacobs, Minister or Cooperation and Humanitarian Affairs, Luxemburg, Moderator Ms Kgomotso Matsunzane, Dr Jarbas Barbosa, Deputy Minister of Health of Brazil, Helen Clark, United Nations Development Programme, and Jaevion Nelson, youth activist from Jamaica.
Photo : Photo ONU/Eskinder Debebe

Global rates of new HIV infections have steadily declined over the past years, with the annual rate falling by nearly 25% between 2001 and 2009. But with 7 000 new HIV infections daily, the rate of people becoming newly infected still outpaces the capacity to extend treatment access and cope with the effects of HIV. 

As part of the United Nations General Assembly High Level Meeting on AIDS, a panel entitled Prevention—what can be done to get to Zero new infections? chaired by Ms Mari-Josee Jacobs, Minister or Cooperation and Humanitarian Affairs, Luxemburg, brought together the Administrator of the United Nations Development Programme (UNDP), Helen Clark, Jaevion Nelson, youth activist from Jamaica, and Dr Jarbas Barbosa, Deputy Minister of Health of Brazil engaged with the audience in an inspired and interactive session on how to amplify and sustain the momentum of this HIV prevention revolution.

Setting the scene, Ms Jacobs opened with stressing the importance on involving people living with HIV in all aspects of HIV prevention programming: “It is important to engage people living with HIV—and especially young people living with HIV—in HIV prevention efforts to improve programmes with full respect for human rights to all.”

Moderated by South African TV personality Kgomotso Matsunzane, the discussion centred around key questions such as ‘What stands in the way of getting to zero new infections?’ and ‘How are rights integral to prevention?’

“With this High Level Meeting we have a unique opportunity,” said Dr Barbosa as he opened the panel discussion. “We cannot wait for another 30 years to eliminate HIV. We need a strong declaration from this High Level Meeting that represents the political commitment, and that moves the agenda forward.”

According to the most recent population-based surveys in low- and middle-income countries, only 24% of young women and 36% of young men responded correctly when asked five questions on HIV prevention as well as misconceptions about HIV transmission. And while global new HIV infections are decreasing, Eastern Europe and Central Asia is the only region in the world where new HIV infections are increasing.

In her opening address Ms Helen Clark, UNDP Administrator noted that there is a need to confront the social, sexual and gender norms that drive vulnerability to HIV.

“Legal frameworks need to accommodate effective responses to HIV. So often the law stands in the way of reducing risk and vulnerability, and of spreading access to treatment and prevention services. Where human rights are not upheld, genuine universal access to services is impossible,” said Ms Clarke.

Jaevion Nelson, youth activist from Jamaica, agreed: “Far too many programmes are failing because they are not based on the evidence that exists. We must all: as governments, as civil society and the international community do the right thing.”

HIV prevention investments only represent about 22% of all HIV spending in 106 low- and middle-income countries. Clearly much remains to be achieved to ensure that the vision of zero new HIV infections is reached.

In an impassioned intervention from the floor, Dr Nafsiah Mboy Executive Director of the Indonesian National AIDS Commission urged the panellists to remember to address a group who are commonly not considered most at risk, but indeed are—the ‘4 M’s’ as she called them—mobile men with money in a ‘macho’ environment. “Let us turn these men into responsible men. That way we will have zero new infections among our women and zero new infections among our children,” said Dr Mboy.

It was also agreed in the discussion that rapid access to both future and existing HIV prevention tools—including male and female condoms, male circumcision, the elimination of vertical transmission and treatment for prevention—is needed. The last point inspired by the recent announcements of the HPTN 052 study which showed 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%.

UNAIDS strategy 2011 – 2015: Getting to Zero outlines the bold goals for 2015: 1) sexual transmission of HIV reduced by half, including among young people, men who have sex with men and transmission in the context of sex work; 2) Vertical transmission of HIV eliminated and AIDS-related maternal mortality reduced by half; and 3) all new HIV infections prevented among people who use drugs. This is part of UNAIDS vision to reach zero new HIV infections.

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.

L to R: Honourable Denzil Llewellyn Douglas, Prime Minister of the Federation of St Kitts & Nevis, Mr Søren Pind Minister for Refugees, Immigration and Integration and Minister of Development Cooperation of Denmark, UNAIDS Executive Director Michel Sidibé, and the General Secretary of the National Confederation of Municipal Workers in Brazil (Central Única dos Trabalhadores) and inter-American Regional co-President for Public Services International Ms Juneia Batista.
Credit: UNAIDS/B.Hamilton

A call for a new global deal of compacts to shift leadership of the AIDS response to countries was made in the first panel Shared responsibility–a new global compact for HIV on the opening day of the UN General Assembly High Level Meeting on AIDS. 

Chaired by the Honourable Denzil Llewellyn Douglas, Prime Minister of the Federation of St Kitts & Nevis, the panel brought together the UNAIDS Executive Director Michel Sidibé, Mr Søren Pind Minister for Refugees, Immigration and Integration and Minister of Development Cooperation of Denmark, and the General Secretary of the National Confederation of Municipal Workers in Brazil (Central Única dos Trabalhadores) and inter-American Regional co-President for Public Services International Ms Juneia Batista.

Shared responsibility needed

Against the backdrop of the global financial crisis, , the panel pprovided a unique opportunity to build consensus on a new global agreement for the AIDS response that could serve as a pathfinder to a new deal of shared but differentiated responsibility for health and development.

“Small is beautiful. And different,” said Hon Douglas sharing his experiences from the island Federation of St Kitts & Nevis “Shared responsibility is not an option for small states.  It is our reality. We have no choice in the Caribbean but to develop shared approaches in all sectors.”

Despite the increasing clout of emerging political powers and strong economic growth in many African countries, many national responses to HIV in low- and middle-income countries remain fragile, are largely externally-funded and driven by external development agendas. In 56 countries, international donors supply at least 70% of HIV resources.

Shared values for shared responsibility

Emphasizing the need for mutual respect and understanding in development cooperation Mr Pind encouraged participants to be truthful and work together.  “But there are certain principles that you cannot ignore. Like discrimination against populations at higher risk.  And this needs to be said,” he noted.  

According to the panel, country ownership and sustainability will require increased and predictable long-term domestic and international funding. “Don’t get me wrong, I am all for innovative financing. But certain donors can not hide behind the need for innovative financing to shy away from meeting their commitments on official development assistance,” said Mr Pind.

At the same time, governments must be accountable for increasing domestic investment where possible and allocating resources where they are most needed and putting in place an enabling environment said the panel.

“10 years ago we would not have had this debate. The world has changed completely and we have to reflect on this. It is time to think about a new paradigm of partnership based on share responsibility,” said Mr Sidibé. “And we need share responsibility based on shared values for a social compact.”

Panellists and audience alike discussed priorities such as assuring continued leadership and shared responsibility for the AIDS response, including a new generation of leadership; strengthening broad national ownership and engaging communities in order to foster local and sustainable solutions; securing long-term financing; and increasing efficiency and ensuring mutual accountability for the future global response. Importantly, as noted by Ms Batista: “Shared responsibility and intelligent investment does not mean that countries should in any way adjust in reaching their commitments.”

Outlines of a new global compact

In this light, the new global compact discussed in the panel can be formulated around three key pillars. The country’s responsibility, the international community’s responsibility and the shared responsibility for innovation:

The Country responsibility

• ensuring voice and participation in democratic governance
• delivering smart responses—including enabling environments and human rights
• increased domestic investment on basis of ability

International responsibility

• responsible ‘donorship’—including long-term predictable and aligned financing
• increased support from emerging countries and new development partners
• more coherent international policy on trade, regulation, etc

Shared responsibility for innovation

• innovative financing mechanisms—including the private sector
• innovative partnerships including South-South cooperation and triangular cooperation
• enhanced mutual accountability for the reciprocal responsibility in the compacts including joint planning and reviews of the smart responses

According to the participants, universal access to HIV prevention, treatment, care and support can be achieved by spending smartly and increasing annual investment to between US$ 22 and 24 billion by 2015. These resources can be mobilized by diversifying funding sources and balancing responsibilities.

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.